Magnitude and perceived impact of child fosterage on HIV/AIDS orphaned children: A case study of Mathare a suburb of Nairobi
BY
JAMES NYANJWA
SW/02/10

A research proposal submitted to the department of sociology and psychology for the requirements of the Bachelor of Arts degree in Social Work
MOI UNIVERSITY
4TH NOVEMBER, 2013

DECLARATION AND RECOMMENDATION
Declaration by candidate
I hereby declare that the work presented in this research proposal is my own work Citation from other information sources is given where applicable. No part of this document is to be reproduced in any other form, be it print or electronic without permission from the copyright holder
Name……………………….Sig……………….date………………….
Recommendation by Supervisor
This proposal has been submitted with my approval as the Departmental supervisor
Name………………….Sig……………….Date……………

DEDICATION
This work is dedicated to my beloved brothers Victor Onyuka and Philip Ogola without whose caring and financial support it would not have been possible and I would also like to dedicate this work to the memory of my parents, my loving dad Joseph Onyuka and caring moms Pamela Anyango and BeldineAoko who passed on the love of reading and respect for education.

ACKNOWLEDGEMENT
I would like to express my sincere gratitude to Dr. Masinde for impacting us with knowledge on research proposal. I want to thank most profoundly Mrs. Adeli for her guidance on the relevance materials needed in writing research proposal.
It is my hope that all families and institution of foster care will remain focused and committed to rescuing children from the Streets and empowering them to resourceful citizens and that this research will encourage more responses and interventions that are geared towards the same.

ABSTRACT
The care and protection of children experiencing orphan hood presents a major child-care policy challenge. This paper draws on a review of the literature to document the impact of child fosterage on the welfare of the children, how the hurdles for the care of orphans reflect wider issues of poverty and inequality, as well as the ways in which different care interventions (familial, institutional, community-based and rights-based) might be appropriated for children in need. It is argued that the map of contemporary orphan hood overlaps with the contours of global poverty, inequality, age-based deprivations and marginalization. An example of a ‘globalised’ model of orphan care, namely SOS Children’s Villages, is presented and its implications for policy are examined. The paper highlights the significance of foster families and institutions and their impact on the welfare of the child.
An abstract is a summary , it has the title, objectives, methodology and significance( all in one paragraph).

TABLE OF CONTENTS
Declaration….................................................................................................ii
Acknowledgement……………………………………………………………...iii
Dedication……………………………………………….……….……………..iv
Abstract………………………………………………………………………….v
Table of contents………………………………………………………………..vi
List of tables………………………………………………...............................vii
List of figures…………………………………………………………………….viii
Abbreviation and acronyms……………………………………………………..ix
All the above should be in c
CHAPTER ONE: INTRODUCTION
1.1OVERVIEW…………………………………………………………………..1
1.2 BACKGROUND………………………………………………………………1
1.3 STATEMENT OF THE PROBLEM ………………………………………….4

1.4 OBJECTIVE OF THE RESEARCH………………………………………………………………………..5

1.5 RESEARCH QUESTION………………………………………...…...6

1.6 JUSTIFICATION OF THE RESEARCH………………………………………………..………………………7

1.7 THEOPRATICAL FRAMEWORK…………………………………………

1.8 OPERATIONAL DEFINITION OF THE ITEMS…………………………..
All these are in lower case
CHAPTER TWO: LITERATURE REVIEW
2.1 OVERVIEW……………………………………………………………………8
2.2 SOCIO-CULTURAL AND ECONOMIC SITUATION OF THE ORPHANS…………………………………………………………………………8

2.3IMPACT OF ORPHAN HOOD ON THE WELFARE OF ORPHANS………………………………………………………………………..11

2.4THE NATURE AND CHALLENGES FAMILIES AND INSTITUTION WHICH FOSTER ORPHANS FACE AND THE IMPLICATIONS ON THE WELFARE OF THE CHILDREN……………………………………………….14
All in lower case
CHAPTER THREE: METHODOLOGY
3.1 OVERVIEW…………………………………………………………………17

