Psychosocial conditions of orphans and vulnerable children in two Zimbabwean districts doc

PSYCHOSOCIAL CONDITIONS OF
ORPHANS AND VULNERABLE
CHILDREN
IN TWO ZIMBABWEAN DISTRICTS
Simba Rusakaniko, Alfred Chingono, Stanford Mahati,
Pakuromunhu F Mupambireyi, & Brian Chandiwana
Edited by Parkie S Mbozi, M Boy Sebit & Shungu Munyati
NATIONAL฀
INSTITUTE
OF
฀HEALTH฀
RESEARCH,฀
MINISTRY฀OF฀
HEALTH฀AND฀
CHILD฀WELFARE
BIOMEDICAL
RESEARCH฀&
TRAINING
INSTITUTE
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Prepared by the Biomedical Research and Training Institute (BRTI) and
the National Institute of Health Research (NIHR) of the Ministry of Health and Child
Welfare, Harare, Zimbabwe.
Published by HSRC Press
Private Bag X9182, Cape Town, 8000, South Africa
www.hsrcpress.ac.za
© 2006 HSRC, BRTI, NIHR & FACT
First published 2006
All rights reserved. No part of this book may be reprinted or reproduced or utilised in
any form or by any electronic, mechanical, or other means, including photocopying
and recording, or in any information storage or retrieval system, without permission

in writing from the publishers.
ISBN 0-7969-2147-4
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iii
TABLE฀OF฀CONTENTS฀
About the contributors iv
Acknowledgements vi
Operational definitions of concepts vii
List of tables & figures viii
Acronyms and abbreviations x

Executive summary xi
Chapter฀1฀฀฀฀Introduction฀฀฀฀1
1.1 The Situation of OVC in sub-Saharan Africa 1
1.2 HIV/AIDS and orphanhood in Zimbabwe 3
1.3 Zimbabwe OVC project 4
1.4 The baseline psychosocial survey (of OVC and their guardians) 4
Chapter฀2฀฀฀฀Methodology฀฀฀฀7
2.1 Study design 7
2.2 Study areas 7
2.3 Questionnaire development 8
2.4 Pre-testing of the instruments 9
2.5 Field work activities 10
2.6. Sampling procedures 10
2.7. Field monitoring activities 12
2.8. Data management 12
Chapter฀3฀฀฀฀Results:฀Chimanimani฀฀฀฀15
3.1 OVC aged 6–14 years 15
3.2 OVC aged 15–18 years 24
3.3 Guardians of OVC in Chimanimani 39
Chapter฀4฀฀฀฀Results:฀Bulilimamangwe฀฀฀฀51
4.1 OVC aged 6–14 years 51
4.2 OVC aged 15–18 years 59
4.3 Guardians of OVC 82
Chapter฀5฀฀฀฀฀Conclusions฀&฀recommendations฀for฀
Chimanimani฀and฀Bulilimamangwe฀฀฀฀93
5.1 Conclusions 95
5.2 Recommendations 95
Appendices฀and฀References
Appendix 1: Vulnerability Score Assessment 97
References 98

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iv
Authors
Mr Alfred Chingono: MSc, Clinical Psychologist, College of Health Sciences, University
of Zimbabwe, Team Leader for PSS (Zimbabwe)
Professor Simba Rusakaniko: PhD, Consultant Biostatistician, College of Health
Sciences, University of Zimbabwe (Zimbabwe)
Stanford T. Mahati: MPhil, BSc (Hons) Sociology & Anthropology, Social Scientist,
National Institute of Health Research (NIHR) Ministry of Health & Child Welfare, Harare
(Zimbabwe)
Pakuromunhu Freddie Mupambireyi: MSc Demography, BSc (Hons) Econs Statistician,
University of Zimbabwe, Deputy Dean, Faculty of Commerce, Harare (Zimbabwe)
Brian Chandiwana: BSc Econs, MBA, Health Economist, Biomedical Research & Training
Institute, Harare, OVC Research Project Manager (Zimbabwe)
Editors
Shungu Munyati: MSc, PhD (Cand), OVC Research Project Director, Acting Director,
National Institute of Health Research (NIHR), Ministry of Health & Child Welfare
(Zimbabwe)
Mr Parkie S. Mbozi: Communications Consultant, World Agroforestry Centre CRAF

Dr M. Boy Sebit, Senior Lecturer, Clinical Psychologist, College of Health Sciences,
University of Zimbabwe
Other Contributors
Peter P. Chibatamoto: MBA, MSc Infectious Diseases, Biological Sciences; HIV/AIDS
(Mainstreaming) Technical Advisor UNDP, Windhoek (Namibia)
Natsayi Chimbindi: BSc HEP, (Health Education), Biomedical Research & Training
Institute Harare (Zimbabwe)
Stephen Buzuzi: MSc, BSc (Hons) Sociology & Anthropology, Biomedical Research &
Training Institute, Harare (Zimbabwe)

Stella Gwini: BSc (Hons) Statistics, Biomedical Research & Training Institute, Harare
(Zimbabwe)
Wilson Mashange: Dip Med Lab Tech, Medical Laboratory Technologist, National Institute
of Health Research (NIHR), Ministry of Health & Child Welfare, Harare (Zimbabwe)
George Chitiyo: MSc, BSc Econs; Catholic Relief Services, Harare (Zimbabwe)
Maxwell Chirehwa: BSc (Hons) Applied Maths (Cand), National University of Science
and Technology, Bulawayo (Zimbabwe)
ABOUT฀THE฀CONTRIBUTORS
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v
Timothy Mutsvari: BSc (Hons) Applied Maths, Biomedical Research & Training Institute,
Harare (Zimbabwe)
Teramai A. Moyana: BSc (Hons) Sociology & Anthropology; Biomedical Research &
Training Institute, Harare (Zimbabwe)
Chenjerai K. Mutambanengwe: BSc (Hons) Applied Maths (Cand), National University of
Science & Technology, Bulawayo (Zimbabwe)
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vi
ACKNOWLEDGEMENTS
The authors would like to thank the Biomedical Research and Training Institute (BRTI)
together with the National Institute of Health Research (NIHR) former Blair Research
Institute, of the Ministry of Health and Child Welfare for all the support it received from
staff, through contributions of their time, skills, expertise and resources during the survey.
Special thanks go to the Human Sciences Research Council (HSRC), in particular the
new President and Chief Executive Officer, Consultant and Project Champion of OVC
Project, Dr Olive Shisana, who together with the Principal Investigator of the Research
Component of the project, Professor Leickness Simbayi and the Overall Project Manager,
Dr Donald Skinner, supported the OVC research project.
The team would like to thank Mr Rogers Sango from the Zimbabwe Central Statistics

