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Taib NI, Arinell H, Öster C, Ramklint M. Mental disorders in former street-working boys. Eur Child Adolesc Psychiatry 2024; 33:1783-1792. [PMID: 37598108 PMCID: PMC11211161 DOI: 10.1007/s00787-023-02282-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/31/2023] [Indexed: 08/21/2023]
Abstract
The continuity of mental disorders in street-working children is rarely studied. This study therefore investigated homotypic continuity, recurrence of the same disorder, and heterotypic continuity, when a new disorder follows on the previous, of mental disorders from childhood to adulthood in street-working boys from Duhok City, Kurdistan Region of Iraq. Mental disorders were assessed by structured diagnostic interviews in 40 street-working boys in 2004-2005 and again in 2021, when the participants' mean ages were 12.1 (SD 1.8) and 29.7 (SD 2.3), respectively. Mental disorders were common; 24 participants (60%) satisfied the criteria for at least one diagnosis at baseline and 28 (70%) at follow-up. Comorbidity increased from 1.2 (SD 1.4) disorders initially to 2.5 (SD 1.8) at follow-up. Only anxiety disorders showed homotypic continuity. Depressive disorders exhibited the greatest increase over time whereas externalizing disorders exhibited a decreasing tendency. The number of mental disorders in adulthood was related to the number of mental disorders in childhood but not to the number of childhood traumas experienced, having previously worked for more than two hours per day, having worked for over two years on the streets, or having at least one dead parent as a child. Parental ratings on the Child Behaviour Check List (CBCL) from childhood were also unrelated to the number of adult disorders. More longitudinal studies with bigger samples of both genders are needed to fully evaluate the continuity of mental disorders in street-working children and to determine whether the number of mental disorders in childhood is a stronger predictor of being mentally disordered in adult life than psychosocial risk factors or experiences of internalizing or externalizing symptoms in childhood.
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Affiliation(s)
- Nezar Ismet Taib
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University Hospital, 751 85, Uppsala, Sweden.
| | - Hans Arinell
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University Hospital, 751 85, Uppsala, Sweden
- Department of Medical Sciences, Psychiatry, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Caisa Öster
- Department of Medical Sciences, Psychiatry, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Mia Ramklint
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University Hospital, 751 85, Uppsala, Sweden
- Department of Medical Sciences, Psychiatry, Uppsala University Hospital, 751 85, Uppsala, Sweden
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Sutherland SC, Shannon HS, Ayuku D, Streiner DL, Saarela O, Atwoli L, Hogan J, Braitstein P. Resilience and associated factors in orphaned and separated adolescents in Kenya: Understanding the relationship with care environment and HIV risks. Glob Public Health 2024; 19:2271970. [PMID: 38252788 PMCID: PMC10832302 DOI: 10.1080/17441692.2023.2271970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/12/2023] [Indexed: 01/24/2024]
Abstract
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.
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Affiliation(s)
- Sarah C. Sutherland
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
| | - Harry S. Shannon
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Science, McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, Canada
| | - David Ayuku
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Nandi Road, Eldoret, Kenya
| | - David L. Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th, L8N 3K7, Hamilton, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, M5T 1R8, Toronto, Canada
| | - Olli Saarela
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
| | - Lukoye Atwoli
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Nandi Road, Eldoret, Kenya
- Brain and Mind Institute and the Department of Medicine, Aga Khan University Medical College, East Africa, Nairobi, Kenya
| | - Joseph Hogan
- Academic Model Providing Access to Healthcare (AMPATH), Nandi Road, Eldoret, Kenya
- Department of Biostatistics, Brown University, 121 S Main St, Providence, RI 02912, Rhode Island, United States of America
| | - Paula Braitstein
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
- Academic Model Providing Access to Healthcare (AMPATH), Nandi Road, Eldoret, Kenya
- Department of Epidemiology and Medical Statistics, School of Public Health, College of Health Sciences, Moi University, Nandi Road, Eldoret, Kenya
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Shawar YR, Shiffman J. Global priority for the care of orphans and other vulnerable children: transcending problem definition challenges. Global Health 2023; 19:75. [PMID: 37817245 PMCID: PMC10566118 DOI: 10.1186/s12992-023-00975-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/26/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Tens of millions of children lack adequate care, many having been separated from or lost one or both parents. Despite the problem's severity and its impact on a child's lifelong health and wellbeing, the care of vulnerable children-which includes strengthening the care of children within families, preventing unnecessary family separation, and ensuring quality care alternatives when reunification with the biological parents is not possible or appropriate-is a low global priority. This analysis investigates factors shaping the inadequate global prioritization of the care of vulnerable children. Specifically, the analysis focuses on factors internal to the global policy community addressing children's care, including how they understand, govern, and communicate the problem. METHODS Drawing on agenda setting scholarship, we triangulated among several sources of data, including 32 interviews with experts, as well as documents including peer-reviewed literature and organizational reports. We undertook a thematic analysis of the data, using these to create a historical narrative on efforts to address children's care, and specifically childcare reform. RESULTS Divisive disagreements on the definition and legitimacy of deinstitutionalization-a care reform strategy that replaces institution-based care with family-based care-may be hindering priority for children's care. Multiple factors have shaped these disagreements: a contradictory evidence base on the scope of the problem and solutions, divergent experiences between former Soviet bloc and other countries, socio-cultural and legal challenges in introducing formal alternative care arrangements, commercial interests that perpetuate support for residential facilities, as well as the sometimes conflicting views of impacted children, families, and the disability community. These disagreements have led to considerable governance and positioning difficulties, which have complicated efforts to coordinate initiatives, precluded the emergence of leadership that proponents universally trust, hampered the engagement of potential allies, and challenged efforts to secure funding and convince policymakers to act. CONCLUSION In order to potentially become a more potent force for advancing global priority, children's care proponents within international organizations, donor agencies, and non-governmental agencies working across countries will need to better manage their disagreements around deinstitutionalization as a care reform strategy.
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Affiliation(s)
- Yusra Ribhi Shawar
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.
- Johns Hopkins University, Paul H. Nitze School of Advanced International Studies, Washington, D.C, USA.
| | - Jeremy Shiffman
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University, Paul H. Nitze School of Advanced International Studies, Washington, D.C, USA
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Neville SE, Okunoren O, Crea TM. Youth Who Have Lived in Alternative Care in Nigeria, Zambia, and Zimbabwe: Mental Health and Violence Outcomes in Nationally Representative Data. JAACAP OPEN 2023; 1:141-150. [PMID: 37982091 PMCID: PMC10656048 DOI: 10.1016/j.jaacop.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
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.
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Affiliation(s)
| | | | - Thomas M Crea
- Boston College School of Social Work, Newton, Massachusetts
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Ayaya S, DeLong A, Embleton L, Ayuku D, Sang E, Hogan J, Kamanda A, Atwoli L, Makori D, Ott MA, Ombok C, Braitstein P. 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? CHILD ABUSE & NEGLECT 2023; 139:104920. [PMID: 33485648 PMCID: PMC8289926 DOI: 10.1016/j.chiabu.2020.104920] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 12/12/2020] [Accepted: 12/23/2020] [Indexed: 06/04/2023]
Abstract
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.
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Affiliation(s)
- Samuel Ayaya
- Department of Child Health and Paediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Allison DeLong
- Department of Biostatistics, School of Public Health, Brown University, Providence, RI, USA
| | - Lonnie Embleton
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David Ayuku
- Department of Mental Health and Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Edwin Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Joseph Hogan
- Department of Biostatistics, School of Public Health, Brown University, Providence, RI, USA
| | | | - Lukoye Atwoli
- Department of Mental Health and Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya; Aga Khan University Medical College, East Africa, Nairobi, Kenya
| | - Dominic Makori
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Mary A Ott
- Department of Pediatrics, Indiana University, School of Medicine, Indianapolis, USA
| | - Caroline Ombok
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Medicine, College of Health Sciences, School of Medicine, Eldoret, Kenya.