3.2 RSEARCH DESIGN…………………………………………………………17

3.3 STUDY AREA…………………………………………………………………………….18

3.4 SAMPLING TECHNIQUES…………………………………………………19

3.5 SAMPLING ………………………………………………………………….19

3.6 DATA COLLECTION METHODS………………………………………….20

3.7 RELIABILITY AND VALIDITY……………………………………………21

3.8 DATA ANALYSIS……………………………………………………………………….21
Lower case
REFERENCES
APPENDICES

ABBREVIATIONS AND ACCRONYMS- start this on a new page .
HIV - Human immune deficiency virus
AIDS - Acquired immune deficiency syndrome
UN - United Nation
NGOs - Non Governmental Organizations
ARVs - Anti retroviral medicine
Should be in alphabetical order.

All magins should be one inch

CHAPTER ONE: INTRODUCTION
1.1 OVERVIEW
This chapter describes the situation of mathare slums, the in depth situation that is affecting the area of study and the means of survival of the people.
1.2 Background Mathare Slum is one of the oldest and the worst slums in Africa. Situated three miles east of Nairobi city’s central business district, Mathare slum is home to over 700,000 people occupying an area of two miles long by one mile wide. Because of congestion, survival is a daily battle for the resident’s against the backdrop of diseases, crime, prostitution and lawlessness. Life in Mathare slums is pathetic and unbearable for everyone who resides and visits the slums. Most residents are engaged in small-scale petty businesses either makeshift housing structures or on narrow open raw sewer filled alley ways; it would take a miracle for these hand-to-mouth investments to blossom into big-time business. However the manner in which these slum dwellers carry on with life is owe-inspiring and remarkable. Apart from having no access to basic amenities like clean water, food, clothing, shelter and healthcare, the close to 1 million residents also suffer the misfortune of having no roads that can allow for any emergency services like fire outbreak. The makeshift housing structures are either made out of mud or metal. There is absolutely no government security inside the slums leaving the residents at the mercies of lawless tribal gangs. A closer look of the slums reveals a depressing way of life for all. The environment is unhealthy, there are very few filthy public bathrooms but payment is demanded before one can use them, there is no garbage collection system, leaving open sewers to run the fronts of the shanties. 1. A walk through what is called “the main road” is a poor lesson in a waste disposal. Numerous examples abound and they paint a depressing picture of the area. The most disheartening of all is to learn that children who would be in school run about in tattered clothes hassling for something to eat and looking for any open space to play. These children have nothing except their life and age in common with the children in better placed city localities. The children and youth in Mathare slums live under pathetic conditions. Most of the children come from single parented homes, while others come from very poor families since their parents are sick, unemployed or underemployed. Orphans who are helpless after both or one of their parents die of HIV-Aids or other causes are forced to face the harsh reality of unbearable slum life. These children and youth have no one to care for them in this dangerous slum.
The situation is worsened when orphaned children and those from poor families turn to fend for themselves in the alley way, the young girls live under the fear of being raped, some turn to prostitution to earn a living, leading to the rise of teen pregnancies and abortion cases which further damages their emotional well-being. Looking for money to support their drug and alcohol habits and a sense of belonging, the young boys join gangs in the slums to rob and mug people in and outside Mathare slums leading to insecurity in Mathare slums, the city of Nairobi and the whole country of Kenya. Apart from robbery, use of drugs and alcohol, these young boys are often recruited by powerful drug cartels to peddle drugs which lead to other forms of criminality. Despite the gloomy outlook in Mathare slums and other marginalized areas in Africa.

2. Looking at the situation in mathare the activities young boys and girls endulge in for survival, how girls live in fear, this case study focuses on assessing the magnitude and perceived impact of child fosterage on the HIV/AIDs children. It goes on to examine the impact of HIV/AIDS on the welfare of the children and continues to look at the challenges families and institutions which foster orphans face and their implications on the welfare of the children.

