Food security and nutritional outcomes among urban poor orphans in Nairobi, Kenya

Food safety certification in urban food markets: the willingness to pay for safer meat in Peru

This paper estimates consumers' willingness to pay (WTP) for meat certified to be safe for human consumption in Peru. Citizens in low- and middle-income countries (LMICs) are increasingly concerned about the safety of food they consume. Across LMICs, urban markets remain the most important source of fresh and nutritious produce and therefore policymakers need to ensure food safety in urban markets. Much focus has been put on providing producers and supply chain actors with economic incentives to improve food safety. However, such effort has had limited effect without addressing the overall market and food safety governance. In this paper, based on an innovative policy experience from Peru, we explore if and how much consumers are willing to pay for meat sold at market stalls that are certified to provide safe meat. Peru has employed a series of economic packages to incentivise market vendors to improve their practices, and in turn increase their revenue. Our analysis based on a consumer survey across three cities in Peru reveal that consumers are willing to pay 7.1%, 5.8% and 5.3% of the average retail prices of chicken, pork and beef, respectively. This amounts to an average of about 216USD/month of extra revenue for vendors.

Child-report food insecurity assessment measures: A scoping review

BACKGROUND

Experiences of household food insecurity are associated with a wide range of deleterious nutritional, developmental, psychological and social consequences for children. Children's distinct experiences of food insecurity, compared to adults, have been identified in diverse economic and cultural contexts. Yet historically, measurement of food insecurity in children has been predominantly reported by adult respondents on behalf of children, potentially underestimating prevalence and neglecting their unique perspectives. In response to this, child-report measures have been developed to assess food security status at both the individual and household level.

OBJECTIVES

To identify and characterise child self-report food insecurity assessment tools used globally, with particular interest in how children's perspectives have been included in measure development processes.

METHODS

A scoping systematic literature review was conducted using PRISMA-ScR. Searches were conducted in four databases in January 2024 using keywords and MeSH terms. Data were extracted and synthesised relating to population and measure characteristics, validity and reliability metrics, and child involvement in measure development.

RESULTS

A total of 169 papers employing child-report measures were included after screening. Most papers originated in North America, used a single-item and included children aged >12 years. Of the child-report measures identified (n = 33), most were not specifically validated in the population of use. Only a small number of included papers (n = 13) had the aim to specifically evaluate measure validity. The Child Food Insecurity Experiences Scale and Child Food Assessment Scale emerged as child-centred measures with comprehensive validity evidence.

CONCLUSIONS

Further child-centred validity testing, particularly with younger children (<12 years) is necessary to ensure validity of measures across age-groups and contexts. Ethical considerations when employing child-report measures, including how to best use tools across different child settings also warrant further exploration.

Growth Anthropometrics as a Metric of Malnutrition Disparities Among Young Children Affected by HIV who are Orphaned Maternally, Paternally, or Totally in Western Kenya: A Retrospective Chart Review

This retrospective study investigated growth outcomes of Kenyan children born to women living with HIV, comparing children who were orphaned maternally, paternally, and totally (both parents deceased) to those who were non-orphaned. We reviewed HIV clinic visits performed in Kenya from January 2011 to August 2016 in children 0 to 4 years of age. Malnutrition was assessed using stunting, underweight status, and wasting (z-scores of ≤-2). Descriptive statistics, Chi-square, t-tests, multivariable logistic regression, and ANCOVA models were performed. Of 15 027 total children in the study population, 3.5% (n = 520) were orphaned maternally, 8.1% (n = 1222) were orphaned paternally, and 2.2% (n = 336) were orphaned totally. Children who were orphans had higher rates of malnutrition compared to non-orphans (P < .001). Children who were orphaned maternally and totally had lower anthropometric mean scores, presented to clinic later, and were more likely to be living with HIV. Children who are orphaned maternally or totally should be targeted in interventional strategies.