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Sutherland SC, Shannon HS, Ayuku D, Streiner DL, Saarela O, Atwoli L, Braitstein P. The relationships between resilience, care environment, and social-psychological factors in orphaned and separated adolescents in western Kenya. VULNERABLE CHILDREN AND YOUTH STUDIES 2022; 17:165-179. [PMID: 35874427 PMCID: PMC9302592 DOI: 10.1080/17450128.2022.2067381] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Sarah C. Sutherland
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
| | - Harry S. Shannon
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Science, McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, Canada
| | - David Ayuku
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Nandi Road, Eldoret, Kenya
| | - David L. Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5, L8N 3K7, Hamilton, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8 floor, M5T 1R8, Toronto, Canada
| | - Olli Saarela
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
| | - Lukoye Atwoli
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Nandi Road, Eldoret, Kenya
- Brain and Mind Institute and the Department of Medicine, Aga Khan University Medical College, East Africa, Nairobi, Kenya
| | - Paula Braitstein
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada
- Academic Model Providing Access to Healthcare (AMPATH), Nandi Road, Eldoret, Kenya
- Department of Epidemiology and Medical Statistics, School of Public Health, College of Health Sciences, Moi University, Nandi Road, Eldoret, Kenya
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Myers C, Apondi E, Toromo JJ, Omollo M, Bakari S, Aluoch J, Sang F, Njoroge T, Morris Z, Kantor R, Braitstein P, Nyandiko WM, Wools-Kaloustian K, Elul B, Vreeman RC, Enane LA. "Who am I going to stay with? Who will accept me?": family-level domains influencing HIV care engagement among disengaged adolescents in Kenya. J Int AIDS Soc 2022; 25:e25890. [PMID: 35192747 PMCID: PMC8863355 DOI: 10.1002/jia2.25890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/01/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV (ALHIV, ages 10-19) have developmentally specific needs in care, and have lower retention compared to other age groups. Family-level contexts may be critical to adolescent HIV outcomes, but have often been overlooked. We investigated family-level factors underlying disengagement and supporting re-engagement among adolescents disengaged from HIV care. METHODS Semi-structured interviews were performed with 42 disengaged ALHIV, 32 of their caregivers and 28 healthcare workers (HCW) in the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya, from 2018 to 2020. Disengaged ALHIV had ≥1 visit within the 18 months prior to data collection at one of two sites and nonattendance ≥60 days following their last scheduled appointment. HCW were recruited from 10 clinics. Transcripts were analysed through thematic analysis. A conceptual model for family-level domains influencing adolescent HIV care engagement was developed from these themes. RESULTS Family-level factors emerged as central to disengagement. ALHIV-particularly those orphaned by the loss of one or both parents-experienced challenges when new caregivers or unstable living situations limited support for HIV care. These challenges were compounded by anticipated stigma; resultant non-disclosure of HIV status to household members; enacted stigma in the household, with overwhelming effects on adolescents; or experiences of multiple forms of trauma, which undermined HIV care engagement. Some caregivers lacked finances or social support to facilitate care. Others did not feel equipped to support adolescent engagement or adherence. Regarding facilitators to re-engagement, participants described roles for household disclosure; and solidarity from caregivers, especially those also living with HIV. Family-level domains influencing HIV care engagement were conceptualized as follows: (1) adolescent living situation and contexts; (2) household material resources or poverty; (3) caregiver capacities and skills to support adolescent HIV care; and (4) HIV stigma or solidarity at the household level. CONCLUSIONS Family-level factors are integral to retention in care for ALHIV. The conceptual model developed in this study for family-level influences on care engagement may inform holistic approaches to promote healthy outcomes for ALHIV. Developmentally appropriate interventions targeting household relationships, disclosure, HIV stigma reduction, HIV care skills and resources, and economic empowerment may promote adolescent engagement in HIV care.
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Affiliation(s)
- Courtney Myers
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Judith J Toromo
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mark Omollo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Salim Bakari
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Festus Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Tabitha Njoroge
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Zariel Morris
- Indiana University-Purdue University-Indianapolis, Indiana University, Indianapolis, Indiana, USA
| | - Rami Kantor
- Division of Infectious Diseases, Department of Medicine, Brown University Apert Medical School, Providence, Rhode Island, USA
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Epidemiology, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Winstone M Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Indiana University Center for Global Health, Indianapolis, Indiana, USA
| | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Rachel C Vreeman
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.,Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Arnhold Institute for Global Health, New York, New York, USA
| | - Leslie A Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Indiana University Center for Global Health, Indianapolis, Indiana, USA
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8
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Braitstein P, DeLong A, Ayuku D, Ott M, Atwoli L, Galárraga O, Sang E, Hogan J. Association of Care Environment With HIV Incidence and Death Among Orphaned, Separated, and Street-Connected Children and Adolescents in Western Kenya. JAMA Netw Open 2021; 4:e2125365. [PMID: 34529063 PMCID: PMC8446813 DOI: 10.1001/jamanetworkopen.2021.25365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Paula Braitstein
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Epidemiology and Medical Statistics, School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH) Program, Eldoret, Kenya
| | - Allison DeLong
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - David Ayuku
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Mary Ott
- Department of Pediatrics, Faculty of Medicine, Indiana University, Indianapolis
| | - Lukoye Atwoli
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
- Dean’s Office, Aga Khan University Medical College, East Africa, Nairobi, Kenya
| | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Edwin Sang
- Academic Model Providing Access to Healthcare (AMPATH) Program, Eldoret, Kenya
| | - Joseph Hogan
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
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Murphy K, Embleton L, Lachman JM, Owino E, Kirwa S, Makori D, Braitstein P. "From Analog to Digital": The Feasibility, Acceptability, and Preliminary Outcomes of a Positive Parenting Program for Street-Connected Mothers in Kenya. CHILDREN AND YOUTH SERVICES REVIEW 2021; 127:106077. [PMID: 34421160 PMCID: PMC8372834 DOI: 10.1016/j.childyouth.2021.106077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Children of street-connected women in Kenya are at risk of child maltreatment. There have been increasing calls for positive parenting programs for parents experiencing homelessness, however never has one been implemented with this population. We therefore adapted the evidence-based Parenting for Lifelong Health for Young Children program using participatory methods, and piloted the adapted program with street-connected mothers in Kenya. OBJECTIVES To (a) determine if the adapted program was feasible and acceptable with street-connected mothers, and (b) assess indicative effects on child maltreatment, positive parenting, and parental stress. PARTICIPANTS AND SETTING Two groups of 15 mothers (ages 19+, and 20- ) participated between June-July 2018 in Eldoret, Kenya. Participants were eligible if they (a) were the mother of at least one child and (b) self-identified as street-connected. METHODS Feasibility was measured via enrollment, attendance, drop-out rates, and engagement in take-away activities. Focus groups explored program acceptability and program outcomes. Self-report surveys assessed pre-post changes in child maltreatment, parental stress, parental sense of inefficacy, and positive parenting practices. RESULTS 70% of participants attended ≥3/4 of sessions, 10% dropped out, and >50% of take-away activities were completed. Participants reported high acceptability and requested its continuation for themselves and other parents. There was an increase in supporting good behaviour (t(21)=8.15, p < .000) and setting limits (t(18) = 10.03, p < .000); a reduction in physical abuse (t(23) = -2.15, p = .042) and parental stress (t(22) = -7.08, p < .000); results for parental inefficacy were not statistically significant (t(22) = 0.15, p = .882). CONCLUSIONS The adapted program is feasible and acceptable to street-connected mothers, and may reduce child maltreatment and parental stress, and increase positive parenting. Further research should test program effectiveness.
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Affiliation(s)
- Kathleen Murphy
- Dalhousie University, Halifax, Canada, 6420 Coburg Rd., Halifax, Nova Scotia, B3H 4R2, Canada
| | - Lonnie Embleton
- University of Toronto, Dalla Lana School of Public Health, Toronto, Canada, 155 College St, Toronto, Ontario, M5T 3M7, Canada
| | - Jamie M. Lachman
- Department of Social Policy and Intervention, University of Oxford, UK; MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK, 32 Wellington Square, Oxford, United Kingdom, OX1 2ER
| | - Eucabeth Owino
- Beruham, Eldoret, Kenya, P.O. Box 3950 Eldoret, 30100 Kenya
| | - Sheila Kirwa
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya, P.O. Box 4606, Eldoret, Kenya, 30100
| | - Dominic Makori
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya, P.O. Box 4606, Eldoret, Kenya, 30100
| | - Paula Braitstein
- University of Toronto, Dalla Lana School of Public Health, Division of Epidemiology, Toronto, Canada, Moi University, College of Health Sciences, School of Public Health, Department of Epidemiology and Medical Statistics, Eldoret, Kenya, 155 College Street, Toronto, ON Canada M5T 3M7
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Omari F, Chrysanthopoulou SA, Embleton LE, Atwoli L, Ayuku DO, Sang E, Braitstein P. The impact of care environment on the mental health of orphaned, separated and street-connected children and adolescents in western Kenya: a prospective cohort analysis. BMJ Glob Health 2021; 6:bmjgh-2020-003644. [PMID: 33789867 PMCID: PMC8016077 DOI: 10.1136/bmjgh-2020-003644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction The effect of care environment on orphaned and separated children and adolescents’ (OSCA) mental health is not well characterised in sub-Saharan Africa. We compared the risk of incident post-traumatic stress disorder (PTSD), depression, anxiety and suicidality among OSCA living in Charitable Children’s Institutions (CCIs), family-based care (FBC) and street-connected children and youth (SCY). Methods This prospective cohort followed up OSCA from 300 randomly selected households (FBC), 19 CCIs and 100 SCY in western Kenya from 2009 to 2019. Annual data were collected through standardised assessments. We fit survival regression models to investigate the association between care environment and mental health diagnoses. Results The analysis included 1931 participants: 1069 in FBC, 783 in CCIs and 79 SCY. At baseline, 1004 participants (52%) were male with a mean age (SD) of 13 years (2.37); 54% were double orphans. In adjusted analysis (adjusted HR, AHR), OSCA in CCIs were significantly less likely to be diagnosed with PTSD (AHR 0.69, 95% CI 0.49 to 0.97), depression (AHR 0.48 95% CI 0.24 to 0.97), anxiety (AHR 0.56, 95% CI 0.45 to 0.68) and suicidality (AHR 0.73, 95% CI 0.56 to 0.95) compared with those in FBC. SCY were significantly more likely to be diagnosed with PTSD (AHR 4.52, 95% CI 4.10 to 4.97), depression (AHR 4.72, 95% CI 3.12 to 7.15), anxiety (AHR 4.71, 95% CI 1.56 to 14.26) and suicidality (AHR 3.10, 95% CI 2.14 to 4.48) compared with those in FBC. Conclusion OSCA living in CCIs in this setting were significantly less likely to have incident mental illness, while SCY were significantly more, compared with OSCA in FBC.
