Improved Measures of the Family Environment in Longitudinal Population Studies of Child Health in Sub-Saharan Africa

Lead Research Organisation: University of Southampton
Department Name: School of Social Sciences

Abstract

Child health is a global health priority with over 6 million preventable child deaths occurring every year in developing countries and more than 200 million children failing to reach their full developmental potential. The Millennium Development Goal to reduce child mortality by two-thirds is far from being met in sub-Saharan Africa. Families are central to the health and development of children. There is increasing evidence that interventions and policies can successfully support families in promoting better health and wellbeing of children. The design and evaluation of these interventions requires high quality, detailed and validated data on families and child health which is currently very limited in sub-Saharan Africa.

Our research will identify better ways to measure and characterize complex and dynamic family relationships and processes. The improvements in data about families will assist us and other researchers and service-sector agencies in our efforts to understand and support families in promoting the health of their children in low and middle-income countries. Using a well-established demographic surveillance system in rural South Africa as a model, we will develop and test new instruments and strategies for collecting improved data about families. The research involves researchers at the University of Southampton, the London School of Hygiene and Tropical Medicine and the Africa Centre for Health and Population Studies.

Planned Impact

The collaboration, activities and findings from our project will impact six groups of beneficiaries:

1.The conceptual and methodological dimensions of the project will be of considerable interest to researchers with a broad range of interests in children and families, social determinants of health, measurement and data collection methods. The project will advance knowledge about the specific dimensions of family relationships, processes, intergenerational care and support that can be used to promote child health and wellbeing.

2. The project will directly benefit research groups working with demographic surveillance systems in Africa and Asia (e.g. the 47 members of the INDEPTH-Network of HDSS) and family cohorts and social surveys (e.g. COHORTS) by identifying and evaluating measures of the family environment that are conceptually relevant, feasible and methodological reliable in a rural sub-Saharan African context.

3. Improved instruments to measure key indicators of the family environment that have been shown to be feasibly implemented in individual and household data collection in a rural, sub-Sahran African population will be of value to government and international agencies engaged in national and international data collection efforts related to families and health (e.g. UNICEF, WHO, Macro/DHS, Statistics South Africa).

4.Improved understanding of how multiple and dynamic family risk environment influence child health and wellbeing will also benefit researchers and policy-makers involved in the design, implementation and evaluation of family-orientated interventions (e.g. UNICEF, The Global Fund to Fight AIDS, Tuberculosis and Malaria).

5. Southern African early career scientists and research assistants employed through this project will directly benefit from the opportunities for capacity building afforded by the Africa Centre and the University of Southampton. Beyond gaining scientific and operational knowledge and skills within the project, the Wellcome Trust provides funding for all Africa Centre employees wishing to access additional education and training courses.

6. The project will increase wider knowledge and understanding within social science of the value of existing data and opportunities for new data collection, not only in the Africa Centre demographic surveillance system but in the many other DSS in Africa and Asia. This project will be the first time that Berrington and Ploubidis are involved in the analysis of demographic surveillance system data. By bringing these widely respected UK-based experts' understanding of social statistics together with a well-established South African team in order to address the issue of improving measures and understanding of the family environment will serve as a catalyst for many other new areas of collaboration.

Publications

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Camlin CS (2014) Gendered Patterns of Migration in Rural South Africa. in Population, space and place

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Darbes LA (2019) Results of a Couples-Based Randomized Controlled Trial Aimed to Increase Testing for HIV. in Journal of acquired immune deficiency syndromes (1999)

 
Description We are able to expand the detail and quality of information about parenting and caregiving collected in rural African household surveys particularly with respect to information about diverse contributions that men and women make to biological and non-biological children in the same household.
We can improve our measurement of the range of carework and extent of contact that mothers and fathers have with children with whom they are not living.
Such hard-to-reach parents, if contact can be made, are more likely than resident parents to consent to participate in data collection activities; however, in a large proportion of cases where parents are not members of the same household, resident household members living with the child act as gate-keepers restricting contact.
That increasing uptake of HIV treatment by public health service users in rural KwaZulu-Natal since 2004 has led to substantial declines in maternal and paternal mortality particularly of adults with young children. However, our analyses of longitudinal population-based data 2003-2012, shows that the level of orphaning incidence in older children remains very high and suggests that strategies to support children affected by HIV needs to adapt to the changing risk of survival post-HIV infection and meeting the needs of older adolescents and indeed, young adults during a critical period of seeking to transition from school to work.
Exploitation Route We are continuing to contribute new findings and develop secondary analyses with colleagues involved in the new Healthy Adolescents and Young Adults (HAYA) Centre that is initiating intervention research in the same population, and; which is also an evaluation community for the major new initiative DREAMS that is being tested in multiple countries. In addition, our work with the Coalition for Children Affected by HIV and AIDS is being taken forward in strategy forums linked to the International AIDS conference this year.
We have also been recently started to share our work with Dr Bernadette Daelmans, Coordinator of the WHO Policy Planning and Programmes in the Dept. of Maternal, Newborn, Child and Adolescent Health, who is convening with colleagues gaining input from experts on how to improve the data on families in the health surveys including DHS. We are delighted to be involved with this WHO initiative as this is one of the major goals of the project. We have recently started to collaborate with the African Centre for Migration & Society (ACMS), the University of the Witwatersrand, Johannesburg. The aim of the collaboration is to take forward the application of our findings on child health and welfare in the context of stretched family households, in particularly in the large, well-established flows between rural KwaZulu-Natal (the site of the ESRC-funded research) and urban Johannesburg (the primary area of ACMS studies).
Sectors Communities and Social Services/Policy,Education,Healthcare

