Author: Adejuwon, G A; Oki, S
Date published: March 1, 2011
(ProQuest: ... denotes formulae omitted.)
In Nigeria, AIDS prevalence among adults increased from 1.8% in 1991, to 4.5% in 1996 and 5.8% in 2001, but declined to 5.0% in 2003 and 4.4% in 2005 (FMOH 2005). With an estimated 2.86 million people (2.62 million adults > 15 years; 238,000 children) living with HIV in the country by the end of 2005, Nigeria has the third largest number of people living with HIV in the world, after South Africa and India (FMOH 2005). Orphans and vulnerable children remain a pressing challenge for many countries. Worldwide, it is estimated that more than 15 million children under 18 have been orphaned by AIDS (UNAIDS, 2006). A joint study by USAID, UNICEF and UNAIDS in 2005 found that there are about 12.3 million AIDS orphans in Sub-Sahara Africa. By 2010, an estimated 15.7 million children - 30 per cent of the 53 million anticipated orphans from all causes in sub-Saharan Africa - will have lost at least one parent due to AIDS (UNAIDS and UNICEF estimates, 2006). Even where HIV prevalence stabilizes or begins to decline, the number of orphans will continue to grow or at least remain high for years, reflecting the time lag between HIV infection and death. In 2003 alone 800,000 children orphaned by AIDS were added to the estimated 7 million orphans in Nigeria ( UNAIDS, UNICEF 8c USAID, 2004). Recently published data (UNAIDS 2006) show that 1.3 million children (0 - 17 years) lost one or both parents to AIDS in Nigeria in 2005.
Although awareness of the plight of orphans is growing, no country has mounted the kind of response that is needed to match the severity of the crisis (Subbarao, 8c Coury, . (2004). Serious strains on the traditional coping mechanisms with orphans and vulnerable children are now evident considering the poverty level in most families in Africa especially Nigeria. Given the swelling numbers of orphans and the enormity of the orphan crisis in Africa most especially in Nigeria, it can be argued that more and more children will need to be placed in orphanages.
Emotional well-being of orphans:
Atwine, Cantor-Graae and Banjunirwe, (2005), found that anxiety; depression and anger were more common among AIDS orphans and they had lower expectations about the future than other children in Uganda. Also, 12% of AIDS orphans affirmed that they wished they were dead, compared to 3% in other children (Salaam, 2005). AIDS orphans in Tanzania had marked internalising problems compared to non-orphans. 34% of the orphans reported that they had contemplated suicide in the previous year. The study also found the independent predictors of internalising problems to be sex (females were found to be higher than males on internalising problems), going to bed hungry, no reward for good behaviour, not currently attending school, as well as being an orphan (Makame, Ani and McGregor 2002). Manuel (2002) in Mozambique found that orphans (n = 76) were more likely than controls (n = 74) to be depressed, bullied and less likely to have a trusted friend. Ohnishi, Anoemuah, Jagah and Feyisetan (2004) found that more than half (52.0%) of the OVC in Ogun State wanted caregivers to stop abusing and/ or beating them. These findings from various studies emphasize the importance of understanding the impact of the emotional wellbeing of OVC on their overall development.
Stigmatization/ Discrimination and emotional well-being: Children may begin to be stigmatized early as their parents fall ill with AIDS. Some children may be teased because their parents have AIDS, while others may lose their friends because it is assumed that proximity can spread the virus. A study in Kenya revealed that 77% of children orphaned by AIDS reported having no one outside of their families to "tell their troubles to" (Human Rights Watch, (2001). Foster, Makufa, Drew, Mashumba and Kambeu (1997), reported that anxiety, fear, stigmatization and depression were found among AIDS orphans. Consequently, stigmatization/ discrimination and depression have been found to be related in previous studies.
Education/ School Enrolment and well being: Schooling is important for normal child development (Lockheed, Verspoor, Bloch, Englebert, Fuller, King, Middleton, John, Paqueo, Rodd, Romain, and Welmond, (1991). It affords children the opportunity to socialize with peers and is strongly related to employment and earning potential in adulthood. Mishra and Arnold (2005) found that children of HIV positive parents are significantly less likely to attend school than other children. Even before the death of a parent, children may miss out on educational opportunities. This is because many expenses such as school fees and uniforms may not be affordable (UNICEF, 2006). Extended families usually see school fees as a major factor in deciding to take in additional children orphaned by AIDS (Malshalaga, 2002). This may lead to reluctance and abandonment of the children. Such children may then be placed in orphanages either temporarily or permanently. Without valuable life-skills from parents and a basic school education, out-of-school OVC are more likely to face social, psychological, economic and health problems as they grow up (Salaam, 2005). Also, without education and skills training OVC are more likely to fall deeper into the cycle of poverty and engage in high-risk behaviour which perpetuates the cycle of HIV transmission.
