Objective To describe the nutritional status of orphaned and separated children and adolescents (OSCA) living in households in the community (HH), on the street, and those in institutional environments in western Kenya. Methods The study enrolled OSCA from 300 randomly selected households (HH), 19 Charitable Children’s Institutions (CCIs), and 100 street-involved children. Measures of malnutrition were standardized with Z-scores using World Health Organization criteria; Z-scores ≤-2 standard deviations (sd) were moderate-severe malnutrition. Data were analyzed using multivariable logistic regression adjusting for child age, sex, HIV status, whether the child had been hospitalized in the previous year, time living with current guardian, and intra-household clustering for adequacy of diet and moderate-severe malnutrition. Results Included are data from 2862 participants (1337 in CCI’s, 1425 in HH’s, and 100 street youth). The population was 46% female with median age at enrolment of 11.1 years. Only 4.4% of households and institutions reported household food security; 93% of children in HH reported an adequate diet vs. 95% in CCI’s and 99% among street youth. After adjustment, OSCA in HH were less likely to have an adequate diet compared to those in CCI’s (AOR 0.4, 95% CI 0.2–1.0). After adjustment, there were no differences between the categories of children on weight-for-age, weight-for-height, or BMI-for-age. Children living in HH (AOR 2.6, 95% CI: 2.0–3.4) and street youth (AOR: 5.9, 95% CI: 3.6–9.5) were more likely than children in CCI’s to be low height-for-age. Conclusion OSCA in HH are less likely to have an adequate diet compared to children in CCI’s. They and street children are more likely to be moderately-severely low height-for-age compared to children in CCI’s, suggesting chronic malnutrition among them.
References
[1]
UNICEF (2012) The State of the World's Children: Urbanization. Geneva: United Nations Children's Fund.
[2]
World Health Organization (2011) Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access Progress Report 2011.
[3]
UNICEF (2006) Africa's Orphaned and Vulnerable Generations: Children Affected by HIV/AIDS. Geneva, CH; Washington, DC: UNICEF, UNAIDS, PEPFAR. 16 p.
[4]
UNICEF (2012) Kenya at a Glance. In: UNICEF, editor. Geneva: UNICEF.
[5]
Heymann J, Earle A, Rajaraman D, Miller C, Bogen K (2007) Extended family caring for children orphaned by AIDS: balancing essential work and caregiving in a high HIV prevalence nations. AIDS Care 19: 337–345.
[6]
Hosegood V, Floyd S, Marston M, Hill C, McGrath N, et al. (2007) The effects of high HIV prevalence on orphanhood and living arrangements of children in Malawi, Tanzania, and South Africa. Popul Stud (Camb) 61: 327–336.
[7]
Miller CM, Gruskin S, Subramanian SV, Rajaraman D, Heymann SJ (2006) Orphan care in Botswana's working households: growing responsibilities in the absence of adequate support. Am J Public Health 96: 1429–1435.
[8]
Monasch R, Boerma JT (2004) Orphanhood and childcare patterns in sub-Saharan Africa: an analysis of national surveys from 40 countries. AIDS 18 Suppl 2S55–65.
[9]
Nyambedha EO, Wandibba S, Aagaard-Hansen J (2001) Policy implications of the inadequate support systems for orphans in western Kenya. Health Policy 58: 83–96.
[10]
Nyambedha EO, Wandibba S, Aagaard-Hansen J (2003) Changing patterns of orphan care due to the HIV epidemic in western Kenya. Soc Sci Med 57: 301–311.
[11]
UNICEF Malawi (2005) Report on the pilot survey on orphans and other vulnerable children in Blantyre, Malawi.
[12]
UNICEF Zimbabwe, Ministry of Public Service and Social Welfare, Zimbabwe (2005) Survey on Orphans and Other Vulnerable Children in Rural and Urban High Density Zimbabwe 2004/2005.
[13]
Lindblade KA, Odhiambo F, Rosen DH, DeCock KM (2003) Health and nutritional status of orphans <6 years old cared for by relatives in western Kenya. Trop Med Int Health 8: 67–72.
[14]
Sarker M, Neckermann C, Muller O (2005) Assessing the health status of young AIDS and other orphans in Kampala, Uganda. Trop Med Int Health 10: 210–215.
[15]
Watts H, Gregson S, Saito S, Lopman B, Beasley M, et al. (2007) Poorer health and nutritional outcomes in orphans and vulnerable young children not explained by greater exposure to extreme poverty in Zimbabwe. Trop Med Int Health 12: 584–593.
