Sexual Behavior Among Orphaned Adolescents in Western Kenya: A Comparison of Institutional- and Family-Based Care Settings

Resilience and associated factors in orphaned and separated adolescents in Kenya: Understanding the relationship with care environment and HIV risks

Orphans are at higher risk of HIV infection and several important HIV risk factors than non-orphans; however, this may be due to a combination of related social, psychological, and economic factors, as well as care environment, rather than orphan status alone. Understanding these complex relationships may aid policy makers in supporting evidence-based, cost-effective programming for this vulnerable population. This longitudinal study uses a causal effect model to examine, through decomposition, the relationship between care environment and HIV risk factors in orphaned and separated adolescents and youths (OSAY) in Uasin Gishu County, Kenya; considering resilience, social, peer, or family support, volunteering, or having one's material needs met as potential mediators. We analysed survey responses from 1105 OSAY age 10-26 living in Charitable Children's Institutions (CCI) (orphanages) and family-based care settings (FBS). Follow-up time was 7-36 months. Care in CCIs (vs. FBS) was associated with a decreased likelihood of engaging in forced, exchange, and consensual sex. Excess relative risks (ERR) attributable to the indirect pathway, mediation, or interaction were not significant in any model. Care environment was not statistically associated with differences in substance use. Our findings support the direct, unmediated, association between institutional care and HIV risk factors.

Youth Who Have Lived in Alternative Care in Nigeria, Zambia, and Zimbabwe: Mental Health and Violence Outcomes in Nationally Representative Data

Objective

We explore whether having previously lived in alternative care (foster, kinship, and/or residential care) is linked to sexual risk-taking, mental health, and experiencing violence in Nigerian, Zambian, and Zimbabwean youth ages 13-17 living in households with or without their biological parents, and assess the utility and limitations of existing data.

Method

This study is a secondary analysis of nationally-representative Violence Against Children Surveys (N=6,405). Logistic regressions examined the effect of alternative care experience on the odds of poor outcomes, controlling for covariates including parental care status, orphanhood, and household assets.

Results

In both bivariate and multivariate analyses, having lived in alternative care in the last five years was associated with lowered odds mental distress (OR=0.25, 95% CI: [0.10, 0.61], p=.002), and higher odds of sexual risk taking (OR=1.70, 95% CI: [1.11, 2.59], p=.014), caregiver physical abuse (OR=1.81, 95% CI: [1.30, 2.50], p<.001), caregiver emotional abuse (OR=1.75, 95% CI: [1.20, 2.54], p=.004), and peer violence (OR=1.57, 95% CI: [1.09, 2.26], p=.015). It was not associated with suicidality, self harm, or sexual assault after controlling for covariates.

Conclusion

Youth who have lived in alternative care in the last five years may benefit from programs that address violence, self-harm, and sexual risk taking behavior, even if they are now in families. To better understand children outside parental care, national data collection efforts should distinguish between residential and family-based care.

Sexual knowledge, risk behavior, and access to reproductive health services among orphaned adolescents in Southwest Nigeria: implications for institutionalized care

Introduction

An orphan has been defined as a child under 18 years of age who has lost one or both parents to any cause. It has been reported that for every 10 Nigerian children, 1 is likely to be an orphan. Adolescents are faced with a serious challenge in meeting their reproductive health need, which oftentimes becomes overwhelming especially when they are orphaned.

Objectives

We compared institutionalized and non-institutionalized orphaned adolescents for their knowledge of sexuality, risky sexual practice, and access to reproductive health services.

Methods

The study adopted a cross-sectional descriptive study design conducted via structured, pretested, and interviewer-administered questionnaires among 205 orphaned adolescents (140 institutionalized and 65 non-institutionalized). Data were analyzed using the Statistical Product and Service Solution (SPSS version 25.0) and summarized using frequency, mean and percentages, and inferential statistics. All analyses were done at a 95% confidence interval and at a p < 0.05 level of significance.