Evaluation of physical and mental health status of orphan children living in orphanages in Sonitpur district of Assam: a cross-sectional study

BACKGROUND

Orphan children living in orphanages are often neglected. These children's physical and mental health status is essential as they are highly prone to malnourishment and psychosocial distress. We aim to evaluate the orphan children's physical and psychosocial status living in orphanages.

METHODS

This study adopted a cross-sectional research design conducted with the children living in the orphanages using a pretested, predesigned schedule. A total of 83 children (aged 5 to 19 years) living in three different orphanages in the Sonitpur District of Assam were randomly selected for the study. Body Mass Index (BMI) for age and height were then determined using WHO standards. Thinness was defined as BMI for age below -2 SD (Standard Deviation) and thinness as height for age below -2 SD. The behavioural and mental status of children aged 10-19 years were evaluated using the Strengths and Difficulties Questionnaire (SDQ-21) with a cut-off value of SDQ score > 15 as the presence of emotional and behavioural distress.

RESULTS

Almost 50% of orphans were in the age group of 10-14 years, 62.7% were females, and 42.2% had a primary level of education. 52.5% of orphans exhibited severe thinness for < -3 SD. Observed severe thinness more among the 5-9 years and 10-14 years (p-value < 0.05) group and among the male orphans (p-value < 0.05). Of 65 children aged 10-19, 18.5% had behavioural and mental distress. Emotional (32.3%) and poor conduct problems (23%) were observed significantly among male adolescents.

CONCLUSIONS

Orphaned children, particularly those living in orphanages, are at risk of malnutrition and experience behavioural and psychosocial problems. Frequent assessments of their physical and mental health are advocated for early detection, prevention, and timely intervention.

Households' Food Insecurity and Their Association With Dietary Intakes, Nutrition-Related Knowledge, Attitudes and Practices Among Under-five Children in Gaza Strip, Palestine

The present study aimed to determine the households' food insecurity and their association with dietary intakes, nutrition-related knowledge, attitudes and practices (KAP) among under-five children in the Gaza Strip, Palestine. This cross-sectional study was conducted in 2021 among a representative sample of under-five children. A total of 350 children and their proxy were selected from all Gaza strip governorates, using a cluster random sampling method. The Radimer/Cornell food-security scale was used. A 24-h dietary recall was employed for dietary intakes assessment. Nutrition-related KAP for feeding under-five children, anthropometric measurements, and demographic-socioeconomic characteristics were obtained with an interview-based questionnaire. Statistical analysis was performed using SPSS version 25. The children from food-insecure households had a high prevalence of moderate underweight (30.4%), stunting (32.8%), wasting (9.6%), and acute undernutrition (30.4%). Between food-insecure and food-secure groups there were significant differences in weight, height/length, mid-upper arm circumference, weight-for-age and mid-upper arm circumference z-scores, underweight, acute undernutrition, intakes of protein, fat, vitamin D, zinc, continued breastfeeding, having nutrition-related adequate knowledge, having nutrition-related positive attitudes, and achieved minimum dietary diversity score (P < 0.05 for all). Additionally, about (56.0%) food-insecure households have inadequate nutrition-related knowledge, (77.6%) have nutrition-related negative attitudes, and (95.2%) did not achieve a minimum dietary diversity score. In conclusion, the children from food-insecure households had a high prevalence of moderate underweight, stunting, wasting, and acute undernutrition. Moreover, low economic status, poor dietary intakes, low levels of nutrition-related KAP, and lack of dietary diversity could contribute to the high levels of food insecurity among under-five children.

Family Composition and Stability for Orphans: A Longitudinal Study of Well-Being in 5 Low- and Middle-Income Countries

Objectives: Many orphaned children in low- and middle-income countries live with family. Yet, their household composition and its stability are not well-characterized, nor is impact of stability on longer-term outcomes.

Methods: We used the longitudinal, multi-country Positive Outcomes for Orphans cohort to describe adult family living with orphans. Stability was measured by changes in presence of six familial relations over time, and related to three outcomes: 1) incident abuse, 2) cognitive functioning, 3) emotional difficulties. Associations were estimated using generalized linear models fit with generalized estimating equations. For abuse, Poisson regression estimated risk ratios. For continuous scores of cognitive functioning and emotional difficulties, linear models estimated mean differences (MDs) with 95% confidence intervals.

