University of Ghana http://ugspace.ug.edu.gh SOCIO-ClJLTURAL DETERMINANTS OF CARE OF AIDS ORPHANED CHILDREN AMONG THE ASANTE AND KROBO OF GHANA LILYYARNEY This thesis is submitted to the University of Ghana, Legon, in partial fulfilment of the requirement for the award of PhD Public Health degree JUNE, 2011 University of Ghana http://ugspace.ug.edu.gh DECLARA TION I hereby declare that except where specific references have been made, this thesis is the result of my own research. Under the supervision and tutelage of my team of supervisors, I confirm the originality of this thesis as my own, and that it has not been submitted in part or whole to any institution for an award of a degree. CANDIDATE TEAM OF SUPERVISORS DR. MATILDA PAPPOE (Principal Supervisor and Chairperson) ...........~.........I..!.C:.:~. (Signature) PROF. CLEMENT AHIADEKE (Member) ..... ~ (Signature) PROF. AKOSUA ADOMAKO-AMPOFO (Member) University of Ghana http://ugspace.ug.edu.gh DEDICATION TI-llS THESIS IS DEDICATED TO: JOEL ENTSIE, ESI BOSUA, C:;YEDU, AND KODWO f\H[N. AND ALL ORPHANS AND THEIR CARLGIVF:RS 11 University of Ghana http://ugspace.ug.edu.gh ACNOWLEDGEMEN'rs There arc many individuals and institutions that have slIPP(lrkt.i me (Imlllgil()LlI the ("tlhC '.,1' my study, and to each or them, J ex (end Illy appreciation. I ex press a "IKCiLiI and h.·mlll'l!. gratitude to Dr. Matilda Pappoc. my primary supervisor, fur her continued supnort :lmi guidance, and I am indebted to her for the many hours of advice, editing, suggestions. ami encouragement that she freely gave. To the rest of my tc.nn or supervisors: Prof C lcmcnt Ahiadeke, Dr. Emmanuel Adjci, and Prof. Akoxua Adornako-Ampofo. I say a hig th.mk YOLI. They were all there for Inc anytime I called on them to review the work. I am grateful to Dr. P. Adongo, Illy head of department. OJ. P. Ouranchic, Dr. I~. Arycctcy. Dr. M. Dzakobo, and Dr. A. Laar for their kind contribution to this work f "Isf) thank all till: staff of Social and Behavioural Science Department. Scl]()nl o f Pub] ic Hc;i1IIi. jilr rclcr llessly supporting my cause. Spccial appreciation needs 1<.1 he expressed to Dr II. N,lg.ii MI<.. Barbara Dadson, and lVII'S. Aba Oppong lor introducing me to the appropriate perStlll." 1\ 11\) took time to orient me on the cultural practices 01 the Asanic (mel Krobo and also to identi I~l sources of data collection-It would have been very eli fficult finding PCl)PJc to respond to me without their assistance. I cannot thank my research 2IS."jsl:ll,ls enough, Mr. Achc.unfour (illd his team in the Ashanti Region, Mr. Bimbal Nsanya and his team ill the Eastern Region, Mr. Joseph Darke. and all the key informants for their immense contribution \(1 this work. I am also very grateful to (\11 the ;'\:'<:111\\'. CIne! !(robo orph.mx and their clregl\ crs. who Illddc !ilis work possible by making Ihcmsclve: ~i\o;lili.lbk (lild sil.i years who correctly identify ways of preventing 1-IIV infection is 44 (y;, 1'01' males :1I1d 38% for females (UNAIDS, 200T)_ Thus, infection relics C()J1tiJlLl,~ tL) iucrcasc with serious impact on individuals, lamilics, communities and ;111sectors of' the ClhdJ1LlIC11l society due to difficulties in attaining matching behavioural change levels. rvbll\' factors have been identified to contribute to this situation includim; economic. ~'()l'iilL cultural, religious and political L1CtorS among others, 1.3 STATEMENT OF THE PROBLEM AND RATIONALE FOR STLIDY "I'I//Ie,.'11 ///VIA/f)S enters a iloll,\('/Io/d h" il/feelillg nile I!I' hot]. parent», tlt«: \CI'Y fabric oro cluld : /i/e/(///.I apart" (UNiceF, 20(4) Almost three decades alter the discovery or HIV CIne! /\IDS, the impact 01' /-\I[)S Oil populations has been enormous considering the luct that it affects the reproductive dge or most countries. Key among these impacts is the growing orphan crisis ill'lCl'ling most larnil ics cl)()oling, bereavement process and psychological well-being (Zimmerman. 20().'i: i'v1,I;,lll;\S i.'l or, 20()4: Monash, and BOe1'11132.004: Makami, Alii. and Gruntluuu-Mc Grcuor. 2(J(12: Salman. 2()()4: Nyamuk apa. and Cirq,;scn. 200.'i: Sarkcr. Ncckcrmunn. and \'ltlikr. 20(5). Although these are essential, the impacts or social ami cultural lactors Oil care 1)1' children orphaned by AIDS are equally important il' meaningful interventions can he achieved, Nyambcdha d al . (2003) hold the conviction that although community- based interventions are urgently needed as the most appropriate way OfddLlI'l;ssillg the rising orphan problem, the complex local reality in which cultural factors. kinship til'S and poverty are interwoven needs lo he t,lkcn into c()nsicln,lt il)n ii' c;1Ic;tdint1hk solution" are to be Il.llllld, Unli)l,tunakiy. ,Llld Il!'this IwtUI'C ill\: lil11ilcd ill SlIl,-'';dhI till' contributory factors to the high level or II IV in the Kroho area ill ihc Lastcrn Region of Ghana is the history of' out-migration to Cote D' Ivoirc as a result of poverty. lack of arable land and unemployment in the area, According to them, two thirds or the Ghanaian migrants in Abidjan arc females or whom a large proportion arc commercial sex workers since that is the easiest identifiable occupation 1'01' them especially because or language barrier. Hampton (1991), observed in Agom,lI1Y,1 -- a town in the Eastern I~egi()n or (;h IIl:Jn IHlI1- orphans in rural Zimbabwe. According to the researchers, these patterns reflected the adaptations and gaps in the extended family orphan care arrangements. They also found that sustained high primary school completion amongst paternal and double orphans, particularly lor girls resulted lrorn increased residence in female headed households and greater access to external resources, and that low primarv sch()(ll completion amongst maternal orphans W~IS the result 01' lack or support trorn lathers and stepmothers and incligibility 1'01' welfare assistance due to higher socio-economic status households. A study or maternal orphans by Tuha c/ 1// (2()()()) in M;JLJ\\ i disLl found that there was no association between the mothcrs H IV positive status 01 the child's orphanhood status, and the orphan's risk of' stunting, wasting or reponed ill health. The authors attributed these findings (0 non-discrimination on the par: oi' fostering extended rami lies. -+5 University of Ghana http://ugspace.ug.edu.gh 2.9 INSTITUTIONAL VEn.SUS HOME-BASED CARE In comparing institutional care with foster care, one study round insututioual c.uc or group homes to meet the material needs of orphans better than roster care, hut 10 deprive the orphans 01' autonomy and personal COil tact with their caregivers (\VuIII 1998). Another research found that orphans housed in group homes su Iler Irorn psychological issues such as delayed cognitive development and impaired social functioning. It must however be pointed out here that the control group in this case was non-orphans. not orphans in roster care (Drew. 19c)S). A quantitative study conducted ncar Blantyre in Malawi also revealed interesting findings about the health 01' orphans in orphanages. orphans ill foster homes, ;111cl 11\ )11- orphans. It was found that children in orphanages Iacc a 54.:-n;, prevalence Iilk or malnutrition, as compared to 33.3% lor village orphans and 3()(% for non-orphans. However, children admitted to an orphanage for more than a year \V'_TC less malnourished, which is perhaps explained by the rae! that only those orphans whll have faced severe neglect arc eligible to be placed in an orphanage. The same study also indicated that younger orphanage children (less than 5 years old) had lower height-for-age ratios than either their non-orphan or foster home orphan counterparts. However, older orphanage children (greater \11' equal to 'i ye,I1'Sold) had high...:r heigh!- for age ratios, and only 6_(:'% 01' orphanngc chi ldrcn had diurrhcal diseuse. ,IS compared to rates or IO.K%) of' village orphans and JO'Yn or non-orphans (Panp.mich ct (/1.,1999). University of Ghana http://ugspace.ug.edu.gh For some researchers, while orphanages may seem to be the simple ,1I1S\\'LT til till' increasing orphan problem elt III'S! ;;1ancc. ihoughuu: :-;CiUlillY ~;lI~ge,;.,h llthLI\\ I',L (Foster and Williamson, 2000~ Lcycnaar. 2()())), Orphanages. according to them .nc not an inherent part or many cultures, They take significant resources lrorn ,drc- nianvc (queen mother) beside them. Soci;iI grouping ~11l10ngthe Krobo is based on patrilineal descent. thus \\'e/so means '1~ll11ily tree', For Manya Krobo the six major divisions (H'C/SO) arc: /)::.