Office and a former employee of the same organisation, Mr Tichaona Chirimanyemba
for their valuable technical input during the development of the research instruments,
mapping, training of fieldworkers and fieldwork.
The District Administrator for Bulilimamangwe, Mr Mzingaye Sithole, the Rural District
Council Chairman for Bulilima (Mr Christopher Ndlovu), Plumtree (Mr Patrick Mabuza)
and Mangwe (Mr Grey Ncube), traditional Chiefs and Councillors, are saluted for their
facilitatory role in ensuring the successful implementation of the field data collection
exercise. The research team appreciates the support they received from the Bulilima,
Mangwe and Plumtree OVC Local Liaison Team: Mr Irvine Ncube, Mrs. Melta Moyo, Mr
Frank Ngwenya, Mr Lincolin Ncube, Mrs. Sifiso Dube and Mr Alois Sibanda during the
whole exercise of data collection. Gratitude is also extended to Mr Andrew Nleya and Mr
Khumbulani Tshuma for their assistance during the fieldwork.
In Chimanimani, we are grateful to the then District Administrator of Chimanimani
Mr Edgar Nyagwaya, Chimanimani Rural District Council Chairman of Chimanimani
Mr Joseph Harahwa, Traditional Chiefs and Councillors who facilitated the exercise.
We acknowledge the support received from the Chimanimani OVC local liaison team
members Mr Jobes Jaibesi, Mr Brian Muchinapo, the then District Nursing Officer the
late Sister Mistress Ndhlovu and the new District Nursing Officer Sister Sifovo during the
whole exercise.
Our thanks are extended to the headmasters, teachers and nurses in all districts who
readily assisted the research team, including supervisors and interviewers, with free
training venues, accommodation and logistical support. We are also greatly indebted
to the communities of Bulilimamangwe and Chimanimani for their co-operation and
hospitality throughout.
The field supervisors are highly commended for their sterling work. We also thank the
interviewers who industriously collected the data. We would like to further acknowledge
the work undertaken by the data entry clerks under the supervision of Mr Tendai Madiro
and Mr Lowence Gomo.
Sincere gratitude is also extended to the implementing partners, the Grant Maker FACT
Mutare for their support during the entire psychosocial survey, and the WK Kellogg

Foundation who generously funded the project.
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vii
In the context of the OVC project in Zimbabwe, the following definitions were used:
Care-giver: a person who regularly voluntarily assists a household, whose members
are related or not related to him/her, in doing household chores, offering advice, giving
spiritual, psycho-social and material support.
Child: a person under the age of 18 years.
Child-headed household: a household in which a person aged 18 years and below is
responsible for making day-to-day decisions for a group of persons who stay or who
usually reside together and share food from the same pot, whether or not they are related
by blood.
Enumeration area: the smallest demarcation of a district that is a cluster of about 100
households.
Guardian: parent/someone who assumes responsibility for someone else’s welfare on a
day-to-day basis.
Grant maker: organisation that sources resources and rolls out grants to community-
based organisations to implement OVC interventions. Family AIDS Caring Trust (FACT) is
the grant maker for the OVC project in Zimbabwe.
Head of household: a person, regardless of age, who is responsible for making day-to-
day decisions for a group of persons who stay or who usually reside together and share
food from the same pot, whether or not they are related by blood.
Household: a group of persons who stay or who usually reside together and share food
from the same pot, whether or not they are related by blood.
Local liaison teams: key people selected from the districts where research is being
conducted who spearhead the OVC project activities.
Orphan: a person under the age of 18 who has lost either one or both parents.
Vulnerable Child: A child is considered vulnerable if he/she is living under difficult
circumstances. These include children living in poor households, those receiving
inadequate care, those with sick and terminally ill parents, those living in child-headed

households, those dependent on old, frail or disabled care-givers, and children in
households that assume additional dependency by taking in orphaned children. There is
no direct relationship between orphanhood and vulnerability. One can be an orphan and
yet not vulnerable and another can be vulnerable and not necessarily be an orphan.
Ward: a ward is a composition of 500 to 600 households.
OPERATIONAL฀DEFINITIONS฀OF฀CONCEPTS
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viii
Table 2.1: Targeted and actual sample sizes of guardians by district 11
Table 2.2: Targeted and actual sample sizes of OVC by district 12
Table 3.1: Distribution of OVC by Household standard of living 16
Table 3.2: Inheritance-related issues as reported by orphans 17
Table 3.3: Distribution of family items inherited by people other than orphans/siblings 18
Table 3.4: Psychological issues (emotions) 19
Table 3.5: Psychological issues or experiences expressed by OVC 20
Table 3.6: Reported sexual experiences and abuse of OVC 22
Table 3.7: Distribution of reported indices of psychological well-being 26
Table 3.8: Distribution of orphans by the things that made them happy 28
Table 3.9: Distribution of OVC by their reported coping strategies 29
Table 3.10: Agencies and forms of assistance received by OVC or orphans? 31
Table 3.11: Reported sexual experiences of OVC 33
Table 3.12: Discussions held with OVC concerning parents’ illness 35
Table 3.13:Distribution of guardians by employment status and source of income 40
Table 3.14: Distribution of guardians according to what they perceived to be the main
needs of OVC 41
Table 3.15: Guardians’ perceptions of the community’s concerns with regards to HIV/AIDS 42
Table 3.16: Distribution of guardians by reported communication on HIV/AIDS with children 43
Table 3.17: Perceptions about OVC situation in their neighbourhood 43
Table 3.18: Children’s reactions to the coming in of OVC into their households 44
Table 3.19: Demographic characteristics of child heads of households 45

