Geubbels, Eveline

Lugoi, Justin

Ochieng, Bernad

RePass, Kendall

Shemdoe, Aloisia

William, Jeje

English

Digital Library of the Tanzania Health Community

 Wellbeing and knowledge, attitudes and practices on HIV/AIDS among 
orphans and vulnerable children in a rural Tanzanian district  
The  Tanzania Red Cross  Society  (TRCS) / American Red Cross  (ARC) ―Tujenge Jamii 
Bora‖  (―Let‘s  build  our  community  together‖)  program‘s  long  term  goal  is  to  reduce  the 
incidence of HIV and to reduce HIV/AIDS associated morbidity and mortality of the chronically 
ill and  orphans and vulnerable children (OVC) in the Shinyanga region of Tanzania.  
Information  about  OVC‘s  wellbeing,  stigma  perceptions  and  sexual  risk  behavior  is  not 
measured  in  national  surveys,  hampering  effective  design  and  evaluation  of  HIV  risk 
reduction and impact mitigation programs for OVCs like  the Tujenge Jamii Bora program.  
A survey was therefore done to assess the current status and needs of program beneficiaries, 
and to provide the basis against which any future measurements of the impact of the program 
can be compared. As part of the survey the field practicability and outcomes of two different 
tools for measuring  wellbeing status were compared for the older OVC age group (13-17 
years) , i.e. the Child Status Index (CSI)1 and the Orphan Wellbeing Tool (OWT).2 
 1 Ifakara Health Institute, Tanzania; 2 Tanzania Red Cross Society, Tanzania ; 3 American Red Cross, USA 
egeubbels@ihi.or.tz ; www.ihi.or.tz 
 
 Eveline Geubbels1, Aloisia Shemdoe1, Jeje William1, Justin Lugoi2, Kendall RePass3, Bernad Ochieng3  
Background 
1. To  assess  the  wellbeing  of  OVC  in  a 
rural district in Tanzania  
2. To  understand  determinants  of 
wellbeing  
3. To  compare  wellbeing  measurement 
tools for adolescent OVC. 
4. To analyze OVC’s knowledge, attitudes 
and practices (KAP) on HIV/AIDS 
Objectives 
Methodology 
Results - Wellbeing  
Conclusion    References   
281 OVC and their caretakers were observed and interviewed (response rate 76%). Most common reason for non-response was having moved out of the area. 
Wellbeing of this this rural Tanzanian OVC population is especially low on the 
domains measuring basic needs. Better wellbeing for children in HIV affected 
households for some domains / subgroups may be an indication of already 
established support. Social desirability bias and the context dependent 
interpretation may lead to overestimation of OVC wellbeing with the CSI tool, 
and where possible, self-reported wellbeing estimates should be used to 
complement caretaker-reported measurement. Low HIV/AIDS knowledge and 
high stigma levels puts this OVC population at risk for HIV acquisition.  
 Cross-sectional study done in Bukombe district, Shinyanga region, which has a high and rising adult HIV prevalence (7.6% in 2007/8).3  
 Location - sex – age- stratified sampling of  377 OVC from among the future beneficiaries of an integrated HIV community support program. 
 OVC defined as children who lost one or both parents and/or who lived with chronically ill parent(s), or in a child / grandparent-headed household.  
  In April-May 2010, trained interviewers observed and interviewed OVC and their caretakers. Adolescents interviewed by same-sex young adult interviewers 
 Measurement tools were CSI (for all OVC), OWT and standard KAP questionnaires for HIV/AIDS (only for OVC 13-17 years). HIV Knowledge and accepting attitudes were 
measured as in the Tanzania DHS 2010,4 extended stigma indicators were measured using questions validated in Tanzania.5 
 CSI measures 12 items across 6 domains: Food & Nutrition, Shelter & Care, Abuse & Protection, Wellness & Health care services,  Emotional Health & Social behaviour, 
Performance & Education or Skills Training. Data collected through child observation and caretaker interview. Domain specific scores range from 1 (very bad) to 4 (good). No 
composite score can be calculated. 
 OWT measures 36 items across 10 domains: Food & Nutrition, Shelter, Protection, Family, Health, Spirituality, Mental Health, Education, Economic Opportunities, Community 
Cohesion. Data collected through child interview. Domain specific scores range from 1 (wellbeing never there) to 2 (wellbeing sometimes there) to 3 (wellbeing always there). 
Composite score of <22 for in-school youth and <20 for out-of-school youth signifies deficits.2 
 Un-weighted analysis presented because survey analysis in Stata 11.0 using design- and selection-specific non-response weights yielded similar results. 
 
