Cognitive, Motor, and Behavioral Development of Orphans of HIV/AIDS in Institutional Contexts

Abstract

This chapter describes the cognitive, motor, and behavioral development of sixty 2- to 35-month-old infants living in institutional settings in Malawi. This assessment is critical given the growing number of orphaned infants in sub-Saharan Africa due to the HIV/AIDS pandemic (Malawi National Statistical Office and UNICEF, Malawi Multiple Indicator Cluster Survey (MICS) 2006: Preliminary report. Zomba: Malawi National Statistical Office, 2007). As a result, infant orphanages are becoming increasingly common in this region (Beard, J Community Health Nurs 22:105–115, 2005), yet little is known about the quality of care provided in these institutions nor about the developmental outcomes of the children living in them. We found that children’s cognitive and motor development appeared to be less optimal, while their behavioral development was more optimal, than representative US samples. These findings are discussed in relation to available comparative African and institutional data and related to a general analysis of the caregiving and environmental context. Recommendations for future systematic assessments of the quality of the physical and social environment, as well as of children’s health (including HIV status) and nutrition, are outlined. This research is critically needed to inform orphan-care providers and policy makers in sub-Saharan Africa as to the current developmental functioning of institutionalized children.