('/)1(1/1/, SII\lIi, Akwenor. Ma 111'(1, PICIIg:IIO and DOl/I, Similarly, Yilo Krobo also has six major units which arc: 76 University of Ghana http://ugspace.ug.edu.gh clans or /\{/,Ii under it. A clan 111ily have up to six loculitics under it. Changes in the organization of Krobo were caused by colonial government .md till' influence of Christianity. The works or the early Christian missionarie-, affected Manya Krobo more than Yi 10 Krobo. H uber ( ll)l)J) has recorded that when the 111's[ two adults were baptized ill September ! ~5(), Oclonko Azu, the /\UII() (paramount chief) himself was among twenty people who were ready to become Christians. Though he never got baptized, he remained ,I friend olthc priest. There (Ire no major eli Ifcrcnccs in the social and local grouplllg<.; or the :wllpk (11' Manya and Yilo Krohn, their traditional eCOI)OI11:',crafts and industries. kinship ami marriage, or in general forms olsocial contact GU} l Study Regions Source: www.mapsofworld.com 94 University of Ghana http://ugspace.ug.edu.gh south-eastern Ghana to Yupci, 520 kilometres to the north. Till' luke PI'\)\ ides inland transportation, and it is the main source 01' hydro-electric power to the coum ry. It is also a valuable resource 1'01' irrigation and fishing. The hydroelectric power generation from the Akosombo darn was severely constrained Irorn the last quarter or 2(J()~ to September 01' 2009 due to thc poor rainfall in the previous year and a consequence 01' the changing weather pattern. The socio-economic implicutions 01' this cannot be over emphasized. 4.2 DEMOGRAPHIC OVERVIEW OF KliMASI iVIF:TROPOLIS A'\) I) SEKYI~REEAST DISTRICT OF TilE ;\~nIANTI REGION 4.2.1 Ku masi Metropolis Kumasi metropolis is the most populous district ill the Ashanti Region. During the 2000 Population Census it recorded a figure or 1,170,270, and this accounts lor " third of the region's population. The Metropolitan /vrca has ,I total surface area ('(' 25..+ sq kill (200() population census) with a population density or 5,41 <) persons pCI' square kilometre. the second to Accra metropolis with 5•.~3() persons pCI' square kilometre. The Metropolis has attracted such a large population partly because it is the regional capital. and also the most cornmcrcialiscd centre in the Ash:\I1ti Regi()n. II has however been est imelted that 4W~/~, 46%, LInd 6'Y() () r the Met ropo lis nrc urban. peri- urban aile! rural respectively (Metro Agri«. Directorate). !)5 University of Ghana http://ugspace.ug.edu.gh The age structure 01' the population in the metropolis is skewed toW,II·t!s the youth (2000 Population census). The highest proportions 01' the population arc In the ~l!:;e cohorts () - 4 years (13.21!;;,) and 5-- l) years (12.4%). Cumulatively, Y)()"'I' ()I tile population is below 15 years, in contrast to other districts, which range i'rolll·\(J':,o to 47%, Thus, children constitute 34.0%, the highest proportion ofhousehold members in the metropolis. There are more 1l1<11cs (50.2°r;,) than lcmalcx (4k.K'::;,) ill lile metropolis. The 2000 census results indicated that 'i6.9 percent or the POPULltJOI1 aged 15 years and older in the region is economically active. The proportion 01' the economically active population that is those who worked, 1'01 at least one (by. ill seven days prior to the census was 71.4% in the Kumasi metropolis. The proportion 01' the unemployed population in the Kurnasi Metropolis is Ih.O(>; •. The unemployment rates are more pronounced in the metropolis than the remaining urban areas. Students form the highest proportion or those who are not economically active ill the metropolis. followed by the agee! Although the Metropolis attracts a number of migrants from several parts ()( Ghana and neighbouring African countries Stich as Togo, Burkina Faso. Mali, Nigeria. lvory Coast and abroad due to its strategic location its status as a brisk adminixtrauvc ,mel commercial centre, the Asantc dominate all tribes in the metropolis. 4.2.2 SCI,YCH' East Dlsrrict Sek ycrc East District WJS created in 1988 with Elfiduasc :IS tile capital. It covers ,I total area of 4,516 square kilometres ;llld is located in the north-eastern p.irt (II' the Ashant i Region. The district h,IS now been divided into two distril'h. hut the (lid ()() University of Ghana http://ugspace.ug.edu.gh demarcation \V,1'-; Lisee! lor the study. It shares l'OUJ1d,II'ies with Sckycrc Wesl 1)1~I!icl in the west, Sene District in the Brong Ahafo I~(;gion on the north-cast: 1\11,:'.),<1 Sekyerc and Kwabrc Districts on the south west, Ejisu-Juabcn District 011 the south, Afrarn Plains District ill the Eastern Region on tile south-cast and /vsante Akim North District on the south. The total population ofthe district was 157,:'<)6 ill tile year 2()()O antl accounted tor ,f.-J. per cent 01' the Ashanti Region's total population (CSS, 2()()s). The mules and females formed 52 per cent and 41) per cent respectively, The district is sparsely populated with density or 35 persons per square kilometre compared to 14R persons pCI' square kilometre lor the Ashanti Region. The sex ratio based on the 20()() census was IOS.'i males to 100 females. The district's population growth rate or 3.5 per cent per annum is higher than both the regional and national averages or 3.4 per cent and 2.7 pCI' cent respectively. Similarly, the district's fertility rate or 7.5 children per woman was remarkably higher than the averages for the Ashanii Region (4)1) and Ghana (4.{J) III 2000. The age distribution or the population is ,IS follows: 0-14 years (45.9~';,), 15- ()4 years (44%) and over (A years (~.I(~;»), The population dependency ratio was! 17.h ill 2000 relative to 02.6 1'01' the Ashanii Region. The district is predominantly rural \\ ith 33.7% or the population being urban dwellers. Agriculture is tile mui n Sll\II'CC or employment in the district accounting 1'01' about 6WYt) or the labour force. lmport.mt crops cultivated include yam, cocoa, oil palm, maize, tomatoes onion, etc. Livestock rearing is also carried out in some parts ofthe district. 07 University of Ghana http://ugspace.ug.edu.gh remaining live per cent speak other Ghanaian Idllgu;lges ill addition to ;\sclllk-l\vi. 4.3 DEMOCRAPHIC OVERVIEW OF MANYA AND VILO KROBO DISTRICTS OF THE EASTERN REGION 4.3.1 Manya Krohn Distr-ict Manya Krobo has recently been divided into two main districts, Lower and Upper Manya, however the study covered the old boundaries or the Manya Krobo District. The district covers an area or 1.470 square kilometres which lorrns about R.I ';<) of tile total l.md area o lthc Eastern Region. The 2000 Population and Housing Census recorded the population \ll' MallYCI krobo district of the Eastern Region as 154,301 with about a thousand less usually reSiding in the district. This number forms about 7.3% of the total population oj' the Lastcrn Region. The urban population was 61,477 as against the rural population ()I' 92,S24. The sex ratio Illr the district was 75,254 males to 79,047 females. The most populous localities among the several localities of the district are Kpong (14, 725 people): Krobo Odumasi (13,903 people): Agomanya (13,)03 people): and !\scsewa (7,314 people), The census report groups the Krohn ~I11Wllg the Ga-Dangmc ethnic group <.I11e! tile Krobo arc the most numerous 01' tile !\dilllgmespcdkilig tribes 01' xouth-castcrn Ghana. Fanning is the main economic activity or the ruajorit y o l' the people in the district followed by bead making, University of Ghana http://ugspace.ug.edu.gh 4.3.2 Vito Krobo District Yilo Krobo District, also 0" the Eastern Region covers un area 0" SOS c;quLlrc kilometres constituting or about 4,2(/'() of the land area in the region. Tile 2()()() Population (me! Housing census recorded L\VI-I/\ ~Ittclillillg c lini, ,Il the Atua hospital. and one hundred and forty one (141) 1'\"O1ll tile Ashanti l~egl(\Il. identified through NCiOs working with PLWHA and orphans. were interviewed and their anthropometric measurements taken. These measurements were used a~ surrogate r"or care in testing the hypotheses. Orphan categories involved in the study are: Maternal. Paternal, and Double orphans. These orphans were interviewed. observed and assessed to determine the quality or care they were rccciv illg. The primary caregivers o lthcsc orphans were also interviewed tl) ascertain the r,let,)!"S that influence their care giving activities '1I1e1. also to uuthcnucaic responses by orphans. Two hundred and eighty live (2R5) caregivers were involved in the study. one hundred and forty five (145) from the Eastern Region and one hundred unci forty (140) from the A shanti Region. The n u III bcr 0 f ca regi vcrs was less than the uum bcr 0 f orphans because some cal egivers were taking care of more than one orphan. hut where the caregiver was responsible lor more than two orphans only two or the orphans were allowed to take part in the study. This was done to recruit into the study as many orphans as possible from di lfcrcnt households. Thus, the total mmbc: or respondents for thc quuruit.uivc study Wil,'; rive hundred and seventy seven (577) 4.9 DATA COLLECTION METHODS AND INSTRUMENTS The data lor the research were collected Llsing live main methods which arc: Interviews (using questionnaires and Anthropometric Measurements 01' Orphans): In- depth Interviews: Focus Group Discussions; Key In formants Interviews: 1c' ligdllc orph.ur». II];iI IS tII(I:-'l' orphans above age 12 years who were willing to pun icipatc directly \VI1.11 ,:()II';CI11 i'I'om their parent or caregiver; one for orphans 5 to I I vcars who needed assistance Irorn their parents or caregivers to participate in the study, ill such instances the parents or caregivers had to agree and sign the consent form 011 hchall 01' tile orphan to enable the orphan to participate; and one lor caregivers, The consent form detailed the purpose or the study to all participants; stated that participation wac; voluntary ;lIlel participant could quit i I' he/she decided to at any point. The limn also spcci Ill~d the length of time needed 1'01' the interview: indicated the lnct that