Sexual involvement and emotional well-being: Children orphaned by AIDS may also suffer exploitation and abuse (Stein, 2003). Children especially girls have reported instances of sexual abuse in their new households. However, many may silently accept it because they have nowhere else to turn for shelter or protection (UN Office for the Coordination of Humanitarian Affairs, 2003). In Uganda, sexual debut occurred earlier in orphans than in non-orphans; by age of 12, 30% of orphan girls were sexually active rising to 85% by the age of 18. The reasons for becoming sexually active included economic need, peer pressure, lack of parental or care-giver supervision and rape by strangers, relatives, friends and teachers (The Human Rights Watch 2003; Sharpe, Ssentongo and Ssenyonga, 1993) Bingham and Crockett (1996) revealed that the earlier adolescence boys and girls engage in sexual intercourse, the more likely they were to show adjustment problems. Santrock (2002) suggested that though sexual intercourse can be a meaningful experience for older, mature adolescents, many adolescents are not emotionally prepared to handle sexual experiences, especially in early adolescence.
The main purpose of this study is to provide a better understanding on emotional well-being of orphans and vulnerable children especially those in orphanages in Nigeria. This is because the situation is complex, findings cannot necessarily be generalized, and assistance to orphans and vulnerable children is challenged by this complexity. Findings from Foster, Makufa and Drew, (1997); Richter and Swart- Kruger (1995) indicate that stigmatisation and sexual involvement exist among orphans and vulnerable children. This study therefore examined stigmatisation, sexual involvement and school enrolment as predictors of emotional well-being of orphans and vulnerable children.
Design of the Study
A survey research design was used in this study. The independent variables which are school enrolment, stigmatization and sexual involvement were not manipulated, but their influence was merely observed on the dependent variable which is emotional well-being.
The sample population consist of one hundred ( 1 00) orphans and vulnerable children who had lost one or both parents to AIDS. They were identified through local NGO's and social welfare officers working with AIDS orphans.
The participants whose age range is 7-18years were drawn from the Sagamu Community Centre, Sagamu, Ray of Hope Community Foundation Ijebu-Ode, Save Our Souls Children's Village (SOS) Owo-Ijebu, and The Redeemed Christian Church Orphanage Km 46 Lagos-Ibadan Express Way, Sagamu. Accidental or convenience sampling technique was used to select participants for the study.
Demographic section provided information on age, sex and ethnic group. It also provided information on school enrolment and class of the participant. Social stigmatization scale was developed by Berger, Ferrans and Lashley (2001). It consists of fifteen (15) items in a five point Likert response format of strongly disagree to strongly agree. The coefficient alpha for the scale is 0.96. It was adapted for the orphan and vulnerable children population with coefficient alpha of 0.84. All items in the scale focus on experiences, feelings and opinion of OVC and how they are treated for example, "people don't want me around their children once they know the cause of my parent(s) death"
Emotional well-being checklist was developed by USAID/ SCOPE/FHI (2002) to measure the emotional well-being of OVC in Zambia. It has a cronbach Alpha of 0.67 and a split-half reliability coefficient of 0.75. The scale consists of two parts. Question 1-14 is in a five point Likert format with every item having a score of between 5 and 1. 5 represents always, 4- often, 3- do not know, 2- sometimes and 1 -never. In items 15- 33, the response format was changed to enable the OVC express their mood, worries, anxiety, positive affect, pessimism, somatic symptoms and emotional ties. Two questions were asked about running away from home. A high score indicates emotional distress while a low score indicates a stable emotional well-being. Example of item on this scale is ??\? often would you say that you ever feel worried?
Sexual involvement scale was adapted from the USAID/ SCOPE/ FHI (2002) checklist. It provided information on sexual involvement of OVC. Five (5) questions catering on whether OVC has ever had sexual intercourse and whether it was against their will was asked. The questions were in a Yes/ No response format and a checklist to indicate with whom OVC had the sexual debut. An example of a question asked is "Have you ever had sexual intercourse?"
