Do not forget the boys – gender differences in children living in high HIV-affected communities in South Africa and Malawi in a longitudinal, community-based study

Abstract

Gender is an important factor in child development. Especially in sub-Saharan Africa, girls have often been shown to be less likely to access education compared to boys. The consequence of this has been that that programmes addressing child development are often aimed at girls in order to redress gender imbalances. This study examines the effect of gender on the development of children attending community-based organisations in high HIV-affected areas, and explores whether community-based organisation attendance was associated with any changes in gender differences over time. Baseline data from 989 children and 12–15 month follow from 854 (86% response rate) were used to examine gender differences in children from Malawi and South Africa. At baseline, where there were differences by gender, these tended to disadvantage boys. It was found that boys were significantly more often found to be subjected to violence. Boys showed worse performance at school and more behavioural problems than girls. These gender differences persisted from baseline to follow-up. At follow-up, boys self-reported significantly worse average quality of life than girls. Only harsh discipline differed by gender in progression over time: boys experienced a stronger reduction in harsh physical discipline than girls from baseline to follow-up. Since harsh discipline was associated with boys’ worse educational outcomes and behavioural problems, our data cautiously suggests that gender differences could be reduced over time. In conclusion, our data suggests that, perhaps due to the narrow equity approach focusing on provision for girls, boys may be overlooked. As a result, there are some specific experiences where boys are generally worse off. These differences have distinct ramifications for the educational and emotional development of boys. A broader equity approach to child development might be warranted to ensure that the needs of both girls and boys are considered, and that boys are not overlooked.

Poverty moderates the association between gender and school dropout in South African adolescents

“…It will be important to identify whether policies to support school retention work similarly or differently across genders. This finding is Poverty, gender, and school dropout 13 consistent with a recent call for a broader equity approach to child development in the context of vulnerability, particularly in highly HIV-affected communities (Hensels et al, 2016).…”

The Strengths and Difficulties Questionnaire (SDQ) in Africa: a scoping review of its application and validation

“…Seven studies (12.9%) employed 2 SDQ versions [ 29 , 32 , 40 , 42 , 43 , 47 , 65 ]. Thirty-one studies (57.4%) used only one version of the SDQ, of which 22 used the SDQ-S [ 26 , 30 , 34 , 35 , 37 – 39 , 41 , 45 , 46 , 53 , 55 , 56 , 58 , 60 , 62 , 64 , 69 – 71 , 75 , 78 ], four the SDQ-T [ 25 , 27 , 36 , 59 ] and five the SDQ-P [ 33 , 48 , 61 , 67 , 68 ] (see Table 2 for summary of results by SDQ versions). In the remaining 12 articles (22.2%), three used only the peer and conduct problem subscales from the SDQ self-report version [ 28 , 31 , 77 ], one used only the peer and emotional problem subscales [ 66 ], while a further two articles used only the conduct subscale of the self-report SDQ [ 52 , 54 ].…”

“…Peer problems were among the common mental health difficulties for children orphaned due to AIDS [ 26 , 28 , 31 , 77 ], followed by posttraumatic stress disorder [ 26 , 28 ] and conduct problems [ 28 , 31 ]. Studies included examination of emotional and behavioural difficulties in HIV positive adolescents [ 29 , 61 , 64 ], the impact of parental HIV/AIDS status and death on the mental health of the child [ 34 ], psychosocial adjustment of children affected by HIV/AIDS [ 37 ], evaluation of community art therapy intervention on the mental health of children affected by HIV [ 38 ], randomised controlled trials pilot evaluation [ 45 ], caregiver social support [ 33 ], positive parenting [ 48 ], and in the provision and outcomes of community-based organizations for children and adolescents [ 54 , 67 , 73 , 74 ].…”

“…Children affected by HIV/AIDS (OVC) has significantly more domestic chores and care responsibilities. Child labour mediated the association between orphan status and psychological difficulties Hecker (2016) [ 66 ] Tanzania 6–15 Examine associations between harsh discipline, internalising mental health problems and cognitive functioning (working memory and scholastic performance) Harsh discipline, cognitive functioning Peer problem and emotional symptoms subscales (self-report) 409 primary school students, 52% were male Swahili Translated into Swahili, and blind back-translation Peer: a score of 4-5 indicates “enhanced levels” of peer problems, and 6 indicates abnormal levels of peer problems Emo: a score of 6 indicates “enhanced levels” of emotional problems, and a score higher than 6 indicates abnormal levels of emotional symptoms Did not use UK cut-off scores to make comparisons Combined alpha score of.67 was presented A strong relationship was established between harsh discipline and internalising problems, and were associated with lower working memory and scholastic performance Hensels (2016) [ 67 ] South Africa and Malawi 4–13 Examine the effect of gender on the development of children attending a community-based organisation in high HIV-affected areas and to examine associations in community-based organisation attendance and changes in gender differences Gender differences Parent 979 children from high HIV-affected communities Not specified None mentioned Not specified Cut-off score not specified and made no comparison to UK norms Not specified Males experienced more violence, performed worse at school and more behavioural problems were prevalent than for females at baseline. At follow-up, gender differences persisted, but males reported worse quality of life than females and males were found to experience poorer educational outcomes and behaviour problems Lentoor (2016) [ 68 ] Eastern Cape, South Africa 31.38–92.78 months (caregivers were 18 or older) Explore associations in primary caregiver depressive symptomology and psychological functioning of children infected with HIV Parent depression, HIV/AIDS, psychological well-being …”

Children and HIV – a hop (hopefully), a skip (lamentably) and a jump (ideally)?

“…HIV can disrupt functioning in many ways and the paper by Skovdal ( 2016 ) explores why HIV-affected children have classroom concentration problems and consequently poorer educational outcomes. Hensels et al ( 2016 ) focus on gender differences in children attending community-based organisations in Malawi and South Africa, highlighting that for younger children there are many similarities across the gender divide, but when there are differences, it is boys who are disadvantaged and overlooked – perhaps prompting the equity needs of boys to be maintained, although girls have often been the target of interventions. In a systematic review, Goldberg and Short ( 2016 ) summarise the current literature on children living with HIV-infected adults and offer suggestions for future research in this area.…”