Primary data study respondents

Four categories of primary data study respondents were included in this study according to the four objectives.

o Children carrying adult responsibilities aged between 7 and 18 o Adult community members including key informants

o Service providers based in Akobo town

o IDP children displaced by the Nyandit attack age between 12 and 18

4.4.1. Selection of children

Quota sampling and snowball sampling were used in the selection of children in the qualitative study. Boys and girls aged between 7 and 18 years were included. All children were selected from the community in Bilkey and Nyandit Payams. The aim of selecting children from the community and not from the schools was to allow for inclusion of children who have not been able to attend school and the fact that all schools were closed for five months until the end of May. Local knowledge as well as information from key informants helped to decide on the homogenous groups of

children. The saturation principle (Bernard, 2000) determined the proportion of participants needed in each group. Saturation within a category of study respondents can be achieved if interviews and FGDs for each research question are continued until no new information is elicited. Children for FGD’s and workshops (in consultation with caregivers) were asked to participate the day before the actual event took place. All caregivers considered their children to be mature enough to participate unaccompanied. This was so even for children as young as seven. Children for individual interviews were selected and invited through the same approach but on the same day the interviews were conducted. Snowball sampling was used for ‘difficult to reach’ children. The initial reference points for snowball sampling were individual children from a particular group, leaders of existing social networks such as the orphan school, the parent teacher association, children’s clubs, and the local authorities. This process identified 144 children, 77 boys and 67 girls who took part in 6 workshops, 6 FGDs and 46 individual interviews.

4.4.2. Selection of adult community members and key informants

Quota and snowball sampling was also used to identify adult community members for individual interviews and FGDs. They were selected by taking into consideration the existing diversity within the social structure of the community. Participants for FGD’s were selected based on identified sub-groups and invited to participate the day before the actual event took place. The location was negotiated and people were requested to assemble at a particular time in a particular place. The walking distance was within 30 minutes. The locations chosen were empty school or church buildings, empty tukuls in participant’s compounds, under big trees, in the compound of a local NGO or in administration buildings provided by the local authorities. Participants for individual interviews were selected on the spot and invited to participate at the time and in the place of their convenience. All adult community members were eligible to participate in this investigation. It was assumed that all adults were able to offer their opinion on health risks for children as well as their views, experiences and perceptions with regards to child participation. It was also expected that adults were able to describe and explain cultural and societal changes over time. Community members were excluded if they did not have time to participate. Key informants were selected through purposive sampling. They were selected because of their first-hand experience in providing services for children and their willingness to participate: they included teachers, medical officers, returnees from bordering countries, leaders of the parent teacher association, leaders of youth

groups including sports clubs. The key informants were identified in consultation with the local authorities, the head teacher and with NGOs. Once identified, key informants were approached and asked to participate at a day, time and place of their convenience. Key informants were excluded from the study if they were too busy or gave two consecutive appointments which were not honoured. Overall, a total of 88 adult community members, 44 men and 44 women, were identified who took part in 12 FGDs and in 28 interviews. 9 of the 28 interviews were key informant interviews.

4.4.3. Selection of service providers

Staff members of service providers were selected based on their first-hand experience in providing services to adults and children in Akobo County and their willingness to participate in the study. Preference was given to staff members based in Akobo County who had at least one year professional experience working in Southern Sudan. With the assistance of the local program manager or person in- charge of a particular organisation an appointment was made to introduce the purpose of the study and to identify participants. The selection approach was repeated and included all service providers present in Akobo town at the time this study was conducted. The respondents were later approached individually and appointments were made at their convenience. A total of 20 staff members of service providers, based on the above criteria, participated in individual interviews.

4.4.4. Sample size: mental health survey

The sample size for the survey was calculated in order to estimate the proportion of children found to have a mental health outcome (probable PTSD, anxiety and/or depression) with a pre-specified level of precision. Informed by previous research (Attanayake et al., 2009), it was assumed that 30% of the children in the study population would have such a mental health outcome, and it was estimated that the total study population size was 16,000, of whom 2880 (18%) would be children aged 12 to 18 years. Although the children were at the time resident in three different locations, it was considered that location would not in itself influence the prevalence of the mental health outcome of interest, so no design effect adjustment was made for this factor. Using the standard equation for a 95% confidence interval for a proportion with a finite population size correction:

CI = p ± ( z * sqrt[p * (1 – p) / n] * sqrt[(N – n)/(N – 1)] )

where z is the standard Normal deviate (=1.96 for a 95% confidence interval) p is the proportion of children sampled expected to have a mental health outcome

n is the actual number of children sampled

N is the total number of children in the study population.