Written permission was obtained permission from the directors/ matron of the organizations before the administration of the questionnaire. A date was fixed for each centre. At each centre, the researcher was introduced to the children by the director/ matron of the centre. The researcher after establishing rapport with the children explained the purpose of the research. They were assured of the confidentiality of their responses and that the exercise was meant for research purposes. The children who were willing to participate in the study were then taken to a different room and comfortably seated. Each of them was provided with a pencil and a questionnaire booklet. The researcher standing in front then explained the contents of questionnaire to the participants. They were told that as the researcher reads out aloud each item on the questionnaire they should place a tick in the appropriate space provided for the response option that applies to them. When the researcher reads out each item on the questionnaire, some minutes were allowed for the children to respond. They were encouraged to indicate if they had any question or if they did not understand the item read. Trained research assistants attended to those who needed more explanation.
At the end of the exercise, each child was made to submit personally to the researcher who went through the questionnaire to make sure that it was properly completed. Children who had not completed their questionnaire properly were taken apart and supervised by the research assistant. All the participants were provided with drinks and snacks at the end of the exercise.
The OVC consist of 59 males (59%) and 41 females (41%). There are 76 Yoruba's (76%), 9(9%) Hausas, 8(8%) Igbo's while 7(7%) were from other ethnic groups. 30(30%) are in primary school, 49 (49%) in secondary school, 10 (10%) in tertiary institutions, while 11 (11%) are not in school
The table 4.2 shows frequency of the participants' responses to each item on the emotional well-being and sexual behaviour. Ever have scary dreams or nightmares?: 46% of the OVC reported always having scary dreams or nightmares, 39% often, while 3% sometimes have scary dreams or night mares respectively. 4% do not know while 8% never have nightmares or scary dreams.
Ever feel unhappy: 3% always feel unhappy, 65% often feel unhappy while 23% sometimes feel unhappy. 1% does not know while 8% never feel unhappy.
How often feel happy: 11% always feel happy, 19% often feel happy and 51% sometimes do. 10% do not know while 9% never feel happy.
Fights with other children: 10% report that they always fight with other children, 49% often fight while 21% sometimes fight with other children. 14% do not fight while 6% never fight.
Prefer to be alone: 19% always prefer to be alone instead of playing with other children, 68% often prefer to be alone while 4% sometimes prefer to be alone. 6% do not know while 3% never prefer to be alone.
Ever feel worried: 10% of the OVC report that they ever feel worried, 57% always feel worried, while 14% sometimes feel worried. 3% do not know while 16% never fell worried.
Ever refuse eating at mealtimes: 27% always refuse, 65% often refuse eating at meal times and 3% sometimes refuse eating while 5% do not refuse eating at meal times.
Feel frustrated easily ..... : 11% of the OVC always feel easily frustrated, 63% often feel easily frustrated while 3% sometimes feel frustrated. Only 5% do not easily feel frustrated.
Ever become very angry: 8% of the children report always becoming angry, 63% often become angry, while 15% sometimes feel angry. 10% do not become angry while 4% never become angry.
Hopeful about the future: 48% of the OVC are always hopeful about their future 5% are often hopeful while 36% are sometimes hopeful. 2% do not have any hope for the future while the remaining 9% report that they are never hopeful for the future.
Ever feel afraid of new situation? 20% are always afraid of new situations, 60% are often afraid of new situations while 11% are sometimes afraid. 6% do not know while 3% are never afraid of new situations.
Have trouble falling asleep: 35% report always having trouble with falling asleep, 44% often have trouble falling asleep while 7% sometimes have trouble with falling asleep. 14%do not know.
Difficulty with making friends: 23% of the OVC always have problem with making friends, 51% often have difficulty with making friends while 3% sometimes have difficulty with making friends. 19% of them do not know while 4% never have such difficulty.
Ever felt like running away from home? 22% of the OVC have always felt like running away from home, 56% often feel like running away from home, while 6% sometimes feel like running away. 8% are not sure while 8% never felt like running away from home.
Risky sexual behaviour: Of the 35 OVC who have had their first sexual intercourse, people regarded as friends had sex with 18 of them, neighbours had sexual intercourse with 3 of them, strangers had sex with 13 of them while teacher had sex with 1 of them.
Table 4.3a shows that there is no significant main effect of school enrolment of OVC on emotional well-being [F (1, 96) = 0.14; P >.05]. The table however, shows a highly significant main effect of sexual involvement of OVC on emotional well-being [F (1, 96) = 17.97; P <.001]. There is no significant interaction effect between school enrolment and sexual involvement of OVC on emotional well-being [F (1. 96) = 0.16;P>.05].
