ASSESSMENT OF NURSE-LED RESILIENCE TRAINING AND PEER SUPPORT INTERVENTIONS ON THE MENTAL AND SOCIAL WELL-BEING OF ORPHANS AND VULNERABLE CHILDREN IN OSUN STATE, NIGERIA

CHAPTER ONE

INTRODUCTION

1.1. Background of the Study

Globally, the well-being of children has been a subject of great concern. For many years, multilateral organizations such as the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), bilateral organizations, non-profit groups, and charitable foundations have focused their resources on improving the health and well-being of children. Nonetheless, the health needs of millions of children still remain unmet. Children under the age of 18 constitute a third of the world population (UNICEF, 2012). According to World Population Awareness (2010), 2.2 billion of the people living in the world are under 18 years old, with 2 billion from developing countries. Children are one of the groups at risk of diverse health problems, which sometimes become worsened when they lose eitheror both parents who take responsibility for ensuring that they are physically, psychologically, emotionally,, and spiritually healthy. Therefore, the loss of parents has been identified as a major threat to the health of children in general (Segendo and Nambi, 1997; Manuel, 2002; Atwine et al., 2005; and Nyamukapa et al., 2008). 

Out of the two billion children in the developing countries, over 140 million under the age of 18 have lost one or both of their parents. And sub-Saharan Africa, where Nigeria is located, has the largest orphan burden of over 70 million children (State of the World's Children, 2011). In Nigeria, out of the total population of 140 million in 2008, total orphans and vulnerable children (OVC) were estimated at 17.5 million, constituting 24.5% of the children’s population (Federal Ministry of Women Affairs and Social Development, 2008). Although the HIV/AIDS epidemic has been reported to be the main cause of orphanhood and vulnerability, most children are orphaned and made vulnerable by other causes such as natural disasters, family or communal conflicts, poverty, and other health conditions (Gulaid, 2008).  

Aday (2001) defined vulnerability as being susceptible to neglect or harm or being at the risk of poor social, psychological, and/or physical health outcomes. On the other hand, Leight (2003) defined vulnerable population as groups who have a heightened risk for adverse health outcomes. One important category of such groups in Nigeria is the orphans and vulnerable children, which include children affected by HIV or other chronic illnesses, children in need of alternative family care, the abused and neglected children, physically challenged ones, children affected by armed/communal conflicts and children in need of legal protection (National Guidelines and Standards of

Practice on Orphans and Vulnerable Children, 2007).

These children often face a lot of adversities in their pathway of development to full adulthood (Brooks, 2006). The adversities may compromise their health or assist them to develop resilience that enhances their well-being depending on the resources at their disposal. The process of growing up in itself is a task that children often learn how to cope with. Besides, the diverse challenges experienced by OVC further deepened their vulnerability, exposing them to varying degrees of psychosocial health problems, which may hamper their ability to cope with life challenges. Conversely, some individuals among the vulnerable children may not exhibit poor psychosocial health outcomes despite all the varying risk factors that they are continually exposed to (Alvord and Grados, 2005; Brooks, 2006;; and Masten, 2007, 2011). The risk factors may be internal or external hazards or threats that increase the child’s vulnerability or susceptibility to negative developmental and health outcomes (Engle, Castle, and Menon, 1996). When individuals made vulnerable are able to cope with life challenges so as to attain optimal health with good health outcomes, the individual is said to be resilient (Masten, Best, and Garmezy, 2005). 

Resilience as a concept has often been used to describe a person’s ability to cope with living in spite of stresses and problems while building strengths that protect and promote well-being (Luthar, Cicchetti, and Becker, 2000; Masten, 2001; and Boyden and Mann, 2005). Ungar (2008) defined resilience as the individual capacities, behaviors, and protective processes associated with health outcomes despite exposure to a significant number of risks. Resilience is recognized as depending on both individual and group strength and is highly influenced by supportive elements in the wider environment. Those positive reinforcements in children’s lives are often described as “protective factors” or “protective processes” (Boyden and Mann, 2005). They operate at different levels and through different mechanisms—individual, family, communal, and institutional—and they frequently correlate with and complement one another. Their effects are shown only in their interaction with risk (Boyden and Mann, 2005). 

