Correlates of poor health among orphans and abandoned children in less wealthy countries: the importance of caregiver health

Nathan Thielman, Jan Ostermann, Kathryn Whetten, Rachel Whetten, Karen O'Donnell, Positive Outcomes for Orphans Research Team, Frehiwot Alebachew, Sisay Woldeyohannes Ameya, Robin Briggs, Sopheak Chan, Haimanot Diro, Rama Devi Durgam, Belaynesh Engidawork, Amy Hobbie, Dafrosa Itemba, Venkata Gopala Krishna Kaza, Becky Kinoti, Rajeswara Rao Konjarla, Mao Lang, Dean Lewis, Ira Madan, Cyrilla Manya, Max Masnick, Sabina Mtwewe, Restituta Mvungib, Laura Kathleen Murphy-McMillan, Robert Mujera, Kokeb Badma Negatu, Imliyanger Pongen, Pelevinuo Rai, John Shao, Neville Selhore, Amani Sizya, Vanroth Vann, Augustine Wasonga, Nathan Thielman, Jan Ostermann, Kathryn Whetten, Rachel Whetten, Karen O'Donnell, Positive Outcomes for Orphans Research Team, Frehiwot Alebachew, Sisay Woldeyohannes Ameya, Robin Briggs, Sopheak Chan, Haimanot Diro, Rama Devi Durgam, Belaynesh Engidawork, Amy Hobbie, Dafrosa Itemba, Venkata Gopala Krishna Kaza, Becky Kinoti, Rajeswara Rao Konjarla, Mao Lang, Dean Lewis, Ira Madan, Cyrilla Manya, Max Masnick, Sabina Mtwewe, Restituta Mvungib, Laura Kathleen Murphy-McMillan, Robert Mujera, Kokeb Badma Negatu, Imliyanger Pongen, Pelevinuo Rai, John Shao, Neville Selhore, Amani Sizya, Vanroth Vann, Augustine Wasonga

Abstract

Background: More than 153 million children worldwide have been orphaned by the loss of one or both parents, and millions more have been abandoned. We investigated relationships between the health of orphaned and abandoned children (OAC) and child, caregiver, and household characteristics among randomly selected OAC in five countries.

Methodology: Using a two-stage random sampling strategy in 6 study areas in Cambodia, Ethiopia, India, Kenya, and Tanzania, the Positive Outcomes for Orphans (POFO) study identified 1,480 community-living OAC ages 6 to 12. Detailed interviews were conducted with 1,305 primary caregivers at baseline and after 6 and 12 months. Multivariable logistic regression models describe associations between the characteristics of children, caregivers, and households and child health outcomes: fair or poor child health; fever, cough, or diarrhea within the past two weeks; illness in the past 6 months; and fair or poor health on at least two assessments.

Principal findings: Across the six study areas, 23% of OAC were reported to be in fair or poor health; 19%, 18%, and 2% had fever, cough, or diarrhea, respectively, within the past two weeks; 55% had illnesses within the past 6 months; and 23% were in fair or poor health on at least two assessments. Female gender, suspected HIV infection, experiences of potentially traumatic events, including the loss of both parents, urban residence, eating fewer than 3 meals per day, and low caregiver involvement were associated with poorer child health outcomes. Particularly strong associations were observed between child health measures and the health of their primary caregivers.

Conclusions: Poor caregiver health is a strong signal for poor health of OAC. Strategies to support OAC should target the caregiver-child dyad. Steps to ensure food security, foster gender equality, and prevent and treat traumatic events are needed.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Conceptual model of factors potentially…
Figure 1. Conceptual model of factors potentially associated with health outcomes of orphaned and abandoned children.
Figure 2. Receiver operating characteristic curves for…
Figure 2. Receiver operating characteristic curves for caregiver health as an indicator of poor OAC health.
The SF-8, re-indexed to a 5 point scale, is used as the caregiver health measure to indicate fair or poor child health (Panel A), child symptoms in the past 2 weeks (Panel B), and persistent fair or poor child health (Panel C).

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Source: PubMed

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