Results: Among 1,359 orphans, 53–61% reported living with their mother each year; 7–13% with father; nearly 60% reported ≥1 change in composition over follow-up. Compared to 0 changes, difficulties increased with 1 change [MD: 0.23 (−0.33, 0.79)], 2 changes [MD: 0.57 (0.00, 1.16)] and ≥3 changes [MD: 0.73 (0.18, 1.29)]. No associations were found with abuse or cognitive functioning.

Conclusion: Orphan well-being may be improved through supports stabilizing household composition or targeting emotional resilience.

Undernutrition and associated factors in orphan children aged 6-59 months in Gambella Southwest, Ethiopia: A community-based cross-sectional study

OBJECTIVE

The study aimed to assess the prevalence of stunting, wasting, underweight and associated factors in orphaned children under 5 years old.

DESIGN

A cross-sectional study.

SETTING

Gambella City, Ethiopia.

PARTICIPANTS

A sample of 419 under 5 orphaned children included in the study. Eligible households with orphans had selected using a systematic random sampling method. The lottery method was used when more than one eligible study participants live in the household. An OR with 95% CI was performed to measure the strength of association between each dependent variable and independent variables. Variables with p<0.05 were declared statistically significant.

PRIMARY OUTCOME

The main outcome of this study was the prevalence of undernutrition among orphaned under 5 and its associated factors.

RESULTS

Prevalence of stunting, wasting and underweight in orphan children under 5 were 12.2%, 37.8% and 21.7%, respectively. The prevalnce of wasting peaks among age group of 36-47 months (42.5%), whereas underweight peaks in 48-59 months (27.7%). Food insecurity, wealth index, family size, vitamin A supplementation, diarrhoea, fever 2 weeks before the survey, children under 5 and parents' death were associated with undernutrition.

CONCLUSION

The prevalence of stunting, wasting and underweight among orphan children under 5 was significantly high. Multisectoral collaborative efforts towards access to health services, improving income-generating activities, micronutrient supplementation and social support and protection targeting orphan and vulnerable populations have to be built up.

Prevalence of food insecurity and related factors among slum households in Kerman, south of Iran

INTRODUCTION

Household food insecurity (FI) is defined as limited or uncertain access to nutritionally adequate and safe food or limited ability to obtain foods in socially acceptable ways has become a global issue in recent decades.

METHODS

This cross-sectional study was conducted in Kerman, southeast of Iran in 2019, covering 559 marginalised households. United States Department of Agriculture food security measure was used for data collection. Finally, data were analysed using t-test, χ ² , Mann-Whitney tests and logistic regression.

RESULTS

The prevalence of FI was 82% among slums households. The most important experience of FI in households was reliance on low-cost foods. There was a significant relationship between slums FI and gender of head of household, household size, household income, household education level and marital status (p ˂ 0.05). According to the results of the multivariate regression the variables of education, household income level and household size significantly determined FI (p ˂ 0.05).

CONCLUSION

The most important determinant of FI was low socioeconomic status (income, education, household size). Hence, public policies targeting socioeconomic factors should be made to improve the socioeconomic status of slum dwellers.

Review: Mitigating the risks posed by intensification in livestock production: the examples of antimicrobial resistance and zoonoses

Major shifts in how animals are bred, raised and slaughtered are involved in the intensification of livestock systems. Globally, these changes have produced major increases in access to protein-rich foods with high levels of micronutrients. Yet the intensification of livestock systems generates numerous externalities including environmental degradation, zoonotic disease transmission and the emergence of antimicrobial resistance (AMR) genes. Where the process of intensification is most advanced, the expertise, institutions and regulations required to manage these externalities have developed over time, often in response to hard lessons, crises and challenges to public health. By exploring the drivers of intensification, the foci of future intensification can be identified. Low- and middle-income (LMICs) countries are likely to experience significant intensification in livestock production in the near future; however, the lessons learned elsewhere are not being transferred rapidly enough to develop risk mitigation capacity in these settings. At present, fragmentary approaches to address these problems present an incomplete picture of livestock populations, antimicrobial use, and disease risks in LMIC settings. A worldwide improvement in evidence-based zoonotic disease and AMR management within intensifying livestock production systems demands better information on the burden of livestock-associated disease, antimicrobial use and resistance and resources allocated to mitigation.