Table 4.1b (see appendix) shows that 35 (16 males and 19 females) out of the 100 respondents (35%) agreed to have had sexual intercourse while Table 4.1c, reveal that sexual involvement was more among the 13-18 age range (adolescents OVC).
Table 4.1d also shows that out of the 35 OVC who agreed to have had sexual intercourse, 11 (11%) claimed to have had it against their will (6 males and 7 females), indicating sexual coercion or abuse among OV in Ogun State orphanages.
Table 4.4 shows that OVC who scored high on social stigmatisation ( ...) also scored higher on emotional well-being than OVC who scored low on social stigmatisation (...); (t=-5.95, df = 98; p<.001). This means that OVC who score high on social stigmatisation experience emotional distress than OVC who score low on social stigmatisation. Social stigmatisation therefore predicts OVC negative emotional well-being.
Conclusion, Discussion, Implication and Recommendation
Of great concern in this study is the level of emotional instability among the OVC in the orphanages. More than half of them in the institutions often feel unhappy, often refuse eating at meal times, often become angry, often have difficulty with making friends, often feel like running away, are often afraid of new situations and always feel worried. Previous studies found that anxiety, depression and anger were more common among AIDS orphans and they had lower expectations about the future than other children (Atwine, CantorGraae and Banjunirwe, 2005) orphans went to bed hungry (Makame, Ani and McGregor, 2002) are more likely to be depressed and less likely to have trusted friends than non-orphans (Manuel, 2002). More than half (52.0%) of the OVC in Ogun State, Nigeria wanted caregivers to stop abusing and/ or beating them (Ohnishi, Anoemuah, Jagah and Feyisetan, 2004). The findings in this study therefore agree with other studies to show that the orphanages in Ogun State are not meeting the emotional needs of the OVC in their care. This may be as a result of the complete absence of psychologists in all the orphanages and lack of psychoeducational training for the caregivers employed to work in the orphanages. In these orphanages, punitive measures such as beating the orphans were utilized (Ohnishi, Anoemuah, Jagah and Feyisetan, 2004). This is capable of causing more damage to their emotional health and it indicates lack of understanding about the emotional needs of the OVC and in the orphanages. More emphasis may have been placed on gathering OVC into orphanages in order to secure financial support from foreign granting bodies by individuals and Nongovernmental Organizations who have little or no knowledge about child development.
To understand some of the factors underlying the emotional state of the OVC, the study revealed that sexual involvement and social stigmatization significantly predict emotional well-being of orphans and vulnerable children. Significant number of the OVC (13-18year olds) in this study is sexually active. Also, OVC who are sexually involved experienced more emotional distress than OVC who are not sexually involved. This is line with Santrock (2002) that many adolescents are not emotionally prepared to handle sexual experiences, especially in early adolescence; Bingham and Crockett (1996) had indicated that they are more likely they were to show adjustment problems. Sexual involvement also has great implications for their vulnerability to sexually transmitted diseases (STD's) including HIV/ AIDS, unwanted teenage pregnancy and its attendant problems of abortion and poverty. In this study, more females than males were found to be sexually active. Studies already revealed gender disparity indicating that two thirds of all newly HIV-infected 15-19 year olds in Sub-Saharan Africa were females (USAID, UNICEF, and UNAIDS, 2002).
Of those that are sexually active some reported having sexual intercourse against their will report and that they had it with teacher, stranger, relative, neighbour or friend. Human Rights Watch, (2003) showed that at school young girls may be raped by their peers or coerced into having sex with their teachers. The evolutionary theory of sexual coercion suggests that a victim of rape experiences psychological pain which could lead to anxiety and depression (Thornhill and Palmer, 2000). This implies that sexual involvement against their will negatively affect the emotional well-being of the OVC. Some of the OVC may have been sexually involved prior admission into the orphanage or while in the orphanage during school hours. This suggest a need for developing and establishing positive relationship with the OVC to gain their confidence and administer appropriate psychosocial intervention to improve their emotional well-being.
