title: The contribution of schools to supporting the well being of children affected by HIV in eastern Zimbabwe.
abstract: OBJECTIVE
  Schools are often cited as a source of support for orphans and children affected by HIV/AIDS in populations experiencing generalized HIV epidemics and severe poverty. Here we investigate the success of schools at including and supporting the well being of vulnerable children in rural Zimbabwe.
  
  
  METHODS
  Data from a cross-sectional household survey of 4577 children (aged 6-17 years), conducted between 2009 and 2011, were linked to data on the characteristics of 28 primary schools and 18 secondary schools from a parallel monitoring and evaluation facility survey.
  
  
  METHODS
  We construct two measures of school quality (one general and one HIV-specific) and use multivariable regression to test whether these were associated with improved educational outcomes and well being for vulnerable children.
  
  
  RESULTS
  School quality was not associated with primary or secondary school attendance, but was associated with children's being in the correct grade for age [adjusted odds ratio 2.0, 95% confidence interval (CI) 1.2-3.5, P = 0.01]. General and HIV-specific school quality had significant positive effects on well being in the primary school-age children (coefficient 5.1, 95% CI 2.4-7.7, P < 0.01 and coefficient 3.0, 95% CI 0.4-5.6, P = 0.02, respectively), but not in the secondary school-age children (P > 0.2). There was no evidence that school quality provided an additional benefit to the well being of vulnerable children. Community HIV prevalence was negatively associated with well being in the secondary school-age children (coefficient -0.7, 95% CI -1.3 to -0.1, P = 0.03).
  
  
  CONCLUSIONS
  General and HIV-specific school quality may enhance the well being of primary school-age children in eastern Zimbabwe. Local community context also plays an important role in child well being.
authors.affiliation: aDepartment of Infectious Disease Epidemiology, Imperial College London, London, UK bBiomedical Research and Training Institute, Zimbabwe cDepartment of Social Psychology, London School of Economics and Political Science, London, UK dDepartment of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Erica L
authors.initials: EL
authors.lastname: Pufall
authors.forename: Simon
authors.initials: S
authors.lastname: Gregson
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Eaton
authors.forename: Tidings
authors.initials: T
authors.lastname: Masoka
authors.forename: Edith
authors.initials: E
authors.lastname: Mpandaguta
authors.forename: Louise
authors.initials: L
authors.lastname: Andersen
authors.forename: Morten
authors.initials: M
authors.lastname: Skovdal
authors.forename: Constance
authors.initials: C
authors.lastname: Nyamukapa
authors.forename: Catherine
authors.initials: C
authors.lastname: Campbell
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D012574:Schools; D012944:Social Support; D055815:Young Adult; D015030:Zimbabwe