 
Description Our research methods and findings have directly contributed to a discussion process for international and national donors and policy makers on the 'HIV-Sensitive Care Force Planning for Children', February 16-17 2016, facilitated by the Coalition for Children Affected by HIV and AIDS to UNAIDS Headquarters, 20 Avenue Appia, Geneva, Switzerland. Invited to give a plenary presentation, Hosegood was part of the discussions about how best to ensure that the needs of children affected by HIV remain on the policy agenda during international forums occurring later this year in which international heads of governments will reformulate their commitment to HIV.
First Year Of Impact 2015
Sector Communities and Social Services/Policy,Education,Healthcare
Impact Types Policy & public services

 
Description African Programme
Amount £128,401 (GBP)
Organisation Nuffield Foundation 
Sector Charity/Non Profit
Country United Kingdom
Start 04/2014 
End 04/2015
 
Description African Studies Center of the University of Michigan
Amount $1,500 (USD)
Organisation University of Michigan 
Sector Academic/University
Country United States
Start 12/2014 
End 11/2015
 
Description Gates Foundation HIV and AIDS research
Amount R 16,850,507 (ZAR)
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 12/2014 
End 04/2015
 
Description Research Collaboration Stimulus Fund/The Web Science Institute
Amount £15,000 (GBP)
Organisation University of Southampton 
Sector Academic/University
Country United Kingdom
Start 09/2015 
End 06/2016
 
Description ViiV - Healthy Adolescents and Young Adults (HAYA) Centre
Amount £3,000 (GBP)
Organisation Viiv Healthcare 
Sector Private
Country United Kingdom
Start 11/2015 
End 07/2016
 
Description ViiV Healthcare - Healthy Adolescents and Young Adults (HAYA) Centre
Amount £40,840 (GBP)
Organisation Viiv Healthcare 
Sector Private
Country United Kingdom
Start 01/2016 
End 06/2016
 
Title Two new questionnaires on parenting and child care for use in demographic surveillance systems 
Description We have developed and in the process of implementing two new questionnaires to collect data on childcare and parenting in demographic surveillance system platforms. The IPC collects information from directly from an adult about their involvement with children within and outside the household. The HPC collects information about children and adults within and outside the household from a household proxy informant. New assessments are included on child disability, strengths and difficulties of children, harsh parenting behaviours and attitudes as well as the involvement of people with children other than biological parents both within and outside the household. 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2014 
Provided To Others? Yes  
Impact We are at the stage of testing the questionnaire in one third of households and adults in the Africa Centre demographic information system. We have shared this instrument with family researchers in Uganda, Dr Danny Wight and Professor Janet Seeley, who are in the process of applying for funding to study family care arrangements in Uganda. 
 
Description African Centre for Migration & Society (ACMS) 
Organisation University of the Witwatersrand
Country South Africa 
Sector Academic/University 
PI Contribution We have engaged with Prof. Jo Vearey and colleagues at the African Centre for Migration & Society (ACMS) in the University of Witswatersrand, Johannesburg in order to take forward the findings from the ESRC project on measuring child health and welfare in contexts of stretched family households into policy-related studies in specific groups of children who are part of the well-established and sizeable circular migratory flows between rural KwaZulu-Natal and urban Gauteng including Johanesburg.
Collaborator Contribution The University of Southampton and Africa Centre for Health and Population Studies (merged into a new organisation - AHRI) bring their extensive evidence-based and data collection experience of migraiton and familes in rural KwaZulu-Natal, South Africa. ACMS has an exciting set of complementary experience working with migrants in Johannesburg, some of which has been in former townships where a large proportion of Zulu-speaking circular migrants from rural KwaZulu-Natal have historically been concentrated. ACMS is also has a strongly policy-related research mandate with close links to local municipal and regional migration agencies. Our aim in collaborating is to bring together the evidence from origin and destination communities and to consider the experiences of children in relation to health, education and welfare from a policy and practice-related perspective.
Impact We are exploring funding opportunities to undertake a set of policy case studies.
Start Year 2017
 