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Affiliation(s)
- Felicita Omari
- Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Lonnie E Embleton
- Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Lukoye Atwoli
- Mental Health, Moi University College of Health Sciences, Eldoret, Kenya
| | - David O Ayuku
- Behavioral Sciences, Moi University College of Health Sciences, Eldoret, Kenya
| | - Edwin Sang
- Data Management and Biostatistics, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Paula Braitstein
- Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
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11
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Theory of Mind Ability and Socioeconomic Status, a Study of Street-Connected Children and Adolescents in Ecuador. PSYCH 2021. [DOI: 10.3390/psych3020008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Family socioeconomic status (SES) is closely associated with cognitive ability in children and adolescents. However, most of the research has come from high-income countries. There is only limited research on ‘street children’, who represent an aspect of low-SES particularly associated with low- and middle-income counties. The current research in Quito, Ecuador, compared a group of street-connected youth with a not street-connected control group on two different measures of theory of mind ability and verbal comprehension. Initial analysis revealed that the street-connected sample scored significantly below the level of the control sample for verbal comprehension. For the main analysis, street-connected youth were matched to control participants for age, sex, and verbal comprehension scores. The street-connected sample was found to perform significantly below the control sample on both measures of theory of mind. Furthermore, worse performance appeared to be linked to severity of symptoms of post-traumatic stress disorder (PTSD) within the street-connected sample. In conclusion, the association of relatively poor verbal comprehension with street-connectedness is consistent with existing research from high-income countries on SES gradients and cognitive development. In contrast, theory of mind ability, a core aspect of social cognition, may be particularly linked to the street-connectedness form of low SES that exists in many low- and middle-income countries.
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Lonnie E, Pooja S, Allison G, Reuben K, David A, Juddy W, Edith A, Paula B. Exploring patient-provider interactions and the health system's responsiveness to street-connected children and youth in Kenya: a qualitative study. BMC Health Serv Res 2021; 21:363. [PMID: 33874934 PMCID: PMC8056657 DOI: 10.1186/s12913-021-06376-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 04/12/2021] [Indexed: 12/30/2022] Open
Abstract
Background In Kenya, street-connected children and youth (SCY) have poor health outcomes and die prematurely due to preventable causes. This suggests they are not accessing or receiving adequately responsive healthcare to prevent morbidity and mortality. We sought to gain insight into the health systems responsiveness to SCY in Kenya through an in-depth exploration of SCY’s and healthcare provider’s reflections on their interactions with each other. Methods This qualitative study was conducted across 5 counties in western Kenya between May 2017 and September 2018 using multiple methods to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY in Kenya. The present analysis focuses on a subset of data from focus group discussions and in-depth interviews concerning the delivery of healthcare to SCY, interactions between SCY and providers, and SCY’s experiences in the health system. We conducted a thematic analysis situated in a conceptual framework for health systems responsiveness. Results Through three themes, context, negative patient-provider interactions, and positive patient-provider interactions, we identified factors that shape health systems responsiveness to SCY in Kenya. Economic factors influenced and limited SCY’s interactions with the health system and shaped their experiences of dignity, quality of basic amenities, choice of provider, and prompt attention. The stigmatization and discrimination of SCY, a sociological process shaped by the social-cultural context in Kenya, resulted in experiences of indignity and a lack of prompt attention when interacting with the health system. Patient-provider interactions were highly influenced by healthcare providers’ adverse personal emotions and attitudes towards SCY, resulting in negative interactions and a lack of health systems responsiveness. Conclusions This study suggests that the health system in Kenya is inadequately responsive to SCY. Increasing public health expenditures and expanding universal health coverage may begin to address economic factors, such as the inability to pay for care, which influence SCY’s experiences of choice of provider, prompt attention, and dignity. The deeply embedded adverse emotional responses expressed by providers about SCY, associated with the socially constructed stigmatization of this population, need to be addressed to improve patient-provider interactions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06376-6.
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Affiliation(s)
- Embleton Lonnie
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.,Institute of Medical Sciences, Faculty of Medicine, University of Toronto, 1 Kings College Circle Room 2374, Toronto, ON, M5S 1A8, Canada
| | - Shah Pooja
- London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK.,Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Gayapersad Allison
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - Kiptui Reuben
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Ayuku David
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya.,Department of Behavioural Science, Moi University, College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya
| | - Wachira Juddy
- Department of Behavioural Science, Moi University, College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya
| | - Apondi Edith
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Braitstein Paula
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada. .,Institute of Medical Sciences, Faculty of Medicine, University of Toronto, 1 Kings College Circle Room 2374, Toronto, ON, M5S 1A8, Canada. .,Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya. .,Moi University, College of Health Sciences, School of Medicine, P.O. Box 4606-30100, Eldoret, Kenya.
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13
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Enane LA, Apondi E, Omollo M, Toromo JJ, Bakari S, Aluoch J, Morris C, Kantor R, Braitstein P, Fortenberry JD, Nyandiko WM, Wools‐Kaloustian K, Elul B, Vreeman RC. "I just keep quiet about it and act as if everything is alright" - The cascade from trauma to disengagement among adolescents living with HIV in western Kenya. J Int AIDS Soc 2021; 24:e25695. [PMID: 33838007 PMCID: PMC8035676 DOI: 10.1002/jia2.25695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION There are approximately 1.7 million adolescents living with HIV (ALHIV, ages 10 to 19) globally, including 110,000 in Kenya. While ALHIV experience poor retention in care, limited data exist on factors underlying disengagement. We investigated the burden of trauma among disengaged ALHIV in western Kenya, and its potential role in HIV care disengagement. METHODS We performed in-depth qualitative interviews with ALHIV who had disengaged from care at two sites, their caregivers and healthcare workers (HCW) at 10 sites, from 2018 to 2020. Disengagement was defined as not attending clinic ≥60 days past a missed scheduled visit. ALHIV and their caregivers were traced through phone calls and home visits. Interviews ascertained barriers and facilitators to adolescent retention in HIV care. Dedicated questions elicited narratives surrounding traumatic experiences, and the ways in which these did or did not impact retention in care. Through thematic analysis, a conceptual model emerged for a cascade from adolescent experience of trauma to disengagement from HIV care. RESULTS Interviews were conducted with 42 disengaged ALHIV, 34 caregivers and 28 HCW. ALHIV experienced a high burden of trauma from a range of stressors, including experiences at HIV disclosure or diagnosis, the loss of parents, enacted stigma and physical or sexual violence. A confluence of factors - trauma, stigma and isolation, and lack of social support - led to hopelessness and depression. These factors compounded each other, and resulted in complex mental health burdens, poor antiretroviral adherence and care disengagement. HCW approaches aligned with the factors in this model, suggesting that these areas represent targets for intervention and provision of trauma-informed care. CONCLUSIONS Trauma is a major factor underlying disengagement from HIV care among Kenyan adolescents. We describe a cascade of factors representing areas for intervention to support mental health and retention in HIV care. These include not only the provision of mental healthcare, but also preventing or addressing violence, trauma and stigma, and reinforcing social and familial support surrounding vulnerable adolescents. In this conceptualization, supporting retention in HIV care requires a trauma-informed approach, both in the individualized care of ALHIV and in the development of strategies and policies to support adolescent health outcomes.