Results

The knowledge levels of a majority of non-institutionalized respondents (73.8%) were good when compared with those in institutions (56.4%) (χ² = 5.713, p = 0.017). Institutionalized orphans displayed better sexual behavior (80.7%) than non-institutionalized respondents (64.6%) (χ² = 6.239, p = 0.011). Access to reproductive health services was found to be slightly higher among institutionalized respondents (66.4%) than among their non-institutionalized counterparts (64.6%).

Conclusion

Institutionalized and non-institutionalized orphans differed in terms of their knowledge of sexuality, sexual behavior, and risky practices, including access to reproductive health services. This study demonstrated the effectiveness of institutionalized care of orphans toward improved access to reproductive health services and good sexual practices. In the light of this, the government and relevant stakeholders should advocate the need for providing better sexuality education and understanding, make sure that access barriers for orphans are removed and orphans utilize the facilities for reproductive health that are available, and also make sure that adolescent health policies are implemented effectively.

Bridges-Round 2: A study protocol to examine the longitudinal HIV risk prevention and care continuum outcomes among orphaned youth transitioning to young adulthood

BACKGROUND

Youth orphaned by HIV in sub-Saharan Africa experience immense hardships including social disadvantage, adverse childhood events and limited economic prospects. These adversities disrupt the normative developmental milestones and can gravely compromise their health and emotional wellbeing. The Bridges to the Future study (2012-2018) prospectively followed 1,383 adolescents, between 10-16 years, to evaluate the efficacy and cost-effectiveness of a family-based economic empowerment intervention comprising of child development accounts, financial literacy training, family income generating activities and peer mentorship. Study findings show efficacy of this contextually-driven intervention significantly improving mental health, school retention and performance and sexual health. However, critical questions, such as those related to the longitudinal impact of economic empowerment on HIV prevention and engagement in care remain. This paper presents a protocol for the follow-up phase titled, Bridges Round 2.

METHODS

The Original Bridges study participants will be tracked for an additional four years (2022-2026) to examine the longitudinal developmental and behavioral health outcomes and potential mechanisms of the effect of protective health behaviors of the Bridges cohort. The study will include a new qualitative component to examine participants' experiences with the intervention, the use of biomedical data to provide the most precise results of the highly relevant, but currently unknown sexual health outcomes among study participants, as well as a cost-benefit analysis to inform policy and scale-up.

DISCUSSION

Study findings may contribute to the scientific knowledge for low-resource communities on the potential value of providing modest economic resources to vulnerable boys and girls during childhood and early adolescence and how these resources may offer long-term protection against known HIV risks, poor mental health functioning and improve treatment among the HIV treatment care continuum.

Intersectional Stigma and Implementation of HIV Prevention and Treatment Services for Adolescents Living with and at Risk for HIV: Opportunities for Improvement in the HIV Continuum in Sub-Saharan Africa

Adolescents in sub-Saharan Africa, specifically adolescent girls and young women, young men who have sex with men, transgender persons, persons who use substances, and adolescents experiencing homelessness experience intersectional stigma, have a high incidence of HIV and are less likely to be engaged in HIV prevention and care. We conducted a thematic analysis informed by the Health and Discrimination Framework using a multiple case study design with five case studies in 3 sub-Saharan African countries. Our analysis found commonalities in adolescents' intersectional stigma experiences across cases, despite different contexts. We characterize how intersectional stigma impacts the uptake and implementation of HIV prevention and treatment services along the continuum for adolescents. Findings reveal how intersectional stigma operates across social-ecological levels and worsens HIV-related outcomes for adolescents. We identify opportunities for implementation science research to address stigma-related barriers to the uptake and delivery of HIV services for adolescents in sub-Saharan Africa.

Prevalence, incidence and chronicity of child abuse among orphaned, separated, and street-connected children and adolescents in western Kenya: What is the impact of care environment?

