Evaluation of the Child Status Index



Final Report 2010

Sabin, L., Brooks B., Tsoka M., Miller C., Sabin L. (2011). “Measuring vulnerability among orphans and vulnerable children in rural Malawi: validation study of the Child Status Index tool.” In review.

Abstract: Objectives:  To validate the Child Status Index (CSI) as an instrument that can meaningfully measure the vulnerabilities of orphaned and vulnerable children (OVC), including those infected and affected by HIV/AIDS.

Methods:  Two instruments comprised of previously validated tools and indicators commonly considered best practice were administered to 102 children aged 5-10 years and 100 children aged 11-17 years in Mchinji, Malawi. Respondents were randomly sampled from a roster of children recently scored with the CSI tool. For each of the CSI’s twelve sub-domains, we assessed construct validity using Spearman Rank correlation coefficients. We also calculated cross tabulations to explain the resulting correlation coefficients. Analyses were conducted separately for the two age groups.

Results: No relationships exceeded the standard for high construct validity (≥0.7). Only 2 were moderate (0.3-0.7), both for the younger age group: food security (0.4) and wellness (0.36). All other relationships were weak or negative. In most sub-categories, a substantial proportion of children indicated distress that was not evident from CSI scores. In the abuse and exploitation sub-domain, all children were rated as “good” or “fair” by the CSI, but among surveyed children aged 11-17, 20% or more reported being beaten, kicked, locked out of the house, threatened with abandonment, cursed, and made to feel ashamed.      

Conclusions: In this rural Malawi population, we were not able to validate the CSI as a tool for assessing the vulnerabilities of OVC. We recommend caution in interpreting CSI scores, revisions to the tool, and further validation research.   

Children affected by HIV/AIDS have many needs. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), an initiative with the largest financial commitment to the global HIV/AIDS response, has made assistance to orphans and vulnerable children (OVC) a major priority. OVC are children aged 0-17 years who are either orphaned, or made  vulnerable because of HIV/AIDS.1  By 2008, PEPFAR had supported care for more than four million OVC, providing over $300 million for OVC activities in 2008 alone.2 In 2006, PEPFAR supported the development of a tool to measure the vulnerabilities and needs of OVC, and outcomes of OVC services. The Child Status Index (CSI) was developed by U.S.-based researchers with input from partners and potential future tool users in sub-Saharan Africa.3 It was made available publicly in 2008.4

The CSI is comprised of 6 domains that address: 1) Food/nutrition; 2) Shelter and care; 3) Protection; 4) Health; 5) Psychosocial situation; 6) Education and skills training (Table 1).4 Every domain, in turn, has two specific factors that community workers identified as key areas of concern during the development phase. The factors were designed to help community workers identify urgent situations for a child.3 A field guide recommends the use of several sample questions to consider for each factor. For example, Domain 1, ‘Food and Nutrition,’ encompasses factors ‘food security’ and ‘nutrition and growth.’ The questions for the former include: “Tell me about times when there is no food;” and “Does this child complain of hunger?”5 For each factor, the guide recommends that assessors provide a score that indicates the child’s situation: good, fair, bad, or very bad.3, 5

Throughout several African countries, various agencies, including community based organizations (CBOs), have been using the CSI. While the extent of CSI utilization is unclear, a 2009 survey distributed to OVC organizations elicited responses from 18 organizations operating in 9 countries.6 Of these, most were non-governmental organizations (NGOs).

The primary motivation for developing the CSI was to establish a tool for widespread use. Thus, it is critical to evaluate the tool’s ability to generate valid information regarding child vulnerability. This study is an independent assessment of the construct validity of the CSI.