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Affiliation(s)
- Leslie A Enane
- The Ryan White Center for Pediatric Infectious Disease and Global HealthDepartment of PediatricsIndiana University School of MedicineIndianapolisINUSA
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Moi Teaching and Referral HospitalEldoretKenya
| | - Mark Omollo
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Judith J Toromo
- The Ryan White Center for Pediatric Infectious Disease and Global HealthDepartment of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Salim Bakari
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Clemette Morris
- Indiana University‐Purdue University‐IndianapolisIndiana UniversityIndianapolisINUSA
| | - Rami Kantor
- Division of Infectious DiseasesDepartment of MedicineBrown University Apert Medical SchoolProvidenceRIUSA
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Department of EpidemiologyIndiana University Fairbanks School of Public HealthIndianapolisINUSA
- Dalla Lana School of Public HealthDivision of EpidemiologyUniversity of TorontoTorontoONCanada
- Department of MedicineCollege of Health SciencesSchool of MedicineMoi UniversityEldoretKenya
| | - J Dennis Fortenberry
- Division of Adolescent MedicineDepartment of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Winstone M Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Department of Child Health and PediatricsCollege of Health SciencesSchool of MedicineMoi UniversityEldoretKenya
| | - Kara Wools‐Kaloustian
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Division of Infectious DiseasesDepartment of MedicineIndiana University School of MedicineIndianapolisINUSA
| | - Batya Elul
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Rachel C Vreeman
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
- Division of Infectious DiseasesDepartment of MedicineIndiana University School of MedicineIndianapolisINUSA
- Department of Health System Design and Global HealthIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Arnhold Institute for Global HealthNew YorkNYUSA
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Embleton L, Shah P, Amin Gayapersad A, Kiptui R, Ayuku D, Braitstein P. Identifying Strategies to Advance Health Equity through Action on Social Determinants of Health and Human Rights for Street-Connected Children and Youth in Kenya. Health Hum Rights 2020; 22:177-197. [PMID: 33390706 PMCID: PMC7762894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Despite the fact that street-connected children and youth (SCY) in low- and middle-income countries experience numerous social and health inequities, few evidence-based policies and interventions have been implemented to improve their circumstances. Our study analyzed strategies to advance health equity through action on the social determinants of health (SDH) for SCY in Kenya based on General Comment 21 of the United Nations Committee on the Rights of the Child. To identify policies and interventions, we analyzed archival newspaper articles and policy documents and elicited ideas from a diversity of social actors across Kenya. Our results identified three types of policies and interventions: repressive, welfare oriented, and child rights based. We then situated these strategies within the World Health Organization's conceptual framework on SDH inequities to understand their mechanism of impact on health equity. Our results demonstrate that a child rights approach provides a strong avenue for advancing health equity through action on the SDH for SCY in Kenya. As a result of these findings, we developed a checklist for policy makers and other stakeholders to assess how their policies and interventions are upholding human rights, addressing needs, and working to advance health equity for SCY.
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Affiliation(s)
- Lonnie Embleton
- Postdoctoral fellow at the Dalla Lana School of Public Health at the University of Toronto, Canada
| | - Pooja Shah
- PhD student in the Faculty of Public Health and Policy at the London School of Hygiene and Tropical Medicine, United Kingdom
| | - Allison Amin Gayapersad
- Postdoctoral fellow at the Dalla Lana School of Public Health at the University of Toronto, Canada
| | - Reuben Kiptui
- Research Coordinator at the Academic Model Providing Access to Healthcare in Eldoret, Kenya
| | - David Ayuku
- Professor of Clinical Psychology at the Moi University School of Medicine, Eldoret, Kenya
| | - Paula Braitstein
- Epidemiologist and Associate Professor at the Dalla Lana School of Public Health at the University of Toronto, Canada
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Wilke NG, Howard AH, Pop D. Data-informed recommendations for services providers working with vulnerable children and families during the COVID-19 pandemic. CHILD ABUSE & NEGLECT 2020; 110:104642. [PMID: 32753231 PMCID: PMC7392096 DOI: 10.1016/j.chiabu.2020.104642] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic and associated response measures have led to unprecedented challenges for service providers working with vulnerable children and families around the world. OBJECTIVE The goal of the present study was to better understand the impact of the pandemic and associated response measures on vulnerable children and families and provide data-informed recommendations for public and private service providers working with this population. PARTICIPANTS AND SETTING Representatives from 87 non-government organizations (NGOs) providing a variety of direct services (i.e. residential care, family preservation, foster care, etc.) to 454,637 vulnerable children and families in 43 countries completed a brief online survey. METHODS Using a mixed methods design, results examined 1) ways in which children and families have been directly impacted by COVID-19, 2) the impact of the pandemic on services provided by NGOs, 3) government responses and gaps in services for this population during the pandemic, and 4) strategies that have been effective in filling these gaps. RESULTS Data revealed that the pandemic and restrictive measures were associated with increased risk factors for vulnerable children and families, including not having access to vital services. The NGOs experienced government restrictions, decreased financial support, and inability to adequately provide services. Increased communication and supportive activities had a positive impact on both NGO staff and the families they serve. CONCLUSIONS Based on the findings, ten recommendations were made for service providers working with vulnerable children and families during the COVID-19 pandemic.
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Embleton L, Shah P, Gayapersad A, Kiptui R, Ayuku D, Braitstein P. Characterizing street-connected children and youths' social and health inequities in Kenya: a qualitative study. Int J Equity Health 2020; 19:147. [PMID: 32859193 PMCID: PMC7455900 DOI: 10.1186/s12939-020-01255-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/10/2020] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Street-connected children and youth (SCY) in Kenya disproportionately experience preventable morbidities and premature mortality. We theorize these health inequities are socially produced and result from systemic discrimination and a lack of human rights attainment. Therefore, we sought to identify and understand how SCY's social and health inequities in Kenya are produced, maintained, and shaped by structural and social determinants of health using the WHO conceptual framework on social determinants of health (SDH) and the Convention on the Rights of the Child (CRC) General Comment no. 17. METHODS This qualitative study was conducted from May 2017 to September 2018 using multiple methods including focus group discussions, in-depth interviews, archival review of newspaper articles, and analysis of a government policy document. We purposively sampled 100 participants including community leaders, government officials, vendors, police officers, general community residents, parents of SCY, and stakeholders in 5 counties across Kenya to participate in focus group discussions and in-depth interviews. We conducted a thematic analysis situated in the conceptual framework on SDH and the CRC. RESULTS Our findings indicate that SCY's social and health disparities arise as a result of structural and social determinants stemming from a socioeconomic and political environment that produces systemic discrimination, breaches human rights, and influences their unequal socioeconomic position in society. These social determinants influence SCY's intermediary determinants of health resulting in a lack of basic material needs, being precariously housed or homeless, engaging in substance use and misuse, and experiencing several psychosocial stressors, all of which shape health outcomes and equity for this population. CONCLUSIONS SCY in Kenya experience social and health inequities that are avoidable and unjust. These social and health disparities arise as a result of structural and social determinants of health inequities stemming from the socioeconomic and political context in Kenya that produces systemic discrimination and influences SCYs' unequal socioeconomic position in society. Remedial action to reverse human rights contraventions and to advance health equity through action on SDH for SCY in Kenya is urgently needed.
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Affiliation(s)
- L Embleton
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, 1 Kings College Circle Room 2374, Toronto, ON, M5S 1A8, Canada
| | - P Shah
- London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - A Gayapersad
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada
| | - R Kiptui
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - D Ayuku
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
- Department of Behavioural Science, School of Medicine, Moi University, College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya
| | - P Braitstein
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada.
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, 1 Kings College Circle Room 2374, Toronto, ON, M5S 1A8, Canada.
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya.
- Department of Medicine, School of Medicine, Moi University, College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya.
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Mbwayo AW, Mathai M, Harder VS, Nicodimos S, Vander Stoep A. Trauma among Kenyan School Children in Urban and Rural Settings: PTSD Prevalence and Correlates. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:63-73. [PMID: 32318229 PMCID: PMC7163810 DOI: 10.1007/s40653-019-00256-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This study estimated the prevalence and correlates of PTSD in Kenyan school children during a period of widespread post-election violence. The UCLA PTSD Reaction Index was administered to 2482 primary and secondary school students ages 11-17 from rural and urban communities. A high proportion of school children had witnessed people being shot at, beat up or killed (46.9%) or had heard about the violent death or serious injury of a loved one (42.0%). Over one quarter (26.8%, 95% CI = 25.1% - 28.7%) met criteria for PTSD. Correlates of PTSD included living in a rural (vs urban) area (AOR = 1.72, 95% CI = 1.41-2.11), attending primary (vs secondary) school (AOR = 2.25, 95% CI = 1.67-3.04) and being a girl (with girl as referent AOR = .70, 95% CI = .57-.86). We recommend training Kenyan teachers to recognize signs of emotional distress in school children and psychosocial counselors to adapt empirically-supported mental health interventions for delivery in primary and secondary school settings.
