Title: Evaluation of the orphans reunification project in Eritrea
Authors: E Morah, S Mebrathu, K Sebhatu
The evidence clearly shows that the status of assisted orphans compares favorably with that of non-orphans, thus indicating that the psychosocial integration between the host families and the orphans has been successful. Although orphan boys were indicated to be slightly better off, the gender differences were not dramatic. Substantial evidence also suggests that the project has built capacities of the relevant government ministry on a number of key areas’ research skills and appreciation of the importance of solid operational research before social interventions, participatory planning, monitoring and management tools, community mobilization and advocacy for child protection. Finally, the reunification project is found to be significantly more cost-effective, psychosocially acceptable and sustainable than the alternative strategy of keeping the children in orphanages.
Title: Prevalence and predictors of HIV-related stigma among institutional- and community-based caregivers of orphans and vulnerable children living in five less-wealthy countries
Authors: Lynne Messer, Brian Pence, Kathryn Whetten, Rachel Whetten, Nathan Thielman, Karen O’Donnell, Jan Ostermann
In the face of the HIV/AIDS epidemic that has contributed to the dramatic increase in orphans and abandoned children (OAC) worldwide, caregiver attitudes about HIV, and HIV-related stigma, are two attributes that may affect caregiving. Little research has considered the relationship between caregiver attributes and caregiver-reported HIV-related stigma. In light of the paucity of this literature, this paper will describe HIV-related stigma among caregivers of OAC in five less wealthy nations.
Baseline data were collected between May 2006 through February 2008. The sample included 1,480 community-based and 192 institution-based caregivers. Characteristics of the community-based and institution-based caregivers are described using means and standard deviations for continuous variables or counts and percentages for categorical variables. We fit logistic regression models, both for the full sample and separately for community-based and institution-based caregivers, to explore predictors of acceptance of HIV.
Approximately 80% of both community-based and institution-based caregivers were female; and 84% of institution-based caregivers, compared to 66% of community-based caregivers, said that they would be willing to care for a relative with HIV. Similar proportions were reported when caregivers were asked if they were willing to let their child play with an HIV-infected child. In a multivariable model predicting willingness to care for an HIV-infected relative, adjusted for site fixed effects, being an institution-based caregiver was associated with greater willingness (less stigma) than community-based caregivers. Decreased willingness was reported by older respondents, while willingness increased with greater formal education. In the adjusted models predicting willingness to allow one’s child to play with an HIV-infected child, female gender and older age was associated with less willingness. However, willingness was positively associated with years of formal education.
The caregiver-child relationship is central to a child’s development. OAC already face stigma as a result of their orphaned or abandoned status; the addition of HIV-related stigma represents a double burden for these children. Further research on the prevalence of HIV-related acceptance and stigma among caregivers and implications of such stigma for child development will be critical as the policy community responds to the global HIV/AIDS orphan crisis.
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Title: A Comparison of the Wellbeing of Orphans and Abandoned Children Ages 6–12 in Institutional and Community-Based Care Settings in 5 Less Wealthy Nations
Authors: Kathryn Whetten, Jan Ostermann, Rachel Whetten, Brian Pence, Karen O’Donnell, Lynne Messer, Nathan Thielman, The Positive Outcomes for Orphans (POFO) Research Team
Leaders are struggling to care for the estimated 143,000,000 orphans and millions more abandoned children worldwide. Global policy makers are advocating that institution-living orphans and abandoned children (OAC) be moved as quickly as possible to a residential family setting and that institutional care be used as a last resort. This analysis tests the hypothesis that institutional care for OAC aged 6–12 is associated with worse health and wellbeing than community residential care using conservative two-tail tests.
The Positive Outcomes for Orphans (POFO) study employed two-stage random sampling survey methodology in 6 sites across 5 countries to identify 1,357 institution-living and 1,480 community-living OAC ages 6–12, 658 of whom were double-orphans or abandoned by both biological parents. Survey analytic techniques were used to compare cognitive functioning, emotion, behavior, physical health, and growth. Linear mixed-effects models were used to estimate the proportion of variability in child outcomes attributable to the study site, care setting, and child levels and institutional versus community care settings. Conservative analyses limited the community living children to double-orphans or abandoned children.