3.
1.3 STATEMENT OF THE PROBLEM
HIV/AIDS transforms generational relationship by placing heavy material and emotional burdens on both the sick and on those who act as caregivers. This project focuses on child foaterage in Mathare slums, the issue is of a particular concern where HIV positive children are neglected by their parents, others are forced to adopt parental roles in order to survive, their situation of living in fear and mistrust. The aim of the study is to assess the challenges posed by orphans to foster families and institutions and the solution to dealing with it.

4.
1.4 OBJECTIVE OF THE STUDY 1. To describe the socio cultural and economic situation of orphans 2. To examine the impact of HIV/AIDS on the welfare of the children 3. To identify the nature and the kinds of the challenges families and institution which foster orphans face and the implications in the welfare of the children

5.
1.5 RESEARCH QUESTION 1. What social and cultural problems do orphans face with the immediate foster family and institution and in the wider society? 2. What is the impact of orphan hood on the welfare of HIV positive orphan children? 3. What kinds of challenges do families and institution that foster families face and how does this impact on the welfare of the children under their care

6.

1.6 JUSTIFICATION OF THE STUDY
Studies in HIV/AIDS in Africa have tended to concentrate on behavioral aspects, transmission issues, AIDS progression rates and patient care. Few studies have published findings on orphan care and especially the challenges the foster families and institutions face. This is in spite of the fact that more than ever the problem of AIDS orphans is becoming more and more acute as AIDS mortality continues to increase to increase. This study therefore brings into focus the nature and the extent of the problem faced by foster families and institutions in their attempts to provide care to orphans.
In addition, the AIDS pandemic has led to proliferation of a number of NGOs seeking to address the problem through home based care or through orphanages. It is there imperative to find out the effectiveness of the institution the NGO s have set up to address the problem of orphans and to make recommendations on how they can improve on their services.

7.
CHAPTER TWO: INTRODUCTION
2.1 OVERVIEW
In this chapter, the information entails the socio cultural and economic situation of orphans, the impact of orphan hood on the welfare of children and the nature and kinds of challenges families and institutions which foster orphans face and the implications on the welfare of the children.
2.2 The socio cultural and economic situation of orphans
Foster care is a full-time substitute care of children outside their own home by people other than their biological or adoptive parents or legal guardians. An 'orphan' is defined by the United Nations as a child who has 'lost one or both parents'. Worldwide, it is estimated that more than 16 million children under 18 have been orphaned by AIDS. Around 14.8 million of these children live in sub-Saharan Africa. AIDS is responsible for leaving vast numbers of children across Africa without one or both parents. In some countries, a larger proportion of orphans have lost their parents to AIDS than to any other cause of death - meaning that, were it not for the AIDS epidemic, these children would not have been orphaned.
HIV/AIDS is a heterosexual epidemic in Mathare affecting mainly prime-age adults. HIV/AIDS in the region must be seen in the context of poverty. The poor are not only at high risk for infection but also face the greatest difficulty in accessing treatment once they are infected. Immune systems already compromised from malnutrition and other diseases contribute to infected individuals’ vulnerability to opportunistic infections. Once sick, the social and economic consequences for the individual as well as his/her household are magnified.
8.
Should the sole income earner in a household suffer from and eventually die from the disease, the rest of the household will inevitably suffer. Gender differences in vulnerability and susceptibility to HIV infection are an important component of the epidemic in Mathare. In Mathare, women are at greater risk for infection than men. While anatomical differences make women more susceptible physiologically, women’s social location also contributes to higher infection rates. Evidence is beginning to show that its elderly citizens in Mathare also bear a large burden as their children suffer and die from HIV/AIDS. The repercussions on the elderly are likely to be economic, emotional and physical.
In Mathare where the study is focused, has high cases orphans dropping out of school. Due to poverty level which is very high parents who are HIV positive and cannot support their children who are also HIV positive they neglect their children. There are a lot of cases reported by foster care institutions whereby they find a small baby dropped at the gate of the NGO. An example is Maji Mazuri Children Centre an NGO in Kasarani a suburb of Nairobi, a child roughly 2 to 3 years was found at the gate very ill and malnourished. When the case was followed by the social worker in the organization it was found that the boy was from Mathare slums, the child would identify the mother but it was quite unfortunate because the mother totally denied that she was the mother of the child, there the child was adopted by the organization. This is an example of the many cases reported by foster care institutions and families related in Mathare. Most people live a life of food to mouth, even children have adopted the role of parents to such for food, so many turn to be street children, thieves or engage in any activity like prostitution just to earn income to feed themselves. It is so painful that even the society in Mathare has accepted this fact and it’s normal to them.
9.
Little is known about the health and nutritional status of fostered children and children living with HIVinfected parents in Mathare. Despite the attention surrounding the orphan crisis in Mathare slums, orphan hood with respect to their exposure to HIV infection have a risk factor for early sexual activity, unprotected sexual activity, and HIV infection among adolescents of Mathare slums, stemming from poverty, emotional distress, and/or lack of parental or societal control.