Factors associated with acute malnutrition among children 6-59 months in rural Mozambique

Factors associated with acute malnutrition are complex and wide‐ranging particularly in developing countries. In Mozambique, contextual factors associated to children acute malnutrition are yet to be fully investigated and the evidences used to better inform prevention programme. The objective of this study is to identify key factors associated with acute malnutrition among 6‐ to 59‐month‐old children living in nine districts in rural Mozambique assessed in the 2018 seasonal nutrition assessment. We analysed Standardized Monitoring and Assessment for Relief and Transition (SMART) nutrition survey data of 1,116 children from three districts and rapid nutrition assessment (RNA) data of 3,884 children from six districts of Mozambique. We used a multiple logistic regression analysis to respond to the research question. Experiencing diarrhoea [odds ratio (OR) = 4.54; P = 0.001] was the only variable associated with acute malnutrition from the SMART survey dataset, whereas in the RNA, fever (OR = 3.0; P = 0.000) access to sanitation (OR = 0.118; P = 0.037), experiencing shock in the household (OR = 0.5; P = 0.020), diarrhoea (OR = 2.41; P = 0.001) and cough (OR = 1.75; P = 0.030) were the variables with significant association to acute malnutrition. We believe that the findings were influenced by the proportion of acute malnutrition in each survey type. Study findings confirm the association between acute malnutrition and child's health outcomes that are generally linked to poor living conditions and independent effects of shocks. This highlights the need for policy and programme to implement integrated, cross‐sectoral approaches to tackling child acute malnutrition, particularly addressing community level conditions such as water and sanitation.

Growing Roots: A Newcomer Nutrition Program Designed Using Action Research Methods

Many newcomers to Canada struggle with food insecurity and the health impacts of dietary acculturation. "Growing Roots" is a newcomer nutrition program designed through a community development approach to help immigrants and refugees adapt positively to the Canadian food environment. This qualitative action research project documented the development, implementation and impacts of the program in an inner city neighbourhood of Winnipeg, Manitoba, Canada. Data was collected through oral questionnaires and interviews. Impacts included: 1) Healthy adaptation to the Canadian foodscape; 2) Enhanced nutrition knowledge and behaviours; 3) Improvements to food security status; and 4) Enhanced social networks.

AIDS-Affected Orphans in Sub-Saharan Africa: A Scoping Review on Outcome Differences in Rural and Urban Environments

Currently, there are more than 11 million AIDS-affected orphans that suffer from various adverse effects, most of whom reside in sub-Saharan Africa. The difference between whether a child resides in a rural or urban environment can have a significant role in a child's education, health status and access to healthcare, and social or family relationships. A scoping review was conducted in order to understand any possible environment-based differences on orphans directly affected by HIV/AIDS in sub-Saharan Africa. There were 233 sources used for this review; however, 164 manuscripts focused more so on a general review of orphans within a rural or urban environment. Thus, after eliminating for various factors, 69 manuscripts were removed, which focused primarily on the social aspect of orphans due to HIV/AIDS. Rural environments provided more family support, while urban environments generally had more resources available to orphans (e.g. school fees). Unfortunately, both rural and urban environments were found to be fairly non-supportive of orphans and their development. This scoping review found, in general, that orphans in both urban and rural environments continue to suffer from the consequential effects of low parental support due to AIDS mortality. These conclusions suggest that specific support to orphans through school and social relationships encourage better development outcomes in sub-Saharan Africa.

