Table 1

Study measures for inclusion within the OCAY study

DomainMeasuresExample items and response categoriesExamples of previous use and/or validation within LMIC
Demographic and social circumstance factors
 Demographic informationChild age, biological sex, gender and basic demographic information will be obtained from items using the South African Census.27
 Anthropometric measurementsHeight and weight will be obtained to assess physical development.
 Household food securityStudy-specific items adapted from the household food insecurity access scale (10 items), which measures food security in the previous 30 days.Eg, Did you worry that your household would not have enough food?
Response: never/rarely/sometimes/often
Marlow et al (South Africa)28
Knueppel et al (Tanzania)29
Kabalo et al (Ethiopia)30
 Socioeconomic statusDo you have running water? Do you have electricity? Do you have a flush toilet?Eg, Do you have running water at your house?
Response: yes/no
Du Toit et al (South Africa)31
Socioeconomic status will also be measured by measuring access to the top eight socially perceived necessities for children, as identified by the Centre for South African Social Policy in the ‘Indicators of poverty and social exclusion project’32 and endorsed by over 80% of the South African population in a nationally representative survey (the South African Social Attitudes Survey 2006).33 These include items such as ‘enough clothes to keep you warm and dry’.Please tick all of the things that you can afford at home….
Response: three meals a day, school fees
Cluver et al (South Africa)34
Steventon Roberts et al (South Africa)35
Cash grant receipt.Eg, Are you or anyone in your household receiving any grants?
Household employment.Eg, How many people in your household are employed?
 Household informationStudy-specific questions on household arrangements and living circumstances.Eg, What type of house do you live in?
Response: house made of bricks on a separate yard/block of flats
 COVID-19Study-specific questions on experience of COVID-19 including caregiver death, COVID-19 infection within the household, experience of lockdown and presence of long COVID.Eg, Were you or anyone in your household infected with COVID-19?
Response: yes/no
 HIVStudy-specific questions on household HIV status, testing, status and treatment.Eg, Is anyone in your household living with HIV?
Response: yes/no/do not know/decline to answer
 Overall health statusAn adapted subscale from the International Classification of Functioning Disability and Health (3 items) will be used to assess self-reported health within the previous 12 months.36Eg, In the last 12 months, did you have difficulty remembering things or following a story or conversation?
Response: no, no difficulty at all/yes, some difficulty/yes, a lot of difficulty/cannot do it at all
 Sexual and reproductive healthStudy-specific questions adapted from the National Survey and risk behaviour among South Africans37 will be used to explore sexual and reproductive health. Items focus on sexual activity, age of sexual debut, contraception use, transactional sex, substance use during sexual activity, pregnancy and sexual abuse.Eg, Are you currently in a sexual and/or romantic relationship or have you ever been in a sexual and/or romantic relationship?
Response: yes/no
 Health service utilisationStudy-specific questions regarding what health services have been accessed by the participant in the previous 12 months.Eg, Which of the following health services have you accessed in the last 12 months?
Mental health
 Depressive symptomsThe Child Depression Inventory Short Form (10 items)38 was used to assess depressive symptomology within the previous 2 weeks.Eg, Select the statement which best describes how you have felt in the past 2 weeks.
Response: nothing will ever work out for me/I am not sure if things will work out for me/things will work out for me OK
Suliman (South Africa)39
Cluver et al (South Africa)34
Sherr et al (South Africa, Malawi, Zambia)40
Roberts et al (South Africa)41
The Patient Health Questionnaire-9 (9 items)42 was used to assess depressive symptomology within the previous 2 weeks.Eg, Have you felt down, depressed, irritable or hopeless?
Response: not at all/several days/more than half the days/nearly every day
Aggarwal et al (South Africa)43
Mudra Rakshasa-Loots et al (South Africa)44
Chibanda et al (Zimbabwe)45
 Anxiety symptomsThe Generalised Anxiety Disorder-7 (7 items)46 was used to assess anxiety symptoms in the previous 2 weeks.Eg, Have you felt nervous, anxious or on edge?
Response: not at all/several days/more than half the days/nearly every day
Kigozi (South Africa)47
Adjorlolo (Ghana)48
Roberts et al (South Africa)41
Chibanda et al (Zimbabwe)45
Mughal et al (LMIC)49
 Post-traumatic stress symptomsA single item informed by the Child PTSD checklist was used to explore post-traumatic stress symptoms among those children and adolescents who had lost a caregiver.Eg, How stressed have you been since the death of your caregiver?