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Affiliation(s)
| | - Muthoni Mathai
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | - Semret Nicodimos
- Child Health Institute, University of Washington, Seattle, WA USA
| | - Ann Vander Stoep
- Department of Psychiatry and Behavioral Sciences and Department of Epidemiology, University of Washington, Box 354920, Seattle, WA 98195 USA
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Ogunbajo A, Kang A, Shangani S, Wade RM, Onyango DP, Odero WW, Harper GW. Awareness and Acceptability of pre-exposure prophylaxis (PrEP) among gay, bisexual and other men who have sex with men (GBMSM) in Kenya. AIDS Care 2019; 31:1185-1192. [PMID: 31039628 PMCID: PMC6663573 DOI: 10.1080/09540121.2019.1612023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/16/2019] [Indexed: 12/17/2022]
Abstract
Kenyan gay, bisexual, and other men who have sex with men (GBMSM) are significantly affected by HIV. Pre-exposure prophylaxis (PrEP) is an effective biomedical approach to HIV prevention. We conducted a cross-sectional survey of 459 HIV-negative Kenyan GBMSM to assess individual and interpersonal correlates of PrEP awareness/acceptability using univariate and hierarchical logistic regression modeling. We found that 64.3% of participants had heard of PrEP and 44.9% were willing to use PrEP. In hierarchical logistic regression models for PrEP awareness, condom use with regular partners, higher condom use self-efficacy, higher perceived ability to use PrEP, history of STI, and membership in LGBT organization were significantly associated with being aware of PrEP (χ2 = 69.6, p < .001). In hierarchical logistic regression models for PrEP acceptability, higher self-esteem, higher condom use self-efficacy, depression/anxiety, higher perceived ability to use PrEP, willingness to engage in PrEP follow-up visits, coercion at sexual debut, and family exclusion were significantly associated with being acceptable to PrEP (χ2 = 231.8, p < .001). Individual and interpersonal factors were significantly associated with PrEP awareness and acceptability. Our findings underscore the need to promote awareness and understanding of PrEP as an effective HIV prevention tool in combination with other safer-sex methods that are appropriate given an individual's personal circumstances.
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Affiliation(s)
- Adedotun Ogunbajo
- Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, RI, United States of America
- Center for Health Equity, Brown School of Public Health, Providence, RI, United States of America
| | - Augustine Kang
- Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, RI, United States of America
- Center for Health Equity, Brown School of Public Health, Providence, RI, United States of America
| | - Sylvia Shangani
- Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, RI, United States of America
| | - Ryan M. Wade
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | | | | | - Gary W. Harper
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
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Gayapersad A, Ombok C, Kamanda A, Tarus C, Ayuku D, Braitstein P. The Production and Reproduction of Kinship in Charitable Children’s Institutions in Uasin Gishu County, Kenya. CHILD & YOUTH CARE FORUM 2019. [DOI: 10.1007/s10566-019-09506-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Embleton L, Ayuku D, Makori D, Kamanda A, Braitstein P. Causes of death among street-connected children and youth in Eldoret, Kenya. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:19. [PMID: 29764412 PMCID: PMC5952842 DOI: 10.1186/s12914-018-0160-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/07/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Street-connected young people carry a disproportionate burden of morbidities, and engage in a variety of practices that may heighten their risk of premature mortality, yet there are currently no reports in the literature on the rates or risk factors for mortality among them, nor on their causes of death. In low- and middle-income countries they are frequently in situations that violate their human rights, likely contributing to their increased burden of morbidities and vulnerability to mortality. We thus sought to describe the number of deaths annually, causes of death, and determine the number of deaths attributable to HIV among street-connected young people aged 0 to 30 years in Eldoret, Kenya. METHODS Eldoret, Kenya has approximately 1900 street-connected young people. We collected data on deaths occurring from October 2009 to December 2016 from Moi Teaching and Referral Hospital records, Academic Model Providing Access to Healthcare HIV program records, and utilized verbal autopsies when no records were available. Descriptive analyses were conducted stratified by sex and age category, and frequencies and proportions were calculated to provide an overview of the decedents. We used logistic regression to assess the association between underlying cause of death and sex, while controlling for age and location of death. RESULTS In total there were 100-recorded deaths, 66 among males and 34 among females; 37% of were among those aged ≤18 years. HIV/AIDS (37%) was the most common underlying cause of death, followed by assault (36%) and accidents (10%) for all decedents. Among males, the majority of deaths were attributable to assault (49%) and HIV/AIDS (26%), while females primarily died due to HIV/AIDS (59%). CONCLUSION Our results demonstrate a high number of deaths due to assault among males and HIV/AIDS among males and females. Our findings demonstrate the need for studies of HIV prevalence and incidence among this population to characterize the burden of HIV, particularly among young women given the higher number of deaths attributed to HIV/AIDS among them. Most deaths were preventable and require the urgent attention of service providers and policymakers to implement programs and services to prevent premature mortality and uphold children's rights.
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Affiliation(s)
- Lonnie Embleton
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - David Ayuku
- College of Health Sciences, School of Medicine, Department of Behavioral Sciences, Moi University, Eldoret, Kenya
| | | | | | - Paula Braitstein
- College of Health Sciences, School of Medicine, Department of Medicine, Moi University, Eldoret, Kenya. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Regenstrief Institute Inc., Indianapolis, USA. .,Fairbanks School of Public Health, Indiana University, Indianapolis, USA. .,Division of Epidemiology, 155 College Street, Toronto, ON, M5T 3M, Canada.
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21
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Shangani S, Operario D, Genberg B, Kirwa K, Midoun M, Atwoli L, Ayuku D, Galárraga O, Braitstein P. Unconditional government cash transfers in support of orphaned and vulnerable adolescents in western Kenya: Is there an association with psychological wellbeing? PLoS One 2017; 12:e0178076. [PMID: 28562627 PMCID: PMC5451046 DOI: 10.1371/journal.pone.0178076] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 05/05/2017] [Indexed: 11/30/2022] Open
Abstract
Background Orphaned and vulnerable adolescents (OVA) in sub-Saharan Africa are at greater risk for adverse psychological outcomes compared with their non-OVA counterparts. Social interventions that provide cash transfers (CTs) have been shown to improve health outcomes among young people, but little is known about their impact on the psychological wellbeing of OVA. Objective Among OVA in western Kenya, we assessed the association between living in a household that received monthly unconditional government CTs and psychological wellbeing. Methods We examined the likelihood of depression, anxiety, post-traumatic stress symptoms (PTSS) and positive future outlook among 655 OVA aged between 10 and 18 years who lived in 300 randomly selected households in western Kenya that either received or did not receive unconditional monthly CTs. Results The mean age was 14.0 (SD 2.4) years and 329 (50.2%) of the participants were female while 190 (29.0%) were double orphans whose biological parents were both deceased. After adjusting for socio-demographic, caregiver, and household characteristics and accounting for potential effects of participant clustering by sub-location of residence, OVA living in CT households were more likely to have a positive future outlook (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.08, 1.99), less likely to be anxious (OR 0.57, 95% CI 0.42, 0.78), and less likely to have symptoms of post-traumatic stress (OR 0.50, 95% CI 0.29, 0.89). We did not find statistically significant differences in odds of depression by CT group. Conclusion OVA in CT households reported better psychological wellbeing compared to those in households not receiving CTs. CT interventions may be effective for improving psychological wellbeing among vulnerable adolescents in socioeconomically deprived households.
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Affiliation(s)
- Sylvia Shangani
- Brown University, Department of Behavioral Social Sciences, Providence, Rhode Island, United States of America
- Moi Teaching and Referral Hospital, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Don Operario
- Brown University, Department of Behavioral Social Sciences, Providence, Rhode Island, United States of America
| | - Becky Genberg
- Brown University, Department of Health Services, Policy and Practice, Providence, Rhode Island, United States of America
| | - Kipruto Kirwa
- Brown University, Department of Epidemiology, Providence, Rhode Island, United States of America
- Moi University, College of Health Sciences, School of Public Health, Department of Epidemiology and Biostatistics, Eldoret, Kenya
| | - Miriam Midoun
- Brown University, Department of Behavioral Social Sciences, Providence, Rhode Island, United States of America
| | - Lukoye Atwoli
- Moi University, College of Health Sciences, School of Medicine, Department of Behavioral Sciences, Eldoret, Kenya
| | - David Ayuku
- Moi University, College of Health Sciences, School of Medicine, Department of Behavioral Sciences, Eldoret, Kenya
| | - Omar Galárraga
- Brown University, Department of Health Services, Policy and Practice, Providence, Rhode Island, United States of America
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University, College of Health Sciences, School of Medicine, Department of Medicine, Eldoret, Kenya
- University of Toronto, Dalla Lana School of Public Health, Division of Epidemiology, Toronto, Canada
- * E-mail:
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Gray CL, Pence BW, Messer LC, Ostermann J, Whetten RA, Thielman NM, O'Donnell K, Whetten K. Civic engagement among orphans and non-orphans in five low- and middle-income countries. Global Health 2016; 12:61. [PMID: 27729052 PMCID: PMC5057410 DOI: 10.1186/s12992-016-0202-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Communities and nations seeking to foster social responsibility in their youth are interested in understanding factors that predict and promote youth involvement in public activities. Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in resource-poor settings. Understanding whether and how OSC are engaged in civic activities is important for community and world leaders who need to provide care for OSC and ensure their involvement in sustainable development. METHODS The Positive Outcomes for Orphans study (POFO) is a multi-country, longitudinal cohort study of OSC randomly sampled from institution-based care and from family-based care, and of non-OSC sampled from the same study regions. Participants represent six sites in five low-and middle-income countries. We examined civic engagement activities and government trust among subjects > =16 years old at 90-month follow-up (approximately 7.5 years after baseline). We calculated prevalences and estimated the association between key demographic variables and prevalence of regular volunteer work using multivariable Poisson regression, with sampling weights to accounting for the complex sampling design. RESULTS Among the 1,281 POFO participants > =16 who were assessed at 90-month follow-up, 45 % participated in regular community service or volunteer work; two-thirds of those volunteers did so on a strictly voluntary basis. While government trust was fairly high, at approximately 70 % for each level of government, participation in voting was only 15 % among those who were > =18 years old. We did not observe significant associations between demographic characteristics and regular volunteer work, with the exception of large variation by study site. CONCLUSION As the world's leaders grapple with the many competing demands of global health, economic security, and governmental stability, the participation of today's youth in community and governance is essential for sustainability. This study provides a first step in understanding the degree to which OSC from different care settings across multiple low- and middle-income countries are engaged in their communities.