BACKGROUND

The effect of different types of care environment on orphaned and separated children and adolescents' (OSCA) experiences of abuse in sub-Saharan Africa is uncertain.

OBJECTIVE

Our two primary objectives were 1) to compare recent child abuse (physical, emotional, and sexual) between OSCA living in institutional environments and those in family-based care; and 2) to understand how recent child abuse among street-connected children and youth compared to these other vulnerable youth populations.

PARTICIPANTS AND SETTING

This project followed a cohort of OSCA in Uasin Gishu County, Kenya (2009-2019). This analysis includes 2393 participants aged 18 years and below, 1017 from institutional environments, 1227 from family-based care, and 95 street-connected participants.

METHODS

The primary outcome of interest was recent abuse. Multiple logistic regression was used to estimate the odds of recent abuse at baseline, follow-up, and chronically for each abuse domain and adjusted odds ratios (AOR) between care environments, controlling for multiple factors.

RESULTS

In total, 47 % of OSCA reported ever experiencing any kind of recent abuse at baseline and 54 % in follow-up. Compared to those in family-based care, street-connected participants had a much higher reported prevalence of all types of recent abuse at baseline (AOR: 5.01, 95 % CI: 2.89, 9.35), in follow-up (AOR: 5.22, 95 % CI: 2.41, 13.98), and over time (AOR: 3.44, 95 % CI: 1.93, 6.45). OSCA in institutional care were no more likely than those in family-based care of reporting any recent abuse at baseline (AOR: 0.85 95 % CI: 0.59-1.17) or incident abuse at follow-up (AOR: 0.91, 95 % CI: 0.61-1.47).

CONCLUSION

OSCA, irrespective of care environment, reported high levels of recent physical, emotional, and sexual abuse. Street-connected participants had the highest prevalence of all kinds of abuse. OSCA living in institutional care did not experience more child abuse than those living in family-based care.

Rural-Urban Migration, Childbearing Decision-Making, Fertility and Contraceptive Perspectives of Street Adolescents and Youth in Kampala, Uganda

Introduction

This paper aims to describe and assess social demographic factors associated with childbearing decision-making, fertility and contraceptive intentions among street adolescents and youth in Kampala, Uganda while considering rural-urban migration as an explanatory factor.

Materials and Methods

A cross-sectional survey of 513 adolescents and youth aged 12–24 years self-identifying as street adolescents and youth were interviewed with a structured questionnaire in 2019. Street adolescents and youth who migrated from other rural districts to Kampala were compared with those from the city. Logistic regression was performed to assess associations between the independent factors and personal childbearing decision-making, fertility and contraceptive intentions.

Results

Overall, 80.31% of the street adolescents and youth had a rural-urban migration experience. Fifty six percent (56.32%) of the street adolescents and youth made personal childbearing decisions, 94.15% expressed intentions to have children in the future and 42.88% expressed intentions to use contraceptives in the future. Intentions to use contraceptives were significantly higher among males (58.75%) than females (20.00%), and higher among migrants (65.91%) compared to non-migrants (34.09%). Contraceptive intentions were positively associated with self-perceived permanent residential status (aOR = 10.26, 2.70–39.08), intra-urban mobility (aOR = 4.99, 95%CI 1.50–6.59) and intentions to migrate to other towns within the country (aOR = 5.33, 95%CI 1.59–17.80). Being married (aOR = 0.13, 95%CI 0.02–0.85), a large shelter population size (aOR = 0.13, 95%CI 0.03–0.63) and having repeat migrations between the city and home district (aOR = 0.23, 95%CI 0.05–0.94), including migration-associated challenges reduced the odds of street youth's personal childbearing decision-making, while belonging to a social support group increased the odds of childbearing decision-making. We found no significant association between social demographic characteristics and fertility intentions.