Description Healthy Adolescents and Young Adults (HAYA) Centre/Africa Centre/LSHTM 
Organisation Africa Health Research Institute
Country South Africa 
Sector Charity/Non Profit 
PI Contribution The Healthy Adolescents and Young Adults (HAYA) Centre has been funded by ViiV Healthcare and is jointly based at the Africa Centre for Population Health in South Africa and LSHTM. I have been involved since its inception in providing demographic expertise to its developing research agenda which focuses on the design and implementation of interventions to support adolescent HIV treatment and prevention in rural KwaZulu-Natal. Our work in the ESRC-funded Family Environment project has made an important contribution to the first scientific planning meeting in London in Feb 2015 (Adolescent Health Research in Africa Workshop) and subsequent funding of a secondary analysis of the existing data on the demographic and social context in which adolescents and their families are living and how this has changed over the period since 2000 using ACDIS data. And in contributing findings from the Parenting and Caregiving data collection conducted as part of the ESRC-funded project in which we collected information about parenting and caregiving arrangements for adolescents, the first community-based disability survey of adolescents and self-reported comparative data collected from 15-17 year olds themselves on their family and caregiving experiences. HAYA is directed by Dr Jane Ferguson, formerly the head of WHO's Adolescent programme. This new collaboration with HAYA has allowed the Family Environment project to make an direct and substantive contribution to informing a new set of adolescent health interventions including the very large multi-country DREAMS initiative that is being trialled in the Africa Centre population surveillance area. With new 5-year funding for the Africa Centre from the Wellcome Trust announced in March 2016 in which our Family Environment project contributed to the portfolio of research in the Society in Transition theme, we look forward to a long-term collaboration with the HAYA Centre at the Africa Centre in which our findings and subsequent research arising from the project will be directly used in the design and implementation of new intervention studies and programmes for roll-out in South Africa and the region.
Collaborator Contribution Using funds awarded by ViiV Healthcare, HAYA has funded the Family Environment researchers to conduct two research activities in 2016: 1. 'Adolescents in Context: The characteristics of adolescents across household, community, school and HIV treatment and care settings in rural KwaZulu-Natal' and 2. DISC-SA - A Study of Disability in Children and Adolescents in a rural South African Population' They have awarded the University of Southampton a total of £43,840 for these activities. In June 2016, the findings of these activities will be included in a symposium on Policy and programmes for adolescent health to be hosted by HAYA in Johannesburg, South Africa in advance of the International AIDS Conference 2016.
Impact Adolescent Health Research in Africa Workshop 4-5 February 2015; Wellcome Trust Gibbs Building, London, UK. Adolescent Health Research in Africa Workshop report. Available online at: https://blogs.lshtm.ac.uk/hayaresearchunit/files/2015/09/Haya-report.pdf
Start Year 2015
 