there arc no physicnl risks involved in participating ill the study, and the potential uses and hcncfit: 01' the study, Participants were asked to sign the form or agreed that the interviewer put their initials on the torm before the interviews started. The contact address <1I1e1 telephone numbers or the researcher were all provided on the form (see appendix VI r l ). Among the Krobo, the researcher counselled three orphans who showed signs 01' emotional distress about their plight during the in-depth interviews, and these were referred to the district department or social welfare through their teachers lor local professional assistance. Among the Asuntc, two or such orphans were referred to NGOs 1'01' assistance, 4.11 DATA QUALITY CONTROL MEASURES 4.11.1 Tnlining of Data Collection Team The data collection team included lour research assistants und one supervisor in each region. They were trained to assist the researcher in the field during the data collection I I () University of Ghana http://ugspace.ug.edu.gh phase of the research, In the Ashanti Region, the supervisor \V,IS the ~1dr()I'()lli;1I1 Statistician 'whilst the other four were l lighcr National Diploma (IINIJ) gr;ldu,ikc. working at the Statistics Department 01' the KUIl1<1si Metropolitan Assembly, 111 Ilh': Eastern Region, the supervisor was the District Bio-Statistician 01' the Iower M,lnYd Krobo District. and the other (QUI' were liND graduates worklllg ,II the I~,-x(mls Department or Atua Hospital. The team members were trained in data collection techniques, the lacts and dynamics or HIV and AIDS in Ghana, and orphan care. In general. the training covered basic concepts 01' research, objectives 01' the study, techniques 01' interviewing. problem- solving during interviews, and recording or responses, Other training issues that were discussed included: the intcrvicwcrs role. the idcntificatior, ami selection 01 respondents and how to handle issues or consent. They were also t;lught how 10 take anthropometric measurements 01' orphans using the weighing scale. microto isc, and tape measu re and they were made to pract icc the usc o r these ins: ru men Is on S()1l1C children during the training session, They \VeIT also taught how l(l calibrate the weighing seale to ensure reliability ofreadings. The tr;linillg lasted three days. 4.11.2Pr('-testing of Data Collection lnstrumcuts The FGD and Kll data collection instruments were pre-tested in purposively selected districts close to the study districts to determine their appropriateness lor collect ing the desired data, This exercise was used (0 lest clarity. suitability CIS well as Ingical flow or quest ions, The instruments were refined Oil the basis or isslies that were raised and noted during the pre-testing exercise, The pre-test also hclpcd lo ~ld;lpl the t(l(ll" tt) 117 University of Ghana http://ugspace.ug.edu.gh the study objectives, and improve on the dat~l collection techniques 01 t11,-'d.uu collection team. Following the pre-test and subsequent rcvisionx, the tools were rehearsed in Asantc Twi language in the Ashanti Region and in Adangrnc language in the Eastern Region before they were used for the actual data collection. 4.11.3 Execution of Field Work Each region had u team or five Research Assist.nus who Interviewed the orphans ~1J1d their caregivers using the interview questionnaires designed for i)rph~llls nnd caregivers. Each district had a team or two Research Assistants wlw were assigned to each district and one of' them in each region worked as a supervisor. At tile end 01' each clay. the teams reported their day's activities to their respective supervisors. In the Ashanti Region, the supervisor was based ill the office olthc Kumasi Metropolitan Assembly (KMA) in KUIl1Clsi, and in the Eastern Region, the supervisor was based at Atua Hospital. Almost all the interviews with orphans and their carcgi vcr-, were conducted on weekends since most or the orph.u»: were school pupils, The Researcher and the supervisors made follow up and support visits especially In the Iirst two weeks 01' field work to ensure the accuracy and completeness or the Cbtil being collected. All the qualitative data were collected by the Researcher with ~ISSISt~IIlCCIrorn three Research Assistants in each region, This \NdS to ensure accurate recording nl' data and adequate participation of' target respondents. The entire process 01' data collection lasted approximately eight months. 1 IS University of Ghana http://ugspace.ug.edu.gh 4.11.4 Response Rates Initially the plan was 1.0 interview three hundred CWO) ,.)rph~1I1S,1l1e1 their L'tlidy do not warrant the generalization 01' results 10 all children orphaned hy ;\ IDS in the cou ntry 2. The study did not test the I-IIV status or orphans which could influence the nutritional state of orphans, though such effect could cancel out since f\fOS orphans were involved in the study across the two ethnic groups 3. The plight 01' general orphans in the study districts and metropolis is unknown. ami this makes the comparison or the plight 01 the AIDS orphan to [h~11o lthc general orphan difficult. 4, Filldings of" the study reflect that o l tile ASCIniC and Krobo and 111~ly Ilut necessary apply to other matrilineal Lind pauilincal societies elsewhere, i2J University of Ghana http://ugspace.ug.edu.gh CHAPTER 5 RESULTS 5.1 SOCIO-CULTURAL FACTORS AND CARE or AIDS ORPHANS In the previous chapter. the study dcsign and Illdh(l '_)'.' 15.2 -'X ~7 hi ~I)'} 10- I 4 ~2 5'-1 . .1 711 "1').1l IS.' .S.2.I 15 - I 7 411 .;(lS " :'i .4 7') y, .1 N 1."1 11111 I" I 1111) ~()~ 11)/) SEX OF ORPHAN ~'blc (,(, '-lil.K 75 "1')7 Iell ~;; ; lcmulc 7S 5J.2 711 S(I.' 1.5 I 51 7 Towl 1'-1 I 1111) 15 I II)() 2')2 11111 ORPIII\N STATlIS Sillgk: Murcmul '-I') .\25 45 .1 I '} ')-1 , :'.2 Single: !',llc)')],Ji ()3 41.7 ,'ih ;').7 II') ·HI;'; Douhle 39 2S.~ 40 2g"1 i'} ~ 'III Tol 7..57 KS o.« Ill' 22 1 "1.(, I:, ').:. .~5 '1._) scllu," Tolal I" I I/)O 14 I 1111) 21)~ 11)(1 RELICION OF OJ{PII!\N Christi.u: 151 1110.(1 1-'5 ')S7 2Xh 'n') Muslim 6 4 ..' (, 2. I Tl'l,ll 151 lUll 241 100 ::>')2 11)0 Source: Ficld Data As presented in table 5.1.1, the ages or caregivers ranged IWIll 21 years lo ',',1 yeilrs of age, 2 (I ~''O) Asantc caregivers did not indicate their ages hccausc they did 11,)1 knov, exactly how old they were. One hundred and thirty eight (! ~R). that i~; ·4S"~) 01 caregivers were widowed: 106 (37%) married: 19 (7'Yo) had never married before: und the rcmai n ing 22 (8'X') were ci t her d ivorccd (II' scpara led I'J"OIl1 thci r spouses. ;\11 125 University of Ghana http://ugspace.ug.edu.gh level or formal education. Among these only 12 (4';;(lj had tertiary cclucai ion. the majority or them, 83 (29'1;») had eitherjunior or senior high education whilst 6~ (24%) had only primary education. A significant proportion ofcarcgivcr-; 43"';' (122) (lid nul have any form of' formal education. Table 5.1.2: Socio-Dcmographic and Socio-Economic Characrcristics of Caregivers KROBO ;\SANTI~ ALL AGE OF CARECIVERS 21-30 IX 12.4 12 X7 .'10 IOh J 1-40 47 ~2A 4(i lJ ...f ') .1 01:2() 41-50 ,lCJ 2(\.') .10 21.7 ()0 244 51-60 24 I (d) IX 1.1. I -12 I-I.k (,1-70 I() (, .') 22 15. ,) .,v."; I I ..~ 71K 7 4X !() 7.2 17 (d) ::lho\'c Total 14S 100 I.'X IIJ() 2;\,")'!: 100 SEX OF CAREGIVEHS Malt: 2X 19.3 14 10 42 14.7 lcmalc I 17 gO.7 121) l)(j 2-13 R ~- .-,, ' Total 14:; 100 1-10 iOO ~gS 100 MARRITAL STATUS OF CAREGIVERS Marricd (,2 42.X 44 .\ I A lOll :, 7.2 Never :) ., .4 14 10.0 10 h.7 Manicd Divorced 10 (,. C) .1 2.1 U Scparurcd J 2.1 () -I "l' ') Widowed ()S 44)\ n 52. I I.,g ,')R.4 TOI,1I !()()I-I.~ 1()O 0 1-10 ioo.o 211S xo. OF DEPENDANTS ON CAREGIVER 1-., 20 I,X .1(, 25.7 5h 4-(\ 7(l S2.-1 :;2 .' 7. 12X 7& 1 -If) .1.) .R .~ :? .,7. 1(11 Tol~i1 I-h I()().O i·HI I O(J () :2kS I ()( J.I ) 126 University of Ghana http://ugspace.ug.edu.gh EDUCATION,\I, BAKGROUND OF CAREGIVERS No .,1.7 7(, 122 cducai ion ~7 25.5 ., IPri mary ::'2. 14 ., Junior high -11 21U 20 21.,,\ Senior high II II 7.9 7 7 Tcrtiury 10 2 14 I.~ lot I-1S 100 140 100al lilf) EMPLOV!\IENT STATlIS OF CARE<;IVERS rn 1 !C:-.;~iUlli! 1:1: :!~ 7 4,8 1(1 Anisans*** 20,7 59,3 ()2 S I ,') 12 45 .,2,1 57 l()1) l lncmpl oycd In 10 \ S7 1.1,f) 1'0\,11 145 i oc.o 140 IOO() 101111 RELIGION OF CARI'.:GIVERS Christ ian 14S 100 Ll.5 Muslim () o 5 1,8 Total 14S 100 140 100 100 IU'LATIONS" II' OF CARF:GI\TH TO OR!'I! AN Maternul 22 !-I.h Aunt.Lluclc 1<) 12.h 17 1,2, I I :~.~ Aunt/I lnclc 511 ..~-,. 2-1, I G rand P,II'CIlI Sibling 2,11 12 .~,5 15 'i,1 Mother 41 7<) ~7,1 »» -; 5,11 22 7.5 Other Tol,0.05 1'01' all the variables indicated) 12~ University of Ghana http://ugspace.ug.edu.gh Tahle 5.2.1: Iudcpcn dcnt Sample T-Tcsl between AS2 (,22 3.'\ (,(,,7 21 5x ; Tul,,1 II) 11;0 41 11111 I "I.~ 11111 57 IlJn -~() [III) X2 = 1.8511; dj=4; p: Value = . 762 KROIJO Stunted " 2"11 0, I~.c) ~~ 21),~ 1 12 " '),;' ,I NIlI Stunted (, 7S,Ii 1'1 XhA 5') 70,2 ~I t: 7 _:~ III 7('() Tnl;1i X 1110 22 lOll :\4 11111 24 10(1 I ' II)() i = 4.59·1; "/=4; 1'-Value = ,332 ASANTE Stunted 511,Ii () -17,~ .~ I cj~"1 1(, ->1<, " I" ::;2.~: Nor SllIl1lctl SOli III 52.h "" \ si.« 17 :'1" II 17,.\ Tl)I;1i 2 Ilill 1'1 11111 (",1 11111 _'.' 1(:11 ~l 111(1 ,/=0.125; df= (i'{_'CIl( lrcq. Percent Stunted 52 ,,, :) 1.5 ') - ').)('" _).- I R.2('() Not S\lllll.cd '-I() 4R.S I 1,\ 74.