Discussion

Factors that influenced personal childbearing decision-making and contraceptive intentions among street adolescents and youth in Kampala operate mainly at the interpersonal and community levels, with marital status, shelter population size, rural-urban migration and its associated challenges associated with childbearing decision-making. Interventions to promote childbearing decision-making and contraceptive use among street adolescents and youth should take into consideration their migration and intra-urban mobility patterns.

A systematic review of substance use and substance use disorder research in Kenya

Objectives

The burden of substance use in Kenya is significant. The objective of this study was to systematically summarize existing literature on substance use in Kenya, identify research gaps, and provide directions for future research.

Methods

This systematic review was conducted in line with the PRISMA guidelines. We conducted a search of 5 bibliographic databases (PubMed, PsychINFO, Web of Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and Cochrane Library) from inception until 20 August 2020. In addition, we searched all the volumes of the official journal of the National Authority for the Campaign Against Alcohol & Drug Abuse (the African Journal of Alcohol and Drug Abuse). The results of eligible studies have been summarized descriptively and organized by three broad categories including: studies evaluating the epidemiology of substance use, studies evaluating interventions and programs, and qualitative studies exploring various themes on substance use other than interventions. The quality of the included studies was assessed with the Quality Assessment Tool for Studies with Diverse Designs.

Results

Of the 185 studies that were eligible for inclusion, 144 investigated the epidemiology of substance use, 23 qualitatively explored various substance use related themes, and 18 evaluated substance use interventions and programs. Key evidence gaps emerged. Few studies had explored the epidemiology of hallucinogen, prescription medication, ecstasy, injecting drug use, and emerging substance use. Vulnerable populations such as pregnant women, and persons with physical disability had been under-represented within the epidemiological and qualitative work. No intervention study had been conducted among children and adolescents. Most interventions had focused on alcohol to the exclusion of other prevalent substances such as tobacco and cannabis. Little had been done to evaluate digital and population-level interventions.

Conclusion

The results of this systematic review provide important directions for future substance use research in Kenya.

Systematic review registration

PROSPERO: CRD42020203717.

The relationships between resilience, care environment, and social-psychological factors in orphaned and separated adolescents in western Kenya

The relationships between care environment, resilience, and social factors in orphaned and separated adolescents and youths (OSAY) in western Kenya are complex and under-studied. This study examines these relationships through the analysis of survey responses from OSAY living in Charitable Children's Institutes (CCI) and family-based care settings (FBS) in Uasin Gishu County, Kenya. The associations between 1) care environment and resilience (measured using the 14-item Resilience Scale); 2) care environment and factors thought to promote resilience (e.g. social, family, and peer support); and 3) resilience and these same resilience-promoting factors, were examined using multivariable linear and logistic regressions. This cross-sectional study included 1202 OSAY (50.4% female) aged 10-26 (mean=16; SD=3.5). The mean resilience score in CCIs was 71 (95%CI=69-73) vs. 64 (95%CI=62-66) in FBS. OSAY in CCIs had higher resilience (β=7.67; 95%CI=5.26-10.09), social support (β=0.26; 95%CI=0.14-0.37), and peer support (β=0.90; 95%CI=0.64-1.17) than those in FBS. OSAY in CCIs were more likely to volunteer than those in FBS (OR=3.72; 95%CI=1.80-7.68), except in the male subgroup. Family (β=0.42; 95%CI=0.24-0.60), social (β=4.19; 95%CI=2.53-5.85), and peer (β=2.13; 95%CI=1.44-2.83) relationships were positively associated with resilience in all analyses. Volunteering was positively associated with resilience (β=5.85; 95%CI=1.51-10.19). The factor most strongly related to resilience in both fully adjusted models was peer support. This study found a strong relationship between care environment and resilience. Care environment and resilience each independently demonstrated strong relationships with peer support, social support, and participating in volunteer activities. Resilience also had a strong relationship with familial support. These data suggest that resilience can be developed through strategic supports to this vulnerable population.

