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Applying a Family-Level Economic Strengthening Intervention to Improve Education and Health-Related Outcomes of School-Going AIDS-Orphaned Children: Lessons from a Randomized Experiment in Southern Uganda

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Abstract

Children comprise the largest proportion of the population in sub-Saharan Africa. Of these, millions are orphaned. Orphanhood increases the likelihood of growing up in poverty, dropping out of school, and becoming infected with HIV. Therefore, programs aimed at securing a healthy developmental trajectory for these orphaned children are desperately needed. We conducted a two-arm cluster-randomized controlled trial to evaluate the effectiveness of a family-level economic strengthening intervention with regard to school attendance, school grades, and self-esteem in AIDS-orphaned adolescents aged 12–16 years from 10 public rural primary schools in southern Uganda. Children were randomly assigned to receive usual care (counseling, school uniforms, school lunch, notebooks, and textbooks), “bolstered” with mentorship from a near-peer (control condition, n = 167), or to receive bolstered usual care plus a family-level economic strengthening intervention in the form of a matched Child Savings Account (Suubi-Maka treatment arm, n = 179). The two groups did not differ at baseline, but 24 months later, children in the Suubi-Maka treatment arm reported significantly better educational outcomes, lower levels of hopelessness, and higher levels of self-concept compared to participants in the control condition. Our study contributes to the ongoing debate on how to address the developmental impacts of the increasing numbers of orphaned and vulnerable children and adolescents in sub-Saharan Africa, especially those affected by HIV/AIDS. Our findings indicate that innovative family-level economic strengthening programs, over and above bolstered usual care that includes psychosocial interventions for young people, may have positive developmental impacts related to education, health, and psychosocial functioning.

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Acknowledgments

The Suubi-Maka study was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R34MH081763-02 (PI, Fred Ssewamala). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The study received Institutional Review Board approval from Columbia University (AAAD2525) and the Uganda National Council for Science and Technology (SS 1540). The authors are grateful to Professors Jane Waldfogel at Columbia University and Mary McKay at New York University for their help with the study design; and Jennifer Nattabi, Rev. Fr. Joseph Kato Bakulu, and the Suubi-Maka Research Team in Uganda. The authors also thank the children and their caregiving families who participated in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Research Involving Human Participants and/or Animals

Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. School of Social Work, Columbia University, New York, NY, USA

    Fred M. Ssewamala, Julia Shu-Huah Wang & Vilma Ilic

  2. International Center for Child Health and Asset Development, Columbia University, New York, NY, USA

    Fred M. Ssewamala, Leyla Karimli, Julia Shu-Huah Wang & Vilma Ilic

  3. University of Chicago School of Social Service Administration, Chicago, IL, USA

    Leyla Karimli & Proscovia Nabunya

  4. Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, CA, USA

    Neilands Torsten

  5. Department of Social Welfare, Sungkyunkwan University, Seoul, South Korea

    Chang-Keun Han

Authors
  1. Fred M. Ssewamala
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  2. Leyla Karimli
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  4. Julia Shu-Huah Wang
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  7. Proscovia Nabunya
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Correspondence to Fred M. Ssewamala.

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Ssewamala, F.M., Karimli, L., Torsten, N. et al. Applying a Family-Level Economic Strengthening Intervention to Improve Education and Health-Related Outcomes of School-Going AIDS-Orphaned Children: Lessons from a Randomized Experiment in Southern Uganda. Prev Sci 17, 134–143 (2016). https://doi.org/10.1007/s11121-015-0580-9

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