~ TC1\::iI 101 100 I) I 100 , y, _,_._._".- .--•.,,- """" ""'_" .H"W' Source: Field Data 135 University of Ghana http://ugspace.ug.edu.gh Thus, the alternate hypothesis (HI) that (lrpi1clllS Linder the patlilil1e;!I :-'Y"k'lll nl inheritance receive better care than those under the mauil incal system ofinhc: itancc i:-. maintained. 5.6.2 Orphan Status and Orphan Care One would always perceive that when (l child loses OI1C parent the other parent is alive (0 take care of the child. However, whether the single orphan receives good ediT or not would depend on which of' the parents is alive. 111 the same vein. care nj' orphans who have lost both parents (double) may he perceived to diller from care oj' single orphans. Thus, sections 5.6.2.1 and 5A~.2 present the results in relation to the hypotheses that (i) paternal orphans (those who have lost their lathers) arc better cared for than maternal orphans (those who have lost their mothers) and (i i ) single orphans receive better care than double orphans respectively. 5.6.2.1 Orphan Status (Paternal/Maternal) and Orphan Care As presented ill table S.h.2.1. greater proportion Ill' paternal orphans W(lS stunted (37.8'1'0) than the proportion or maternal orphan stunted (J4.()(};»). This difference is however. not statistically signi licant, implying that paternal orphans do not receive better care than maternal orphans (X2 =0.:324: p' O.){j" (FG!), Mell, KlImC/si Mel/·{)/)o//.I "(-fud il lIot hC(;11 11'.\' /l/olhcr, / wOllld he dCl.ld hi' 110\1' heCl/IlIt' IIn'/i/lha \Iwlter! IIIC dellc/ (.'1'('11 lie(o/'(' I was h{)I'II, hll/ 1111' II/o/IICI' III{/Ii{lgCr! /(1 kn'li 11/(' I(P lillll(i\l', I dOli '/ kllfill' 111\' !i'lt!/('I' .. \'{! / C(/ililol SiI\ 1/11\1 Ii/I., \1()lIid he lik(' i/ I / I _)<) University of Ghana http://ugspace.ug.edu.gh lose 1111' mother, hili 1/ ntv /01/1('1' is aliv« 01' de(/(/, / rlUII '/ «1/(' (F( in, Ildo/cSCCIII 1501'S, /\'/lII/O,Ii Mcll'ofJ(lli,l) Participants and informants again pointed out that mothers love their children anrl spend more time with them than their Fathers. and would always encourage their children to become successful in life. "When vour mother dies, vourfathc: does I/O! give vou !!IOIlCI' but gil,(,,1 IIIOi!el' (0 other I I '()t 11 ('II " (P(;f) O,pIIUI/S, Sckvctc Los( District). "SOIllC corcgivcrs tak« good C{{I'C' o] thcit: OIl'!! gil'ill/": IIICIII nun.: [oot], ('IO//Iillg, 01/1/ O(IICI' (itillg.l (/1/(/ 1I10J'(' attention II){/II liS' (F(;!), Oljl/UIIIS, Mauva Ktobo niSI/'ie!) "II'Litc matt dies and IIII.' IWJ/IlUII rc-nuurics. the IICII' /111.1'1701/(/ wi]! //('//, //('I take care o/' (lie paternal orphans /)eC(III,I(' ill (jill' tracliticnm] sd(i!!,~;, 11'/11_'11 II IIWII ntarrics lite entire [antilv of' his II'i/,c 11('('011/('\ /IIS rcsponsibil itv' (Fti!'). Wo II1cn , Yi/o Krobo District) "f~\'C'1I ill our cII/II//'(' where children ar« seen (IS hclollgill,!.!, (n their paternal [aniilv, th« [aniilv o]' (he WOIII(ln is still III,)/'(' responsible \1/iCII it C(JIIIC'S 10 taking CClI'Cofornhan: than tlicIcunilv of'111e /I/{III" (Caregiver. MUIll'U /\./'()/J() Dis! rict) The orphan who perceived that it is better lor a child to lose his OJ' her mother than to lose the ruther narrated her story as follows: "] did IIO( know niv mother he(r)rc she died. / 11'0.1' ()/lh' !Old Ihui .I/IC died il/ /lhidjilll, 11/1(/ I 1101'(' I/('VCl' ,1'('('11 Olll' 1/J(llcl'lwl/Ullli/1' /l1L'I/lhcl' ill /Ill li(e ,loll' jill/wI' 1111.1/)'('('11 I'CIT (71'()/ec(il.'C of' /lIe' (/1/(1 Ilmiid c/o IIIIUliillg /0 ('11.1'111'f(i'll' \I'elrol'e, I (//11 (I (('IIiO/C, (llid !Jeerlll.l'(, olll'Iolili/1 /)/'{/elice /)(1/('1'111// illl/('I'il{fll(i', 1Ill' altll( willi / ,I/UI' wilh I)I'C.I'CII(/I' docs 1101like 111(' hecolI.l'(, I//c!i/II/i/\' ('/'1)/)('('/1' is ill II/(' hOl7d.l' 0/ Ill\' .lLII/ICI' II)/() is 10 IW/lc/ il dOII'1I 10 111L'. Sf/(' gucs (0 I/Ie (',/ell( o/eollillg 111(' (III ,101'(.1' ()('IIUIIIC.I' M\' (fI1I1( SUI'S, IIll'/rlfll('/' .I/lOllid liT {l1/(/ hove (J 11'101(' cltild 01' II'ill 1i(J\'e (0 l/{flld du\l'l/ tllcjil/llift' jJmpC/'/I' 10 IICI' 'Oil, III 0/1 Si(IIO(ioll.l IIJlj'othcl' II'ill (I/JPI'()Oc/1 111('Cllld 0.1'.1'111'(' IIle 1/1(1/ /i(' I\'IIIII}(I/-(' Sl//'C Ihul Il()(/;ill,f!, CI)il IiU(J(Jell,I' tlJ lIIe, HillC'l'c is 1111' /IIo(licf' 's (mllill' do (1i!'I' eu/,(' uhOIl( /11(':) AI\' Oil/I' /tope i.l' 111\' /ellIICI' ", (OljJ/lUlI, Fell/ll/c, 15.1'c(II'.I' ;II{fI/I'iI f:mho ni.l'/I'ie/) 14() University of Ghana http://ugspace.ug.edu.gh 5.6.2.2 Orphan Status (Single/Double) a nd OqJh'lII Care The results shm,villg the relationship hc[\-VCCII ()J"1~11;t~1t1dtLlS (single or cloul.l. ..) ,\1)(1 Nutritional Status 01' orphans indicated that tile proportion or double orphun-. who receive good care was greater than the proportion 01' slIlglc orphans who receive S(l(1ata The relationship between orphan status (Single or double) and Nuuition.il Status among the Krobo was, however, the opposite or the Asanic. As shown In tub!c 5.6.2.2, more single orphans were stunted than the proportion 01' double orphans who were stunted (27.7% and 17.9%, for single and double orphans respectively). University of Ghana http://ugspace.ug.edu.gh This difference is ~tlso not statistically significan: cb presented in tub!c :=;.il,),~ (;' 1.454: p = ().22~), at confidence interval scl at l)S'X, With a degree (ii' freedom ul i, implying that among the Krobo, there arc no differences in the cure givCll t.,J sin::;1c and double orphans. 5.6.3 Age of Care-Giver and Care of Orphan Where AIDS is the cause or orphanhood, studies from F;Is! /\rrIC,1 have shown that care 01' orphans usually Ialls 011 old peoplewho urc grandparents PI' Oil older c;ihlings who are orphans themselves, since HIV and /\IDS most often claim the li\cc; or persons in their productive ages, This situat ion has been described ;IS prohlcmal ic because both groups or caregivers find it di fficult 10 provide care as they themselves may frequently require care rr0111 others (Biccgo, c/ of I <)C)<)). Thus the hypothesis that age or caregiver a ffccts orphan care was conceived agai nst this backdrop. When the relationship between Caregiver Age and Orphan Care was analysed. the results indicated that orphans being taken care or hy caregivers between the ages oJ' 21 and 60 years were better cared for than those whose caregivers were () Iy,'(ir~ (Inti above. The best cared Cor orphans had caregivers aged between 4! and 50 years (76.R~,1Jnot stunted), and the worst cared for orphans had caregivers aged hL:~\\'CCII () I and 70 years (53. I% stunted). The erred 01' caregiver rlge nil care ni' orphans C.!lSlT\cd in table 5.fd is, however, insignificant statisticully at )'1;, level or signi licancc with 5 degrees or freedom (/ -=- 9.6()2: p = (J.O~7). Thus the results indicate that age 01' caregiver has no effect on care or orphans, the Null Hypothesis (HII) is therefore ma in ta ined. 1-+3 University of Ghana http://ugspace.ug.edu.gh Table 5.6.3: Age of Caregiver and Nutri rional Status of Orphaus ----------j i'l'\j of \ ""It!' \ Nutritional \CF OF CARECI\FR (YF\RS) (I) I 'I:R 11/,) _I Stalus 21-311 .~ I -~H1 41-511 :; I -(,Il (, I ~711 71 (~ : 11")( \ \ ~~ I ;1 I :rc:cl l).h tI 112 I() Stunted .>:1 .~h ~1X . Ih 2.1 I~ 3.'1, 17 .5 " 7 ·11 1 7 2 2() hh. )7 Not hi 5.1 t«. 27 ()·l. 15 -lil. It I .'i~ ; X 1 l) Ii Stunted h'J ~10 100 I)] IO() 100 42 1(1) ~;2 11)(1 17 I I() Total ,1S·INTI:' 7 5~. ) , \1 l,l (,' ; 111Stunted -.' ,2 1).77S (1.,1):-; l:ill) (IAh2 Palcl'I1<11 5,l.R I .110(1 I(c I<:I'CI)I Rcrcn-nt Rclcrcu: 140 University of Ghana http://ugspace.ug.edu.gh .ISAI\'7E ;\~e of Can'givcr 21-,,0 l) 7 (j l·tO (). () I () I 11')2 (I I .; .1 I --I.() " ,.).) ..) O~OS () 1,1:' .~q.'; 11.;';1)11 41-50 2()A 1.O() I () I~n ('.1 h5 I I') '\ 7 51-()0 12.5 0.9-17 () 12() (,(){,2 ! l. ():~- 61-70 R ..'' 0.757 II ()>-: ..\ (,.71)-:0 (I.IIR-I 71 &abovc 9.7 I.(JOO I~ckl'clli 1<('' 1','I'cl II f<." 1'(,/"'111 Orphan Status Maternal SOU .232 ().cJ5' ,1.-'5·\ ()J,;';.' Paternal 50.0 I OO() I<.ci'ucilt l<'cl'crC'llt 1{,'kiTlll KROIW Age of Carcgivcr 21-30 12.7 ()74 I ()()2J 102 7(,.:( ().rlS.~ ,,1-40 ,12.7 4.2\<) ()507 :W. I 01> ().I-II) 41-50 :'1.'\ 1:.1 ()R [(1-12 r,··l.()51 ()(I,\(, 51-()O IhA ,00(, 1).'RlJ ~.) . .2.~S (j.~C) I () 1-70 ('.4 I 7iS5 (II (,7 Io.o.o or, ,I 71&ab,-,\c -1 . .'1 I ()()() l~ck'rl'llt 1~('I'cITIII 1<\'1 ,'/,'11 I Orphan Status Maternal 4:1.(, 1,.')5 11.511I .1S()() (IS() ) Paternal 56.4 I.O(JO l<.elCl·clll 1!" \I'isliillg rllilf / /1Ue! nioncv 10 17111' something 10 col" (/:1.'111011' (hp/IOII. 14 "('{/I'S, AlillliI.li Metropolis] Figure 5,1 indicates that about 6(/X) or orphans sat down thrice a day to cat during the month prior to the interview whilst :;Yi;) ale twice a day. Only I Asantc orphan indicated that he ate once in a clay. and allot her also indicated that his ell 11l~ pattern was irregular. A greater proportion or Krobo orphans had 3 regular meals per day (76.2%), than the proportion or Asanic orphans who ate 3 times in a clay (55.3()·:,). University of Ghana http://ugspace.ug.edu.gh Figure 5.1: Number of Meals/day by Orphans in the Month Prior to Interview 90 80 70 60 50 • Krobo • Asante 40 All 30 20 10 o 3 meals/day 2 meals/day 1 meal/day Source: Field Data From figure 5.2, almost 42% of orphans reported not having enough food to eat during the month prior to the interview, this consisted of about 20% not having enough food to eat two to six times a week, 4% seven times in a week, about 14% of orphans did not have enough food two to six times in the month and 4% four times in the month. Fifty eight percent (58%) of orphans, however, had enough food to eat in the month. More Asante orphans went hungry (46%) than the proportion of Krobo orphans that went hungry (38%) in the month. Thus a greater proportion (62%) of Krobo orphans reported having enough food to eat, than Asante orphans (54%). 