Association of Care Environment With HIV Incidence and Death Among Orphaned, Separated, and Street-Connected Children and Adolescents in Western Kenya

IMPORTANCE

In 2015, there were nearly 140 million orphaned children globally, particularly in low- and middle-income regions, and millions more for whom the street is central to their everyday lives. A total of 16.6 million children were orphaned because of deaths associated with HIV/AIDS, of whom 90% live in sub-Saharan Africa. Although most orphaned and separated children and adolescents in this region are cared for by extended family, the large number of children requiring care has produced a proliferation of institutional care. Few studies have investigated the association between care environment and physical health among orphaned and separated youths in sub-Saharan Africa.

OBJECTIVE

To examine the association of care environment with incident HIV and death among orphaned and separated children and adolescents who were living in charitable children's institutions, family-based settings, and street settings in western Kenya over almost 10 years.

DESIGN, SETTING, AND PARTICIPANTS

The Orphaned and Separated Children's Assessments Related to Their Health and Well-Being (OSCAR) project was an observational prospective cohort study conducted in Uasin Gishu County, Kenya. The cohort comprised 2551 orphaned, separated, and street-connected children from communities within 8 administrative locations, which included 300 randomly selected households (family-based settings) caring for children who were orphaned from all causes, 19 charitable children's institutions (institutional settings), and a convenience sample of 100 children who were practicing self-care on the streets (street settings). Participants were enrolled from May 31, 2010, to April 24, 2013, and were followed up until November 30, 2019.

EXPOSURES

Care environment (family-based, institutional, or street setting).

MAIN OUTCOMES AND MEASURES

Survival regression models were used to investigate the association between care environment and incident HIV, death, and time to incident HIV or death.

RESULTS

Among 2551 participants, 1230 youths were living in family-based settings, 1230 were living in institutional settings, and 91 were living in street settings. Overall, 1321 participants (51.8%) were male, with a mean (SD) age at baseline of 10.4 (4.8) years. Most participants who were living in institutional (1047 of 1230 youths [85.1%]) or street (71 of 91 youths [78.0%]) settings were double orphaned (ie, both parents had died). A total of 59 participants acquired HIV infection or died during the study period. After adjusting for sex, age, and baseline HIV status, living in a charitable children's institution was not associated with death (adjusted hazard ratio [AHR], 0.26; 95% CI, 0.07-1.02) or incident HIV (AHR, 1.49; 95% CI, 0.46-4.83). Compared with living in a family-based setting, living in a street setting was associated with death (AHR, 5.46; 95% CI, 2.30-12.94), incident HIV (AHR, 17.31; 95% CI, 5.85-51.25), and time to incident HIV or death (AHR, 7.82; 95% CI, 3.48-17.55).

CONCLUSIONS AND RELEVANCE

In this study, after adjusting for potential confounders, no association was found between care environment and HIV incidence or death among youths living in institutional vs family-based settings. However, living in a street setting vs a family-based setting was associated with both HIV incidence and death. This study's findings suggest that strengthening of child protection systems and greater investment in evidence-based family support systems that improve child and adolescent health and prevent youth migration to the street are needed for safe and beneficial deinstitutionalization to be implemented at scale.

The Occurrence of Sexual Risk Behaviors and Its Association With Psychological Well-Being Among Kenyan Adolescents

Objective: Sexual risk behavior during adolescence is an important public health problem. Self-esteem and hopefulness are potentially important psychological factors that may play a role in the behavioral regulation mechanisms of adolescents. These factors are inadequately explored in sub-Saharan Africa. This study aimed at exploring patterns and associated factors for sexual risk behavior (SRB), self-esteem, and hopefulness among adolescents from a resource-poor setting in Kenya.

