Family economic strengthening and mental health functioning of caregivers for AIDS-affected children in rural Uganda

Abstract

In sub-Saharan Africa, many extended families assume the role of caregivers for children orphaned by AIDS (AIDS-affected children). The economic and psychological stress ensued from caregiving duties often predispose caregivers to poor mental health outcomes. Yet, very few studies exist on effective interventions to support these caregivers. Using data from a randomized controlled trial called Suubi-Maka (N = 346), this paper examines whether a family economic strengthening intervention among families caring for AIDS-affected children (ages 12–14) in Uganda would improve the primary caregivers’ mental health functioning. The Suubi-Maka study comprised of a control condition (n = 167) receiving usual care for AIDS-affected children, and a treatment condition (n = 179) receiving a family economic strengthening intervention, including matched savings accounts, and financial planning and management training to incentivize families to save money for education and/or family-level income generating projects. This paper uses data from baseline/pre-intervention (wave 1) interviews with caregivers and 12-month post-intervention initiation (wave 2). The caregiver’s mental health measure adapted from previous studies in sub-Saharan Africa had an internal consistency of .88 at wave 1 and .90 at wave 2. At baseline, the two study groups did not significantly differ on caregiver’s mental health functioning. However, at 12-month follow-up, multiple regression analysis located significant differences between the two study groups on mental health functioning. Specifically, following the intervention, caregivers in the treatment condition reported positive improvements on their mental health functioning, especially in the symptom areas of obsession–compulsion, interpersonal sensitivity, hostility, and psychoticism. Findings point to a need for programs and policies aimed at supporting caregivers of AIDS-affected children to begin to consider incorporating family-level economic strengthening components in their usual care protocols, especially in low-resource countries of sub-Saharan Africa. Economic empowerment programming may help enhance the well-being of caregivers and their families.

Keywords:

• Uganda
• sub-Saharan Africa
• orphaned children caregivers
• mental health
• children savings accounts

Acknowledgements

We are grateful to the Suubi-Maka Research Staff and volunteers for monitoring the study implementation process, especially Proscovia Nabunya at University of Chicago, Jennifer Nattabi with the International Center for Child Health & Asset Development (ICHAD) and Suubi-Uganda Projects, and Reverend Fr. Kato Bakulu of Masaka Diocese, Uganda. We thank Professor Jane Waldfogel at Columbia University for her helpful comments on the study intervention design, implementation, and data collection methods. Our thanks also go to all the children and their caregiving families who agreed to participate in the Suubi-Maka study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

Funding

The Suubi-Maka study acknowledges the financial support from the National Institute of Mental Health [grant number RMH081763A].