149 University of Ghana http://ugspace.ug.edu.gh Figure 5.2: Number of Times without Enough Food for Orp!!!!!ls in ~he_Montb Pri()I to Intervie~_ 70 60 50 40 30 • Krobo • Asante 20 All 10 0 Source: Field Data 5.9 SHELTER OF ORPHANS The median number of rooms occupied by households of orphans is 2, and the median number of persons that orphans sleep in the same room with is 3. 5.9.1 Sleeping Places of Orphans The majority of orphans sleep in a bedroom or hall (97.6%), and 2.4% sleep in a kitchen or on a veranda. The proportion of Asante orphans that sleep in bedroom or hall is greater (98.6%) than the proportion of Krobo orphans that sleep in bedroom or hall (96.7%) by about 2%. Thus, whilst l.4% of Asante orphans sleep in either kitchen 150 University of Ghana http://ugspace.ug.edu.gh or veranda, the proportion of Krobo orphans that sleep in such places is 3.3% (Figure 5.3). Figure 5.3: Sleeping Places of Orphans 100 90 80 70 60 50 40 • Krobo 30 .. Asante • ALL 20 10 o Source: Field Data 5.9.2 Beddings of Orphans The majority of orphans (64%) sleep on a mat, blanket, or cloth, whilst about 2% sleep on the bare floor, and the remaining 36% sleep on mattress (Figure 5.4). Thirty five percent (7 out of 20) of orphans involved in in-depth interviews expressed dissatisfaction with their beddings, and where they sleep. 151 University of Ghana http://ugspace.ug.edu.gh Figure 5.4: Beddings of Orphans 70 60 50 40 • Krobo • Asante 30 All 20 10 o Mattress MatIBlanket ClothlFloor Source: Field Data 5.10 CLOTHING OF ORPHANS Orphans that had more than one set of clothing apart from school uniform formed 80.8% of all the orphans studied. The remaining 19.2% had only one set of clothing apart from their school uniform (Table 5.10). The proportion of Asante orphans who had only one set of clothing apart from school uniform was about five times greater (32.6%) than that of Krobo orphans (6.6%). 152 University of Ghana http://ugspace.ug.edu.gh Table 5.10: .C1othi!l~ of Orphans KROBO ,\S;\:-iTE I\LL Frcq. Percent Frcq. !'ernnl Frcq , PncclIl Possession of More Than One Set of Clothing Apart from School Uniform YES 141 ')5 (,7.4 .~.~() S()., NO I() 6.il 41> Y2.r, 5(, i ').2 Total 151 I ooo 141 1110.0 2().~ I()II.O Possession of Footwca r YES 12) K().X K) h(J.,; ~I 17 711.'1 NO 1'1 1<)1 5(' .;'17 s:; 2').1 Total 15 I I ()().o 141 II)().O 2')2 I()O.II Suu rcc: Fidel Data From Table 5.10. 70.9'% 01" orphans had footwear, whilst 29.1 % did not have any kind 01" footwear. The proportion 01" Asantc orphans who did not have footwear W,I', ahou: twice (39.7%) that 01" Krohn orphans (I ().2°!'\) 5.11 EDUCA'rION OF ORPHANS The need lor school items was very high among orphans involved ill in-depth interviews. Fourteen (70'Yo) out of 2() orphans indicated the need 1'01' school items ranging from money [0 pay for printing or exam materials and extra classes [0 school gadgets and clothing for school. Table 5.11 presents information 011 schooling S[cl!US 01" the orphans involved in the study. The majority or orphans 257 (SR%) were ill- school, out 01' this, ahout70% had their school ChMgCS paid: W il2-; I~·I II i) N" 2S I'H '-IX ~7 -; 7 ~ I~ I 129 I()O 12X 1(1(1 )57 11)11 Total Bag: yc-. 5(, 4.lt1 4X .'17.S 1114 "I()'; No n SIJJ, SO (,2.'; IS; 5l).5 12') I()O 12K IO()Total 257 Illi) --~-",.,--",.""'''''''''''''",,"'-''' ............. ' ~-~""'''''''''.'''''''~~~- '""~'···._uv<,,_~ .-~____ - Source: Field Data claimed that they were (Jut 01' school because their school ch~lr::;,c" could not he paid for, the remaining 23 (65,7'X») did not give any ITdSOIl I()I' not attending school. lor those in school 221 (86%) go to school every day 01' thcwcck except on puhl ic holidays, the remaining 36 (14%) were absent 1'1'011'1 school at least once a week. The proportion 01' Krobo orphans lila! were not going to school was more (146";;,) than that of Asante orphans (9,2%), 5.12 I-lEAL TI--IOF ORPHANS In-depth interviews with orphans revealed that 15 (75'>;)) out 01' 2() caregivers would seek health service for the orphan only when the orpi1'IIl's health condition IS very poor, (111(1only 6 out 01' 20 orphans had health iIlSUJ'(lIlCC cards. Thirteen ()5'~()) oj' caregivers involved ill in-depth interviews also indicated that whu: hinders them 1'\'(1111 taking orphans to hospital when ill is money to pay lor transportation and hospital bills, rour(204.<) 'il ~().:? 141) 510 Nil .'\1 3_~.,~ 75 SJ ..~ 12(, 4.12 DOll I 2 I ..l know 15 111.(' 17 S.X '1'111,,1 151 11111 141 1110 ~:»2 lilll When Orphans Receive Treatment When III S;IIllC l)ilV :\1 .'i.'.1l I.~ I :2.~ 1)11 .~-~. () Tlvl)/Thrcl: 4.> ~.~ .5 40 2:\4 ~, 2.~.4 " Days l.arcr When Very Ih 10(, <,7 40A 7 ; 2.' .11 III Trcatrucnt ., 20 10 7.1 I , ·LS 1101 ,()ughl ;11 ;111 No 5 ..1 II .., 2-1 X.2 Response Total 151 I ()O.I) 14 I I 1111. Ii 1110(1 Health Needs of Orphans Mel .'(, 1_1.X :24 17.11 (,II 211.5 Not ivlct ()J hi () hO 42.(, 153 ~2 ..1 DOIl't 22 14.11 '.7 -il14 7<) 17 .1 I< no \I' Tntal I S I 1000 1..11 __ . N.·-"'_-.¥H 100.11 2'12 I II!). I!w-,,-· • _'·_'ry._·· " SOli rce: Ficld Dal;I 1.')6 University of Ghana http://ugspace.ug.edu.gh Table 5.12 presents information on how orphans rate their health, 1'()SSl:~;:-;I()il o l insurance card, health needs, and how their health needs nrc catered It)1 h\ their carcg: vel's. The majority 01' orphans, 21 R (74.7%) perceive their gcucr.il health condition 10 he very good or good, however over 200,;;, or them indicated that their gCllcr,t1 hculth condition was rail' or poor, and that they have some kind 01' health needs ihnt \\I..'I"l..' not mel. The Health Seeking Behaviour or caregivers indicated tkIt ,I sizeable J1cn;cll[;I~~e (57.9(Y()) or orphans were being taken care or hy caregivers who will Oilly seck treatment for orphan when the orphans physical health condition worsens, ,111<.1 about 34(Y<) 0(' orphans were being taken care of by caregivers who will seck treatment lor 011)h311imrncdiatcly that orphan complains or ill-health to avoid health complications. 5.13 WORKING STATUS OF ORPHANS Figure 5.S indicates that about 4()(~~ nl' [he orphans were doing some kind "I' work however, only 12'/'i) or thcin were working ['or money. 1~7 University of Ghana http://ugspace.ug.edu.gh Figure 5.5: Working Status of Orphans Working Status of Orphans (Overall) • Paid Work .Unpaid Work .No Response Source: Field Data Those engaged in paid work indicated that they use the money to buy food, and to pay for school expenses when the need arises. They also indicated that they do so to assist their caregivers financially. 5.14 PSYCHO-SOCIAL STATE OF ORPHANS In assessing the psycho-social wellbeing of orphans, they were asked to indicate how often they stay close to their primary caregiver; whether they perceive themselves to be withdrawn; unhappy, sad, or depressed most of the time; whether they are too fearful or anxious; or whether or not they have trouble sleeping. The responses are indicated in table 5.14. 158 University of Ghana http://ugspace.ug.edu.gh Tahle 5.14: Psycho-Social Stale of Orphans I~ROBO ;\SAI~TE .\LL F!'('q. Perr cnt Frcq. I'crccnt !'r('q. P(Tl'("11 Staying close to caregiver when at home Very often 7R 51.7 52 .\I,. <) I iii "14.4 Quilc oftc» ~I l.l.S 75 5~~2. I ~(, c~~.! 1\;m_:ly III lOll ') ('."1 25 ~.(, D(l11'! Sl;IY (, 4.0 'i J.S II .~.\ ill home Total 151 IOOIl 141 1011.11 2')1 1(111) Being withdrawn/Preferring to be alone Yes .~) 2.~.2 27 I'J.I 112 21] N() l l o 7().,~ 11 ..1 ,~II.') ).,1) 7~ x Total IS I 1111)0 141 1(111.(1 2l)~: IOIl() Unhappy, sad/depressed most of the time Yes .'is -'R.4 I,( I 42.() I I X ~().·I No l),) (, I .1) XI 57<1 I 7LI .~'J.1l Total 151 1011.11 141 111(1) 2'J] II)lUI Being too fearful or a nxious Yc, S~ ~'4 4 :;') 4U: III is .1) No C)<) (),;.r, ~2 5x ..2 I X I h2(1 Total l.'il W(I() 141 !OIl.1) 2'n 1111111 Trouble sleeping Yes 14 'U .\4 24 I ·~x 11>.·1 N" I -;7 ()O.7 1117 75<) 24-1 x i.(, Total 1."1 111Il.() I'll 1111l.11 2()2 11)11.11 _,,..,..,.,,.,..... ~'"," "'""·',"'~,~w· Source: Firld Data 1:')9 University of Ghana http://ugspace.ug.edu.gh The results indicated that the majority, 256 (X7.