Three-Year Change in the Wellbeing of Orphaned and Separated Children in Institutional and Family-Based Care Settings in Five Low- and Middle-Income Countries

Abstract

BackgroundWith more than 2 million children living in group homes, or “institutions”, worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central question for international policymakers.MethodsA two-stage random sampling methodology identified community representative samples of 1,357 institution-dwelling orphaned and separated children (OSC) and 1,480 family-dwelling OSC aged 6–12 from 5 low and middle income countries. Data were collected from children and their primary caregivers. Survey-analytic techniques and linear mixed effects models describe child wellbeing collected at baseline and at 36 months, including physical and emotional health, growth, cognitive development and memory, and the variation in outcomes between children, care settings, and study sites.FindingsAt 36-month follow-up, institution-dwelling OSC had statistically significantly higher height-for-age Z-scores and better caregiver-reported physical health; family-dwelling OSC had fewer caregiver-reported emotional difficulties. There were no statistically significant differences between the two groups on other measures. At both baseline and follow-up, the magnitude of the differences between the institution- and family-dwelling groups was small. Relatively little variation in outcomes was attributable to differences between sites (11–27% of total variation) or care settings within sites (8–14%), with most variation attributable to differences between children within settings (60–75%). The percent of variation in outcomes attributable to the care setting type, institution- versus family-based care, ranged from 0–4% at baseline, 0–3% at 36-month follow-up, and 0–4% for changes between baseline and 36 months.InterpretationThese findings contradict the hypothesis that group home placement universally adversely affects child wellbeing. Without substantial improvements in and support for family settings, the removal of institutions, broadly defined, would not significantly improve child wellbeing and could worsen outcomes of children who are moved from a setting where they are doing relatively well to a more deprived setting.

The Production and Reproduction of Kinship in Charitable Children’s Institutions in Uasin Gishu County, Kenya

“…For example, a study conducted in UG County, Kenya, provides evidence indicating that the prevalence of posttraumatic stress disorder was significantly higher among OSCAs in households than those in CCIs, and OSCAs in households had a higher prevalence of sexual abuse than those in CCIs (Atwoli et al 2014, p. 6). Studies conducted in other low-and middle-income countries (Whetten et al 2009(Whetten et al , 2014 provide evidence contradicting the hypothesis that institutional care of orphan and abandoned children is associated with poorer well-being when compared to family settings or community care. The differences in the study findings were attributed to a number of factors, including the inability of caregivers in these poor communities to provide adequate care in comparison to "positive institutions where children can focus on education and their own needs" and the fact that institutional caregivers in these cultures may provide "parent-like support".…”

“…The ethnographic record and guidelines on alternative care (UNICEF and Republic of Kenya 2014) underscore the importance of family-especially consanguinity and descent-in caring for orphaned and vulnerable children. There is, however, some evidence to suggest that the outcomes of children in CCIs in some places may be better, or at least not worse, than their counterparts living in kinship care (Atwoli et al 2014;Braitstein et al 2013;Embleton et al 2014Embleton et al , 2017Whetten et al 2009Whetten et al , 2014. It is important to understand how and why this may be the case, given that, until more robust infrastructure and comprehensive services exist to support and protect orphaned and vulnerable children, institutions may remain a "necessary evil".…”

Challenges and their overcoming when implementing the restructuring of children's care homes in Lithuania

“…2018 development of children, who live in care homes, slows down due to the lack of quality relationships and meaningful communication with the adults [9]. The scientists also draw attention to the fact that living conditions in care homes can cause different problems in children within a field of their health, cognition, emotions and morality [10][11][12]. Care homes are not designed for a child's positive socialisation, because these institutions, although they have sufficiently good financial resources, are not comparable with family environment, it is impossible to safeguard child's individual needs, and in particular quality relationships with the adults.…”

Direct and Spillover Impacts of a Community-Level HIV/AIDS Program: Evidence from a Randomized Controlled Trial in Mozambique

“…In the 2015 fiscal year, PEPFAR spent $218 million on OVC programming (PEPFAR 2017).6 Reviews of research on OVCs includeBryant and Beard (2016),Goldberg and Short (2016),Nyberg et al (2012),and Shann et al (2013). See alsoEvans and Miguel (2007),Case et al (2004),Larson et al (2013), andWhetten et al (2014).7 Program provinces and districts are: Manica province (Manica, Chimoio, and Gondola districts), Sofala province (Dondo and Nhamatanda districts), and Zambezia province (Namacurra and Nicoadala districts).…”