Physical and sexual abuse in orphaned compared to non-orphaned children in sub-Saharan Africa: A systematic review and meta-analysis

Abstract

This systematic review assessed the quantitative literature to determine whether orphans are more likely to experience physical and/or sexual abuse compared to non-orphans in sub-Saharan Africa (SSA). It also evaluated the quality of evidence and identified research gaps. Our search identified 10 studies, all published after 2005, from Zimbabwe, South Africa, Kenya and Uganda. The studies consisted of a total 17,336 participants (51% female and 58% non-orphans). Of those classified as orphans (n = 7,315), 73% were single orphans, and 27% were double orphans. The majority of single orphans were paternal orphans (74%). Quality assessment revealed significant variability in the quality of the studies, although most scored higher for general design than dimensions specific to the domain of orphans and abuse. Combined estimates of data suggested that, compared to non-orphans, orphans are not more likely to experience physical abuse (combined OR = 0.96, 95% CI [0.79, 1.16]) or sexual abuse (combined OR = 1.25, 95% CI [0.88, 1.78]). These data suggest that orphans are not systematically at higher risk of experiencing physical or sexual abuse compared to non-orphans in sub-Saharan Africa. However, because of inconsistent quality of data and reporting, these findings should be interpreted with caution. Several recommendations are made for improving data quality and reporting consistency on this important issue.

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

“…In general, orphans in sub-Saharan Africa may be at risk of experiencing a forced first sexual encounter in comparison to their non-orphaned peers [11,21]. Our findings demonstrate that parental/guardian/caregiver supervision may play a role in reducing these risks, and therefore programs aimed at strengthening parenting skills may merit implementation and future research.…”

“…Orphan status has been associated with having an earlier sexual debut, multiple partners, and transactional sex [5], and orphans may be at heightened risk of physical and sexual abuse compared to non-orphans [21,22]. However, some studies in western Kenya have found that orphan status was not significantly associated with increased sexual risk-taking behaviours among adolescents [23–25].…”

The relationship between parental presence and child sexual violence: Evidence from thirteen countries in sub-Saharan Africa

“…When studies were pooled in a meta-analysis, the authors concluded that orphanhood was not a significant risk factor for sexual violence. However, the authors noted that both because their findings contradict qualitative findings and “because of inconsistent quality of data and reporting, these findings should be interpreted with caution” (p. 304, Nichols et al, 2014). This leaves the relationship between orphanhood and sexual violence equivocal.…”

“…As a result, there is a lack of consistency in these findings. A recently published review found eight studies (from Zimbabwe, South Africa and Uganda) that measured sexual abuse among orphans and non-orphans (Nichols et al, 2014). Only one study reported that orphans were more likely to be sexually abused (Nyamukapa et al, 2008).…”

Are adolescent orphans more likely to be HIV-positive? A pooled data analyses across 19 countries in sub-Saharan Africa

“…Likewise, orphans may be more vulnerable to sexual victimization, which is known to heighten HIV risk via both direct and indirect pathways (i.e., subsequent risky behaviors and coping mechanisms) [6–8]. An association between orphanhood and sexual victimization has not been definitively established, however, with a recent meta-analysis citing poor methodological quality as one explanation for the ambiguity [9]. Moreover, while the above mechanisms are largely untested, others do not withstand basic critique: while some orphans demonstrate lower socioeconomic status [e.g., 10 11], evidence suggests that higher socioeconomic groups are most vulnerable to HIV in Africa [12–16].…”