()%) ol orphans stay close to their caregivers when they are at home, and the rcmain ing 3() (12.4'>IJ) till not SUIY ~lt IHll1le or rarely stay close to their caregivers. About 21 '!.;, indicated that they prefer to he alone most or the time; 40.4(% were unhappy or depressed I11Ust of' the time: 3:-';"0 suid they were too fearful 01 anx ious: and 10.4'>;) said that they could not sleep LIS well ,is they should. In all cases the majority oforphans were ,dright psycho-socially. S.tS SUPPORT f1ROM EXTERNAL SOURCE,S OTHER THAN PRII\'IAI~Y CAREGIVER Orphans were asked to rate the support they receive lrorn other sources apart from thei r carcgi vcrs. These inc ludcd support Irorn ihci r own ex tended 1~1111i 1y, and those outside their extended family -- friends, individuals from the community. NGO:-;. Government, etc. Responses are shown in table ).15 The majority or orphans rated tile support they receive [rom both their extended family and external sources as poor, that is 203 (()0.S'/;,) and 223 (76.4(_Vr» orphans respectively. Only 2 (0.7°11») Krobo orphans kit lilat tile support they receive i'ml11 their extended lurnily was excellent; 5 I (20.9(Y<,) orphans rated their extended family support as either very good or good whilsl 36 (12.YY;,) rated it as Sell is factory. f\g~lill only 1(0.3%), Krobo orphan relied support from external sources as excellent: 20 (6.9%) rated it i\SIIi\NII /\ LI, [:req. I'el'celll Pcrccm l'urccnt SUPPOl't from Extended Family Excellelll 2 1..1 .7 \'cry gu(,d 15 »» .7 1(, 5 .." Ciu()d 1<) 12.11 1(, II -, " ."\s 121) Salisi'acl()I'Y 10 h.t> ~(, I~."j .~h I ~1 Punr 1115 (,9.5 IJi\ {)\.).5 '11.1 (l() .. ';; Tolal 151 III().II 1·11 1111111 ~\).~ 11111.11 Support from External Sources. Ex eellen! .7 4.(, '.4 7 "l.(, (, 4.3 Ii .•1 ,,' S:'.A~·' • ",_,,,,.,,,,,,~_.,,,,~,,,"",_.,,"_,_~.""~~'~'w,,,~,,.""''''''_W'''''''"·w.· .•,.""~""'" Sou rcc: Field Data 5.16 RATING OF CARE FROM PRIMARY CARECIVI~R BY ORPHANS Table S. [6 shows how orphans rated the care they were receiving from their primary caregivers. About 21''/0 (61) or orphans indicated the care they receive i'1'lJI1l their primary caregiver cIS excellent, out or this ()J_4"!() (."17) arc Krobo orphans. One hundred and seventy six (()O.3%) orphans rated primary caregiver care ,IS \ cry goU([ or good and the remaining 4.8% (14) of orphans indicated the care they receive Irorn their primary caregiver as satisfactory. 161 University of Ghana http://ugspace.ug.edu.gh Tahle 5.1 (,: Care from Primary Care-gin!" Ratillg hv Orphans KROBO ;\SANTE ,\ r.r. Frrq. Percent Freq. Percl'nl Frcq, Pl'rrenl Care Received From PI"imary Carcz)i-,vcr Excellent "7 .17,7 4 2,~ hi )11,') VL'l"Y guud 47 :-1 I .-;~ 2/1) ~s }(),I C(l(,d 3S -.."~,,- 5(, .'CJ 7 ()I ,1,2 S:il ixluctorv 5 ', ,, 3() 2~,-, 41 14.11 Poor 7 4,6 7 :i,1I 14 ··L~ T ~".~~..otal........,-,"" ..,............ -,.,,--.--".~.1-5-1- IIlII,Il 11111.11 I ()IJ.(I•.,-~.- 141 2')2....-.,..- ,._"''''_'''''~' ""-~'''''~<'''-'''''~Y - ' -' Source: Ficld Oata However, II (55%.) out 01'20 orphans involved in in-depth interviews Icl: unloved hy their primary caregivers, whilst the remaining 9 (44%) !'cIt the W,lY thci: caregiver takes cure and relate to them is satisfactory, though they !CIt that more could be done for them by their caregivers, "M\' caregiver docs I/O/ like 111(' because she insnlt» cuul be-ats nu: (/ !o!, -.~ SOIl r CC: Field Data 171 University of Ghana http://ugspace.ug.edu.gh 5.IS.1 Cultu ral Practices and Norms and th ci r Impact on Orphan Calc Study participants ill all the study districts viewed traditional ritcx dllli cultural ceremonies JS Factors that ailed orphan care ill their communities. These include Funerals: Inheritance; Marriage ceremonies. P(llygyl1y: n:lIllll1g ceremonies: puberty rites (especially among the Krohn): festivals and other traditional rituals. Funeral Rites and Other Traditional Ceremonies: Traditional rites ill (;h(lI1,1 usually cover the rights of' passage or child-birth. puberty. marriage and death. These celebrations are considered important and memorable in the lives or people, and provide fulfilling moments to many families and communities (MOFPED!UNDP Uganda. 20(3). However, funeral riles and marriage ceremonies (engagements and weddings) were reported to particularly affect orphan care in that a lot of' money is spent in organizing such traditional activities. funerals arc celebrated ill honour 01- the dead, thus both tile /vsantc and Krobo view funerals JS such and therefore place <1 gre;lt (iv<.11n[' importance Oil the luncr.il ceremonies or lami ly members and loved olles.The Asantc believe that a person's worth is unveiled at his funeral, hence, when an individual loses a relative he is expected to perform (J befitting funeral riles and if he is nol able to do so, he i:-. looked down upon by his community (Osei Kwadwo, 2()02), It is therefore not surprising that people attach much importance to funeral rites and would lise l110ncy to buy clothes. shoes, bags. drinks. etc and lor public donations instead 01- buying lood Illi orphans and even their own children or taking them to school 172 University of Ghana http://ugspace.ug.edu.gh The Asantc identified about five phases 0" death. luncral rites ~11l(1 U.:ICI1]()1l1\'Sthdl .uc all money and time consuming. These phases were mentioned CISImmincni death. where the initial announcement ora person's death involves purchasing ofdrinks ~tnd travelling long distances to inform distant relatives ami significant others. printing 01' posters and the one-week celebration. Phase two involves pre-burial and mourrunt; when the place where the corpse will be I,lid in state is refurbished and decorated with expensive materials among other rituals. During tilis phase. C()1ll1l1UIlltV IllCl11hCIS JI'C expected to 111;1I,ecash donations to the bereaved family. Study purticipants mentioned that i I' you are a community member and do not make donations t()\\'(IJ'ds other people's funerals, when you arc bereaved. no one xvi l l make cash donations I(l isfricf). Dipo W~1S also reported to negatively afl'l:ct the schooling 01' girls because, ,IS SOUll ,IS it is performed, men start chasing the girls, ,md 1110st 01' them end up hecoming pregnant and they stop schooling, Another traditional ritual Ihat was mentiolled alllong the Krobn which impacts 011 urphan care is la/Willi, vv'llich involvl:s the perl(1rI11<.1nCeof [Ile Ilt:CCSSJry rites 011 the part or (l 11l;1ll who did not rully l'Il~lITy i1 woman belure having children with her, to claim Ilis children since the chi Idn:n ,Ire regarded as helonging to the woman's C(lillily. /,(.fj7{)IIIi call bl: very expensive ~1Il"if' this is done at the death ul' the mother nr [he children, the Illan IS lIslI;lIly lel't \\itll University of Ghana http://ugspace.ug.edu.gh Traditional Nor"IlIS The traditional norms reported to affect orphan care among the tW(} ethnic ~~roups studied were Inheritance and Polygyny, Inheritance: Among the Krobo, study participants reported that the pauilincal system or inheritance ill itself is not a bad thing since chi ldrcn arc supposed to inhc: it whatever property that belongs to their luther. but what really happens unfortuuatcly i:; that, if parents especially the father dies whilst his children arc young. the inhcrito: usually uses the inherited property lor his own benefit Llnci th;11 01' his own children. The inheritor sometimes totally neglects the widow and the orphans, thus. 1)I'()I~el'lv that is to be handed over to orphans when they gww up is taken up hy the inheritor and he keeps the property 1'01' his own children, so the orphan continues 10 suffer. [0 a point 01' even becoming wayward and rebel when he grows LIp, "Panilincal inheritance ill itsel]' is 110/ u hod tllillg bu! inos! inheritors U/,(,' greed I, and lise oil the /7I"OPC/'tl'/O/' themselves and thci: ()WII !leglcelillg I//(' orphans who should actttallv {))I'/I I/IC !JI'O!l(:/'/I' hacl th ev I/()I /Jc'CII cliil d n-n " (FCD Men, Yilo Krobo Dis/rictj, [I was also indicated among the Krobo th;lt patrilineal inheritance is good lor the orphan only when the deceased left behind some property that the caregiver can 1';,111111 taking care of the orphan, otherwise it pl,ICCS financial eliHicultics 101' the caregiver. "Patrilinca! inheritance is good, because iftlrc cleiul tatlrc»: (lilh,' ot nltan: /IOS all1' /)J'o/7cl'll', it g()es 10 his eli ilc/n'lI , hll/ if he leaves II nlli iII,!},' helll'l/(l (is ill II/(' cwe 0(1711' hmlliN alld Ilis wire. 1171'1I1//(' C(ll'c,t;ivCl' ",,/'(1 !/light h(' //il'/il!I!('f's rel(ftive (1.1' f (/JII shol/lel s!f'II;;gle to I(/ke co/'(' oftlle ()/jl//(/fIS" (/Jlilld C(/I'C'l-!:in'l'. 701 HI/'S, Malll'u Km/)o Dislricl) Reports again indicatcd that if the deceased dicillot !'ully marry the woman with whom he had children, his property and wealth are all transferred to his 1~1I11ily,that is the 179 University of Ghana http://ugspace.ug.edu.gh family. Hence the care 01' the orphan in this situation falls directly 011 the Ill' would usually allow these children out the whole Iliglll thinking that they arc out lill' Jlr('(1/\ IIIC, .II/(' U/I'() give'S /I/(' lill/u/o()d, / '11/ II/IIC/I 1I'()I'I'ier! ohmll 1/1/.1.lilllUlilill ill 1/1(' hUl7/e" (O'p//(/II, ;V!OIlI'O A"r()h() /)I.I//'/'c/) "/1/ Kmho lalle/. (}/phulIS orc coslh idcl/{ified ill {ilc 11'(Il' (he) dre'ss, sd/lJlilil/g, (eedillg', clc, This is hecallse 111(1.1'1 I)(,O(7Ic ill<'illding (,({I'egil'<'/',\ COIl/IJllIill oj lilllifcd/illoncial olld /I/(/[cl'iul r(',I'o//I'(_'('\ (1IIrlll/(},I{ 0/11-//(/1 ,h('l' I/O\'(: arc I/sed Oil Iheil' OWII children/irs{ hero/'(, 1/;(' (JI/i/WI/ is cOl/sic/clcc/"(I,'C,J), /Ji/IJI(,I'Ct'I/f Bo\'.l', )lilo A'mho f)islricl) "Thc/'(' is s/f'{JIIg discrilllinatiill/ he/II'CCII iliphOIlS ({lid 1/(JIl-iJI p!; (111,1, IV(_' II'I'{II' old alld 101'11 III/ifill'lll,\' (he IJiI/()le ,)'('(I/' II'/;ile.l' 0111' collcL/glles 1/(/1'(' I/CII' OIlC,1 Oil, rI'e (lrc 110/ givclI N/lJugll fl'/O IICl, /01' /ccdiflg 01 sc/!