Always acknowledge the source of your information

10.
2.3 IMPACT OF ORPHAN HOOD ON THE WELFARE OF HIV POSITIVE ORPHANS CHILDREN.
Childhood orphan hood is considered a major risk factor for poverty in adulthood, though, among other channels, shortfalls in human capital investments in children. This paper provides unique evidence on the impact of orphan hood in Mathare, a suburb of Nairobi in an area ravaged by HIVAIDS. The focus is on orphaned children experiencing the loss of one or both parents during the survey period, controlling for their characteristics and survival life. Since HIV in Africa is transmitted primarily through heterosexual contact, the epidemic is having a major effect on the mortality of men and women in their prime childbearing and earning years; consequently, mortality rates have risen and life expectancies have fallen dramatically in Africa. As a consequence, orphan hood rates are increasing and putting a larger share of children at risk.

Changes in caregiver and family composition: As a result of death and migration, family members, including dependent children, often move in and out of households. Caregivers change and siblings may be split up. Separation from siblings has not only been found to be a predictor of emotional distress in children and adolescents, but children become more vulnerable when they are cared for by very aged relatives due to the conditions of mutual dependency that often exist between adult and child. Death and migration may also result in the creation of child-headed households. These are most likely to form when there is a teenage girl who can provide care for younger children, when there are relatives nearby to provide supervision, and siblings either wish to stay together or are requested to do so by a dying parent.
11.
New responsibilities and work for children: Several studies have shown that responsibilities and work, both within and outside of the household, increase dramatically when parents or caregivers become ill or die. In such circumstances, instances of work and responsibility being given to children as young as five have been observed. Responsibilities and work in the household include domestic chores, subsistence agriculture and provision of care giving to very young, old and sick members of the household. Work outside of the home may involve a variety of formal and informal labour, including farm work and begging for food and supplies in both the community and beyond.
Education: In households affected by HIV/AIDS, the school attendance of children drops off because their labour is required for subsistence activities and, in the face of reduced income and increased expenditure, the money earmarked for school expenses is used for basic necessities, medication and health services. Even where children are not withdrawn from school, education often begins to compete with the many other duties that affected children have to assume. In addition, stigmatization may prompt affected children to stay away from school, rather than endure exclusion or ridicule by teachers and peers.
Loss of home and assets: As effects on households deepen and parents die, children may suffer the loss of their home and livelihood as most dwellers in mathare live in rental houses which are in poor condition. The children will be forced to live in the street because of the difficulty in paying rent and searching for food for survival. Health and nutrition: Children affected by HIV/AIDS may receive poorer care and supervision at home, may suffer from malnutrition and may not have access to available health services, although no studies have yet demonstrated increased morbidity and mortality among broadly affected children compared to unaffected control groups.
12.
In this regard, it has been suggested that the safety nets of families and communities are still sufficiently intact to protect the majority of children from the most extreme effects of the epidemic or alternatively, that orphans may not be worse off than peers living in extreme poverty. Indeed, with high levels of ambient poverty in most high-prevalence communities, it is difficult to ascertain which effects on children’s health are attributable specifically to HIV/AIDS.