• Three  quarters  of  out-of–school  OVC  who  self-
reported low wellbeing (OWT) experienced no serious 
wellbeing problems according to caretakers (CSI). 
• Tools measure different facets even if domain names 
are the same, hampering domain specific comparison. 
• The exception are the domains for food security / food 
& nutrition and for mental / emotional health. Scores in 
these were slightly worse in the OWT. 
Comparison of CSI and OWT 
Results – HIV Knowledge, Attitudes, Practices  
Determinants of low wellbeing 
 
1. O‗Donnell K, Nyangara F, Murphy R, Nyberg B. Child Status Index. (2009). A Tool for Assessing the Well-Being of 
Orphans and Vulnerable Children — MANUAL. Chapel Hill, USA: PEPFAR, USAID, MEASURE Evaluation. Also 
available at http://www.cpc.unc.edu/measure/csi  
2. Senefeld S, Strasser S, Campbell J. (2009) Orphans and vulnerable children wellbeing tool. User‗s guide. 
Baltimore USA: Catholic Relief Services. Also available at http://www.crsprogramquality.org/ovcwt/ovcwt.html  
3. Tanzania HIV/AIDS and Malaria Indicator Survey 2007-08. (2008). Dar es Salaam, Tanzania: Tanzania 
Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC), National Bureau of Statistics (NBS), Office 
of the Chief Government Statistician (OCGS), and Macro International Inc  
4. Tanzania Demographic and Health Survey 2010. (2011). National Bureau of Statistics (NBS) [Tanzania] and ICF 
Macro. Dar es Salaam, Tanzania: NBS and ICF Macro. 
5. Nyblade L, MacQuarrie K. (2006). Can we measure HIV/AIDS related stigma and discrimination? Current 
knowledge about quantifying stigma in developing countries. Washington, USA: USAID.  
 
Multivariate analysis of determinants for ‘Very Bad’ or ‘Bad’ score on each of the 
12 CSI domains, OVC 0-17 years (n=281).* 
 
   
Non-adult headed 
household versus adult 
headed household
†  
 
 
Ill parent / caretaker 
versus non-ill parent / 
caretaker
† 
 
HIV in household 
versus no HIV in 
household
† 
   
RR 
 
(95% CI) 
 
 
RR 
 
(95% CI) 
 
RR 
 
(95% CI) 
 
Food security 
 
 
1.0 
 
(0.6-1.7) 
 
1.5 
 
(0.9-2.5) 
 