Table 3.20: Household situation and sources of income 46
Table 3.21: Needs and problems within child-headed households 46
Table 4.1: Distribution of OVC according to their kinship to current Guardian 52
Table 4.2: Level of the OVC’s satisfaction with living in current households 52
Table 4.3: Distribution of family Items inherited by people other than orphans/siblings 53
Table 4.4: Psychological issues (emotions) as reported by OVC 55
Table 4.5: Psychological issues (experiences) 56
Table 4.6: Distribution of OVC by reported household economic situation 60
Table 4.7: Distribution of OVC by food consumption patterns 60
Table 4.8: Distribution of OVC by food consumed the day preceding the survey 61
Table 4.9: Distribution of OVC according to their relatedness to and their relationships
with guardian and other household members 62
Table 4.10: Distribution of OVC by district according to reported treatment by their guardian 63
Table 4.11: Distribution of orphans’ expectations of their guardians 65
Table 4.12: Distribution of how orphans felt about their parent(s)’ death 66
Table 4.13: Orphans’ feelings and wishes with respect to inherited items 67
Table 4.14: Distribution of family items inherited by relatives other than orphans and their
siblings 69
Table 4.15: Distribution of reported indices of psychological well being 70
Table 4.16: Reported usual coping strategies following parent(s)’ death 72
Table 4.17: OVC perceptions about how society members treated them 73
Table 4.18: Reported life changes following parent(s) death 74
Table 4.19: Agencies assisting OVC 75
Table 4.20: Forms of assistance received by OVC 75
Table 4.21: Reported sexual experiences of OVC 77
Table 4.22: Discussions held with OVC concerning parent(s)’ illness 78
Table 4.23: OVC’s educational level they attained by age group 83
Table 4.24: Distribution of perceptions of guardians on the impact of taking OVC into
their household 84
LIST฀OF฀TABLES฀AND฀FIGURES

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Chapter฀1
ix
Table 4.25: Distribution of guardians according to what they perceived to be the main
needs of OVC 85
Table 4.26: Distribution of guardians as per perceived challenges of heading a household 86
Table 4.27: Children’s reactions to the coming of OVC into their households 87
Table 4.28: Distribution of guardians by kind of support received 88
Table 4.29: Duration of OVC assuming responsibility of being head of household 88
Table 4.30: Household situation, sources of income and ways of making ends meet for
child-headed households. 89
Table 4.31: Needs, challenges, problems and concerns for child-headed households 89
LIST฀OF฀FIGURES
Figure 2.1: Location of Bulilimamanywe and Chimanimani Districts 8
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x
AIDS Acquired฀Immune฀Deficiency฀Syndrome
BRTI Biomedical฀Research฀and฀Training฀Institute
CBO Community-based฀organisation
CIHP Centre฀for฀International฀Health฀and฀Policy
FACT Family฀AIDS฀Caring฀Trust
FBO฀ ฀ Faith-based฀organisation
FHI฀ ฀ Family฀Health฀International
HIV Human฀Immunodeficiency฀Virus
HSRC Human฀Science฀Research฀Council
IRDP Integrated฀Rural฀Development฀Programme
KABP
KAP฀ ฀ Knowledge,฀attitudes฀and฀practices
MRCZ฀ ฀ Medical฀Research฀Council฀of฀Zimbabwe
NGO฀ ฀ Non-governmental฀organisation

NIHR National฀Institute฀for฀Health฀Research
OVC Orphans฀and฀Vulnerable฀Children
PSS฀ ฀ Psychosocial฀Survey
RH฀฀ ฀ Reproductive฀Health
SAfAIDS Southern฀Africa฀HIV/AIDS฀Information฀Dissemination฀Service
SADC Southern฀Africa฀Development฀Community
STI฀ ฀ Sexually฀transmitted฀infection
UNAIDS Joint฀United฀Nations฀Programme฀on฀HIV/AIDS
UNDP฀ ฀ United฀Nations฀Development฀Programme
WKKF฀ ฀ WK฀Kellog฀Foundation
ZHDR฀ ฀ Zimbabwe฀Human฀Development฀Report
ACRONYMS฀AND฀ABBREVIATIONS
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xi
The Human Sciences Research Council (HSRC) together with its partners within the
Southern African Development Community (SADC) region have been commissioned by
The WK Kellogg Foundation (WKKF) to develop and implement a five-year intervention
project on orphans and vulnerable children (OVC) as well as families and households
coping with an increased burden of care for affected children in Botswana, South Africa
and Zimbabwe.
As part of this broader research and intervention project on OVC across three countries in
the SADC region, a baseline psychosocial survey (PSS) of orphans and vulnerable children
and their guardians was conducted in selected sites aimed at determining baseline data
on the social, psychological, economical and physical conditions and experiences of
OVC. The information would be useful for strengthening existing OVC interventions
and in evaluating the effectiveness of new interventions that would be implemented in
the districts at the mid-point and at the end of the project. The general objective of the
project was to develop a comprehensive understanding of the challenges faced by the
OVC in those sites, regarding their demographic characteristics, housing situation, food
security, psychosocial experiences, inheritance issues, experience with stigmatisation and

sexual involvement and abuse.
The study was carried out in Chimanimani and Bulilimamangwe Districts in Manicaland
and Matabeleland South Province of Zimbabwe respectively. It was cross-sectional in
design and conducted in 10 randomly selected wards out of the 23 in Chimanimani
district and 32 out of the 35 in Bulilimamangwe district.
The study assessed psychosocial issues (i.e. household living situation and relationships,
emotional well-being, experiences of stigma and discrimination) of OVC (6–14 & 15–18
years age group) and their guardians. The sampling frame was derived from the 2003
BRTI/NIHR OVC Census data. Using the census data, households with vulnerable children
were identified using a vulnerability assessment/indicator score, which was a summary
of the household situation in terms of food and clothing availability, and care available
for children in the households. Households which were ranked as either moderately or
highly vulnerable, with children under 19 years, comprised the target population (total 8
972 in Bulilimamangwe and 4 286 in Chimanimani). The target sample sizes for guardians
of OVC were 1 000 in both districts and for the 6–14 and 15–18 age groups it was 500
each.
Data entry was done for a period of two weeks using a template designed in Epi-Info
version 6.0. Data cleaning was first done in Epi Info version 6.0 and then in STATA
Intercooler Version 7.0. The latter was then used for data analysis.
This report describes research findings from the two selected sites in Zimbabwe. In
Chimanimani a total of 743 guardians of OVC aged 0–18years were interviewed. The
overall mean age of OVC was 9.2 years with slightly more males than females. More than
half of the OVC who were aged between 7 and 13 years had attained primary schooling
as their highest level of education, while almost a third of those aged between 14 and 18
years had attained secondary education. Regarding the type of orphanhood, there were
almost three times more paternal orphans than maternal orphans, whilst about a tenth of
the OVC had lost both parents. The mean age at which the OVC lost a mother was 6.6
years, whilst the mean age at which the OVC lost a father was 5.9 years and there was
no significant difference between the two mean ages. The overall mean age of guardians
of OVC was 44.5 years and 2.8% of them were below 19 years of age (child-headed