Method: A cross-sectional study conducted in 2019 among 296 adolescents (12–17 years old) from rural Kilifi (n = 133) and urban informal settings of Nairobi (n = 163) in Kenya. Participants completed the Kilifi Health Risk Behavior Questionnaire, Rosenberg self-esteem questionnaire, and Hope scale administered via computerized tablets. A binary outcome variable based on the experience of adolescents of at least one of the five forms of SRB: transactional sex, sexual violence, intergenerational sex, early sexual debut, and condom non-use was generated. Bi-variate analysis was conducted to summarize various social-demographic and psychosocial factors. A multivariable logistic regression model was fitted to investigate factors associated with the occurrence of SRB, self-esteem, and hopefulness among adolescents.

Results: About 13% of the participants had experienced a form of SRB, and among these, 36% reported co-occurrence of multiple forms of SRB. Adolescent SRB was largely characterized by having experienced sexual violence, as well as intergenerational and transactional sex. Higher scores of hopefulness were reported among adolescents who never experienced SRB (P = 0.03) at bivariate analysis level. However, both self-esteem and hopefulness were not significantly associated with the occurrence of SRB in the adjusted logistic regression analysis. Having depressive symptoms (Adj. OR = 3.8, 95% CI: 1.39–10.4), feeling unsafe in the neighborhood (Adj. OR = 3.4, 95% CI: 1.6–7.2), and being in higher compared with lower primary education level (Adj. OR = 0.3, 95% CI: 0.1–0.8) were statistically significantly associated with the occurrence of SRB.

Conclusion: Targeted reproductive health interventions, designed with the cognizance of structural and social drivers of adolescent SRB, are needed to concurrently tackle multiple forms of SRB. It is important to integrate mental health promotion within these interventions. More research is needed to understand the mechanisms and implications of self-esteem and hopefulness for adolescent sexual and reproductive health.

Reliability and validity of the RS14 in orphaned and separated adolescents and youths in western Kenya

PURPOSE

The 14-item Resilience Scale (RS14) is a tool designed to measure psychological resilience. It has been used effectively in diverse populations. However, its applicability is largely unknown for Sub-Saharan adolescent populations and completely unknown for orphaned and separated adolescents and youths (OSAY), a highly vulnerable population for whom resilience may be critical. This study assesses the RS14's psychometric properties for OSAY in Uasin Gishu County, Kenya.

METHODS

Survey responses from a representative sample of 1016 OSAY (51.3% female) aged 10-25 (mean = 16; SD = 3.5) living in institutional and home-based environments in Uasin Gishu County were analyzed. The RS14's psychometric properties were assessed by examining internal consistency reliability, confirmatory factor analyses, and convergent validity using correlations between resilience and each of social support and depression. Sub-analyses were conducted by age and sex.

RESULTS

Resilience scores ranged from 14-98 (mean = 66; SD = 19) with no sex-based significant difference. Resilience was higher for those aged ≥18 (mean = 69; range = 14-98) versus age <18 (mean = 65; range = 14-98). Internal consistency was good (Cronbach's α = .90). Confirmatory factor analysis indicated a 1-factor solution, though the model fit was only moderate. Resilience was positively correlated with social support in all ages (.22; p < .001) and negatively correlated with depression in individuals age <18 (-.22; p < .001). The relationship between resilience and depression in individuals age ≥18 was statistically significant only in females (-.17; p = .026).

CONCLUSION

This study demonstrates reasonable evidence that the RS14 is both valid and reliable for measuring psychological resilience in the population of OSAY in western Kenya.

Using Social Ecological Theory to Identify Factors Associated With Risky Sexual Behavior in Cambodian Adolescent Girls and Young Women Aged 10 to 24 Years: A Systematic Review

There is an increase in risky sexual behavior (RSB) in Cambodian female youth aged 10 to 24 years, which can contribute to detrimental sexual and reproductive health due to the increased risk of acquiring sexually transmitted infections, unintended pregnancies, or abortions. Bronfenbrenner’s social ecological model was used to identify factors at personal, microenvironment, and macroenvironment levels potentially associated with RSB. A systematic literature review employing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted to search 8 databases for articles published between 1994 and 2019. A risk of bias tool was applied for methodological quality of the 4 included studies. RSB is associated with multiple factors including sexual debut at young age, alcohol and substance abuse, multiple partners, living away from parents or orphan status, peer delinquency, non-use of condoms by partners, transactional sex, low education and socioeconomic status, and no access to sexual and reproductive health services. Multipronged preventive strategies operating at different levels are recommended in terms of including sex education and increasing reproductive health literacy programs at the schools and community programs for safe sex, condom use and sexual negotiation skills, and access to modern contraceptive methods.