Psychosocial impact: Affected and orphaned children are often traumatized and suffer a variety of psychological reactions to parental illness and death. In addition, they endure exhaustion and stress from work and worry, as well as insecurity and stigmatization as it is either assumed that they too are infected with HIV or that their family has been disgraced by the virus. Loss of home, dropping out of school, separation from siblings and friends, increased workload and social isolation may all impact negatively on current and future mental health. Existing studies of children’s reactions suggest that they tend to show internalizing rather than externalizing symptoms in response to such impacts depression, anxiety and withdrawal as opposed to aggression and other forms of antisocial behavior.
Vulnerability to infection: Apart from other impacts, children affected by HIV/AIDS are themselves often highly vulnerable to HIV infection. Their risk for infection arises from the early onset of sexual activity, commercial sex and sexual abuse, all of which may be precipitated by economic need, peer pressure, lack of supervision, exploitation and rape. Some studies of street children, for example, show that vulnerable children do little to protect themselves from HIV infection because the pressures for basic survival such as finding food far outweigh the future orientation required to avoid infection. DITTO
13.
2.4 THE NATURE AND CHALLENGES FAMILIES AND INSTITUTION WHICH FOSTER ORPHANS FACE AND THE IMPLICATIONS ON THE WELFARE OF THE CHILDREN
The UN estimates that up to 8 million children around the world are living in care institutions. The actual figure is likely to be much higher, due to the proliferation of unregistered institutions and the lack of data on vulnerable children. In both developed and developing countries, care institutions are financed and run by both government and private providers, including local and international NGOs, faith-based organizations, private businesses and concerned individuals. In some countries, while some of these providers may be registered with the State, others operate independently and may even be unknown to the authorities. Contrary to common assumptions, the overwhelming majority of children (at least four out of five) in care institutions have one or both parents alive. With support, these parents could look after their own children. Most children in institutions come from poor families and/or those that are discriminated against, although the link is not always straightforward.
The larger issue of the population of orphans not being able to be absorbed into the communities that they live in which has been traditionally what has happened to orphans across the world, but they are usually absorbed in extended families. This is a big challenge to the institutions of foster care to absorb all of them.
Financial problem is a challenge to most institution as they depend on donors, sponsors and good will from people. Therefore providing and sustaining the children, providing them with all their needs is a problem making it difficult for the institutions and families providing foster care because of inadequate finance to support the orphan children.

14.
Most children have untraceable background; this creates difficulty in tracing the background of the child in a situation of exiting of the child. Some children do not have information of their relatives or even their home area making it more complicated forcing institutions to fully support them until they are old enough to be independent which makes it a challenge due to capacity problem.
In cases of single parents who are not able to provide for their children, when Institution of foster care adopts the child the parents tend to assume their responsibility as parents and abandon the child to the Institutions. This is a challenge to the institution.
Lack of government support, the government does not provide any support to the families and institutions of foster care, this makes the situation to be more difficult to handle since the number of orphan children is increasing, which becomes a challenge.
Even though the families and institutions experience a lot of challenges, it has created a big implication to the welfare of the children
Improved health status, the families and institutions of foster care have provided food and shelter to the children, hence improving their condition from malnourished to being strong and healthy.
Provision of home environment. They have filled the gap of the lost parents making the children to feel normal and getting parental care as normal. This improves the psychological and emotional growth of the child.
Provision of education. Most orphans dropped out of school, but after being adopted they are able to acquire education and school like any other normal child. The foster families and institutions provide requirements needed in school and pay school fees giving the child the opportunity to acquire education.
15.
Monitoring and provision of ARVs to the children. The foster families and institutions monitor the children and make sure the children take medication on time regularly as prescribed and acquire ARVs when they get over.

16.
CHAPTER THREE: METHODOLOGY
3.1 OVERVIEW
This chapter provide information on the type of methods to be used in the collection of data in the study, the in depth explanation of the study area, the research design, sampling and sampling techniques, reliability and validity of the data and data analysis of the study.

3.2 Research design
A case study is a descriptive, exploratory or explanatory analysis of a person, group or eventSource?. This research adopts a case study as a research design. The research is case study of Mathare slums, it is about assessing the magnitude and perceived impact of child fosterage on the HIV/AIDS children.