Health, emotional and cognitive functioning, and physical growth were no worse for institution-living than community-living OAC, and generally better than for community-living OAC cared for by persons other than a biological parent. Differences between study sites explained 2–23% of the total variability in child outcomes, while differences between care settings within sites explained 8–21%. Differences among children within care settings explained 64–87%. After adjusting for sites, age, and gender, institution vs. community-living explained only 0.3–7% of the variability in child outcomes.
This study does not support the hypothesis that institutional care is systematically associated with poorer wellbeing than community care for OAC aged 6–12 in those countries facing the greatest OAC burden. Much greater variability among children within care settings was observed than among care settings type. Methodologically rigorous studies must be conducted in those countries facing the new OAC epidemic in order to understand which characteristics of care promote child wellbeing. Such characteristics may transcend the structural definitions of institutions or family homes.
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Title: Are orphans at increased risk of malnutrition in Malawi?
Authors: Ratana Panpanich, Bernard Brabin, Andrew Gonani, Stephen Graham
Abstract: The objective of this study was to compare the nutritional status and health problems of village orphans, non-orphans and orphanage children, and to identify factors associated with undernutrition. A cross-sectional study was conducted in three orphanages and two villages near Blantyre, Malawi. Seventy-six orphanage children, 137 village orphans and 80 village non-orphans were recruited. Anthropometric measurement was done and guardians were interviewed. In the group of children aged <5 years, the prevalence of undernutrition in orphanage children was 54.8% compared with 33.3% and 30% of village orphans and non-orphans, respectively. Sixty-four per cent of young orphanage children were stunted compared with 50% of village orphans and 46.4% of non-orphans. The mean (SD) Z-score of height/age was significantly lower in the orphanage group, -2.75 (1.29) compared with -2.20 (1.51) and -1.61 (1.57) in the village orphan and non-orphan groups (p<0.05). Conversely, older orphanage children (>5 years) were less stunted and wasted than orphans and non-orphans in villages. Illness of children in the last month was reported to be higher in the non-orphan group, especially diarrhoeal disease, which occurred in 30% compared with 10.8% of village orphans and 6.6% of orphanage children. More than three children in a family being cared for by guardians was significantly associated with undernutrition. Orphanage girls were more likely to be malnourished than orphanage boys. Children who had been admitted to an orphanage for more than a year were less malnourished. In village orphans, there was no association between undernutrition and duration of stay in extended families. Age and education of guardians were not associated with the nutritional status of children. We conclude that young orphanage children are more likely to be undernourished and more stunted than village children. Older orphanage children seem to have better nutrition than village orphans. There was no significant difference in nutritional status between village orphans and non-orphans.
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Study Title: Explaining the Expansion of Institutions in Battambang Province
Context: According to a 2009 UNICEF statistic, there are an estimated 630,000 orphans in Cambodia, 12,000 of whom currently reside in orphanages. Although some institutions provide services specific to the needs of certain populations of vulnerable children (victims of sexual trafficking, children living with HIV, street children, and children with disabilities), a 2011 UNICEF report revealed that a majority of the 12,000 children in Cambodia’s orphanages have one living parent; 28% of children in orphanages have lost both parents. Furthermore, the number of children in care has more than doubled in five years. In Cambodia’s northwest province of Battambang, the number of orphanages has more than quadrupled from 11 to 45 over the last decade.
Study Aims: This study aims to better understand the reasons for institutional expansion in Battambang Province. Through a series of qualitative interviews with orphanage directors and caregivers, the study will help us to understand the reasons underlying the expansion in the number of orphanages in the region.