Dietary diversity determinants and contribution of fish to maternal and under-five nutritional status in Zambia

Background

This study examines socio-economic determinants of food consumption patterns amongst women of reproductive age and children aged 6–59 months from urban poor settlements of Lusaka and their implications for nutritional status. Particular emphasis was placed on the role of fish in their diets and nutritional status.

Methods

A cross-sectional survey design was applied, in which 714 mother-child dyads, with children aged 6–59 months were enrolled. A three-stage randomized cluster sampling approach was applied.

Results

The mean dietary diversity score among children aged 6–23 and 24–59 months was 2.98 (±1.27) and 3.478 (±1.07), respectively. In children aged 6–23 months, there was a significant difference in their nutritional status, based on fish consumption (χ² = 10.979, df = 2, p = 0.004). Children from poorer households consumed mostly small fish (Kapenta). The quantity of fish consumed by children was significantly associated with stunting in both age groups, odds ratio = 0.947 (95% CI: 0.896, 1.000) for children aged 6–23 months and odds ratio = 1.038 (95% CI: 1.006, 1.072) for children aged 24–59 months old. Other significant risk factors for stunting in children aged 6–23 months were the child’s age, mother’s body mass index, access to treated water and child morbidity. Child’s age, mother’s educational level and wealth status were determinants of dietary diversity in children aged 6–59 months as shown by the Poisson regression.

Conclusion

Nutritional status of children aged 6–23 months is associated with fish consumption, with children consuming fish less likely to be stunted. Small fish (Kapenta) is an animal-source food that is particularly important in the diet of children in urban poor households in Zambia and contributes to better nutritional outcomes. As all small fish stem from capture fisheries, sustainable one health environmental integration, monitoring and management strategies are desirable.

Nutritional status and dietary diversity of orphan and non - orphan children under five years: a comparative study in the Brong Ahafo region of Ghana

Background

Undernutrition in children under 5 years is a major risk factor to child deaths and is related to impaired cognitive development and lower school performance. Underprivileged children such as orphans are at particularly high risk of undernutrition. Little is however known about the nutritional status and dietary diversity of orphan children in Ghana. This study therefore compared the nutritional status and dietary diversity of orphan and non- orphan children.

Methods

An analytical cross – sectional study design was used. Two hundred and forty-six children (123 non- orphan and 123 orphans) were sampled from households (non - orphans) and four orphanages (orphans). Maternal / caregiver and child socio-demographic characteristics and dietary diversity of children was assessed with a semi – structured questionnaire. We measured anthropometric characteristics of children. Stunting, wasting and underweight in children was classified using Height – for – age Z – scores (HAZ), Weight – for – height Z – scores (WHZ) and Weight – for – age Z – scores (WAZ) respectively. Bivariate and multivariate analyses were used to compare the nutritional status and dietary diversity of orphan and non- orphan children.

Results

Majority of the children were male (52.4%). The prevalence of stunting, wasting and underweight was 17.9, 5.3 and 7.7% respectively for all children. There was no difference in the prevalence of stunting (17.1% vs 18.7%) (p = 0. 74), wasting (4.9% vs 5.7%) (p = 0.78) and underweight (7.3% vs 8.1%) (p = 0.81) among non – orphans and orphans. There was also no difference in mean HAZ (p = 0.52), WHZ (p = 0.27) and WAZ (p = 0.12) of non- orphan and orphan children. However, orphans had higher mean dietary diversity score (p <  0.001) and minimum dietary diversity (p <  0.001) than non – orphans. After controlling for potential confounders, non – orphans were 7.491 times more likely to have a low dietary diversity [AOR = 7.491; 95% CI (1.851–30.320); p = 0.005] compared to orphans.

Conclusion

Present study data show no significant difference in the anthropometric status of orphan and non – orphan children. Orphans were more likely to receive a diversified diet than non – orphans.