{)ol, /1/(' do IIO{ (/(/\'C IICII c/Ol/lillg Oil OCCOSiOIl,1 SI/dl as CIII'i,I'III/OS, Cos{C'r or ('V(,II liJl' SIII/{llIl' ('//llIdl, We arc IcC/s('d h)'/i'ienc/.I /)e(,(III.I'(, 11'(' UI'(' I){){)/' (I/l(( do IIO{ Iwvc 1)(1/'('111,\, JVc 0/ II) I University of Ghana http://ugspace.ug.edu.gh tinics arc: exposed 10 I'CI',' ba.! Ihil/gs ill flit' ('1I1'il'UIIIl/c'lIl (///(I \I', he,( IJ/II(' coniitsct! III/d vvorricc! if ,\'(' jed \1'(' uci-cl 1111 I//('.\'(' II/ill,<_:'I , (/'1;/), (),/,/II/I/\', Mauva Krobo) Some Caregivers however claimed that the character of the orphan is db(_) important in determining whether he/she would be discriminated against or not. according to them some orphans are very bad/wicked children and it is difficult It)!" the caregiver to consider spend ing money on (hem, espcci <.IIyI when rcsou rccx arc Ii 111 ited, .. WI/(;I!?er WI ()Ip/WII would he discruninatcd in tlu: I/(Ji/.I('liolt/ or 1/01 also depends Oil his/her character 111/(/ th« availabilit, of r('.\'()//1'(CS, a! timc:s I/I(,/'(' i.l I'cn' littl« tuonev [or 1/1<: luntscholi]. so tlu: (}II(, 1//(11 is obedient cuu] respecl/iil is consideredfirst "(Caregiver. l'i!o !-:mho District}. Eleven out ul' the 20 (55%») orphans involved in in-depth interviews kit that thcv arc discriminated against physically by their caregivers Jilt! peers \\hil~t 4.'i();1 kit th.n they are not discriminated physically by anyone, "l don 'I [ce! discrinrinatcd against except that Ifee! 1 '/II 100 1)001', (/1/(/ Ih({1 makes II/(' IIlICOIII/(J/'lahlc ill the midst of 1111' peers.' (Olj)//(/II 1"('11/(//(', 14, MWl1u Ktobo District) "I don 'I Icc! stigtuatiscd or discritninutcd agaiu.« bv /11\' (//1111 or I)CI:I'" lied that 11'.1' 01/111 genuinely docs not have the IlIOIICI' {o /WI' [in II/\" SC/I()O/ eX/)CI/SC.I', " (Orphan. Female. 12, Yilo Kroho District). "I (//1/ discriminated against /n 11/" hl'lll/I(:1' 's I\'i/c', h('clIIl.le \\-/1(,11 f I/('(.'ci sOl/lclhillg, s/;c will Iell /Ill' hrol/IL'/' 110110 gin' il {II IIIC Iwc(flisC .\//('I('(,/.I / dlill 'I lIeed iI, hUI 1,(,/, cI,ildl'CII un; olll'(f\',1 gll'ell ,I'!/O("I'(,I' 1/,(,\ (Ilk Ii)/' (),jlllllll, Molc, 14, ;\1/0/1\'(/ I\'who Disll'icl) "I (/II/ discrilllillolcd agaillst hI' 1111'mllll, hecuII.lc /'111 1/01 gil'C.'1l ,,-/,,/1 J lI('cd like se/lOo/ lI11i/f)J'III, Shc ()/iclI hea{s ({lid iIlSII/(S 11"/(', f .1'/('('17 Oil (,/(1//1 Oil II/(' 1/011/' ,,),i/sl hel' childrCII slecp Oil IIIU/lu'.I.\('.I, 1lei' CIIl'ltil'(,11 01.1'11 ill.lll/l 111(' (fl (illl(,.I', " (01 j7/W II , Fe/lla/e, /3, I\.//II/({Ii ;\I/elro/')(}/i.lj. "I ('ecl di.lcrill/illoled {{g({illsl /)1' IIll' ({lillI, hcc({lIsC' I 1111/ 1/1(' (JIIII' IIIIC ill III(' /101/,1'(' who ",,'e(/I' IIld c/ollies dl/n'lI?; CI"'isllll(/S, sl/(' hl/\".1 11(,\\' niles Ii!!' lu'/" c1,ildl'CII C/oimillg Ihal liJeiljillller hOl/g/1I rl/{' c/oIIIL's./iJi {/I('III,I'!'/ 1,10 illllllC //O/'(I \I'II/'k Oil I/IC/Of'lli. " (Olp/lUlI, M(f/e, /~, Sci-Ten; 1:'0'\1 /)ilfl'ici) University of Ghana http://ugspace.ug.edu.gh 5. t 9. Needs of Asautc and Krobo C::lI'CgiV('I'S Money was indicated hy all 20 (I()O'~'(l) cgul~lrmonth!v 111«,\11'1,: ~IS thci r need ~IS well. "Wltl: 1IIIll/LT, J CUll provide [or tlu: IICCr/S o]' IIICSC children \\'il/IIJ11/ {/I/I' prohlcnt, 17111as at now. f IIIIISI SUI' il is !'eiT difliclIll FJI' 1/,\" (( '(//'('gi\(.'I, Sckvcrc Eas! District) "! will SUI' that we need more food, 1/1/(/ clothing. hili vvlutt is II/Osl j)rc,\',\illg is ntoncv, siuc« 11/0/1(,1' call hili' all /1/(/(" (C(//'Cp;i\'('I', ;\I/U/l1(! Krolio District) "l III!Cc/ 0 [ob to enable nte ('(//'11 sonic 1I/()lIe,', so that lire C(/II he (/ littl« hil eusieljor IfS" (Caregiver, Kuinasi Metropolis) For those who ,11\; HIV positive. they requested ill addition to money 'Ciuo(11 k;t\lh' In enable them take good care ofthe orphans in their custody, ";\11i \ilinl [cu: is tliat, i/ 1'111 I/O 11101'(" II';/{) wi]] tal:« oitlu: cllildl'('I/) I ,,('('d ,':!,ood health. / need to he .I/f'()IIg. so I COli ial:« care of Ilu: childrcu, til] 11,(,1 will he independent" (1)/,1+'//// Carcgivc». MUIIl'{/ Krobo District ) The next chapter discusses the main findings or the study making references. where appropriate, Lo findings from other places, It also makes inferences to tile social am! cultured norms or tile study groups where appl iCLlblc. 1')3 University of Ghana http://ugspace.ug.edu.gh CHAPTEH SIX 6.0: DISCUSSION OF RESULTS Introduction Children may lose one or both parents to natural or unnatural CC, 2(1117) Notwithstanding. in communities where the impact 01' AIDS in icrn», nl increased numbers or orphans is being felt. the traditional system oj' orphan cure becomes weak and inadequate (Howard c/ al, 2006: N tozi. and fVI uk iza-Gapcru, I <)C)5: Foster. and Williamson. 2000; UNA IDS, UNICEF. & USAID. 2(04). The Government or Ghana, as well as Non-Governmental Organizations (NCOs). Faith-Based Organizations (FBOs). bilateral agencies, donors and individuals have identified the need to support orphans, In Ghana. every child whether LIIl orphan 01' not. belongs to <'1 recognised household or Iamily. In any given community where a child lives. he or she derives an identity. (I sense of' cultural rootx. oj' hcloll,:;ing, o l u clan. or blood tics, and a particular mother tongue thai connects the chilel to th.u particular community. Thus, orphans ill need cannot be isolated ()I' uprooted Irorn their communities to the extent that. the government, individuals and organizations that have the goodwilito assist needy orphans cannot reach the orphans without first goillt,: through the horne that has taken the orphan ill and the community where the orphan lives. Williamson (2004) has argued that the local customs and practices 01' the communities to which orphans belong need to be considered for effective response (0 the orphan crisis. Therefore, orphan care interventions C<1Il never he effective il' the dynamics 01' the cultural, social, traditional .md economic contexts ol cure ()r tile targeted orphans ~II'(~ignored (Nyambcdha ('I (I/" :W(),3). The Asantc and Krobo pcople or Chana w\:rc chosen "or the study h~lsed OJl the reported high prevalence rates or HIV and .AIDS in their reg~ions ~lIldhv- cXlL:llsioJl the I;, of the ulregiver~ ill the study areas, As in most African countries, women <-lIT the principal caregivers, .ind in this study lormed about SSCYc) 01' all the caregivers involved According tll the results, singles comprising the widowed, divorcees. the unmarried. and those separated from their spouses arc the commonest primary cnrcgivcrx (C)]%) 01' orphans, who may most probably be the heads of their households as well. Most of the orphans involved in the study O~S(I'(») were in-school, although other studies have indicated that orphans or children who live ill homes with chronicul ly ill parents or adults often drop out or school (GDHS, 200~). This indicates greater awareness or adult caregivers 01' the need to educate children a~ high educational attainment is seen as a means or eradicating or mitigating the c lfcctx or severe poverty on households. This may also be due to the effect or the Free Compulsory l 'ni , crsal Basic Education (FCUBE) prngr,lll1111e introduced in till' country in I ()C)() Despite the fact that school enrolment or orphans in the study ,m;,IS is high. the 200K (jDI-IS indicates that school attendance or Ghanaian orphans is about 14(/() lower than school attendance or non-orphans. That is "the overall ratio 01' school attendance ofchildrcn whose parents arc dead to those whose parents are living, and the child resides with ,11 19K University of Ghana http://ugspace.ug.edu.gh least one parent is 0.76" (GDIIS. 200i\). Orphans arc therefore 'ilill dis~l(h'1I1t;lgl'd when it COJl1es 10 school attendance (\\'01'1<1 L1clllk. I ()()7; If3icc::;n. r~lIhic:ill. .uu l Johnson. 20()3; Makarnc, ('/ al., 20()2; M()n~hCIL and L-30(;rIl1thcsi/.eci Li1,Jt" or caregivers were over 50 years, and 85% 01" caregivers were females. These i"igllres do not differ so much from the Ugandan study by Hunter (1990) which recorded that 4YYo or orphan caregivers were over 50 years. and 31 (Yr, or caregivers were grandparents. This is the pattern that prevails in most Sub-Saharan African countries that arc hard hit by AIDS (Oppong, 20(4). The study did not reveal signilicant association between tile various caregiver dgC groups and nutritional status of orphans with the overed I data and the data from }\S<1l1tc (p>O.05 in both cases). However. signi ficant association was found between caregiver age and nutritional status 01' orphans (pO.05 in both cases. the qualitative data held thdL the situation of the paternal orphan in terms of the care he 01' she receives is better than the situation or the maternal orphan with various explanations. ilS recorded in chapter 5, The care situation (II' double orphans was also perceived to he worse than that 01' 212 University of Ghana http://ugspace.ug.edu.gh relationship 0(' a child to an adult caregiver or head of household. the better their health, educational and nutritional status (Case. P(lXS()Il. and Ablcidingcr. 2()(l3). 011(' call say that the type of' orphanhood matters when it comes to care or orphans. In other words, orphan care may he expected 10 be partly dependent on how close the orphan is biologically to the caregiver with the general view that maternal orphans arc (It greater health risk alter the death of their primary caregiver (Gillespie. 