EXECUTIVE฀SUMMARY
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Psychosocial฀conditions฀of฀OVC฀in฀two฀Zimbabwean฀districts฀
xii
households). All in all there were 21 child-headed households surveyed in Chimanimani
district. The majority of the child guardians were females and their mean age was 16.5
years. The majority of guardians were in the economically active age group (19–64 years).
More than three quarters of the children who were heading households in Chimanimani
had attained secondary schooling as their highest level of education, while primary
schooling was the highest attained by those guardians aged 19 years and above. A
greater proportion of the respondents were of the Apostolic sects. Almost two thirds of
the guardians of OVC were married while slightly over a quarter were widowed. The
sex distribution of those who responded in their capacity as guardians of OVC was
skewed towards females with a ratio of almost three females to one male. The HIV/AIDS
pandemic has had negative effects on many aspects of people’s lives both in Chimanimani
and Bulilimamangwe. Despite all the efforts being put in place towards combating its
spread, the majority of the guardians reported that the biggest concern facing their
community with respect to HIV infection and AIDS was that the problem was getting
worse. Almost every guardian/parent had heard about AIDS. While the majority of the
respondents believed that children should know about sex, HIV/AIDS and reproductive
health, the proportions that actually discussed these issues with the children were lower.
In Bulilimamangwe, a total of 728 guardians of OVC were interviewed and it was found
that the study population followed the national general population pattern, with slightly
more female OVC than males. With regard to the type of orphanhood, almost a quarter
of the OVC were reported to be paternal orphans whilst a tenth had lost their mother;
less than a tenth had lost both parents. Generally, the study found that children lost a
father at an age significantly lower than that at which they lost a mother. As reported by
the guardians, around two thirds of the children of school-going age (7–13years) were in
primary school while about a quarter of those aged 14–18years were in secondary school.
The sex distribution of guardians of OVC was over three females to one male. The overall

mean age of guardians of OVC was 48.5 years with guardians below the age of 18 years
only constituting 1%. More than half of the guardians of OVC were married and about
a quarter were widowed. An overwhelming majority of the guardians were unemployed
with only about 3% being in formal employment. Of those guardians who had taken in
OVC into their households, nearly half mentioned the death of the parents of the child
as the main reason for taking in these children. The shortage of food and money and
increased financial expenditure on food were mentioned by most of the guardians as the
major impacts on the households since taking in OVC.
In Chimanimani a total of 329 OVC of the age group 6 to 14 years were interviewed,
with a mean age of 10.8 years, and almost all (93%) of them were attending school at the
time of the survey. The overall magnitude of orphanhood was 46% with paternal orphans
being slightly more than half of the total. This signifies the early disappearance of paternal
role models in the lives of these children. This deprivation of paternal roles at such a
tender age may also exacerbate the vulnerability situation of the orphans with respect to
household financial security. Although, there were only five child heads of households,
whose ages ranged from 10 to 14 years, grant makers need to keep an eye on the
situation, as the problem may get worse as the pandemic grows further. The households
in which the OVC were staying were generally poor, with more than three quarters (84%)
of the OVC mentioning that they did not have enough money for basics such as food
and clothing. This highlights that poverty is a major contributor to vulnerability in the
households of these OVC. Although the proportions of OVC who had engaged in sexual
intercourse and those who had been inappropriately touched on their private parts by
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xiii
guardians may seem rather low (less than 5% for both), it is nevertheless a cause for grave
concern because of the ages of the children involved. About 1% of the OVC had been
inappropriately touched on their private parts by either community members or other
children in the household. This could be a manifestation of hidden sexual abuse, which
should be of concern given the sexual precociousness of children in this age range and
the risks of early pregnancies and infections with STIs and HIV.

In Bulilimamangwe, 432 OVC aged 6–14 yearS were interviewed and their mean age was
10.7 years. The magnitude of orphanhood was 43%. There were more paternal orphans
than maternal orphans by a ratio of two to one. Like in Chimanimani, the households
in which the OVC in Bulilimamangwe were staying were generally poor, with more
than three quarters (83%) of the OVC mentioning that they did not have enough money
for basics such as food and clothes, which indicates that poverty plays a pivotal role in
determining the level of vulnerability in the households of these OVC. Nearly a fifth of
OVC (10%) reported having scary dreams/nightmares while around 9% had trouble falling
asleep.
The next age-group was the 15–18 year old youth, where the survey was carried out with
the general objectives of: characterising their demographic characteristics, housing and
food security situation; KABP; socio-cultural and legal safety nets and support systems of
OVC; OVC experiences of stigma and discrimination; their perceptions of the impact of
HIV/AIDS on the community; the health services available to them and their health status.

In Chimanimani, instead of the targeted 250 respondents, 185 OVC were interviewed and
their mean age was 16.6 years. The prevalence of orphanhood was 51% and 17% of them
were double orphans. At the time of the survey, 44% of the OVC were not attending
school and of these, 30% had only attained primary education. Over 60% of the orphans
reported that they were still bothered by their parents’ death at the time of the survey.
Concerning organisations assisting OVC, 42% of the respondents reported that they had
received assistance from the NGO sector, mainly in the form of food parcels.
In Bulilimamangwe, a total of 262 OVC aged 15–18 were interviewed and their mean age
was 16.5 years. The prevalence of orphanhood was 52.9% and there were three times
more paternal orphans than maternal orphans. This indicates that a significant portion
of the OVC in the study area have been deprived of parental care, support, love and
protection. At the time of the survey, 76% were not attending school and of these, 71%
had only attained primary education. The majority (80%) of the OVC households did
not have enough money for basics. Most orphans expected that their guardians should
provide (33%) or improve (47%) on the provision of material things such as food and

