AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #370 - A psychosocial intervention programme for children affected by AIDS in rural communities: Findings from a quasi-experimental evaluation study in Zambia
Authors: Presenting Author: Mr Adrian Gschwend - Swiss Academy for Development
Additional Authors: Ms Pia Amman, Ms Kaharine Wespi, Mr David Mwiya, Mr Kelvin Ngoma, Dr Lisa Langhaug,
Aim: Background: There is growing evidence that children made vulnerable by HIV and AIDS are at higher risk of psychological disorders. Mental health services are limited in resource-poor settings across Southern Africa. In response, child-focused organizations are incorporating community-based psychosocial programmes for children and youths to improve psychological wellbeing alongside economic programmes. However, there is a dearth of systematically gathered data on intervention outcomes working to improve psychosocial wellbeing. This study assessed the effectiveness of a low-cost youth-centered programme in improving children’s psychosocial wellbeing in the Kafue District of Zambia.
Method / Issue: Methods: Using a quasi-experimental study design, 60% of participants were purposively selected from programme enrolment lists meeting study criteria (aged 10-18, orphans/children with chronically ill caregivers/or elderly caregivers) and an additional 40% non-vulnerable children (same age group) were selected randomly. Participants were interviewed at baseline (2008) and re-interviewed 5 times every 6 months until 2010. The programme consisted of sequenced interventions including a livelihood component, a community sensitization workshop, two structured narrative psychosocial interventions, and kids clubs. Primary outcome was a local adaptation of the Children’s Depression Inventory to screen for psychological wellbeing (α = 0.67-0.71). Secondary measures were standardized scales for socio-economic status, quality of care, social support, bullying, peer relations, perceived stigma, stress, and coping. Analysis was restricted to the first, third and fifth data collection in order to minimize reduction of sample size due to missing data (80% retention rate). Participants with insufficient attendance in the psychosocial interventions were excluded.
Results / Comments: Results: 271 adolescents (50% female; control=138, programme=135) participated in the three surveys. Baseline data indicated significant main effects for vulnerability, confirming that orphans, children with chronically ill caregivers or elderly caregivers have less social support (p<0.01), lower quality of peer relations (p<0.05), and perceive more discrimination at home (p< 0.05) than other children. Prevalence of clinical depression in the overall sample was 26%. Children orphaned by AIDS were two times more likely than non-vulnerable participants to exceed the clinical depression cut-off point. Overall, depression measures did not significantly change between the two groups (p=0.09). There were significant increases in perceived discrimination at home (F (1,162) = 10,46, p<0.01) and perceived community stigma (F (1,190) = 5.26, p<0.05) in those receiving the programme after the introduction of the psychosocial activities, although the effects were small (r=0.25 and r=0.16, respectively). There was no difference between groups for measures of daily stress, daily social support, peer bullying, caregiver support, and material context measures of household and personal possessions.
Discussion: Discussion: The high prevalence of psychological ill-health in this rural population of Zambian children affected by AIDS support data from similar studies in Southern Africa and demonstrate the relevance of cost-effective psychosocial interventions. Adverse effects reported were small and highly structured psychosocial interventions of limited duration could have lagged positive impact. The reported increase in some symptoms could result from the awareness-raising that is central to these psychosocial tools. In addition, psychological scales that measure prevalence, may not be as sensitive when examining smaller changes in a population over time.
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