Description Healthy Adolescents and Young Adults (HAYA) Centre/Africa Centre/LSHTM 
Organisation London School of Hygiene and Tropical Medicine (LSHTM)
Country United Kingdom 
Sector Academic/University 
PI Contribution The Healthy Adolescents and Young Adults (HAYA) Centre has been funded by ViiV Healthcare and is jointly based at the Africa Centre for Population Health in South Africa and LSHTM. I have been involved since its inception in providing demographic expertise to its developing research agenda which focuses on the design and implementation of interventions to support adolescent HIV treatment and prevention in rural KwaZulu-Natal. Our work in the ESRC-funded Family Environment project has made an important contribution to the first scientific planning meeting in London in Feb 2015 (Adolescent Health Research in Africa Workshop) and subsequent funding of a secondary analysis of the existing data on the demographic and social context in which adolescents and their families are living and how this has changed over the period since 2000 using ACDIS data. And in contributing findings from the Parenting and Caregiving data collection conducted as part of the ESRC-funded project in which we collected information about parenting and caregiving arrangements for adolescents, the first community-based disability survey of adolescents and self-reported comparative data collected from 15-17 year olds themselves on their family and caregiving experiences. HAYA is directed by Dr Jane Ferguson, formerly the head of WHO's Adolescent programme. This new collaboration with HAYA has allowed the Family Environment project to make an direct and substantive contribution to informing a new set of adolescent health interventions including the very large multi-country DREAMS initiative that is being trialled in the Africa Centre population surveillance area. With new 5-year funding for the Africa Centre from the Wellcome Trust announced in March 2016 in which our Family Environment project contributed to the portfolio of research in the Society in Transition theme, we look forward to a long-term collaboration with the HAYA Centre at the Africa Centre in which our findings and subsequent research arising from the project will be directly used in the design and implementation of new intervention studies and programmes for roll-out in South Africa and the region.
Collaborator Contribution Using funds awarded by ViiV Healthcare, HAYA has funded the Family Environment researchers to conduct two research activities in 2016: 1. 'Adolescents in Context: The characteristics of adolescents across household, community, school and HIV treatment and care settings in rural KwaZulu-Natal' and 2. DISC-SA - A Study of Disability in Children and Adolescents in a rural South African Population' They have awarded the University of Southampton a total of £43,840 for these activities. In June 2016, the findings of these activities will be included in a symposium on Policy and programmes for adolescent health to be hosted by HAYA in Johannesburg, South Africa in advance of the International AIDS Conference 2016.
Impact Adolescent Health Research in Africa Workshop 4-5 February 2015; Wellcome Trust Gibbs Building, London, UK. Adolescent Health Research in Africa Workshop report. Available online at: https://blogs.lshtm.ac.uk/hayaresearchunit/files/2015/09/Haya-report.pdf
Start Year 2015
 
Description Healthy Adolescents and Young Adults (HAYA) Centre/Africa Centre/LSHTM 
Organisation Viiv Healthcare
Country United Kingdom 
Sector Private 
PI Contribution The Healthy Adolescents and Young Adults (HAYA) Centre has been funded by ViiV Healthcare and is jointly based at the Africa Centre for Population Health in South Africa and LSHTM. I have been involved since its inception in providing demographic expertise to its developing research agenda which focuses on the design and implementation of interventions to support adolescent HIV treatment and prevention in rural KwaZulu-Natal. Our work in the ESRC-funded Family Environment project has made an important contribution to the first scientific planning meeting in London in Feb 2015 (Adolescent Health Research in Africa Workshop) and subsequent funding of a secondary analysis of the existing data on the demographic and social context in which adolescents and their families are living and how this has changed over the period since 2000 using ACDIS data. And in contributing findings from the Parenting and Caregiving data collection conducted as part of the ESRC-funded project in which we collected information about parenting and caregiving arrangements for adolescents, the first community-based disability survey of adolescents and self-reported comparative data collected from 15-17 year olds themselves on their family and caregiving experiences. HAYA is directed by Dr Jane Ferguson, formerly the head of WHO's Adolescent programme. This new collaboration with HAYA has allowed the Family Environment project to make an direct and substantive contribution to informing a new set of adolescent health interventions including the very large multi-country DREAMS initiative that is being trialled in the Africa Centre population surveillance area. With new 5-year funding for the Africa Centre from the Wellcome Trust announced in March 2016 in which our Family Environment project contributed to the portfolio of research in the Society in Transition theme, we look forward to a long-term collaboration with the HAYA Centre at the Africa Centre in which our findings and subsequent research arising from the project will be directly used in the design and implementation of new intervention studies and programmes for roll-out in South Africa and the region.
Collaborator Contribution Using funds awarded by ViiV Healthcare, HAYA has funded the Family Environment researchers to conduct two research activities in 2016: 1. 'Adolescents in Context: The characteristics of adolescents across household, community, school and HIV treatment and care settings in rural KwaZulu-Natal' and 2. DISC-SA - A Study of Disability in Children and Adolescents in a rural South African Population' They have awarded the University of Southampton a total of £43,840 for these activities. In June 2016, the findings of these activities will be included in a symposium on Policy and programmes for adolescent health to be hosted by HAYA in Johannesburg, South Africa in advance of the International AIDS Conference 2016.
Impact Adolescent Health Research in Africa Workshop 4-5 February 2015; Wellcome Trust Gibbs Building, London, UK. Adolescent Health Research in Africa Workshop report. Available online at: https://blogs.lshtm.ac.uk/hayaresearchunit/files/2015/09/Haya-report.pdf
Start Year 2015
 