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Affiliation(s)
- Christine L Gray
- Department of Epidemiology, Gillings School of Global Public Health, CB #7435, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7435, USA.
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, CB #7435, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7435, USA.,Center for Health Policy, Duke Global Health Institute, Box 90519, Duke University, Durham, NC, 27708, USA
| | - Lynne C Messer
- Department of Epidemiology, Gillings School of Global Public Health, CB #7435, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7435, USA.,Center for Health Policy, Duke Global Health Institute, Box 90519, Duke University, Durham, NC, 27708, USA.,School of Community Health, College of Urban and Public Affairs, Portland State University, PO Box 751, Portland, OR, 97207, USA
| | - Jan Ostermann
- Center for Health Policy, Duke Global Health Institute, Box 90519, Duke University, Durham, NC, 27708, USA
| | - Rachel A Whetten
- Center for Health Policy, Duke Global Health Institute, Box 90519, Duke University, Durham, NC, 27708, USA
| | - Nathan M Thielman
- Center for Health Policy, Duke Global Health Institute, Box 90519, Duke University, Durham, NC, 27708, USA.,Department of Medicine, DUMC #3152, Division of Infectious Diseases and International Health, Duke University, Durham, NC, 27710, USA
| | - Karen O'Donnell
- Center for Health Policy, Duke Global Health Institute, Box 90519, Duke University, Durham, NC, 27708, USA.,Center for Child and Family Health, Duke University, 411 West Chapel Hill Street, Suite 908, Durham, NC, USA
| | - Kathryn Whetten
- Center for Health Policy, Duke Global Health Institute, Box 90519, Duke University, Durham, NC, 27708, USA.,Terry Sanford Institute of Public Policy, Box 90239, Duke University, Box 90239, Durham, NC, 27708-0239, USA
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Wachira J, Kamanda A, Embleton L, Naanyu V, Ayuku D, Braitstein P. 'Pregnancy Has Its Advantages': The Voices of Street Connected Children and Youth in Eldoret, Kenya. PLoS One 2016; 11:e0150814. [PMID: 26942724 PMCID: PMC4778759 DOI: 10.1371/journal.pone.0150814] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 02/19/2016] [Indexed: 11/19/2022] Open
Abstract
Objective Little is known about the reproductive health or family planning needs of street-connected children and youth in resource-constrained countries. The study objective was to describe how street-connected children and youth (SCCY) in Eldoret, Kenya, perceive pregnancy. Methods This qualitative study was conducted between August 2013 and February 2014. A total of 65 SCCY aged 11–24 years were purposively sampled from the three referral points: 1) A dedicated study clinic for vulnerable children and youth at Moi Teaching and Referral Hospital (MTRH); 2) Primary locations in which street children reside known as “bases/barracks”; and 3) Street youth community-based organizations. In-depth interviews and focus group discussions were audio recorded, transcribed, and translated into English. Content analysis was performed after thematic coding by 4 independent coders. Results The majority of SCCY interviewed were male (69%) and sexually active (81.5%). None had gone beyond primary level of education. The strong desire for SCCY to go through conventional life experiences including marriage and child bearing was evident. Sub-themes around desired pregnancies included: sense of identity with other SCCY, sense of hope, male ego, lineage, source of income, and avoiding stigmatization. The desire for children was highly gendered with male SCCY more focused on their social status in the street community, while for females it was primarily for survival on the street. Female SCCY generally lacked agency around reproductive health issues and faced gender-based violence. Abortions (either assisted or self-induced), infanticide, and child abandonment were reported. Respondents described a lucrative market for babies born to SCCY and alleged that healthcare workers were known to abduct these babies following hospital deliveries. Conclusion Our findings indicate gender differences in the reasons why SCCY become pregnant and have children. We also noted gender inequalities in reproductive health decisions. SCCY friendly interventions that provide tailored reproductive health services are needed.
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Affiliation(s)
- Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- * E-mail:
| | | | - Lonnie Embleton
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Violet Naanyu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - David Ayuku
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Indiana University, Fairbanks School of Public Health, Department of Epidemiology, Indianapolis, Indiana, United States of America
- Regenstrief Institute, Inc., Indianapolis, Indiana, United States of America
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Ranney ML, Patena JV, Nugent N, Spirito A, Boyer E, Zatzick D, Cunningham R. PTSD, cyberbullying and peer violence: prevalence and correlates among adolescent emergency department patients. Gen Hosp Psychiatry 2016; 39:32-8. [PMID: 26786845 PMCID: PMC4779373 DOI: 10.1016/j.genhosppsych.2015.12.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 12/04/2015] [Accepted: 12/11/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is often underdiagnosed and undertreated among adolescents. The objective of this analysis was to describe the prevalence and correlates of symptoms consistent with PTSD among adolescents presenting to an urban emergency department (ED). METHODS A cross-sectional survey of adolescents aged 13-17 years presenting to the ED for any reason was conducted between August 2013 and March 2014. Validated self-report measures were used to measure mental health symptoms, violence exposure and risky behaviors. Multivariate logistic regression analysis was performed to determine adjusted differences in associations between symptoms consistent with PTSD and predicted correlates. RESULTS Of 353 adolescents, 23.2% reported current symptoms consistent with PTSD, 13.9% had moderate or higher depressive symptoms and 11.3% reported past-year suicidal ideation. Adolescents commonly reported physical peer violence (46.5%), cyberbullying (46.7%) and exposure to community violence (58.9%). On multivariate logistic regression, physical peer violence, cyberbullying victimization, exposure to community violence, female gender and alcohol or other drug use positively correlated with symptoms consistent with PTSD. CONCLUSIONS Among adolescents presenting to the ED for any reason, symptoms consistent with PTSD, depressive symptoms, physical peer violence, cyberbullying and community violence exposure are common and interrelated. Greater attention to PTSD, both disorder and symptom levels, and its cooccurring risk factors is needed.
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Affiliation(s)
- Megan L Ranney
- Department of Emergency Medicine, Rhode Island Hospital/Alpert Medical School, Brown University, 593 Eddy Street, Claverick 2, Providence, RI 02903, USA; Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
| | - John V Patena
- Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
| | - Nicole Nugent
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI 02903, USA.
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI 02903, USA.
| | - Edward Boyer
- Department of Emergency Medicine, University of Massachusetts Worcester, 55 Lake Avenue, North Worcester, MA 01655, USA.
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington, 2815 Eastlake Avenue, Seattle, WA 98102, USA.
| | - Rebecca Cunningham
- Department of Emergency Medicine, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USA; Injury Control Research Center, University of Michigan, Ann Arbor, MI 48109-2800, USA.
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Embleton L, Ott MA, Wachira J, Naanyu V, Kamanda A, Makori D, Ayuku D, Braitstein P. Adapting ethical guidelines for adolescent health research to street-connected children and youth in low- and middle-income countries: a case study from western Kenya. BMC Med Ethics 2015; 16:89. [PMID: 26687378 PMCID: PMC4684915 DOI: 10.1186/s12910-015-0084-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 12/15/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Street-connected children and youth (SCCY) in low- and middle-income countries (LMIC) have multiple vulnerabilities in relation to participation in research. These require additional considerations that are responsive to their needs and the social, cultural, and economic context, while upholding core ethical principles of respect for persons, beneficence, and justice. The objective of this paper is to describe processes and outcomes of adapting ethical guidelines for SCCY's specific vulnerabilities in LMIC. METHODS As part of three interrelated research projects in western Kenya, we created procedures to address SCCY's vulnerabilities related to research participation within the local context. These consisted of identifying ethical considerations and solutions in relation to community engagement, equitable recruitment, informed consent, vulnerability to coercion, and responsibility to report. RESULTS Substantial community engagement provided input on SCCY's participation in research, recruitment, and consent processes. We designed an assent process to support SCCY to make an informed decision regarding their participation in the research that respected their autonomy and their right to dissent, while safeguarding them in situations where their capacity to make an informed decision was diminished. To address issues related to coercion and access to care, we worked to reduce the unequal power dynamic through street outreach, and provided access to care regardless of research participation. CONCLUSIONS Although a vulnerable population, the specific vulnerabilities of SCCY can to some extent be managed using innovative procedures. Engaging SCCY in ethical research is a matter of justice and will assist in reducing inequities and advancing their health and human dignity.