Household food insecurity and its association with nutritional status of under five children in Sekela District, Western Ethiopia: a comparative cross-sectional study

BACKGROUND

Food insecurity influences children nutritional status by limiting the quantity and quality of dietary intake. Studies conducted across different parts of the world revealed controversial evidences about the relationship between household food insecurity and child nutritional status. Although child malnutrition and food insecurity are the main problems in Ethiopia, to what extent food insecurity contributes to children nutritional status is not yet well studied. Therefore, this study was conducted to compare children nutritional status in food secure and insecure housholds.

METHOD

A community based comparative cross sectional study was conducted in Sekela District,Western Ethiopia from February 5-27, 2014. The total sample size was 576 households having at least one children less than 5 year's old. Two stage cluster stratified sampling technique was used to select study participants. Data were collected using a pre tested structured questionnaire and anthropometric measurements. Household food insecurity was measured using household food insecurity access scale. Anthropometry indices were calculated using WHO Anthro 3.1.0 and interpreted according to WHO 2006 cutoff points. Data were entered using Epi.Data 3.2. and exported to SPSS 21.0 for analysis. Logistic regression analysis was employed to identify independent predictors of children under nutrition.

RESULT

The mean of household food insecurity score was 8.16 ± 6.01 and the prevalence of food insecurity was 74.1%. Of children in food insecure households 38.9% were stunted, 22.6% were underweighted and 12.9% were wasted while the respective prevalence of stunting, underweight and wasting were 31.3%, 11.8% and 7.6% among children in food secure households. Food insecurity had association with children underweight (AOR = 2.25; 95% CI = 1.29, 3.94), but not with stunting and wasting. Children under nutrition had independent association with sex and age of the child, colostrum feeding, upper respiratory infection, fever, and maternal literacy.

CONCLUSION

Household food insecurity and child under nutrition were critical problems in the study setting. Socio demographic factors, poor child caring practices, infection and food insecurity had positive association with children under nutrition. Thus, due emphasis should be given for the designing and implementation of multi sectorial community based nutrition interventions and initiation of income generating livelihood to the community to curtail under nutrition and household food insecurity in the locality.

Interventions to tackle malnutrition and its risk factors in children living in slums: a scoping review

CONTEXT

Children living in slums are at high risk of being malnourished. There are no published reviews on existing interventions promoting better nutrition for children living in slums and the risk factors for children's malnutrition. Improved understanding of the risk factors for malnutrition in slums communities and the impact of interventions on children's health can provide guidance to practitioners and decision-makers. The present review is designed to provide this information.

METHODS

The search included 30 electronic bibliographic databases and relevant eligible studies published up to December 2013.

RESULTS

The search located 1512 citations. Full text relevance screening was conducted on 226 studies and on abstracts for 16 studies. The final 58 unique studies included 22 on interventions and 38 on risk. All of the interventions were nutrition-specific, with nutritional intervention being the most dominant type. Seventy-three per cent of the interventions were assessed effective.

CONCLUSION

The findings stressed the gaps in knowledge in terms of quality assessment and programmatic recommendations to identify children who are the most at risk of malnutrition to appropriately target interventions. Finally, the review helped to inform a systematic review (Cochrane Systematic review protocol 2015) that will examine the impact of interventions on outcome measures.

Household food (in)security and nutritional status of urban poor children aged 6 to 23 months in Kenya

BACKGROUND

Millions of people in low and low middle income countries suffer from extreme hunger and malnutrition. Research on the effect of food insecurity on child nutrition is concentrated in high income settings and has produced mixed results. Moreover, the existing evidence on food security and nutrition in children in low and middle income countries is either cross-sectional and/or is based primarily on rural populations. In this paper, we examine the effect of household food security status and its interaction with household wealth status on stunting among children aged between 6 and 23 months in resource-poor urban setting in Kenya.

METHODS

We use longitudinal data collected between 2006 and 2012 from two informal settlements in Nairobi, Kenya. Mothers and their new-borns were recruited into the study at birth and followed prospectively. The analytical sample comprised 6858 children from 6552 households. Household food security was measured as a latent variable derived from a set of questions capturing the main domains of access, availability and affordability. A composite measure of wealth was calculated using asset ownership and amenities. Nutritional status was measured using Height-for-Age (HFA) z-scores. Children whose HFA z-scores were below -2 standard deviation were categorized as stunted. We used Cox regression to analyse the data.

