East African Medical Journal

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Factors associated with internalising problems in orphans and their caregivers in rural mozambique

P Libombo, H Baker-Henningham, S Grantham-Mcgregor


Objectives: To compare internalising problems reported by orphans and their caregivers with that of non-orphans and their caregivers.
Design: Case control study.
Setting: Cahora-Bassa District of Tete, Mozambique
Subjects: Seventy-six maternal or double orphans (aged 10-14 years) and their caregivers were compared with seventy-four non-orphans and their caregivers living in the same neighbourhood.
Main outcome measures: Children were interviewed with a semi-structured questionnaire concerning their internalising problems, family structure, school attendance, daily experiences and perceived problems. The children’s primary caregivers were also interviewed concerning their depressive symptoms, available social support, socioeconomic conditions and perceived problems.
Results: Orphans lived in poorer households than non-orphans and reported more internalising symptoms and more economic and psychosocial disadvantages. Orphan caregivers were more depressed and had less social support than non-orphan caregivers. Child internalising symptoms were independently associated with bullying (B=8.04, 95%CI:0.24, 15.85), perceived undeserved punishment (B=11.98, 95%CI:S.98, 17.98) and orphan status (B=33.36, 95%CI:26.67, 40.05). The effect of punishment was stronger for orphans than non-orphans. Frequency of hunger affected internalising symptoms only in orphans. Caregiver depression was independently associated with low social support (B=-0.35, 95%CI:-0.51, -0.18), few possessions (B=-2.10, 95%CI:-3.42, -0.79) and orphan status (B=4.54, 95%CI: 3.30, 5.78) and possessions had a stronger effect in orphan caregivers. Quality of housing caused depression only in caregivers of orphans.
Conclusion: Both orphans and their caregivers were more depressed than the nonorphans and their caregivers. They were exposed to more economic and psychosocial disadvantages and were more vulnerable to risks.

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