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Affiliation(s)
- L Embleton
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - M A Ott
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - J Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
| | - V Naanyu
- College of Health Sciences, Department of Behavioral Sciences, Moi University, Eldoret, Kenya.
| | - A Kamanda
- Moi Teaching and Referral Hospital, Eldoret, Kenya.
| | - D Makori
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
| | - D Ayuku
- College of Health Sciences, Department of Behavioral Sciences, Moi University, Eldoret, Kenya.
| | - P Braitstein
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
- Fairbanks School of Public Health, Department of Epidemiology, Indiana University, Indianapolis, IN, USA.
- Regenstrief Institute, Inc., Indianapolis, IN, USA.
- Division of Epidemiology, 155 College Street, Toronto, M5T 3M7, ON, Canada.
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Nelson RG. Residential context, institutional alloparental care, and child growth in Jamaica. Am J Hum Biol 2015; 28:493-502. [DOI: 10.1002/ajhb.22819] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 09/18/2015] [Accepted: 11/21/2015] [Indexed: 11/07/2022] Open
Affiliation(s)
- Robin G. Nelson
- Skidmore University, Department of Anthropology; Saratoga Springs New York 12866
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Braitstein P. Institutional Care of Children in Low- and Middle-Income Settings: Challenging the Conventional Wisdom of Oliver Twist. GLOBAL HEALTH: SCIENCE AND PRACTICE 2015; 3:330-2. [PMID: 26374794 PMCID: PMC4570007 DOI: 10.9745/ghsp-d-15-00228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Whether institutions or extended families are better suited to care for orphans depends on the specific circumstances. Reported rates of traumatic experiences among orphans and vulnerable children are high in both institutions and extended families; improving the quality of care for such children should be the paramount priority in all settings.
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Affiliation(s)
- Paula Braitstein
- University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada
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Gray CL, Pence BW, Ostermann J, Whetten RA, O'Donnell K, Thielman NM, Whetten K. Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study. GLOBAL HEALTH: SCIENCE AND PRACTICE 2015; 3:395-404. [PMID: 26374801 PMCID: PMC4570014 DOI: 10.9745/ghsp-d-15-00093] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/10/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Policy makers struggling to protect the 153 million orphaned and separated children (OSC) worldwide need evidence-based research on the burden of potentially traumatic events (PTEs) and the relative risk of PTEs across different types of care settings. METHODS The Positive Outcomes for Orphans study used a 2-stage, cluster-randomized sampling design to identify 1,357 institution-dwelling and 1,480 family-dwelling orphaned and separated children in 5 low- and middle-income countries (LMICs) in sub-Saharan Africa and Asia. We used the Life Events Checklist developed by the National Center for Posttraumatic Stress Disorder to examine self-reported PTEs among 2,235 OSC ages 10-13 at baseline. We estimated prevalence and incidence during 36-months of follow-up and compared the risk of PTEs across care settings. Data collection began between May 2006 and February 2008, depending on the site. RESULTS Lifetime prevalence by age 13 of any PTE, excluding loss of a parent, was 91.0% (95% confidence interval (CI) = 85.6, 94.5) in institution-dwelling OSC and 92.4% (95% CI = 90.3, 94.0) in family-dwelling OSC; annual incidence of any PTE was lower in institution-dwelling (23.6% [95% CI = 19.4, 28.7]) than family-dwelling OSC (30.0% [95% CI = 28.1, 32.2]). More than half of children in institutions (50.3% [95% CI = 42.5, 58.0]) and in family-based care (54.0% [95% CI = 50.2, 57.7]) had experienced physical or sexual abuse by age 13. Annual incidence of physical or sexual abuse was lower in institution-dwelling (12.9% [95% CI = 9.6, 17.3]) than family-dwelling OSC (19.4% [95% CI = 17.7, 21.3]), indicating statistically lower risk in institution-dwelling OSC (risk difference = 6.5% [95% CI = 1.4, 11.7]). CONCLUSION Prevalence and incidence of PTEs were high among OSC, but contrary to common assumptions, OSC living in institutions did not report more PTEs or more abuse than OSC living with families. Current efforts to reduce the number of institution-dwelling OSC may not reduce incidence of PTEs in this vulnerable population. Protection of children from PTEs should be a primary consideration, regardless of the care setting.
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Affiliation(s)
- Christine L Gray
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, USA
| | - Brian W Pence
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, USA Duke University, Duke Global Health Institute, Center for Health Policy and Inequalities Research, Durham, NC, USA
| | - Jan Ostermann
- Duke University, Duke Global Health Institute, Center for Health Policy and Inequalities Research, Durham, NC, USA
| | - Rachel A Whetten
- Duke University, Duke Global Health Institute, Center for Health Policy and Inequalities Research, Durham, NC, USA
| | - Karen O'Donnell
- Duke University, Duke Global Health Institute, Center for Health Policy and Inequalities Research, Durham, NC, USA Duke University, Center for Child and Family Health, Durham, NC, USA
| | - Nathan M Thielman
- Duke University, Duke Global Health Institute, Center for Health Policy and Inequalities Research, Durham, NC, USA Duke University, Division of Infectious Diseases and International Health, Department of Medicine, Durham, NC, USA
| | - Kathryn Whetten
- Duke University, Duke Global Health Institute, Center for Health Policy and Inequalities Research, Durham, NC, USA Duke University, Terry Sanford Institute of Public Policy, Durham, NC, USA
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Wachira J, Kamanda A, Embleton L, Naanyu V, Winston S, Ayuku D, Braitstein P. Initiation to street life: a qualitative examination of the physical, social, and psychological practices in becoming an accepted member of the street youth community in Western Kenya. BMC Public Health 2015; 15:569. [PMID: 26087662 PMCID: PMC4473841 DOI: 10.1186/s12889-015-1942-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 06/16/2015] [Indexed: 11/18/2022] Open
Abstract
Background The objective of this study was to describe the physical, social, and psychological initiation practices of street connected children and youths, in Eldoret, western Kenya. Methods This qualitative study was conducted from August 2013 to February 2014. A total of 65 SCCY aged 11–24 years were purposively sampled from the three referral points: 1) A dedicated study clinic for vulnerable children and youth at Moi Teaching and Referral Hospital (MTRH); 2) Primary locations in which street children reside “bases/barracks”; 3) Street youth community-based organizations. In-depth interviews and focus group discussions were used to collect data. All data were audio recorded, transcribed, translated to English, and a content analysis performed. Results The overall median age was 18 years (IQR 14–20.5 years) and 69.2 % of participants were male. None had gone beyond primary level of education. The majority (81.5 %) reported to be sexually active. The street community had well-defined structures and rules that were protective of members and ensured survival on the streets. To be fully accepted children had to go through an initiation ritual that had important gender differences. Common rituals between males and females included interrogation, smearing of black soot, and payment of tax. Ritual practices unique to boys were physical abuse, theft of personal possessions, volatile substance use, being forced to eat garbage, and sodomy among the physically weak. Rituals unique to girls were being forced to ‘become a wife or sexual partner’, rape, and gang rape. Physical and psychological abuse during initiation was normalized and there were no clear mechanisms of dealing with these forms of abuse. Conclusion There were important gender differences in the initiation practices of SCCY. Normalization of physical and psychological abuse during initiation contributes to the high health risks faced by these SCCY. Appropriate interventions need to be developed in collaboration with SCCY.
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Affiliation(s)
- Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, 30100, Eldoret, Kenya.
| | | | - Lonnie Embleton
- University of Toronto, Dalla Lana School of Public Health, Ontario, Canada.
| | - Violet Naanyu
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, 30100, Eldoret, Kenya. .,Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya.
| | - Susanna Winston
- Brown University, Warren Alpert Medical School, Providence, RI, USA. .,Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA.
| | - David Ayuku
- Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya.
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, 30100, Eldoret, Kenya. .,Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya. .,Department of Medicine, Indiana University, School of Medicine, Indianapolis, USA. .,University of Toronto, Dalla Lana School of Public Health, Ontario, Canada. .,Regenstrief Institute, Inc., Indianapolis, USA.
