Psychosocial support and marginalization of youth-headed households in Rwanda

Tulane University, New Orleans, Louisiana, United States
AIDS Care (Impact Factor: 1.6). 05/2006; 18(3):220-9. DOI: 10.1080/09540120500456656
Source: PubMed


This research aims to characterize the psychosocial aspects of well-being among youth-headed households (YHH) in Gikongoro, Rwanda, through examination of social support and marginalization. Data is presented on perceived availability of support from relatives, an unidentified adult, peers, and other community members and an index of social marginalization. A total of 692 interviews were completed with YHH age 13-24 who are beneficiaries of a basic needs program. Sixteen percent of youth reported there was no one they felt they could go to with a problem. In times of need, only 24% felt relatives would help them, while 57% felt neighbors would offer assistance. Most youth reported significant caring relationships: 73% reported access to trusted adult who offers them advice and guidance, and most indicated close peer relationships. However, many youth also perceived a lack of community support, with 86% feeling rejected by the community and 57% feeling the community would rather hurt them than help them. Social support is a low-cost critical resource for the care of vulnerable youth and an understanding of existing social support networks would enhance the design and implementation of psychosocial and community-based care initiatives.

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    • "The disintegration of social bonds has been hypothesized to be an important factor in hindering psychological adjustment (Scholte et al., 2011). Orphans in Rwanda have been found to have a severe lack of social support, most notably support from an adult (Thurman et al., 2006). This 84 NG, AHISHAKIYE, MILLER, AND MEYEROWITZ was especially true for orphaned heads of household (OHH), who reported that unlike their younger siblings or housemates, they had no one to turn to for advice or assistance (Ward & Eyber, 2009). "
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    ABSTRACT: Thousands of orphaned survivors of the 1994 Rwandan Genocide against the Tutsi were not only exposed to extraordinarily severe forms of violence, but many of these children took on the responsibility of caring and providing for other child survivors. This study describes the poverty, educational attainment, social support, and mental health of orphaned heads of household (OHH) 14 years after the genocide, and analyzes how violence exposure during the genocide and postgenocide stressors contributed to symptoms of posttraumatic stress disorder (PTSD) and distress. Participants were 61 members of an OHH community organization who were interviewed in 2002 about their genocide experiences and who provided a follow-up assessment of postgenocide risk factors and PTSD and distress symptoms in 2008. Almost all of the OHH in this study reported low social support, high levels of poverty, and high rates of PTSD and distress symptoms. Lower educational attainment predicted PTSD symptoms and partially mediated the association between exposure to genocide violence and PTSD. Distress was predicted by lack of social support and witnessing family members harmed during the genocide. Results suggest that public health and community efforts to improve educational outcomes and to strengthen and expand social support networks may improve mental health outcomes of OHH.
    04/2015; 4(2-2):83-97. DOI:10.1037/ipp0000031
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    • "In a longitudinal study with former child soldiers in Sierra Leone, a different but related variable (community acceptance) was associated with higher levels of prosocial behavior and lower levels of internalizing and externalizing symptoms over time [25]. Although the impact of armed conflict on supportive community relations has been a frequent theme in the literature on children and armed conflict [26], we are not aware of studies that have examined the role of social capital as a moderator of intervention efficacy. We hypothesized that children who perceived low levels of social capital would report stronger benefits from a psychosocial intervention, given its focus on improving supportive relations between peers. "
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    ABSTRACT: Armed conflicts are associated with a wide range of impacts on the mental health of children and adolescents. We evaluated the effectiveness of a school-based intervention aimed at reducing symptoms of posttraumatic stress disorder, depression, and anxiety (treatment aim); and improving a sense of hope and functioning (preventive aim). We conducted a cluster randomized trial with 329 children in war-affected Burundi (aged 8 to 17 (mean 12.29 years, standard deviation 1.61); 48% girls). One group of children (n = 153) participated in a 15-session school-based intervention implemented by para-professionals, and the remaining 176 children formed a waitlist control condition. Outcomes were measured before, one week after, and three months after the intervention. No main effects of the intervention were identified. However, longitudinal growth curve analyses showed six favorable and two unfavorable differences in trajectories between study conditions in interaction with several moderators. Children in the intervention condition living in larger households showed decreases on depressive symptoms and function impairment, and those living with both parents showed decreases on posttraumatic stress disorder and depressive symptoms. The groups of children in the waitlist condition showed increases in depressive symptoms. In addition, younger children and those with low levels of exposure to traumatic events in the intervention condition showed improvements on hope. Children in the waitlist condition who lived on their original or newly bought land showed improvements in hope and function impairment, whereas children in the intervention condition showed deterioration on these outcomes. Given inconsistent effects across studies, findings do not support this school-based intervention as a treatment for posttraumatic stress disorder and depressive symptoms in conflict-affected children. The intervention appears to have more consistent preventive benefits, but these effects are contingent upon individual (for example, age, gender) and contextual (for example, family functioning, state of conflict, displacement) variables. Results suggest the potential benefit of school-based preventive interventions particularly in post-conflict settings.Trial registration: The study was registered as ISRCTN42284825.
    BMC Medicine 04/2014; 12(1):56. DOI:10.1186/1741-7015-12-56 · 7.25 Impact Factor
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    • "However, orphans, particularly females, are at high risk for being out of school, as they are more likely to have the responsibility of taking care of the household. Studies from Rwanda conducted among orphan heads of households show that the proportion of YHH was significantly higher for females than for males [30]. "
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    ABSTRACT: As a result of the 1994 genocide and AIDS, Rwanda has a crisis of orphans. In 2005, the Ministry of Local Governance and Social Affairs of Rwanda has reported one million vulnerable children. Many of these are not only orphans but also youth heads of households (YHH). The purpose of this study was to: (a) identify risk behaviors that expose YHH to HIV infection, (b) determine gender-specific high risk profiles and, (c) determine predictors of sexual onset. A household survey was conducted among 692 YHH, aged 12-24, all beneficiaries of a World Vision basic needs program in Gikongoro, Rwanda, from January to March 2004. Participants were interviewed using a structured questionnaire. Data was collected on socio-demographic variables, HIV/AIDS prevention knowledge and sexual risk behaviors. Bivariate analyses of the study variables were performed to examine differences between males and females. A logistic regression analysis was conducted to analyze factors that were independently associated with the debut of having sex. Forty-one percent of respondents reported sexual onset before age 15. Males were more likely to start earlier than females (50.4% versus 26.7%) but females reported more sexual onset with an older partner. Fifty-eight percent of females had their first intercourse with a partner who was four or more years older than themselves. While sexual activity was low (1.75 mean lifetime sexual partner, 0.45 mean sexual partner last twelve months), sexual experience was related to less social connectedness and use of drugs. Having a close friend also appeared to be protective for sexual debut. The analysis also found that although YHH were aware of some prevention measures against HIV/AIDS, there was low (19.8%) knowledge of the "ABC" prevention program promoted by the government. In addition, despite 85% of respondents knowing someone who had died of AIDS, only 31% perceived themselves at risk of HIV infection, and there was very low (13.2%) condom use among the sexually experienced. Results suggest the urgent need of HIV prevention programs tailored to YHH that provide knowledge, enhance negotiations skills, and increase the perception of HIV infection risk among YHH in Rwanda.
    BMC Public Health 03/2012; 12(1):225. DOI:10.1186/1471-2458-12-225 · 2.26 Impact Factor
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