So, assuming that there are 2880 children in the study population, that 30% of children sampled would have a mental health outcome, and that a 95% confidence interval for the prevalence estimate of ±5% is required (i.e. assuming that prevalence would be estimated to a precision of ±5%):

0.05 = 1.96 * ( sqrt[0.30 * (1 – 0.30) / n] * sqrt[(2880 – n)/(2880 – 1)] )

Solving this equation for n gives a desired sample size of 291. This was rounded up to 300, and a further 10% added to allow for refusals, giving a total sample size of 330.

4.4.5. Selection of children for the mental health survey

A systematic random sample approach was used to select the required 330 households in the three locations where an estimated 16,000 survivors of the Nyandit attack had settled. The characteristics of this population have been described in section 4.3, page 76. Households were defined as people living and eating together. The average household size, identified in the case study, was six people (6.48). The total population of 16,000 people was divided by 6.48 (the average household size) which resulted in 2469 households. With an estimated total of 2880 children in the appropriate age range, it was expected to find at least one child aged 12-18 per household, so the theoretical sampling interval calculated was 2469/330 = 7.48.

In reality, of course, not every household sampled would have a child in the required age range – so, to allow for this while preventing overlap / contamination between sampled units (i.e. to ensure a reasonable geographical distance between sampled households) and to ensure that the sample was collected within a reasonable and sensible timeframe, it was decided to slightly reduce the sampling interval to every 6th household (instead of every 7.48th household) in consultation with a statistician.

Starting from a point as close as possible to the geographic centre of the target study population in each section (identified by local chiefs or village leaders), a bottle was spun to determine the direction in which sampling would commence. The

random starting point was determined by counting and numbering the first six households along the way (sampling interval) in the direction indicated by the neck of the spun bottle. The first household (random start) was then determined by drawing one of the numbered cards. The data collectors then walked in a straight line through the study area in the direction indicated by the neck of the spun bottle, taking a systematic sample of households that fell within a pre-specified distance either side of the walking line. When the data collectors reached the perimeter of the study area, they returned to the central starting point, spun the bottle again, and repeated the exercise. This process was repeated as many times as was necessary to obtain the required sample size for that study area.

If there was more than one child in a household, the child for the interview was randomly selected by drawing numbered cards, and asked to participate. The random community-based approach was only possible because the schools were still closed at the time the survey was conducted so that all children had the same probability of being chosen without excluding the children enrolled in school. The pre-testing of the research instruments used to assess mental health demonstrated that children aged 12 and above were able to answer the questions without difficulties. As a result, children younger than 12 and children who were too busy and still not available after returning twice were excluded from the study.

The systematic random sample approach allowed selecting the children approximately proportional to the estimated population size (PPS) in all three locations. The weights were computed using the optimum sample size of 330 children estimated. Using these figures, the required weight was 0.56 in the first location (estimated population 9000), 0.25 in the second location (estimated population 4000), and 0.188 in the third location (estimated population 3000), giving expected sample sizes of 184.8, 82.5 and 62.7 for the three locations respectively.

The final total sample size was 353 children. 179 children took part in face to face interviews conducted in Akobo town, the first location, 95 children participated in face to face interviews in the second location (IDP camp), and 79 children participated in face to face interviews in the third location (Nyandit Payam).

The intended sample size was 330 children. However, at the beginning of the rainy season, a few questionnaires (empty questionnaires) were reported damaged by the floods in two locations. They were replaced with new questionnaires without collecting the wet ones. Since some of the flood affected questionnaires were subsequently salvaged by the data collectors by drying and ironing them (without the knowledge of the supervisor), these questionnaires re-entered the system so that more children than anticipated completed questionnaires in the IDP camp and in Nyandit Payam. This explains the slightly higher sample size of 353 children.