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Winston SE, Chirchir AK, Muthoni LN, Ayuku D, Koech J, Nyandiko W, Carter EJ, Braitstein P. Prevalence of sexually transmitted infections including HIV in street-connected adolescents in western Kenya. Sex Transm Infect 2015; 91:353-9. [PMID: 25714102 PMCID: PMC4518741 DOI: 10.1136/sextrans-2014-051797] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 12/07/2014] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The objectives of this study were to characterise the sexual health of street-connected adolescents in Eldoret, Kenya, analyse gender disparity of risks, estimate the prevalence of sexually transmitted infections (STIs), and identify factors associated with STIs. METHODS A cross-sectional study of street-connected adolescents ages 12-21 years was conducted in Eldoret, Kenya. Participants were interviewed and screened for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, herpes simplex virus-2, syphilis and HIV. Descriptive statistics and logistic regression were used to identify factors associated with having any STI. RESULTS Of the 200 participants, 81 (41%) were female. 70.4% of females and 60.5% of males reported sexual activity. Of those that participated in at least one STI test, 28% (55/194) had ≥1 positive test, including 56% of females; 14% (28/194) had >1 positive test. Twelve females and zero males (6% overall, 14.8% of females) were HIV positive. Among females, those with HIV infection more frequently reported transactional sex (66.7% vs. 26.1%, p=0.01), drug use (91.7% vs. 56.5%, p=0.02), and reported a prior STI (50.0% vs. 14.7%, p<0.01). Having an adult caregiver was less likely among those with HIV infection (33.3% vs. 71.0%, p=0.04). Transactional sex (AOR 3.02, 95% CI (1.05 to 8.73)), a previous STI (AOR 3.46 95% CI (1.05 to 11.46)) and ≥2 sexual partners (AOR 5.62 95% (1.67 to 18.87)) were associated with having any STI. CONCLUSIONS Street-connected adolescents in Eldoret, Kenya are engaged in high-risk sexual behaviours and females in particular have a substantial burden of STIs and HIV. There is a need for STI interventions targeted to street-connected youth.
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Affiliation(s)
- Susanna E Winston
- Division of Pediatric Infectious Diseases, Rhode Island Hospital/Hasbro Children's Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | | | - Lauryn N Muthoni
- Moi Teaching and Referral Hospital, Eldoret, Kenya Aga Khan University Hospital, Nairobi, Kenya
| | - David Ayuku
- Department of Behavioral Sciences, Moi University, School of Medicine, College of Health Sciences, Eldoret, Kenya
| | - Julius Koech
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya Department Child Health and Pediatrics, Moi University, School of Medicine, Eldoret, Kenya
| | - E Jane Carter
- Department of Pulmonary and Critical Care, The Miriam Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA Department of Medicine, Moi University, School of Medicine, College of Health Sciences, Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya Department of Medicine, Moi University, School of Medicine, College of Health Sciences, Eldoret, Kenya Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA Division of Epidemiology, University of Toronto, Dalla Lana School of Public Health, Toronto, Canada Regenstrief Institute, Inc., Indianapolis, Indiana, USA
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Hassan M, Gary FA, Hotz R, Killion C, Vicken T. Young Victims Telling their Stories of Sexual Abuse in the Emergency Department. Issues Ment Health Nurs 2015; 36:944-52. [PMID: 26735502 DOI: 10.3109/01612840.2015.1063026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Among young children, child sexual abuse is a common type of maltreatment. Child sexual abuse (CSA) is an important national public health problem that has a devastating impact on the emotional and psychological makeup of the child, family, and society. The purpose of this analysis is to explore the young victim's own stories of disclosure of child sexual abuse and is an exploratory case study using reported assault histories of victims of CSA between the ages of 6 and 14, taken in the immediate wake of the assault. The data were extracted from the hospital records of child victims treated in an emergency department between 2006 and 2010. This qualitative research, using thematic analysis, explored the stories of sexual abuse for children as told by them. Two themes emerged regarding the experience of sex abuse and the immediate outcomes on the children: (1) Abuse Circumstances, which included the child's level of awareness of child sexual abuse, predisposing factors, and the perpetrator's preparation (physical, behavioral, and verbal tactics), and (2) Physical/Psychological Suffering associated with disclosure. These have important implications for all service and health care providers.
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Affiliation(s)
- Mona Hassan
- a Case Western Reserve University , Bolton School of Nursing , Cleveland , Ohio , USA
| | - Faye A Gary
- a Case Western Reserve University , Bolton School of Nursing , Cleveland , Ohio , USA
| | - Renee Hotz
- b University Hospitals (retired) , Cleveland , Ohio , USA
| | - Cheryl Killion
- a Case Western Reserve University , Bolton School of Nursing , Cleveland , Ohio , USA
| | - Totten Vicken
- c Case Western Reserve University , Department of Emergency Medicine , Cleveland , Ohio , USA
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Gender (in) differences in prevalence and incidence of traumatic experiences among orphaned and separated children living in five low- and middle-income countries. Glob Ment Health (Camb) 2015; 2:e3. [PMID: 26085939 PMCID: PMC4467827 DOI: 10.1017/gmh.2015.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Approximately 153 million children worldwide are orphaned and vulnerable to potentially traumatic events (PTEs). Gender differences in PTEs in low- and middle-income countries (LMIC) are not well-understood, although support services and prevention programs often primarily involve girls. METHODS The Positive Outcomes for Orphans study used a two-stage, cluster-randomized sampling design to identify 2837 orphaned and separated children (OSC) in five LMIC in sub-Saharan Africa and Asia. We examined self-reported prevalence and incidence of several PTE types, including physical and sexual abuse, among 2235 children who were ≥10 years at baseline or follow-up, with a focus on gender comparisons. RESULTS Lifetime prevalence by age 13 of any PTE other than loss of a parent was similar in both boys [91.7% (95% confidence interval (CI) (85.0-95.5)] and girls [90.3% CI (84.2-94.1)] in institutional-based care, and boys [92.0% (CI 89.0-94.2)] and girls [92.9% CI (89.8-95.1)] in family-based care; annual incidence was similarly comparable between institution dwelling boys [23.6% CI (19.1, -29.3)] and girls [23.6% CI (18.6, -30.0)], as well as between family-dwelling boys [30.7% CI (28.0, -33.6)] and girls [29.3% CI (26.8,-32.0)]. Physical and sexual abuse had the highest overall annual incidence of any trauma type for institution-based OSC [12.9% CI (9.6-17.4)] and family-based OSC [19.4% CI (14.5-26.1)], although estimates in each setting were no different between genders. CONCLUSION Prevalence and annual incidence of PTEs were high among OSC in general, but gender-specific estimates were comparable. Although support services and prevention programs are essential for female OSC, programs for male OSC are equally important.
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Sorber R, Winston S, Koech J, Ayuku D, Hu L, Hogan J, Braitstein P. Social and economic characteristics of street youth by gender and level of street involvement in Eldoret, Kenya. PLoS One 2014; 9:e97587. [PMID: 24827584 PMCID: PMC4020866 DOI: 10.1371/journal.pone.0097587] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 04/21/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Street-connected youth are a neglected and vulnerable population, particularly in resource-constrained settings. The development of interventions and supports for this population requires insight into how they live. This study describes the social and economic characteristics of a convenience sample of street youth (SY) in Eldoret, Kenya. METHODS Participants were eligible if they were aged 12-21, living in Eldoret, spending days only (part-time), or nights and days on the street (full-time) and able and willing to consent or assent. Data were collected using a standardized interview conducted in English or Kiswahili. Binary dependent variables were having been arrested and/or jailed, and first priority for spending money (food vs. other). Nominal categorical dependent variables included major source of support, and major reason for being street-involved. Multivariable analysis used logistic regression models to examine the association of gender and level of street-involvement with social and economic factors of interest adjusting for age and length of time on the street. Data were analyzed using SAS 9.3. RESULTS Of the 200 SY enrolled, 41% were female, mean age of 16.3 years; 71% were on the street full-time, and 29% part-time. Compared with part-time SY, full-time SY were more likely to have been arrested (Adjusted Odds Ratio [AOR]: 2.33, 95% Confidence Interval [95%CI]:1.01-5.35), name food as their first spending priority (AOR: 2.57, 95%CI:1.03-6.45), have left home due to violence (AOR: 5.54, 95%CI: 1.67-18.34), and more likely to report friends on the street as a major source of support (AOR: 3.59, 95% CI: 1.01-12.82). Compared with females, males were more likely to have ever been arrested (AOR: 2.66, 95%CI:1.14-6.18), and to have ever been jailed (AOR: 3.22, 95%CI:1.47-7.02). CONCLUSIONS These results suggest a high degree of heterogeneity and vulnerability among SY in this setting. There is an urgent need for interventions taking into consideration these characteristics.
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Affiliation(s)
- Rebecca Sorber
- School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Susanna Winston
- Department of Pediatrics, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, United States of America
- Rhode Island Hospital-Hasbro Youth's Hospital, Providence, Rhode Island, United States of America
| | | | - David Ayuku
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Liangyuan Hu
- Department of Biostatistics, Brown University, Providence, Rhode Island, United States of America
| | - Joseph Hogan
- AMPATH Consortium, Eldoret, Kenya
- Department of Biostatistics, Brown University, Providence, Rhode Island, United States of America
| | - Paula Braitstein
- School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
- AMPATH Consortium, Eldoret, Kenya
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Regenstrief Institute, Inc., Indianapolis, Indiana, United States of America
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