University of Zambia Medical Library
The Impact of HIV/AIDS in Zambia: Orphans (AIDS in Zambia Bibliography #193-98)
- (#193) "Enumeration and Needs Assessment Survey for Orphans: Matero East, Lusaka,Zambia"
Kongwa, P.N., Raavand, L.R., Solami, G., Haworth, A., (1991)
Project, unpublished
Geographical area: Lusaka; Keywords: Orphans, surveillance, households, widows; churches; Location: Family Health Trust
Objectives:
To determine the number of AIDS orphans in Matero East and their expressed urgent and long-term needs. To determine the attitudes of families, school and the community towards orphans.
Methods:
A descriptive and exploratory survey was used. A door-to-door survey was
conducted on all the 396 households of Matero East using a scheduled questionnaire
and coding hand book.
Results:
- The survey revealed that 7 per cent of the total population of Matero East
(3217) were orphans: 61 per cent were paternal orphans, 25 per cent maternal, and 14
per cent double orphans.
- 58 per cent of the total orphan population are split up and
siblings kept by different families, while 42 per cent are intact and kept in the same
family unit. The majority of single orphans (47 per cent) are kept by the living parent
and the minority (15 per cent) are kept by an elder sibling. Of the double orphans the
majority (12 per cent) are kept by relatives while the minority (2 per cent) are living
on their own in their parents' house.
- Both nuclear and extended families absorb
orphans, with 33 per cent of the total extended families keeping orphans and only 8 per
cent of the nuclear families keeping orphans.
- Of the 396 families, 49 (12 per cent)
expressed that they had problems such as food (37, 9 per cent), with the added
responsibility of keeping orphans.
- Of the total 89 families that kept orphans, 92 per
cent are not getting any support from the community; only 8 per cent said they
received some form of support from the community. The support came from relatives
(1 per cent), NGOs (3 per cent), and churches (3 per cent).
- The survey further
showed that of the families keeping orphans, 10 per cent expressed that there was no
limit to the care for orphans: it would last as long as the orphan and guardian lived;
6 per cent said that they would support the orphan until he became self-supportive; 3
per cent until he got married, and 1 per cent until the orphan finished school.
Conclusions:
- The numbers of actual orphans, 215 which constitutes 10 per cent of
the Matero East child population is significant to explain the existence of the orphan
problem.
- The orphan population covers 20 years and below, with highest numbers
in all orphan categories in age group 16 to 20 years. Overall the school going age
groups of 7 to 20 years have more orphans than the age 0 to 6 years.
- Food,
schooling opportunities and school requirements were the assessed urgent needs of
orphans. The long term needs are: adequate food, education, skills training, clothing
and parental guidance.
- The extended family system is the sole system that cares and
offers life long support to orphans. Nonetheless, discrimination is noticed through the
failure of the extended family to prioritise the school opportunity and needs for orphans
above non-orphans.
- The community support for orphans is very insignificant and
hence the added responsibilities on the extended families being significant. The
overstretching of the extended family is demonstrated by the poor feeding and poor
education status of most orphans.