clothes. Around 50% of the orphans reported that they were still bothered by their
parents’ death at the time of the survey.
Regarding recommendations, grant makers need to take note of the OVC situation as the
problem may get worse as the HIV/AIDS pandemic further expands. Programmes that
offer psychosocial support/services should be designed for OVC. There is a need to put
in place intervention programmes to address the problems that are usually associated
with early school drop out, since about three quarters of OVC aged between 15 and 18
years were not attending school, having attained primary education only. Furthermore
since most of the guardians were not employed, grant makers may also need to
implement income-generating activities in order to help alleviate the poor living standards.
Implementation of interventions should target identified areas of needs, concerns and
Executive฀summary
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Psychosocial฀conditions฀of฀OVC฀in฀two฀Zimbabwean฀districts฀
xiv
problems like food, educational and financial support. Since the communities identified
the increasing problem of HIV/AIDS in their communities, there is also a need for more
awareness campaigns on HIV and AIDS in the communities.
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1
Introduction
1.1 The situation of orphans and vulnerable children in sub-Saharan
Africa
The problem of orphans is so great that it has serious negative impacts in society and
demands immediate intervention. AIDS-related deaths have left many children under 15
years of age in the SADC region without a mother or a father, or without either parent
since the epidemic began. According to UNAIDS (2004), the number of children orphaned
by AIDS in sub-Saharan Africa at the end of 2003 was 12 million. According to SAfAIDS
News (2000), 11 countries in sub-Saharan Africa will have 20–37% of children under
15 orphaned, including all nine countries in southern Africa, by 2010. The projections

are worse for Botswana (37%), South Africa (31%), Swaziland (32%), Namibia (32%),
Zimbabwe (34%) and Central African Republic (31%). UNAIDS predicts an ever greater
catastrophe with numbers reaching 40 million in 2010. By far the largest estimated cause
will be AIDS (UNAIDS, 2002) In addition a large number of children have been, and
continue to be, made vulnerable due to the impact of the AIDS pandemic, although they
are not orphans. These vulnerable children include children living with sick parents,
children who were primarily dependent on a breadwinner who has died; children who
are in precarious care as a result of being dependent on old, frail or disabled care-givers
and children in households that assume additional dependency by taking in orphaned
children. However, it is very difficult to obtain the exact figures on the numbers of
vulnerable children.
Hence as the pandemic unfolds and takes its toll on the young adults it is leaving one
or more generations of children to be raised by their grandparents, in households with
high dependency ratios, or child-headed households. Children who have lost their
parents to AIDS face a more difficult future than other orphans. Nationally representative
household surveys from 40 countries in sub-Saharan Africa that assessed the impact of
AIDS on the prevalence of orphanhood and care patterns (Kamali et al., 1996), showed
that orphans more frequently lived in households that are female-headed, larger and
have a less favourable dependency ratio. The head of the household was considerably
older. Child-caring practices differed between countries, and between non-orphans and
orphans. Based on the country medians, almost nine out of ten non-orphans lived with
their mother and eight out of ten non-orphans lived with their father. Single orphans were
less likely to live with their surviving parent: three out of four paternal orphans lived with
their mother and just over half of maternal orphans lived with their father. The (extended)
family took care of over 90% of the double orphans but these double orphans were most
likely to be disadvantaged. In addition orphans were 13% less likely to attend school
than non-orphans. An assessment in a rural population in South-West Uganda with an
HIV seroprevalence of 8% among adults (Monasch & Boerma, 2004) showed that HIV-1
seroprevalence rates were higher among orphans than among non-orphans and were up
to six times higher in the 0–4 year age group. Seropositivity rates were also higher among

surviving parents of orphans than among parents of non-orphans.
Without the care of a parent or appointed care-giver, children are likely to face risks
of malnutrition, poor health, inadequate schooling, migration, homelessness and abuse
(Shetty & Powell, 2003). According to UNAIDS (2000), help for orphans should be
targeted at supporting families and improving their capacity to cope, rather than setting
CHAPTER฀ONE
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up institutions for the children, as orphanages are not a sustainable long-term solution. In
addition, institutional care is known to have deleterious effects on children. Children sent
away from their villages may lose their rights to their parents’ land and other property
as well as their sense of belonging to a family and community. AIDS has both direct and
indirect effects on children. The direct effects result from infection and illness of either or
both the child and his or her care-givers. There are a large number of children who will
suffer indirectly as a result of the HIV/AIDS pandemic. These indirect cases of HIV/AIDS
impact are mostly unreported (Foster & Williamson, 2000). Also, children whose families
provide financially for relatives affected by AIDS, or whose mothers take on or go to
care for sick relatives, may experience a reduced quality of life. In addition, all children
are affected when there are increased deaths in their community, and when their close
and extended family, community and societal institutions and services are strained by
the consequences of the AIDS epidemic. The impact of the AIDS pandemic on children
and families is incremental (Foster & Williamson, 2000). Worst hit are communities that
are already poor, with inadequate infrastructure and limited access to basic services. For
example, not taking into account the effect of the AIDS pandemic on socio-economic
conditions, it is estimated that 61% of children in South Africa live in poverty (Smart,
2000). It is these children whose family and household conditions will further deteriorate
because of the impact of the AIDS epidemic. One hundred and ninety three children
aged 6–20 years in Rakai district of Uganda were interviewed in a study exploring the
psychological effects of orphanhood. All of the children were orphaned due to their

