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

IntroductionThe 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).MethodsThis 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.ResultsThe 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.ConclusionOSCA 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.

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

“… 5 Our data suggest that, when compared directly with orphaned and separated youths in family-based settings, the differences between care environments were minimal, and living in an institutional setting may be associated with some protective benefits. 23 , 24 , 31 , 32 , 42 Our data are consistent with the findings of another study, which reported that the quality of care within care environments was more important to a child’s well-being than differences between care environment types. 25 …”

“…Participants completed a standardized clinical evaluation annually (or semiannually for street-connected youths), and children 10 years and older completed an additional psychosocial evaluation annually. 31 The clinical encounter was an enhanced well-child care visit that included a complete survey of physical history and a review of symptoms. Household-level data were obtained through annual site assessments administered by the project manager (for charitable children’s institutions) or community health workers (for participating households).…”

Care and Rearing of Institutionalized Girls in Arequipa, Peru: An Ethnographic Approach

“…In contrast, Korzh (2015) points out that institutionalized children lack many educational and economic opportunities for full integration into society. Inconsistency with the present study, various studies conducted in low- and medium-income countries consider institutions to be a better place for upbringing (Omari et al, 2021). This author speculates that there are two main reasons for this: the religious nature of the structures and the presence of a vocational caregiver profile.…”

“…Children are the guarantors of this survival (Andrews et al, 2020). The interdependent nature of childhood and community reinforces the responsibility of the second for caring for all its members; therefore, any agent in the environment will be relevant for decision-making on care/rearing practice (Andrews et al, 2020), especially in circumstances of extreme vulnerability, where institutionalization is resorted to for the care of children (Omari et al, 2021). Transcultural nursing (TN) has developed different approaches to the above elements (Leininger, 2002; Purnell, 2019).…”

“…While there is no standardized definition, and it can be given under different names (residential care, public or societal care, children’s homes, orphanages, charitable children’s institutions and others), institutional care is global, with millions of children in institutions (Desmond et al, 2020), offering them basic and social shelter (Omari et al, 2021). However, common threats have been described: isolation, hyper-regulation, intricate relationships between children and professional caregivers, and insufficient attention to psycho-emotional demands (Gabatz et al, 2019).…”