17.
3.3 Study Area
The research is situated in mathare slums a suburb of Nairobi, Kenya. Mathare is situated three miles east of Nairobi city’s central business district, Mathare slum is home to over 700,000 people out of the Kenyan population of 32,021,856 people.It occupies an area of two miles long by one mile wide. The land covers approximately 1sq km and 4sq miles. Most live on an income of less than a dollar per day. Crime and HIV/AIDs are common. Many parents die of AIDS and leave their children to fend for themselves. Mathare Community Outreach tries to care for as many of these orphans as possible, but their resources are limited. People live in 6 ft. x 8 ft. shanties made of old tin and mud. There are no beds, no electricity, and no running water. People sleep on pieces of cardboard on the dirt floors of the shanties. There are public toilets shared by up to 100 people and residents have to pay to use them. Those who cannot afford to pay must use the alleys and ditches between the shanties. "Flying toilets" are plastic bags used by the residents at night, and then thrown into the Nairobi River, which is the source of the residents' water supply.

18.
3.4 Sampling Techniques
The research would adopt stratified sampling, a type of probability sampling. Explain further how you would use this technique
3.5 Sampling
The research would categories the population into total orphans, single parents and orphans who have both parents. Accordingly, sampling will not consider gender or even the level of education. 20 of each category will be sampled whereby the total sample of total orphans, single parent orphan and orphan who have both parent will be 60.

19.
3.6 Data Collection Methods
To generate data therefore, this research will largely employ two major approaches of quantitative and qualitative. Quantitative approach is whereby the first hand information is gotten from the people themselves, either by one on one interaction(interview) or by putting down on writing(questionnaires). Whereas, qualitative approach is the secondary source, which mainly deals with the study of past literature accredited sources. These therefore rely on questionnaires, interviews and personal insight and observation as research instruments.

20.
3.7 Reliability and Validity
The research employs a type of triangulation method, methodological triangulation whereby there is the use of more than one method in the collection of data in the study. There is the use of quantitative and qualitative approach, interviews, questionnaires, personal insight and observation in the collection of data. This helps in provision of consistency of results and full access of information that enables reliability and validity in this research.

3.8 Data analysis
The research will use both simple qualitative and simple quantitative analysis in data analysis. How?

21.
REFERENCE
Alexander, G. & Huberty, T. J. (1993). Caring for troubled children: The Villages follow-up study. Bloomington, IN: The Villages of Indiana. Altshuler, S.J. (1997). A reveille for school social workers: Children in foster care need our help. Social Work in Education.

American Academy of Pediatrics. (1994). Health care of children in foster care. Pediatrics, 93(2), 335-338.

American Academy of Pediatrics Committee on Early Childhood, Adoption and Dependent Care (2000). Developmental Issues for Young Children in Foster Care. Pediatrics, 106, pp. 1145-1150.

Bass S, Shields MK, Behrman RE. Children, families, and foster care: Analysis and recommendations. Future Child. 2004; 14(1):4–29
Briere, J., & Runtz, M. (1989). The trauma symptom checklist (TSC-33): Early data on a new scale. Journal of Interpersonal Violence, 4(2), 151-163.

Colton M, Aldgate J, Heath A. Behavioral problems among children in and out of care. Social Work & Social Sciences Review. 1990; 2:177–191.

Conell A.,M., Goodman S.,H.(2002) Psychological Bulletin. 5. Vol. 128.. The association between psychopathology in fathers versus mothers and children’s internalizing and externalizing behavior problems: A meta-analysis; pp. 746–773.

Department of Social Welfare, Republic of Ghana. (Undated). Guidelines for the operation of orphanages in Ghana.

Foster, G. (2000). The capacity of the extended family safety net for orphans in Africa. Psychology, Health & Medicine, 5(1), 54-62.

S Luthar & E Zigler, Vulnerability and competence: A review of research on resilience inchildhood, American Journal of Orthopsychiatry, 45, 1991, pp 223–235.

Where are your data collection instruments?

*make corrections and proceed to collect data