Discussion

1. Miller C., Brooks B., Tsoka M., Rybasack H., Themba Z., Dyless A., Chitekwe M., Kambalame E., and Sabin L. (2010). Evaluation of the Child Status Index: A Validation Study in Malawi. Boston, MA. BUSPH, Center for Global Health and Development. OVC-CARE Project. Miller C., Brooks B., Tsoka M., Rybasack H., Themba Z., Dyless A., Chitekwe M., Kambalame E., and Sabin L. (2010). Evaluation of the Child Status Index: A Validation Study in Malawi. Boston, MA. BUSPH, Center for Global Health and Development. OVC-CARE Project. Evaluation of the Child Status Index Tool: A Validation Study in Malawi Lora Sabin1, Candace M. Miller1, Mohammed I. Brooks1, and Jacqueline Cho1 1Boston University School of Public Health, Center for Global Health and Development Introduction Methods The Child Status Index (CSI), was developed by MEASURE Evaluation at the Carolina Population Center to help community based organizations (CBOs) serving orphaned and vulnerable children (OVC) assess children’s needs. The CSI was designed to help CBO staff assess children in the following domains: food and nutrition, shelter and care, protection, health, psychosocial wellbeing, education and skills training We collaborated with CBOs based in Mchinji, Malawi, that were trained to use the CSI tool. CBO staff generated CSI scores for the children that they serve. We then selected a sample of the same children and/or their caregivers (depending on the child’s age) to gather more in-depth information on the same dimensions as those captured by the CSI. A local, experienced research team collected data by administering a detailed questionnaire we called the Comprehensive Child Welfare tool. We developed the CCW tool by combining validated instruments or best practice indicators in the same domain as those in the CSI. Data were collected immediately following collection of the CSI scores to reduce the likelihood that changes in the welfare of the children would bias our results. We tested construct validity by examining the correlation between CSI scores and the indicators from the CCW in the same domains. We compared the CCW data with the CSI scores for the same children. We examined the relationship between the domains from the two sources by computing the Spearman's rank correlation coefficient, which measure the strength of the relationship between variables with a ranked correlation coefficient., and does not require that the variables have a linear relationship. The study was approved by the ethical review boards of Boston University and the Malawian Ministry of Health. Despite CBO use of the CSI, there had been no rigorous evaluation of the tool to determine whether the CSI generates valid data regarding the type and degree of vulnerability facing OVC. This evaluation of the validity of the CSI, serves as an independent, external assessment of the tool in a specific country-context. RESULTS DATA ANALYSIS: Spearman Rank Correlation Coefficients and associated p-values The mean height-for-age z-score for children aged 5-10 years that were rated as having ‘good’ nutrition in the CSI was -1.08, ‘fair’ was -1.80, ‘bad’ was -1.79 and ‘very bad’ was 0.63. We would expect to see worsening mean z-scores according to the CSI ratings if the CSI scores accurately identified children with nutritional problems. Among 11-17 year olds, the mean z-score for those rated as having ‘good’ nutrition was -1.38, -1.16 for ‘fair’ nutrition, -0.51 for ‘bad’ nutrition. No 11-17 year olds were rated as having ‘very bad’ nutrition, even though 25% were stunted (2+ SD below the mean). *p<.05; **p<0.01; ***p<0.001 Discussion REFERENCES AND CITATIONS In Malawi, we were unable to validate the CSI tool given the lack of relationship between the CSI and the CCW scores. Although some CSI and CCW scores yielded weak to moderate correlations, there were still important conflicts between the food security, housing, wellness, and education scores, such that children in severe distress were not identified as so in the CSI. Without meaningful correlation in the remaining domains, we concluded that the CSI scores did not accurately assess the welfare of children in the areas of nutrition, care, vulnerability for abuse, legal protection, emotional and behavioral wellbeing, and educational performance. We therefore cannot confirm the validity of the CSI tool in assessing child vulnerability in this particular setting. In this population, children are experiencing serious problems in many domains of their lives and yet the CBO staff that visited these children did not score children as though they recognized these as issues of concern. These findings underscore the scope of unmet needs among OVC children and their households, as well as the severity of problems that OVC encounter. The CSI tool may not be able to accurately assess child welfare. Tool developers may use this evidence to modify the CSI to further improve its performance and utility. • O'Donnell K, Nyangara F, Murphy R, Nyberg B. Child Status Index (CSI): Public Domain: Developed by the support from the U.S. President's Emergency Fund for AIDS Relief through USAID to MEASURE Evaluation & Duke University, 2008. • O'Donnell K, Nyangara F, Murphy R, Nyberg B. Child Status Index: A Tool for Assessing the Well-Being of Orphans and Vulnerable Children -- Manual: United States Agency for International Development, 2009. • Miller C., Brooks B., Tsoka M., Rybasack H., Themba Z., Dyless A., Chitekwe M., Kambalame E., and Sabin L. (2010). Evaluation of the Child Status Index: A Validation Study in Malawi. Boston, MA. BUSPH, Center for Global Health and Development. OVC-CARE Project. The USAID | Project SEARCH, Orphans and Vulnerable Children Comprehensive Action Research (OVC-CARE) Task Order, is funded by the U.S. Agency for International Development under Contract No. GHH-I-00-07-00023-00, beginning August 1, 2008. OVC-CARE Task Order is implemented by Boston University. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the funding agency.