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Published on: February 2, 2017
Measuring vulnerability among orphans and vulnerable children in rural Malawi: validation study of the Child Status
Lora Sabin1, Maxton Tsoka, Mohamad I Brooks
1Center for Global Health and Development, Department of International Health, School of Public Health, Boston Unviersity, Boston, Massachusetts 02118, USA. Candace@bu.edu
Insights
The Child Status Index (CSI) did not effectively measure vulnerabilities in orphaned and vulnerable children in Malawi. The study found the CSI scores did not align with children's reported experiences, suggesting caution is needed.
Area of Science:
- Child Health
- Social Work
- Global Health
Background:
- Orphaned and vulnerable children (OVC) require accurate tools to assess their needs.
- The Child Status Index (CSI) is a tool designed to measure OVC vulnerabilities, including those affected by HIV/AIDS.
- Validation of the CSI is crucial for its effective implementation in diverse populations.
Purpose of the Study:
- To validate the Child Status Index (CSI) for measuring vulnerabilities in orphaned and vulnerable children.
- To assess the CSI's ability to capture the complexities of OVC experiences, including those infected and affected by HIV/AIDS.
Main Methods:
- Two age-specific instruments were administered to 202 children (aged 5-17) in Malawi.
- Construct validity of the CSI's 12 subdomains was assessed using Spearman Rank correlation coefficients.
- Analyses were conducted separately for younger (5-10 years) and older (11-17 years) age groups.
Main Results:
- No CSI subdomain relationships met the standard for high construct validity (≥0.7).
- Only moderate construct validity was found for food security (0.4) and wellness (0.36) in the younger age group.
- CSI scores often failed to reflect children's reported distress, particularly regarding abuse and exploitation.
Conclusions:
- The CSI was not validated as an effective tool for assessing OVC vulnerabilities in rural Malawi.
- Caution is advised when interpreting CSI scores due to observed discrepancies.
- Revisions to the CSI are recommended before widespread global adoption.
Objectives:
To validate the Child Status Index (CSI) as an instrument that can meaningfully measure the vulnerabilities of orphaned and vulnerable children, including those infected and affected by HIV/AIDS.
Methods:
Two age-specific instruments, comprised of previously validated tools and indicators commonly considered best practice, were administered to 102 children aged 5-10 years and 100 children aged 11-17 years in Mchinji, Malawi. Respondents were randomly sampled from a roster of children recently scored with the CSI. For each of the CSI's 12 subdomains, we assessed construct validity using Spearman Rank correlation coefficients. We also calculated cross tabulations to explain the resulting correlation coefficients. Analyses were conducted separately for the 2 age groups.
Results:
No relationships exceeded the standard for high construct validity (≥0.7). Only 2 were moderate (0.3-0.7), both for the younger age group: food security (0.4) and wellness (0.36). All other relationships were weak or negative. In most subcategories, a substantial proportion of surveyed children indicated distress that was not evident from CSI scores. In the abuse and exploitation subdomain, all children were rated as "good" or "fair" by the CSI, but among surveyed children aged 11-17, 20% or more reported being beaten, kicked, locked out of the house, threatened with abandonment, cursed, and made to feel ashamed.
Conclusions:
In this rural Malawi population, we were not able to validate the CSI as a tool for assessing the vulnerabilities of orphaned and vulnerable children. We recommend caution in interpreting CSI scores and revisions to the tool before global scale-up in its use.