-
- (#194) "Case Study of CINDI Project Matero-Lusaka: Kwasha-Mukwenu Matero Project"
Kamanga, P. (1993) Unpublished
Geographical area: Lusaka; Keywords: Orphans, widows, households; Location: Institute of African Studies, UNZA
A descriptive exploratory study design was used to determine the magnitude of the
problems affecting orphans of HIV/AIDS parents and to make assessment on it impact
on the project itself. Data were collected using questionnaires for project staff and school going orphans supplemented by focus group discussions. The study findings indicate that
the number of orphans is increasing in the area and the staff (project) appreciate the
introduction of the project intended for children in distress (CINDI). Socio-economic
problems faced by the orphans are quite significant. The study recommends the need for
collaboration with health personnel to educate the public on HIV/AIDS and government
commitments to address the needs of the orphans. Future expansion of such similar
projects are recommended. -
- (#195) "Orphans, Widows and Widowers in Zambia: A Situation Analysis and Options for HIV/AIDS Survival Assistance
"
Mulenga, C., Kamwanga, J., Ngwisha. J. (1993) Institute of African Studies
Geographical area: National; Keywords: Orphans, widows, widowers; Location: Institute of African Studies, UNICEF, NASTLP, Family Health Trust
An explanatory study which assessed the current status of the problem of supporting and
maintaining the orphans, widows and widowers who survived the epidemic was
conducted in the selected districts of Lusaka, Kitwe, Mansa and Sinda. Lusaka and
Kitwe were expected to give a picture of the problems of orphans, widows and widowers
in the urban setting while Mansa and Sinda presented rural communities and remote rural
areas. Thus the study covered both the urban and rural settings. A sample size of 1007
was determined to represent the four selected areas. The study made use of interviews,
structured household-sample surveys and case studies. The purpose of the interviews
were to establish the extent to which the various governmental and non government
organisations, bilateral donor and development agencies in Zambia were sensitive and
concerned with the plight of the AIDS orphans, widows and widowers.
A questionnaire
was used to solicit information from these agencies. The household sample surveys
aimed at estimating the size of the population of orphans, widows and widowers in
relation to the rest of the population and identify the magnitude of the problem or the
extent to which the Zambian households in general were affected. Thus, the household
sample surveys were expected to provide an indication of the incidence of orphanhood;
widowhood and widowerhood. The study attempts to establish the magnitude of the
problems of orphaned children, widows and widowers, evaluate the living conditions in
which the orphans are being fostered and at the same time examine possible alternative
assistance programmes for the orphaned children widows and widowers, in Zambia. The
study established that the problem of orphanhood is an increasingly growing problem,
most probably because of the increasing deaths due to HIV/AIDS.
The study found that
4 out of every 10 households in Zambia have one or more orphans under its care.
Widowhood on the other hand was estimated at about 25 per cent, while widowerhood
stood at 1.8 per cent. The low incidence or widowerhood was found to be largely due to
remarriages. This was evident from the findings of the study which showed that only 24
per cent of the orphans had lost both parents, while 25 per cent had lost their mothers
only, and the other 57 had lost their fathers. The incidence of the problem will double
itself as HIV/AIDS-related deaths increase. Loss of access to the essential services was
quite significant in this study. The study make a number of recommendations regarding
the management of the imminent problem of looking after the orphans.
-
- (#196) "The plight of orphans in Katete"
St. Francis AIDS Department (1994) Paper presented at the 4th National
AIDS Conference, Lusaka, 1994.
Geographical area: Lusaka; Keywords: Orphans, households; Location: Family Health Trust
Objective: to assess the welfare of orphans in the Katete area.
Methodology: Defining and interviewing households with orphans.
Results:
Of the 450 households, 142 (32 per cent) had at least one orphan. 23 per cent
of all children are orphans, with one parent dead, and 5.7 per cent of all children are
orphans with both parents dead. 11 per cent of all children's parents had died of AIDS,
and 16 per cent of all households reported having had an AIDS death. 62 per cent of
orphans of school going age do not attend school. About one third of the orphans are
cared for by their mother, and 20 per cent by their grandmother.
At a conservative estimate, there are some 10,000 children in Katete who have lost one
or both parents as a result of AIDS. The total number of orphans in Katete district would
be approximately 20,000. Concentrating on home visits to families with orphans, there
was an average of three orphans per family. The carers were much more likely to be
women, and over half of them were grandparents. 355 of all carers were between the age
of 61 and 70 years. Only 5 out of 57 carers said they were in paid employment and the
others were peasant farmers. Only 18 per cent of the families had enough maize to plant
and to consume until the next harvest. 9 per cent of the families had enough groundnuts,
and 23 per cent of the families had a vegetable garden. -
- (#197) "Prevalence of orphans and their education status in Nkwazi Compound -
Ndola"
Rossi, M.M. and Reijer, P. (1995), Paper presented to the 5th National AIDS Conference, Lusaka, 1995
Geographical area: Ndola; Keywords: Orphans, surveillance, households, church; Location: Family Health Trust, UNICEF
Objectives:
To determine the prevalence of orphans and their educational status in Nkwazi compound, Ndola. To assess the attitudes of the community towards orphans.