parents’ death from AIDS. Teachers and some orphans also participated in focus group
discussions, and where possible, guardians were interviewed. The children were able to
distinguish between their quality of life when their parents were alive and well, when
they became sick, and when they eventually died. Most children lost hope when it
became clear that their parents were sick. They also felt sad and helpless. Many were
angry and depressed when they were adopted. Children living with widowed fathers
and those living on their own were significantly more depressed and externally oriented
than those who lived with their widowed mothers. The study suggests that teachers
should be trained on how to diagnose psychosocial problems and given skills to manage
them. Short courses on problem identification and counselling should also be organised
for guardians and community development workers (Foster et al., 1997). This special
article explores a century of paediatric and child psychiatry research covering five areas
of potential biologic and social risk to infants and young children in orphanage care:
(1) infectious morbidity, (2) nutrition and growth, (3) cognitive development, (4) socio-
affective development, and (5) physical and sexual abuse. These data demonstrate that
infants and young children are uniquely vulnerable to the medical and psychosocial
hazards of institutional care, negative effects that cannot be reduced to a tolerable
level even with massive expenditure. Scientific experience consistently shows that, in
the short term, orphanage placement puts young children at increased risk of serious
infectious illness and delayed language development. In the long term, institutionalisation
in early childhood increases the likelihood that impoverished children will grow into
psychiatrically impaired and economically unproductive adults (Foster et al., 1996).
Most southern African orphans are cared for by extended families but the implications
of the spatial dispersal of such families are seldom recognised: orphans often have to
migrate to new homes and communities. A study conducted with children and guardians
in urban and rural Lesotho and Malawi examines orphans’ migration experiences in
order to assess how successful migration might best be supported. Most children found
migration traumatic in the short term, but over time many settled into new environments.
Although many HIV/AIDS policies in southern Africa stress the role of communities, the
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Chapter฀1
3
burden of care lay with extended family households. Failed migrations, which resulted in
renewed migration and trauma, were attributable to one of two household-level causes:
orphans feeling ill-treated in their new families, or changes in guardians’ circumstances.
Policy interventions to reduce disruption and trauma for young AIDS migrants should
aim at facilitating sustainable arrangements by enabling suitable households to provide
care. Reducing the economic costs of caring for children, particularly school-related
costs, would: allow children to stay with those relatives (e.g. grandparents) best able
to meet their non-material needs; reduce resentment of foster children in impoverished
households; and diminish the need for multiple migrations

(Frank et al., 1996).
It is quite clear therefore that orphans may grow up without basic material resources
and may lack the love and support that emotionally-invested care-givers usually provide;
they may be discriminated against because of the presumed sero-status of their parents;
and they may be forced to discontinue their education because of lack of money or the
need to take care of their siblings. From a social perspective, the consequences of large
numbers of children being raised without parents will prove costly for the region, both in
direct costs for relief, indirect costs associated with an increased burden of ill health and/
or social pathology, as well as opportunity costs associated with lost years of education
and work preparedness. As a general response in the region, families and communities
have taken in orphaned children and raised them as part of the extended family. There
are also a growing number of programmes in the region that attempt to provide relief
and support for affected children, encourage fosterage, and provide institutional care for
very vulnerable children.
1.2 HIV/AIDS and orphanhood in Zimbabwe
Before AIDS, the number of orphans in most developing countries was decreasing due to
improvements in life expectancy. Orphans were likely to be older than age five years and
have lost a father. It was uncommon for a child to have lost both parents. This scenario

no longer prevails. As growing numbers of young adults die, sibling- and grandmother-
headed households are becoming increasingly common. An estimated 25 million adults
and children were living with HIV in sub-Saharan Africa at the end of 2003, with an adult
prevalence of 24.6% in Zimbabwe alone, and an estimated 980 000 children have been
orphaned by AIDS (UNAIDS, 2004). In Zimbabwe it is possible that 40% of children may
have lost their parents within a decade (Foster et al., 1995).
Regarding conditions existing for orphans in Zimbabwe, an orphan enumeration survey
was conducted in 570 households in and around Mutare, Zimbabwe, in 1992. Orphan
prevalence was highest in a peri-urban rural area (17%) and lowest in a middle-income
medium density urban suburb (4%). Orphan household heads were likely to be older and
less educated than non-orphan household heads. The majority of orphaned children were
being cared for satisfactorily within extended families, often under difficult circumstances.
Care-giving by maternal relatives represents a departure from the traditional practice of
caring for orphans within the paternal extended family and an adaptation of community-
coping mechanisms. However, the emergence of orphan households headed by siblings is
an indication that the extended family is under stress (Nelson, 2000; Sengendo & Nambi,
1997). Interviews and focus group discussions involving 40 orphans, 25 caretakers and
33 community workers from a rural area near Mutare, Zimbabwe, explored community
responses to children orphaned as a result of the AIDS pandemic and other factors.
The extended family remained the principle orphan-care unit, although some relatives
exploited the children’s labour and failed to meet their educational and medical needs,
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with some of the orphans reporting being forced to work rather than attend school,
isolated from peers, neglected or maltreated by caretakers and stigmatised (Nelson, 2000).
However, stigmatisation was more likely to be based on orphan status or poverty than
AIDS as the cause of a parent’s death

(Ntozi, 1997). On the basis of these findings, non-

governmental organisations are designing programmes to help caretaker households and
communities cope with the stresses of caring for AIDS orphans

(Plotnick, 1997).
A recent study has also supported the fact that the tradition of incorporating orphans into
the extended family has broken down while, on the other hand, HIV-infection rates have
increased. Community-based orphan support programmes that use volunteers to visit the
most needy children have the potential to complement existing coping mechanisms in a
cost-effective manner (Nyamukapa & Gregson, 2005).
It is therefore quite clear from the above literature that the high prevalence of HIV/AIDS
in the region has resulted in an unprecedented number of OVC. Understanding the
impact of HIV and AIDS on households and children is important in the prioritisation,
design and evaluation of programmes to support vulnerable children.
1.3 Zimbabwe OVC project
The Human Sciences Research Council (HSRC), working with partners in the Southern
African Development Community (SADC) region, was commissioned in 2002 by the WK
Kellogg Foundation (WKKF) to develop and implement a five-year intervention project on
orphans and vulnerable children (OVC), as well as families and households coping with
an increased burden of care for affected children initially in Botswana, South Africa and
Zimbabwe, and later including Lesotho, Mozambique and Swaziland. In Zimbabwe, the
Biomedical Research and Training Institute’s Centre for International Health and Policy
(CIHP) and National Institute of Health Research (NIHR) of the Ministry of Health and
Child Welfare form the monitoring and evaluation team of the OVC project. The Family
AIDS Caring Trust (FACT) is the grant maker.
The primary aim of the OVC project is to develop a comprehensive understanding of
the challenges faced by orphans and vulnerable children in Zimbabwe. The overall
philosophy behind the project is the empowerment of communities to help themselves
and this puts a very strong emphasis on sustainability of the project after funding from a
donor ceases.
Thus the project aims to develop, implement and evaluate some existing and/or new