Response: very/a little/no more than usual
Boyes et al (South Africa)50
Roberts et al (South Africa)41
 Suicidality and self-harmMini International Psychiatric Interview for Children and Adolescents Suicidality (5 items)51 was used to assess suicidality and self-harm behaviours in the previous month.Eg, In the past month, did you wish you were dead?
Response: yes/no
Sheehan et al and Lecrubier et al (Global)52 53
Cluver et al (South Africa)34
Roberts et al (South Africa)41
 Self-esteemThe Rosenberg Self-Esteem Scale (10 items)40 was used as an assessment of child and adolescent self-esteem.Eg, I feel that I have a number of good qualities
Response: strongly agree/agree/disagree/strongly disagree
Sherr et al (South Africa, Malawi, Zambia)40
 Access to mental health servicesA single study-specific item to assess whether children and adolescents have access to mental health services.Eg, Do you have access to mental health services?
Response: yes, needed and accessed/yes, but did not need so did not access/no, needed but could not access/no, did not need and did not access
Bereavement experience
 GriefThe Core Bereavement Items—Grief subscale (five items) will be used to assess grief intensity.54Eg, Do reminders of X such as photos, situations, music, places etc. cause you to feel longing for X?
Response: a lot of the time/quite a bit of the time/a little bit of the time/never
Thurman et al (South Africa)55
Parenting and caregiving experience
 Parenting experienceThe Alabama Parenting Questionnaire (16 items) will be used to identify experience of positive parenting, caregiver supervision, experience of caregiver discipline within the previous 2 months.56Eg, Thinking about the person who looks after you the most, your parent or caregiver says that you have done something well…
Response: never/rarely/sometimes/often/always
Cluver et al (South Africa)57
Elgar et al (Global)56
 Experience of caregiving and responsibility for household tasksThe Young Carers Tasks & Outcomes Questionnaire (23 items)58 was adapted to assess children and adolescents experience of having responsibility for household tasks.Eg, In the past week, have you washed other people’s clothes?
Response: yes/no
How many days a week do you do this?
Lane et al (South Africa)59
Support interventions and provision
 Organisational supportStudy-specific questions on support from organisations, for example, support from social services, healthcare workers.Eg, Do you have access to an organisation that provides you with any support services?
Response: yes/no
 Community provisionStudy-specific questions on community provisions.Eg, Are you a member of any youth and/or health organisations, political or activist groups?
Education and school experiences
 EducationStudy-specific questions on school enrolment, being in the correct class for age, educational attainment, education aspirations and school dropout.Eg, Are you currently enrolled in school?
Response: yes/no
Behavioural risk
 Behavioural problemsThe Child Behaviour Checklist: Rule-breaking subscale (17 items) was used to assess behavioural problems in the previous 6 months.60Eg, I drink alcohol to have fun, without my caregivers knowing or approving
Response: not true/somewhat or sometimes true/very true or often true
Sherr et al (South Africa, Malawi, Zambia)40
Violence exposure, stigma and bullying
 Violence exposureStudy-specific questions adapted from the UNICEF measures for national-level monitoring of orphans and vulnerable children61 and the Parent-Child Conflict Tactics Scales were used to assess household, domestic and school violence.Eg, How often has anyone in your family or living in your home or someone at school used a stick, belt or other hard item to hit you?
Response: weekly/monthly/at least once a year/has happened but not in the last year/never
 Community violenceThe child exposure to community violence checklist62 will be used to identify exposure of children and adolescents to community violence.Eg, Have you ever been hot or attacked outside your home?
Response: yes, more than a year ago/yes, in the last year/never
Sherr et al (South Africa, Malawi, Zambia)40
Steventon Roberts et al (South Africa)63
 StigmaStudy-specific questions focusing on COVID-19-related stigma.Eg, I have been treated badly because I lost a caregiver to COVID-19
Response: not at all/sometimes/all of the time
 BullyingThe Social and Health Assessment Peer Victimisation Scale (12 items) was used to examine experiences of bullying in the last 6 months.64Eg, In the past 6 months, other kids have called me names or swore at me…
Response: not at all/once/2–3 times/4 or more times
Boyes and Cluver (South Africa)65
Sherr et al (South Africa, Malawi, Zambia)40
  • LMIC, low-income and middle-income countries; PTSD, post-traumatic stress disorder.