2 ()tl(): Madhavan. (mel Townsend. 20(7). The death 01';1 lather to AIDS in hi" prime-earning years may leave ,I lasting blow 0(' economic viuhil it,: on households. ;\Ild this 111:1] impact 011 the nutritional status 01'orphans ill those household" 0.05), 1110l'esingle orphans were stunted n()·2(~ 1\) than double orphans (35.4%»). The plight or double orphans have been described hy S()llll' researchers as being worse than that ()i' single orphans cspcciallv III school vnrolmcn: and educational attainment (Biccgo, et al.. 2()()3). This may be due to tile rilet that double orphans are most likely to be living with grandparents ()J' child ..headed 216 University of Ghana http://ugspace.ug.edu.gh households. or may he living with strangers and \V{)rki!l~ de; houschokl "en illlh (Nyambcdha, ct a!., 20(3). The impact of the loss of one or both parents on orphan LIre may however he dependent Oil the degree 01' involvement ()j' the deceased parcnus) ill the c.uc or the children prior to their death. Thus, the greater tile involvement o l parents in the care (Ii' their children. the more dcrrimcntal their absence will he to the children they leave behind and vice versa. For those children who arc already vulnerable. the death of their parent may not mean much to them in terms or Ci1rC. 6.6 OTI-IER SOCIO-CULTURAL FACTORS AND THEIH IMPACT ON ORPHAN CARE Other cultural and social practices found to affect orphan care among the studv gl'()lIPS included the rites or passage (out-doming of babies. marriage ceremonies and funeral rites), traditional rituals such as festivals and puberty rites uaditiona] norms like inheritance (already discussed above) and puberty rites, and social practices like alcohol and drug abuse, social eating and drinking, fashion, stigma and discrimination. and others already listed (Table S.IR). The effects ofthese (111 the part ofthe c:\) hilS idcnti l icd seven main aspects of family life that can be marred hy alcohol misuse. thcse LIre roles. routines, social life, communication, finances. conllicts and ritual". It can Ill; inferred [rorn the study that problematic alcohol usc hy c.ucgivcrs call dlli..'c[ the quality of their care-giving activities. This is because a caregiver who drinks may be inconsistent, emotionally unavailable. and unpredictable which can lead to passive neglect, and cruel care-giving. Children under such c(II'CgiVCI'S arc not supported. nurtured or supervised (Cleaver ct al.. I ')()9). Some children are even deprived oftheir childhood as they take Oil icsponsibi liucs that ~lI'C beyond their dgc ill the Iorm or taking care or a sibling or a drunk parent or guardian. thus illlp;lirillg their education they should (Vdlclllan, 20(2). 22() University of Ghana http://ugspace.ug.edu.gh As indicated by some FCiD participants Cllnollg the /vsuutc, childrcn under the Cill(_' o l parents or caregivers who have problem with alcohol or subst.mcc misuse g\) Lhmugll emotional problems and this affects child-parcn: attachment throughout their l ilc cycle (Kroll, and Tylor, 2(03). Evidence also cx ists that children 0[" problem drinking parents have higher levels or ,1 range o l problems than chi ldrcn or nou-problcm drinkers, and children 01' parents with other problems. The ["actors that could increase the likelihood o l children bcing adversely alfcclcd include parental dixh.umony. violence, both parents drinking problematically, and the drinking taking place .vithin thc family home (Eurocarc/Cofacc (I 9c)S). Some studies have also round links between domestic violence and alcohol consumption which is usually perpetrated by men against women (Simmons ('( (/1 .. 2002). The study by Harwin and Forrester (2002) Oil social work with '~lmilies in which parents misuse drugs Or alcohol I(lund that "alcohol misuse \vas'>trongly associated with violence in the horne (pp 'i). Till: impact 0" domestic violence ()!i children is often manifest in damage to family attachment. ~Iggl"cssioll or withdrawal. sleep problems, lear and (] wish for safety (Mullcndcr. 1'/ a] ... 20()2). By implication. ,I combination of a parent who has a prohlcrn with alcohol and who also sutlers or perpetrates violence will exacerbate the harm and risk children r:'ICC.Studies have also shown that some women resort to drinking alcohol to offset the impact 01' domestic violence 011 them (Cantrell, I ()1{6; Corbin, Cl 0/., 20() I; Downs, ('/ al.. I <)()3: Downs and 1\1 iller, 1(94). According to Robinson and Hassell (200n). ,licuhol plays a pml in abOL!1 25~!;)or known cases 01' child abuse. Furtlicr, somc resemch suggcsts lilal children :'ll"l' more 2:2 I University of Ghana http://ugspace.ug.edu.gh likely to suffer physical abuse ifthe luther is the drinker. ;uld ;1I'l' more l ik cl v f,'
    r these childrcii. 229 University of Ghana http://ugspace.ug.edu.gh The source or stigma und discrimination ll1<1y come lrorn till: extender] 1';111111), (IS \\il" indicated by some or the orphans in the study, Till' in-depth interviews indic;Jll:ci that although the main support for orphans is the extended family. smile relatives exploit and abuse them, and laii to meet their basic needs ror food. cloilling. and cduc.n ion. A study in Uganda by Scgcndo, and Nambi (I C)1J7) indicated th.rt most of' the orphans studied especially those aged 10 - 14 years were depressed ;, Fill11s/Vi(k().'DI·;llll~l, Ni:;hl Clubs/Discos. Traditional Dances, Market Days. Church Worship. and Peer Influence. Most 01" these socio-cultural factors compete wirb orphan care lor limited urnc and finance. 7.1.11 Rating of Can.' hy Orphans AIDS orphans perceived care aile! support offered hy extended family. external sources and primary caregivers as poor, irrespective oC cthnicity, even though rnirnary care giver scores had an edge over the others. More Krohn orphans arc content \\ ith how they arc cared lor than Asantc orphans. 7.1.12 Level of' Care of Orphans The level or care 01' children orphaned by /\IDS CIS assessed hy feeding puucms. shelter, clothing, education or orphans, working status or orphans, health seekillg behaviours of caregivers lor orphans when orphans are ill and psycho-social state 01' orphans, showed that the level of care or the Krobo orphan is better than thar of" the Asanic orphan. Although the majority or orphans had three meals per day. must orphans arc in need or' lood. The majority (If orphans are s:ltisl'i,~d with then seeping 2\C) University of Ghana http://ugspace.ug.edu.gh places (mel the things they sleep on, had at k,lst one pair of Il)()I\\C~lr. and more than one set ofclothing apart from school uniform. The majority 01' orphans are in school, attend school rcgulnrly, and have their school expenses and items catered lor with the exception of school bag». School charges, school gadgets, uniforms and money for rood during school hours, Ilg others, also impact negatively 011 the care or orphans hy reducing the household income. Even though Iami lies and communities try 10 cushion the impact or /'\ IDS Oil orphans, they often lack the financial wherewithal to do so adequately thus rendering these orphans vulnerable (0 111311Y social vices including H IV infection. Orphan care stakeholders may, therefore, have to adopt appropriate su.ucgics Ilwt take into consideration. the cultural. economic, ,1Swell as the social [~11.:1()rospcral iu; ill the environment they work. This would enable them to draw up appropria.c 1()·_.~t1 responses to effectively address tile needs 01' orphans and their carcgi\Cl~,. Iii I.~IISLJI'<.: that thc:«, children grow Lip into responsible adults lor the betterment olsocictv. University of Ghana http://ugspace.ug.edu.gh 7.3 RECOMMENDATIONS FOR FUTURE RESEARCH AND POLICY RECOMMENDATIONS 7.3.1 Recommendations for Future Research The present study idcnf ficd the socio-cultural norms and practices thut irnp.ict Ull tilL care of AIDS-orph;-lI1ed children among the Asantc and Krobo or (111<111;]. and hov, these socio-cultural factors affect orphan care. The study also zlsses"cd the level ()I' care given to orphans among these two ethnic groups, z1I1dprovided AIDS orphans with the opportunity to rate the care that they receive from their primary caregivers. extended Iamily members and external sources including the govcrnmcnt. The following areas of orphan care in the country 111<.1hye explored ill subsequent research activities. I. Future research may take into ,ICCOUl1t the HIV status or orphans, to rule ()LIt the effect 01' I-IIV status on nutritional state nl' orphans 2. A study 011 the socio-cultural I'actor,. impacting nil the care or orphan« due to other causes all10llg the two ethnic groups may serve as ,I hasis for comparison between general orphans and A IDS orphans 3. Social, cultural and economic factors that influence the care of' AIDS orphans. and genera I orphans among other cth n ic grou ps ill Ghan« may lh row ' igil [ Oil other culture-specific issues that affect orphan care ill Ghana 7.3.2 Policy Recommendations I. The study found that although the level of knowledge OIl HIV and AIDS in study communities was high, there arc srill some misconceptions about the disease. These misconceptions ill relation to the