Methods:
A pre-tested questionnaire was administered to a sample of 250 households randomly selected among 10 sections of the community.
Results:
- Out of the 250 households surveyed, 81 (32.4 per cent) had orphans and out
of a population of 909 children, 192 (21 per cent) were orphans of which 43 (22.4 per
cent) were double orphans and 149 (77.6 per cent) single orphans. Of the 149 single
orphans, 36 (24.2 per cent) were maternal orphans as compared to 113 (75.8 per cent)
paternal orphans.
- Out of 140 orphans of school going age, only 75 (46.4 per cent) were
attending school compared with 352 non orphans of school going age of which 199 (56.5
per cent) were attending school.
- 53 (65.4 per cent) guardians of the orphans said that
they had added responsibilities due to the presence of an orphan in the family, with 22
(27.1 per cent) mentioning lack of money as the problem, 18 (22.2 per cent) having
problems with school fees, 28 (34.6 per cent) food, 30 (37 per cent) mentioning clothes
as their main problem.
- Only 4 (5 per cent) of the 81 households with an orphan said
that they received support from others in the community with support coming mostly
from other relatives and the church.
Conclusions:
- The number of orphans (192) representing 21.1 per cent of the total child
population of 909 is quite high and significant to explain the existence of the problem of
orphans in Nkwazi compound.
- The extended family system is the only system that
cares for orphans and the majority of the carers find difficulties with this added
responsibility; the major problems being lack of clothes, money for school fees and food.
- In 86.4 per cent of the families caring for orphans, no support from the community,
NGO or Government is received.
- There is an urgent need to sensitise the community,
churches, social development committees on the orphan situation in the compound and
look for possible solutions in order to cope with the future as the total number of orphans
is expected to increase as a consequence of the HIV/AIDS problem.
-
- (#198) "Orphans in Zambia: Nature and extent of demographic change"
Webb, D. (1995) AIDS Analysis Africa (Southern Africa Edition), Vol 6, No.
2, pp 5-6.
Geographical area: National; Keywords: Orphans, households, surveillance, churches; Location: UNICEF, UNZA Medical Library
The implications and manifestations of population restructuring due to AIDS are still
not fully understood, and the importance of the increasing number of orphans in
Zambia needs to be explored. AIDS mortality rates are still rising and as a result the
number of orphans will continue to rise well into the next decade, only stabilising
around 6 years after national HIV prevalence rates have peaked. The spatial variability
of the epidemic means that orphan numbers are highest and most concentrated in the
urban and peri-urban centres. The NASTLP puts the number of orphans at around
200,000-250,000 in 1995, increasing to 550,000-600,000 by the year 2000.
As far as status of orphans are concerned, several enumeration studies have been
completed. The sample sizes vary as do the definitional criteria, but a consistent picture
is emerging. The trend is one of a predominance of paternal orphans (53.9 per cent),
i.e. those who have lost their father, over maternal orphans (18 per cent). This pattern
replicates that found in Tanzania and Uganda. Over time the ratio of paternal, maternal
and double orphans will change as the proportion of double orphans increases from the
current 28.1 per cent. The ratio is currently 1.9:0.6:1, and will stabilise when the
mortality rate peaks, which is estimated to be well into the next decade. The issue of
paternal, maternal and double orphan status is important in that the average conditions
of the different orphans will vary. Double orphans are potentially in the most
vulnerable situation and currently rely heavily on the extended family.