RESULTS

The prevalence of stunting was 49 %. The risk of stunting increased by 12 % among children from food insecure households. When the joint effect of food security and wealth status was assessed, the risk of stunting increased significantly by 19 and 22 % among children from moderately food insecure and severely food insecure households and ranked in the middle poor wealth status. Among the poorest and least poor households, food security was not statistically associated with stunting.

CONCLUSION

Our results shed light on the joint effect of food security and wealth status on stunting. Study findings underscore the need for social protection policies to reduce the high rates of child malnutrition in the urban informal settlements.

The government of Kenya cash transfer for orphaned and vulnerable children: cross-sectional comparison of household and individual characteristics of those with and without

Background

The ‘Cash Transfer to Orphans and Vulnerable Children’ (CT-OVC) in Kenya is a government-supported program intended to provide regular and predictable cash transfers (CT) to poor households taking care of OVC. CT programs can be an effective means of alleviating poverty and facilitating the attainment of an adequate standard of living for people’s health and well-being and other international human rights. The objective of this analysis was to compare the household socioeconomic status, school enrolment, nutritional status, and future outlook of orphaned and separated children receiving the CT compared to those not receiving a CT.

Methods

This project analyzes baseline data from a cohort of orphaned and separated children aged <19 years and non-orphaned children living in 300 randomly selected households (HH) in 8 Locations of Uasin Gishu County, Kenya. Baseline data were analyzed using multivariable logistic and Poisson regression comparing children in CT-HH vs. non-CT HH. Odds ratios are adjusted (AOR) with 95% confidence intervals (CI) for guardian age and sex, child age and sex, and intra-HH correlation.

Results

Included in this analysis were data from 1481 children and adolescents in 300 HH (503 participants in CT, 978 in non-CT households). Overall there were 922 (62.3%) single orphans, 324 (21.9%) double orphans, and 210 (14.2%) participants had both parents alive and were living with them. Participants in CT-HH were less likely to have ≥2 pairs of clothes compared to non-CT HH (AOR: 0.32, 95% CI: 0.16-0.63). Those in CT HH were less likely to have missed any days of school in the preceding month (AOR: 0.62, 95% CI: 0.42-0.94) and those aged <1-18 years in CT-HH were less likely to have height stunting for their age (AOR: 0.65, 95% CI: 0.47-0.89). Participants aged at least 10 years in CT-HH were more likely to have a positive future outlook (AOR: 1.72, 95% CI: 1.12-2.65).

Conclusions

Children and adolescents in households receiving the CT-OVC appear to have better nutritional status, school attendance, and optimism about the future, compared to those in households not receiving the CT, in spite of some evidence of continued material deprivation. Consideration should be given to expanding the program further.

Nutritional status of orphaned and separated children and adolescents living in community and institutional environments in uasin gishu county, kenya

Objective

To describe the nutritional status of orphaned and separated children and adolescents (OSCA) living in households in the community (HH), on the street, and those in institutional environments in western Kenya.

Methods

The study enrolled OSCA from 300 randomly selected households (HH), 19 Charitable Children’s Institutions (CCIs), and 100 street-involved children. Measures of malnutrition were standardized with Z-scores using World Health Organization criteria; Z-scores ≤-2 standard deviations (sd) were moderate-severe malnutrition. Data were analyzed using multivariable logistic regression adjusting for child age, sex, HIV status, whether the child had been hospitalized in the previous year, time living with current guardian, and intra-household clustering for adequacy of diet and moderate-severe malnutrition.