Methods: A stratified random sample of 15 orphanages in Battambang was contacted for participation in this study. Orphanages were stratified based on four criteria: size, length of presence in the province, foreign/locally-run institutions, and religious affiliation. A series of 45-minute interviews are being conducted with the directors of selected institutions to better understand the reasons that they opened the institution, why children are sent to live in orphanages as well as to learn more about the services provided by these institutions. A small sample of 7-10 parents/caregivers in the Ek Phnom District will also be interviewed to gain more direct information about the reasons why Battambang Province families send their children to institutions. Questions regarding the socio-economic background of the family, the reasons for sending children to institutions and the perception of need in the local community will be asked of each participant. The participating individuals will be the parents/caregivers of scholarship students at the Khmer Center for Development (an afternoon-English program in Ek Phnom District, Battambang Province) whose child/children is/are currently placed in institutional care.
- The study will provide relevant information regarding why orphanages are being opened at such a quick pace in the Battambang region. This knowledge could lead to similar studies in other areas.
Principal Investigator: Leila Dal Santo (Duke University)
Investigators: Vanroth Vann (Homeland, Cambodia), Kathryn Whetten (Duke University)
Contact Information: [email protected]
Study Title: Child transitions from residential facilities to other communities: predictors of child wellbeing
Context: Globally, one hundred and fifty three million children are estimated to have been orphaned as defined by the death of one or both parents due to diseases such as malaria, tuberculosis, and cancers, maternal mortality, unintentional injuries, natural disasters and armed conflict: AIDS accounts for 16.6 million of these children. We can anticipate that numbers of orphaned children will increase with factors such as economic declines, decreased agricultural output due to environmental changes and increased natural disasters. In Ethiopia, an estimated 650,000 children have lost one or both parents to AIDS. The majority of orphaned children and children whose biological parents have left them are cared for by the remaining parent, other family members, or non-relatives in family settings: a small proportion live in residential facilities
Study Aims: The primary goal of this pilot study is to understand the emotional and physical well-being of children transitioning out of residential care to better inform good policy and practice on the protection of children. The intent is to understand factors associated with positive and negative transition outcomes. Care transitions occur for a variety of reasons, such as family placement, aging out (reaching the maximum age allowed in residential facilities), child self-initiated departures, community or family initiated retrievals, residential facility initiated expulsions, and residential facility closures. This study attempts to assess children’s mental and physical well-being while still living in residential care and then follow them out of residential facility care into other living environments.
Methods: This initial study is designed to determine the feasibility of finding, following and maintaining communication with children as they leave residential facilities, to examine the different living environments they transition into, and to examine if there are trends or associations in how well transitions are made. In particular, pre-transition child characteristics (e.g., age of entry into residential care, years in residential care, age at placement in a community setting), facility characteristics, transition planning characteristics, community placement characteristics, and child wellbeing outcomes will be analyzed and compared to data from matched controls in community-family settings. Short-term descriptive information such as documenting the range of living environments children transition into is vital. However, short-term outcomes may not reflect longer-term physical or emotional trends. If the pilot study methodology proves successful, i.e., children are able to be followed over time and useful measurements obtained, a longer, multi-country longitudinal study will be proposed.
- To examine the positive and negative physical and mental health trajectories of children and young adults transitioning out of residential facility care for a variety of reasons, including residential facility closures, aging out and self-other initiated departures.
- To determine how different types of residential facility-to-community transition experiences (e.g., types of preparation, planning process, availability of resources) affect children and families’ mental and physical wellbeing.
- To better understand associations between characteristics of the residential facilities and post-residential facility care, and child emotional, physical and social well-being before and after re-location.
- If the pilot study methodology proves successful and children are able to be followed over time, researchers may propose a larger multi-country study.
Principal Investigator: Sumi Ariely (Duke University)
Investigators: Misganaw Eticha (Stand for the Vulnerable Organization, Ethiopia), Charles Nelson (Harvard University), Jan Ostermann (Duke University), Lorraine Sherr (University College London), Kathryn Whetten (Duke University), Rachel Whetten (Duke University)
Project Coordinator: Andrew Goodall
Contact Information: [email protected]