1.3 
 
(0.8-2.2) 
Nutrition & Growth 
 
0.9  (0.4-1.8)  1.2  (0.6-2.3)  0.6  (0.3-1.3) 
Shelter 
 
1.6  (0.9-2.6)  1.5  (0.9-2.4)  0.7  (0.4-1.2) 
Care 
 
1.8  (0.6-5.0)  0.8  (0.3-2.3)  0.8  (0.2-2.3) 
Abuse & 
exploitation 
 
0.3  (0.1-1.2)  2.1  (0.7-6.4)  1.0  (0.3-3.0) 
Legal protection 
 
2.4  (1.4-4.0)
‡  1.0  (0.6-1.7)  1.2  (0.7-2.0) 
Wellness 
 
0.7  (0.4-1.4)  3.1  (1.5-6.2)
‡  0.4  (0.2-0.9)
‡ 
Health care 
services 
 
0.6  (0.3-1.1)  1.0  (0.6-1.7)  0.4  (0.2-0.7)
‡ 
Emotional health 
 
0.6  (0.2-1.2)  2.1  (1.0-4.5)  1.2  (0.5-2.4) 
Social behavior 
 
0.4  (0.0-3.3)  1.8  (0.3-10.2)  1.3  (0.3-7.0) 
Performance 
 
0.7  (0.3-1.6)  2.3  (1.1-4.8)
‡  0.8  (0.4-1.8) 
Education or Skills 
training 
1.4  (0.8-2.5)  1.0  (0.6-1.8)  1.1  (0.6-1.9) 
* All models are adjusted for age 
† reference category
 
‡ p < .05 
• OVC in grandparent-headed or child-headed households 
had  worse  access  to  legal  protection  services  in 
comparison with OVC in adult-headed households.  
• OVC  whose  parent  or  caretaker  was  ill  in  the  past  6 
months had worse physical health and their development 
or performance in school lagged behind. 
• OVC who live in a household in which someone has HIV 
had better physical health and better access to health care 
services than those in households without HIV. 
• In-school OVC who live in a household in which someone 
has HIV had better overall wellbeing than those who lived 
in a household without HIV. 
 
Among adolescents OVCs in this survey: 
• Comprehensive  knowledge  about  HIV  and  accepting  attitudes 
towards PLHIV were lower than in general population.4 
• Blaming / judging attitudes were very common, as was shame in 
relation to HIV, especially for boys. 
• Sexual debut before age 15 years was more common than among 
adolescents in the general Tanzanian population.4 
  
Multivariate analysis of determinants for a low total OWT score, OVC 13-17 years 
(n=133). 
 
   
Non-adult headed 
household versus adult 
headed household
*  
 
 
Ill parent / caretaker 
versus non-ill 
parent / caretaker
* 
 
HIV in household 
versus no HIV in 
household
* 
   
RR 
 
(95% CI) 
 
 
RR 
 
(95% CI) 
 
RR 
 
(95% CI) 
 
In-school OVCs (n=89) 
 
0.3 
 
(0.1-1.1) 
 
1.3 
 
(0.4-3.8) 
 
0.3 
 
(0.1-1.0)
† 
 
Out-of-school OVCs (n=44)  1.2  (0.2-6.7)  6.4  (0.7-58.3)  1.1  (0.2-5.7) 
 
* reference category
 
† p < .05 
Agreement between CSI and OWT scores, in-school OVC 13-17 years (n=89). 
 
Number of CSI 
domains with ‘Very 
bad’ or ‘Bad’ score 
OWT total score   
  Above cutoff  Below cutoff 
0   83% (59/71)  17% (12/71) 
1   64% (7/11)  36% (4/11) 
2 or more   57% (4/7)  43% (3/7) 
Agreement between CSI and OWT scores, out-of-school OVC 13-17 years (n=44). 
 
Number of CSI 
domains with ‘Very 
bad’ or ‘Bad’ score 
OWT total score   
  Above cutoff  Below cutoff 
0  23% (6/26)  77% (20/26) 
1  20% (2/10)  80% (8/10) 
2 or more  0%  (0/8)  100% (8/8) 
 

A Tool for Assessing the Well-Being of Orphans and Vulnerable Children — MANUAL.

Can we measure HIV/AIDS related stigma and discrimination? Current knowledge about quantifying stigma in developing countries.

Catholic Relief Services. Also available at http://www.crsprogramquality.org/ovcwt/ovcwt.html 3. Tanzania HIV/AIDS and Malaria Indicator Survey

Wellbeing and Knowledge, Attitudes and Practices on HIV/AIDS among Orphans and Vulnerable Children in a Rural Tanzanian District

http://ihi.eprints.org/1104/1/IHIposter_(1).pdf

Wellbeing and Knowledge, Attitudes and Practices on HIV/AIDS among Orphans and Vulnerable Children in a Rural Tanzanian District

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