OVC intervention programmes that address the following issues:
• Home-based and child-centred health, development, education and support;
• Family and household support;
• Strengthening of community-support systems;
• Building HIV/AIDS awareness, advocacy and policy to benefit OVC.
1.4 The baseline psychosocial survey (PSS) of OVC and their
guardians

Like other developing countries, HIV has hit Zimbabwe hard with an
HIV prevalence
of 24.6% (ZHDR, 2003; UNAIDS, 2004). The premature death of parents due to AIDS
leaves orphans in countless affected households and communities. Understanding the
impact of HIV/AIDS on households and children is important in the prioritisation, design
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Chapter฀1
5
and evaluation of programmes to support extremely vulnerable children. The 2003 OVC
Census conducted by the Biomedical Research Training Institute and the National Institute
of Health Research showed an orphanhood magnitude of 26.0% in Bulilimamangwe and
30.5% in Chimanimani districts. Hence there was a need to carry out the psychosocial
survey to inform interventions on the burden on households caring for OVC.
The baseline psychosocial survey (PSS) sought to determine baseline data on needs and
experiences of OVC aged 0–5, 6–14 and 15–18 years, as well as obtain information from
their parents and guardians about their own needs and experiences. This information
would be useful for evaluating the effectiveness of the new OVC interventions that would
be implemented in the two districts at mid-point and at the end of the project.
1.4.1 General objective
The general objective of the psychosocial survey was to establish and characterise the
social, economic, psychological and physical conditions and experiences of OVC and
guardians of OVC and the general community responses to the situation of OVC in

Chimanimani and Bulilimamangwe districts of Zimbabwe.
1.4.2 Specific objectives
The specific objectives were to:
1) Investigate and characterise the demographic characteristics of guardians of OVC in
the study districts;
2) Investigate the social conditions under which the OVC and their guardians were
living;
3) Investigate the psychological conditions of OVC and their guardians;
4) Examine the economic conditions of OVC, guardians of OVC and their households
in the two districts;
5) Investigate and characterise the knowledge, attitudes, beliefs and practices with
respect to HIV/AIDS among the OVC and their guardians;
6) Establish guardians’ perceptions and experiences regarding the problem of OVC;
7) Characterise orphanhood and the general causes of orphanhood;
8) Establish and characterise the community and families’ responses to the situation of
orphans;
9) Investigate the coping mechanisms adopted by OVC and families with OVC;
10) Investigate the sexual habits and abuse among OVC.

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Methodology
2.1 Study design
A cross sectional design was adopted for the psychosocial survey.
2.2 Study areas
The study was conducted in Chimanimani and Bulilimamangwe districts, herein
referred to as the Kellogg Sites. These are the two sites where Kellogg Foundation has

been involved in supporting the Integrated Rural Development Programmes (IRDP) in
Zimbabwe and more recently supporting OVC activities, through the HSRC of South
Africa and partners in Zimbabwe.
2.2.1 Description of the study sites
Chimanimani district is located in Manicaland province in the Eastern Highlands of
Zimbabwe (Figure 2.1). The district, which is predominantly rural, is 155 km south east
of the provincial capital Mutare and borders Mozambique to the east, Buhera district to
the west, Chipinge district to the south and Mutare district to the north. The district is
divided into 23 wards that are further divided into enumeration areas. The population is
predominantly of the
Ndau ethnic group, which is a Shona sub-ethnic group. The district
represents all five agro-ecological regions found in Zimbabwe. The high and rugged
terrain in the eastern side experiences high rainfall, while the low-lying flat lands in the
western part are characterised by erratic rainfall pattern.
Bulilimamangwe area is located in Matabeleland South Province. In 2002 it was split into
three districts, namely Bulilima, Mangwe and Plumtree, as it was considered to be too
large for administration. Bulilima and Mangwe districts are rural districts whilst Plumtree
is an urban district. The districts are located in Region 5 of the agro-ecological zones;
this region experiences low rainfall. All three districts are in South Western Zimbabwe
and they share a border with Botswana (Figure 2.1). The Ndebele and Kalanga are the
dominant ethnic groups in the districts. Bulilima district in the north is divided into 19
wards and Mangwe in the south is divided into 12 wards, while Plumtree district, which is
between Mangwe and Bulilima, has four wards. The three districts share one government,
one mission hospital, three rural hospitals, seven rural health centres and 11 clinics.
CHAPTER฀TWO
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Figure 2.1: Location of Bulilimamangwe and Chimanimani Districts
2.3 Questionnaire development

The questionnaires for all three categories of respondents (guardians, OVC aged from
6–14 years, and OVC aged 15–18 years) were adapted from the OVC generic protocol
compiled by the Human Sciences Research Council (HSRC). These comprised three sets
of OVC PSS baseline questionnaires developed by two organisations, ‘Strengthening
Community Participation for the Empowerment of Orphans and Vulnerable Children’
(SCOPE) and Family Health International (FHI) (see />AIDSQuest/summaries/ssSCOPE.html) for a similar project in Zambia and were adapted
for use in this study. The questionnaires concerned measured various issues such as food
intake, psychosocial issues, risk-taking, decision-making processes and emotional well-
being. These tools were further adapted to suit the Zimbabwean situation and necessary
changes were effected. This included addition and/or modification of questions, dropping
irrelevant questions and changing the sequencing of some questions. The questionnaires
comprised a combination of closed questions and open-ended questions. Translations and
back translations were done into the main vernacular languages of Shona and Ndebele by
the BRTI research team and the OVC local liaison teams from the districts. The following
thematic issues were covered in the questionnaires:
A. For guardians of OVC the following questions were considered:
• Demographic data of the child;
• Demographic data of the parent/guardian;
• Perceptions and experiences of the parents/guardians regarding HIV/AIDS and
related issues;
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9
Chapter฀2
• Knowledge of HIV/AIDS;
• Impact of HIV/AIDS on the community;
• Child-guardian communication on HIV/AIDS and related issues;
• General livelihood issues of child-headed households.
B. For OVC aged 6–14 years, the following questions were considered:
• Demographic data of the OVC;
• Food intake;