Results

Included are data from 2862 participants (1337 in CCI’s, 1425 in HH’s, and 100 street youth). The population was 46% female with median age at enrolment of 11.1 years. Only 4.4% of households and institutions reported household food security; 93% of children in HH reported an adequate diet vs. 95% in CCI’s and 99% among street youth. After adjustment, OSCA in HH were less likely to have an adequate diet compared to those in CCI’s (AOR 0.4, 95% CI 0.2–1.0). After adjustment, there were no differences between the categories of children on weight-for-age, weight-for-height, or BMI-for-age. Children living in HH (AOR 2.6, 95% CI: 2.0–3.4) and street youth (AOR: 5.9, 95% CI: 3.6–9.5) were more likely than children in CCI’s to be low height-for-age.

Conclusion

OSCA in HH are less likely to have an adequate diet compared to children in CCI’s. They and street children are more likely to be moderately-severely low height-for-age compared to children in CCI’s, suggesting chronic malnutrition among them.

Resilience through participation and coping-enabling social environments: the case of HIV-affected children in sub-Saharan Africa

Many children and youths living in low-resource and high-HIV-prevalence communities in sub-Saharan Africa are presented with daily hardships that few of us can even imagine. It is therefore no surprise that most research reporting on the experiences of HIV-affected children in resource-poor settings focuses on their poor health and development outcomes, casting them as victims. However, there is a growing trend to draw on more strengths-based conceptualisations in the study and support of HIV-affected children and youths. In this introduction to a special issue of The African Journal of AIDS Research, we cement this trend by providing a theoretical exposition and critique of the ‘coping’ and ‘resilience’ concepts and draw on the 11 empirical studies that make up this special issue to develop a framework that appropriates the concepts for a particular context and area of study: HIV-affected children in sub-Saharan Africa. The articles included here show, albeit in different ways and to different degrees, that the resilience of HIV-affected children in the region is an outcome of their agency and interactions with their social environment. Policy actors and practitioners working to support HIV-affected children in Africa should take heed of the proposed framework and draw on the research presented here to build coping-enabling social environments—presenting children and youths in Africa with greater opportunity to actively deal with hardship and work towards a more promising future.

Family Kinship Patterns and Female Sex Work in the Informal Urban Settlement of Kibera, Nairobi, Kenya

A basic ecological and epidemiological question is why some women enter into commercial sex work while other women in the same socio-economic environment never do. To address this question respondent driven sampling principles were adopted to recruit and collect data for 161 female sex workers and 159 same aged women who never engaged in commercial sex in Kibera, a large informal settlement in Nairobi, Kenya. Univariate analysis indicated that basic kinship measures, including number of family members seen during adolescence and at present, not having a male guardian while growing up, and earlier times of ending relationships with both male and female guardians were associated with commercial sex work in Kibera. Multivariate analysis via logistic regression modeling showed that not having a male guardian during childhood, low education attainment and a small number of family members seen at adolescence were all significant predictors of entering sex work. By far the most important predictor of entering sex work was not having any male guardian, e.g., father, uncle, older brother, etc. during childhood. Results are interpreted in light of the historic pattern of sub-Saharan African child fostering and their relevance for young women in Kibera today.

Partners and clients of female sex workers in an informal urban settlement in Nairobi, Kenya

This paper compares and contrasts number of partners and condom use behaviour for female sex workers and a sample of women working in other economic activities, with both samples drawn from the large informal settlement of Kibera, Nairobi. As expected, univariate analysis revealed much higher numbers of overall sexual partners and higher levels of condom use among female sex workers compared to Kibera women in other occupations. An unexpected finding, however, was that female sex workers with a romantic partner had significantly fewer sexual partners per unit time than female sex workers without such a partner. This finding held for multivariate analysis, with negative binomial regression analyses showing that having a romantic partner was significantly associated with reductions in total number of both sexual partners overall and with sexual partners who did not use condoms. In contrast, HIV status, education, number of immediate family members and levels of alcohol consumption were non-significant factors for both regression analyses. Results suggest that female sex workers' romantic partners act as more than sources of possible HIV infection; rather, romantic partners appear to have an important positive impact on health. We discuss this finding in light of possible harm-reduction programmes focusing on female sex workers and their romantic partners.