Description Research collaboration to examine dynamics in child care in rural South Africa 
Organisation University of Michigan
Country United States 
Sector Academic/University 
PI Contribution Our research team has been in discussion with Professor Kathy Ford at Michigan University about her involvement in working with us to analyse the Africa Centre longitudinal data on child care for orphans and non-orphans in the pre- and post-ART periods. This builds on work that our team has been doing led by the research assistant Dr Gabriela Mejia-Pailles, to examine the quality of the data on parental survival and estimate the trends in orphanhood prevalence and incidence.
Collaborator Contribution Professor Kathy Ford, a statistician, led the writing of an application to the University of Michigan for travel funds to enable us to meet at the Africa Centre in early 2015 and work together on these analyses.
Impact We have obtained a travel grant which we will use to meet in early 2015. We also have started to prepare the datasets that will be needed for the analyses. This collaboration is multidisciplinary - demography and statistics.
Start Year 2014
 
Description Adolescent Health Research in Africa Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Supporters
Results and Impact Hosegood, V. Invited speaker. Demographic context of children and adolescents informing the design and implementation of treatment and prevention programmes and studies. Healthy Adolescents and Young Adults (HAYA). Adolescent Health Research in Africa Workshop 4-5 February 2015; Wellcome Trust Gibbs Building, London, UK. https://blogs.lshtm.ac.uk/hayaresearchunit/files/2015/09/Haya-report.pdf
Year(s) Of Engagement Activity 2015
URL https://blogs.lshtm.ac.uk/hayaresearchunit/files/2015/09/Haya-report.pdf
 
Description Hosegood V. Keynote speaker. Fuzzy fathers and hidden patrons: Population and survey data on fathers and father involvement. Symposium 'Promises and Challenges of Researching Fathering in South Africa.' Medical Research Council, Tygerberg, Cape Town, 17th November 2014. 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact I was an invited keynote speaker at the symposium at the Medical Research Council in Cape Town to explore ways to promote the inclusion of fathers in health research, particularly of young children. I discussed our research work on parents, in particular biological and non-biological fathers including our new research methods, data and findings as part of the ESRC-funded Family Environment project. Hosegood V. Keynote speaker. Fuzzy fathers and hidden patrons: Population and survey data on fathers and father involvement. Symposium 'Promises and Challenges of Researching Fathering in South Africa.' Medical Research Council, Tygerberg, Cape Town, 17th November 2014.
Year(s) Of Engagement Activity 2014
 
Description Plenary presentation at the HIV-Sensitive Care Force Planning Meeting held at the UNAIDS, Geneva February 2016 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact In February 2016, the Coalition for Children Affected by HIV and AIDS (CCABA) hosted a meeting focused on HIV-sensitive "care force" planning for children. Donors, program leaders and researchers came together to identify the necessary interventions, research, advocacy and investment required to meet the unique needs of those responsible for the unpaid care of children affected by HIV. Methodology normally used for workforce planning at national or regional levels was used to help stakeholders think about better supporting familial and other unpaid workers who care for children in the home. The meeting was intended to both feed into results presented at the Coalition's biennial symposium and, ultimately, drive action in order to reach this population.
I presented a plenary presentation on the 'Demography of the Family Careforce' in which I drew directly on findings from the ESRC-Family Environment project. The presentation was very well received by those involved with implementing, planning and funding family support programmes for children in Africa. Of particular resonance was my exploration of how best to identify and maintain support for children in highly mobile family arrangements and with multiple caregiving environments. These are challenges which face practioners but which have not been given adequate attention across the range of programmes and policies targeting parents and caregivers of children who are HIV-infected and HIV-affected.
Year(s) Of Engagement Activity 2016
URL http://www.ccaba.org/what-we-do/convenings/hiv-sensitive-care-force-planning-meeting/
 
Description Population Association of America 2015 Annual Meeting. San Diego, CA 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Third sector organisations
Results and Impact Conference presentation of findings on the level and patterns of parental orphaning of children <18 and the causes of parental death. Results from the ESRC-funded Family Environment project.
Mejia-Pailles G, Hosegood V, Berrington AM. Estimating Orphaning Prevalence and Incidence before and after Antiretroviral Treatment (ART) Roll-Out in Rural South Africa, 2000-2013 (2015) Population Association of America 2015 Annual Meeting. San Diego, CA. April 30th- May 2nd 2015.
Year(s) Of Engagement Activity 2015
URL http://www.cpc.ac.uk/events/?action=story&id=397
 
Description Population Association of America 2015 Annual Meeting. San Diego, CA (Incomplete data on parents) 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Gabriela Mejia-Pailles, Vicky Hosegood and Ann Berrington, 'Exploring Factors Associated with Completeness of Parental Survival Data in a Longitudinal Surveillance System in Rural South Africa' in Data and Methods/Applied Demography/ Spatial Demography/ Demography of Crime. Population Association of America 2015 Annual Meeting. San Diego, CA. April 30th- May 2nd 2015.
Year(s) Of Engagement Activity 2015