A contextually relevant approach to assessing health risk behavior in a rural sub-Saharan Africa setting: the Kilifi health risk behavior questionnaire

BACKGROUND

Health risk behavior (HRB) is of concern during adolescence. In sub-Saharan Africa, reliable, valid and culturally appropriate measures of HRB are urgently needed. This study aims at assembling and psychometrically evaluating a comprehensive questionnaire on HRB of adolescents in Kilifi County at the coast of Kenya.

METHODS

The Kilifi Health Risk Behavior Questionnaire (KRIBE-Q) was assembled using items on HRB identified from a systematic review and by consulting 85 young people through 11 focus group discussions and in-depth interviews with 10 key informants like teachers and employees of organizations providing various services to young people in Kilifi County. The assembled list of HRB items were back and forward translated from English to Swahili and harmonized by a panel of experts. A total of 164 adolescents completed the assembled Swahili questionnaire at baseline and two weeks later 85 of them completed the questionnaire again. A classical test theory approach was utilized for psychometric evaluation. We computed the amount of missing data at item-level to verify data quality. Scaling evaluation was assessed by spread of responses across options at an item-level. Using Gwet's AC1 coefficient, test-retest reliability was assessed using data from the 85 adolescents who answered the questionnaire twice. Observations and completion of a brief questionnaire were done for non-psychometric evaluation of the KRIBE-Q administered via audio-computer assisted self-interview (ACASI) in Swahili language to 40 adolescents.

RESULTS

The KRIBE-Q showed high data quality, good spread of responses across options and a very good test-retest reliability (Gwet's AC1 = 0.82). It comprised 8 components with acceptable test-retest reliability: behavior resulting in unintentional injury and violence (0.85); tobacco use (0.85); alcohol and drug use (0.96); sexual behaviors (0.94); dietary behaviors (0.60); physical activity (0.74); gambling (0.73); and hygiene behavior (0.89). About 96% of the adolescents found the ACASI private and easy to use. Prevalence of bullying (32%), physical fights (40%) and engagement in gambling (26%) was high.

CONCLUSION

The KRIBE-Q assembled in this study is a psychometrically sound instrument for adolescents in rural coastal Kenya and feasible to administer via ACASI. This measure may be useful for surveys and planning interventions in similar settings.

RELATIONSHIP BETWEEN ORPHANHOOD STATUS, LIVING ARRANGEMENTS AND SEXUAL DEBUT: EVIDENCE FROM FEMALES IN MIDDLE ADOLESCENCE IN SOUTHERN AFRICA

This study examined the relationship between orphanhood status, living arrangements and sexual debut. The study is important in the context of southern Africa, where a substantial number of children live apart from their parents because the parent is dead or living elsewhere, and where female adolescents face disproportionate sexual and reproductive health risks. Data for female adolescents were taken from Demographic and Health Surveys conducted in seven southern African countries. Unadjusted and adjusted hazard ratios of sexual debut were estimated using Cox Proportional Hazard models. The results from multivariate analyses showed that non-co-residence with biological parents was significantly associated with higher risk of sexual debut in five of the seven countries. Using pooled data, the results showed that father absence was associated with higher risk of sexual debut - whether the father was deceased or living elsewhere. Interventions to delay sexual debut among female adolescents should seek to promote father-adolescent co-residence and improve access to education.