OVC high on social stigmatization significantly report more emotional distress than OVC who score low on social stigmatisation. This is in line with Foster et al (1997) who reported that anxiety; fear, stigmatization and depression were found in AIDS orphans. Furthermore, stigma, secrecy surrounding AIDS patients and eventual parental loss causes social isolation, bully, sexual abuse, shame and a lack of opportunity to openly discuss parental loss by these orphans (Bray, 2003; UNICEF, 2003). The emotional distress and social isolation experienced by these children both before and after the death of their parent(s), is worsened by the shame, fear and rejection that surrounds people living with HIV/ AIDS. This feeling of isolation only adds to the feelings of anger, sadness and hopelessness AIDS orphans feel after witnessing their parents slowly and painfully die. Often children who have lost parents to AIDS are assumed to be HIV positive themselves adding to the likelihood that they will face discrimination which may damage their future prospects. Such children are likely not to access available social support from relations because of stigma. This finding supports the need for orphanages to cater for OVC who may be in dilemma of accommodation, care, protection and imminent risk of dropping out of school.
The plight of children affected by HI V/ AID S is gaining increasing concern as more and more people die of AIDS each year in Nigeria. Although these children live with caretakers, their emotional well-being is in jeopardy as they face the challenges of stigmatisation and sexual involvement as revealed in this study. This has implication for a wide range of issues including surging street children populations, child prostitutions, vulnerability to crime, a growing population of uneducated and unskilled labourers, teenage pregnancy, abortion, infection with HIV and STDs. The implication for Nigerian government is over dependence on foreign aid.
The government should therefore strengthen the capacity of NGO's working with AIDS orphans, families, and communities to continue providing care, protect the children and to assist them in meeting their needs. Of utmost importance, government should set up mechanisms such as psychoeducational training that can enable caretakers provides psychosocial support to AIDS orphans. This psychosocial support should place emphasis on children's psychological and emotional needs, and their need for social interaction which will help children recover from the trauma and stress of parental illness and death. This implies the involvement of psychologists at the various levels of intervention required.
The Federal Government should set up an agency that would strictly monitor care-givers who take up care of OVC after parental death. Sanctions could also be applied on care-givers who default especially those that exploit OVC, utilize punitive measures and engage them in child labour. Generally, programmes which support and supervise orphans and vulnerable children may be effective in reducing vulnerability and protecting them from HIV infection. Care and supervision of OVC should be a collective responsibility of all members of the society, therefore community based care initiatives should be integrated and strengthened to support and supervise orphans.
Government should also start educational and enlightenment campaign on sex education and HIV/ AIDS prevention targeted on these group of orphans. Empowerment programs for female orphans will also contribute to HIV/ AIDS prevention. In view of the increase in the cases of rape, young female orphans should be given assertiveness training and encouraged to learn self-defence skills to protect themselves from sexual coercion (rape).
Government should also establish a national legislation that enforce the universal basic education (UBE) scheme, especially for AIDS orphans and a compulsory free education scheme (including school uniforms and books) to tertiary levels for AIDS orphans. This will cushion the burden of taking on additional orphans orphaned by AIDS by extended family members and reduce the need to depend on orphanages. Vocational skills training particularly should also be included. This program will not only help boost the self-esteem and emotional well-being of these children but will help them attain basic education and employable skills which is an important part of preventing the spread of HIV/ AIDS and breaking the cycle of poverty. Government should also include HIV/ AIDS prevention into the school curriculum to raise the awareness about the disease among orphans and vulnerable children which are a very vulnerable group. Policies in countries such as the Dominican Republic, Uganda, and Kenya have been successful in reducing this enrolment gap. This means that government policies can have an impact on school attendance rates for orphans. Government and agencies should adopt a multisectoral approach, with emphasis on capacity building of communities and families, community mobilization, economic strengthening, life skills training and involvement of children.
Limitations and Future Research
No one single study can examine all the factors that predict the emotional well-being of orphans and vulnerable children. Other variables that may be considered for further studies include factors resident in the child such as personality of OVC on emotional wellbeing; caregiver-OVC relationship as it affects emotional well-being, monitoring and evaluation strategies for orphanages and NGOs handling AIDS orphans. Also more research should be carried out on the influence of changes in caregivers and its effect on the OVC emotional well-being. Furthermore, it would be useful to find out the effect of psychoeducational capacity training for caregivers on the emotional well-being of OVC. It is doubtful if the results of this study can be generalized to the entire country because of the small sample size. Other researchers could use a larger sample size so that the results can adequately be generalized to the entire ethnic groups in Nigeria.
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Adejuwon, G. A & Oki, S
Department of Psychology
University of Ibadan
* E-mail: email@example.com