The difference
in welfare status between the paternal and maternal orphans is difficult to clarify
without in-depth research. What is certain is that widowers are tending to remarry soon
after the death of their wife, whereas widows find it very difficult to remarry. An
enumeration survey in Libala and Chilenje compounds in Lusaka of 95 families
containing 300 orphans found that nearly half of the carers of the orphans are the
mothers, a figure similar to that in Katete (45 per cent). Surviving fathers, unlike
surviving mothers, are unlikely to be care givers (6.3 per cent) and maternal orphans,
who make up 18 per cent of the total, are more often than not cared for by other
relatives. In none of the cases are the carers outside of the extended families. In 6 per
cent of orphan households elder siblings (who are technically orphans themselves) are
caring for the orphans, and in all of these cases the siblings were over 18 and usually
providing some household income.
Needs assessments of these children indicate that food security, health, education and
protection are the major issues at a material level. For example with educational status;
in urban areas estimates put the proportion of orphans of school going age who are not
enrolled at 32 per cent, compared to around 25 per cent of non-orphans. In rural areas
the situation is more severe, with 68 per cent of orphans not enrolled, compared to 48
per cent of non-orphans. Advocacy from NGOs such as the Family Health Trust caused
a change in the law regarding the compulsory wearing of uniforms in primary schools,
which will lessen the burden on those families who could not afford them. School drop
outs, however, contribute to the rising number of street children, who are currently
estimated to number 70,000. Anecdotal reports indicate that child prostitution is on the
increase, along with other indicators such as malnutrition in children over five.
Hospital initiated home based care programmes have generally failed to go beyond the
medical attention of the patient to look at the needs of the affected children.
The dependency switch in the household as parents fall ill is offset to some extent by help
from other family members, but the impact of this reverse in the dependency
relationship will become more severe over time as family support is stretched further.
Anecdotal evidence suggests that extended families at this stage are still managing to
cope with the burden of orphans, with the caring function remaining with the mothers
and maternal relatives. In urban settings the coping strategies of the AIDS affected
households are mainly informal sector marketeering. Commonly the mother or aunt
will sell salaula, charcoal, cooking oil, kapenta, buns, eggs, rice, fritters, vegetables
or bread. The profit margin from these activities is very low (as low as KW1,500 per
week in one case). Other income comes from subletting. In rural areas coping
strategies are far more related to farming activities and brewing beer, with
marketeering (i.e. buying and reselling) of less importance.
Intra-community support appears to be extremely limited and what help there is comes
from institutions such as the churches, the government Public Welfare Assistance
Scheme, the Department of Social Welfare, small NGOs and some home based care
programmes. Even so, an Ndola survey of orphan households revealed that in 86.4 per
cent of cases there was no support from the community, NGOs or the government.
NGOs have attempted to provide support to orphans and widows through various
means such as the Kwasha Mukwenu project in Lusaka, where women 'caretakers'
visit and monitor the progress of orphans in their catchment area of households.
Other programmes such as drop in centres are involved in food provision, education and
recreation but they are all very small scale and in general under-funded. A prerequisite
to effective interventions is an extensive monitoring system with standardised
definitions which is still lacking in Zambia. Government capacity is low and needs
strengthening, along with that of NGOs such as the Child Care and Adoption Society.
Extended families are still just managing to cope and support programmes must aim
to target the family as the 'coping unit' through community oriented action. Assistance
can take the form of small income generation schemes for widows and vocational
training for orphans, in both small scale manufacturing and service activities. At the
community scale small agricultural schemes are being managed with the profits going
to those most in need as decided by the project committee. Pilot projects are underway
across Zambia, but questions still remain regarding the management capacity of
communities in relation to these projects, the feasibility of income generation schemes
in a severe economic environment, and how the ownership of community projects can
be transferred from institutions such as churches and hospitals to self administering
community structures. It is a time of experimentation as regards these projects, and
there will be failures, but by building on existing coping mechanisms with rotating
credit and small technical inputs for example, strong aspects of sustainability can be
introduced. The scale of the problem is so large that interventions must be low cost and
community centred, to be combined with awareness raising of community leaders as
to the nature of the orphan problem and the potential solutions.
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