AccordingAccording to Crawford, Wright,, and Masten (2005), resilient children are expected to adapt successfully even when they experience stress or trauma that is against their health and development. However, some vulnerable children may not have the necessary resources (protective factors) to help them cope well; thus,s, they become more susceptible to negative health outcomes,, most importantly those that affect their psychosocial well-being. However, major responses addressing the needs of OVC have been focused on their physical well-being while neglecting their psychosocial well-being. The last situational assessment and analysis of OVC in Nigeria by the Federaleral Ministry of Women Affairs and Social Development (2008) found that OVC were significantly more likely to experience psychosocial distress than non-OVC.

Common psychosocial distress reported in literature among this population includes symptoms of anxiety, depression, hopelessness, low self-esteem, and suicidal ideation (Williamson, 2000; Makame etl., 2002; Atwine etl., 2005; Zhao etl., 2007; and Boris etl., 2008). Past studies have consistently linked orphanhood to psychosocial distress among the vulnerable children (Nyamukapa et al., 2008,, and Gilbborn et al., 2006). Most comparative studies have shown that orphans are more at risk for impairment on some psychological dimensions, such as depression, anxiety, and low self-esteem,, than non-orphans' vulnerable children (Segendo and Nambi, 1997; Manuel, 2002; and Atwine et al., 2007). 

The conclusion that could be drawn from several pieces of literature reviewed in this study is that loss of parents and other causes of vulnerability are likely to endanger the psychosocial health of a child. In the light of this, providing physical or material support in the form of clothes, food, shelter, and money will not be enough if the psychological well-being as well as the social interaction of the child is unhealthy. According to the National Standard of Practice for OVC in Nigeria (2007), psychosocial needs of orphans and other vulnerable children have often been ignored, superficially handled, or seen as a specialized low-priority type of intervention. Without their psychosocial health needs being met, the OVC cannot eat, learn, and relate well. It is, therefore, pertinent that this aspect of care be handled with care for children to enhance their performance in other areas of life.

Protecting and enhancing the psychosocial well-being of children is recognized as a major priority in Nigeria for ensuring healthy growth and development of the capacity of vulnerable children to achieve their full potential, while increasing attention is also being given to workforce development across a broad range of professions in helping to protect and nurture children (Federal Ministry of Women Affairs and Social Development, 2008). The care of vulnerable children is a significant public health issue that must be addressed through public health values and concepts, principally universal access to public health professionals through child health promotion programs (Hall and Elliman, 2003; Department of Health and DfES, 2004). Therefore, there is a need to educate and support public health care practitioners so that they can have the necessary values, knowledge, and skills to work effectively with vulnerable children and their families. Public health nurses and school teachers are uniquely placed to increase key protective factors that can assist children to be psychologically and socially stable in the face of adversity.

A review of thA reviewe effects of various interventions designed to promote resilience and improve psychosocial health outcomes across different countries shows that most interventions have been very useful (Cowen, Wyman, Work,, and Iker, 1995; Gance-Claveland,, 2000; Houck, Darnell,, and Lussmann, 2002; Brown etl., 2009a; Karthik-Lakshmann and Mythili, 2010; Jordan et al., 2010;; and Miller etl.,, 2011); however, the outcome measures differ from study to study. Common psychosocial interventions explored by researchers in previous studies include counseling,memory books,, peer support or kids'' clubs, and resilience games. Out of all these interventions, resilience building has been neglected in most interventions addressing the psychosocial health needs of OVC in Nigeria. e focusThe focusupport has been on peer support clubss and counseling. However, studies have shown that people with a highgh level of resilience are likely to notice positive meaning within the problem they face, endured fewer depressive symptoms,, and experienced more positive emotions (Fredrickson et al., 2003, and Bonano et al., 2007). Also, building resilience has been found to be central in personal, social, mental, and physical developments (Wagnild, 2009).