• Psychosocial issues;
• Emotional well-being checklist;
• Issues of inheritance for orphans;
• Experiences of stigma;
• Cultural modes of caring;
• Health related issues;
• Sexual involvement and abuse.
C. For OVC aged 15–18 years, the following questions were considered:
• Demographic data;
• General livelihood issues of child-headed households;
• Food intake;
• Psychosocial issues and emotional well-being;
• Response from NGOs, CBOs, FBOs and the state to the OVC problem;
• Risk-taking (i.e. involvement in sexual activity, drug abuse and alcohol
consumption);
• Decision-making processes.
Ethical approval for the entire OVC project, which included this psychosocial component,
was granted by the HSRC Research Ethics Committee and subsequently, for the
Zimbabwean component, from the Medical Research Council of Zimbabwe (MRCZ).
2.4 Pre-testing of the instruments
A pre-test exercise was carried out in both research sites, Chimanimani and
Bulilimamangwe, a month before the actual field data collection exercise. The pre-
test teams comprised four researchers and two local liaison committee members. The
local liaison committee members assisted with the administration and validation of
the questionnaires. They advised on how to gain entry into the field areas, especially
regarding the normative, cultural and ethical etiquette that had to be observed in
each site. A total of 15 and 22 respondents were interviewed, in Chimanimani and in
Bulilimamangwe, respectively. The pre-test helped the research team to:
• Assess the sequencing/flow of the questions and content validity of the questions;
• Assess the clarity of instructions in the questionnaire ;

• Estimate the time needed to administer the questionnaire and identify other field-
related logistical problems that were likely to be encountered;
• Assess the feasibility of administering the questionnaire.
The pre-test also helped in modification of questions and dropping of irrelevant
questions.
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2.5 Field Work Activities
2.5.1 Community sensitisation
The local leadership participated in the OVC sensitisation workshops held in each of the
study sites before the 2003 OVC Census. The distribution of OVC T-shirts and bags to
supervisors, interviewers and drivers of project vehicles during the PSS and census also
contributed to the successful publicity of the project’s activities. The communities were
well informed regarding the objectives of the PSS and they linked its objectives to that of
the 2003 OVC Census. As a result of this sensitisation, the study was well received by the
communities.
2.5.2 Recruitment and selection of supervisors and interviewers
The majority of the interviewers and supervisors selected in the two districts had
participated in the 2003 OVC Census. Teachers, nurses and environmental health
technicians and other local technocrats were recruited mostly from the communities to
work as supervisors and interviewers. For purposes of empowering community members
and for effective monitoring of the research work, the project saw it prudent to blend the
local people with experienced researchers from BRTI and NIHR.
2.5.3 Training of supervisors and interviewers
Training manuals for supervisors and interviewers were used as the key training
instruments. Training sessions for supervisors and interviewers were conducted
concurrently for three days. The areas of focus during the training were:
• Interviewing skills;
• Research ethics;

• Sampling strategy;
• Quality control checks during and after interviews.
During training, participants engaged in role-plays in groups and during plenary sessions.
Training and data collection started on 26 January 2004 and ended on 12 February 2004.
Fieldwork ended on 15 February 2004. Supervisors and interviewers were instructed to
obtain signed informed consent from the guardians. Guardians aged 16 years and above
were required to sign a consent form. For guardians aged 15 years and below, verbal
consent was sought, as well as obtaining the consent of their guardians.
2.5.4 Field logistics and deployment
A total of 45 interviewers and 15 supervisors
were proportionally distributed throughout
the 10 selected wards in Chimanimani district, and 44 interviewers and 15 supervisors in
the 32 selected wards in Bulilimamangwe district. These were then divided into teams of
four members including the supervisor. Each supervisor was provided with a field kit that
contained T-shirts, questionnaires, pens, letters of introduction, consent forms, notebooks
and bags adequate for the team. Each interviewer and supervisor was given a unique
identification code for administrative and quality control purposes.
2.6 Sampling procedures
Prior to the survey, a population census of OVC was conducted in November 2003
in which households with vulnerable children were identified using a vulnerability
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Chapter฀2
assessment/indicator score. The score was a measure/proxy of the extent of vulnerability
of households in the district and it was developed using the 2003 OVC Census data.
1

The population sampling frame for the PSS was then developed from the census data
using this score (see Appendix 1). The target population comprised households that were
either moderately or highly vulnerable. A total of 13 258 vulnerable households, with

children under six years of age or aged between six to eighteen years, comprised the
target population from which the guardians to be surveyed were drawn. If there was no
orphan in the household, the household still qualified regarding vulnerability. Ten wards
were randomly selected from the 23 wards in Chimanimani, and in Bulilimamangwe 32
wards were selected from the 35 wards. The selection of wards using EPI Info Version
6.0 was done according to land-use patterns namely: communal, resettlement, large-
scale commercial, small-scale commercial and urban. Using the OVC Census data, all
those children aged 18 years and below in the sampled households were listed. Their
first and second names, sex, age and other additional information, which assisted in the
identification of the household and respondents, were recorded.
The sampling frame for the households was obtained from the selected wards. Using
the 2003 OVC Census data and the TVIS, selected households were listed. The required
sample size for each ward, calculated proportional to size, was randomly selected from
the wards. A total of 1 000 households were sampled. Using the census data, all those
children aged 18 years and below in the sampled households were listed. Their first
and second names, sex, age and other additional information, which assisted in the
identification of the household, were recorded. These lists then constituted the sampling
frames for the targeted respondents.
2.6.1 Sample size
A total of 4 283 and 8 972 households satisfied the Total Vulnerability Indicator Score
(TVIS) cut-off point of 50% in Chimanimani and Bulilimamangwe, respectively. The
targeted and actual sample sizes by district and the three respondent categories were
distributed as follows:
Table 2.1: Targeted and actual sample sizes of guardians by district
District฀ Age฀of฀child฀represented฀by฀guardians Total฀
0–5฀years 6–18฀years
฀Targeted฀
Actual Targeted Actual฀ Targeted Actual
Chimanimani 250 261 250 482 500 743
Bulilimamangwe 250 222 250 506 500 728

Total 500 483 500 988 1000 1471
1
The Total Vulnerability Indicator Score (TVIS) was defined from all the nine contributing indicators, (BRTI 2003
OVC Census). Each indicator was coded 1 if the household was commensurate with vulnerable status and coded 0 if
otherwise. The nine vulnerability indicator scores were then added to come up with a TVIS, which was then expressed
as a percentage. The maximum possible score was nine indicating a state of being highly vulnerable.
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