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

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.



Other articles

SERVICES AVAILABLE FOR ORPHANS AND VULNERABLE CHILDREN IN ENUGU STATE

This study sought to find out services available for orphans and vulnerable children in Enugu State and the social workers’…

Read more

Nutritional status and associated factors among orphan children below the age of five years in Gondar City, Ethiopia

Introduction: Orphan and vulnerable children are at high risk for malnutrition due to poor economic status, less medical…

Read more

The extent of community and public support available to families caring for orphans in Malawi

There are an estimated 15 million AIDS orphans worldwide. Families play an important role in safeguarding orphans, but they…

Read more

Rethinking institutional care using family-based alternative child care system for orphans and vulnerable children in Nigeria

The need for alternative child care in Nigeria and other developing societies around the world is crucial given the increasing…

Read more