[16]
Miller CM, Gruskin S, Subramanian SV, Heymann J (2007) Emerging health disparities in Botswana: examining the situation of orphans during the AIDS epidemic. Soc Sci Med 64: 2476–2486.
[17]
UNICEF (2004) The Framework for the Protection, Care and Support of Orphans and Vulnerable Children Living in a Wolrd with HIV/AIDS. Geneva: United Nations Children's Fund.
[18]
Broadhead I (2012) Rwanda Child Policy Spells Possible End of Orphanages. Voice of America. International: Voice of America.
[19]
UNICEF (1986) Children in Especially Difficult Circumstances. New York.
[20]
Uasin Gishu County (2012) ‘Welcome to the county of champions’. Website. Available: [http://www.uasingishucounty.co.ke/index.？php?option=com_content&view=article&id=6？6:welcome-to-the-county-of-champions&cat？id=36:main-info&Itemid=72]. Accessed 2013.
[21]
Government of Kenya (2010) Demographic and Health Survey, 2008–2009. Nairobi.
[22]
UN Habitat (2008) The State of African Cities: A framework for addressing urban challenges in Africa. Geneva.
[23]
Einterz RM, Kimaiyo S, Mengech HN, Khwa-Otsyula BO, Esamai F, et al. (2007) Responding to the HIV pandemic: the power of an academic medical partnership. Acad Med 82: 812–818.
[24]
Bryant JH (2009) Kenya's cash transfer program: protecting the health and human rights of orphans and vulnerable children. Heallth and Human Rights 11: 65–76.
[25]
Government of Kenya (2005) The Children Regulations: A Supplement To The Children Act 2001. In: Kenya Go, editor. Volume 89 (Legislative Supplement No 53). Nairobi.
[26]
Kamanda A, Embleton L, Ayuku D, Atwoli L, Gisore P, et al. (2013) Harnessing the power of the grassroots to conduct public health research in sub-Saharan Africa: a case study from western Kenya in the adaptation of community-based participatory research (CBPR) approaches. BMC Public Health 13: 91.
[27]
Schenk K, Williamson J (2005) Ethical Guidelines for Gathering Information from Children and Adolescents in International Settings. Washington, D.C. : Population Council.
[28]
Coates J, Swindale A, Bilinsky P (2006) Household Food Insecurity Access Scale (HFIAS) for Measurement of Household Food Access: Indicator Guide. Washington, D.C.
[29]
Hesseling AC, Schaaf HS, Gie RP, Starke JR, Beyers N (2002) A critical review of diagnostic approaches used in the diagnosis of childhood tuberculosis. Int J Tuberc Lung Dis 6: 1038–1045.
[30]
Nair PH, Philip E (1981) A scoring system for the diagnosis of tuberculosis in children. Indian Pediatr 18: 299–303.
[31]
Stegen G, Jones K, Kaplan P (1969) Criteria for guidance in the diagnosis of tuberculosis. Pediatrics 43: 260–263.
[32]
World Health Organization (2007) WHO Care Definitions of HIV for Surveillance and Revised Clinical Staging and Immunological Classification of HIV-related Disease in Adults and Children. Geneva: World Health Organization.
[33]
Case A, Paxson C, Ableidinger J (2004) Orphans in Africa: Parental Death, Poverty, and School Enrollment. Demography 4: 483–508.
[34]
Nhate V (2005) Orphans and discrimination in Mozambique: An Outlay Equivalence Analysis. Washington, DC. 1–2, 12 p.
[35]
Seth R, Kotwal A, Ganguly KK (2005) Street and working children of Delhi, India, misusing toluene: an ethnographic exploration. Subst Use Misuse 40: 1659–1679.
[36]
Sherman SS, Plitt S, ul Hassan S, Cheng Y, Zafar ST (2005) Drug use, street survival, and risk behaviors among street children in Lahore, Pakistan. J Urban Health 82: iv113–124.
[37]
Veale A, Dona G (2003) Street children and political violence: a socio-demographic analysis of street children in Rwanda. Child Abuse Negl 27: 253–269.
[38]
Musa DI, Toriola AL, Monyeki MA, Lawal B (2012) Prevalence of childhood and adolescent overweight and obesity in Benue State, Nigeria. Trop Med Int Health 17: 1369–1375.
[39]
Mushtaq MU, Gull S, Mushtaq K, Abdullah HM, Khurshid U, et al. (2012) Height, weight and BMI percentiles and nutritional status relative to the international growth references among Pakistani school-aged children. BMC Pediatr 12: 31.
[40]
Mansourian M, Marateb HR, Kelishadi R, Motlagh ME, Aminaee T, et al.. (2012) First growth curves based on the World Health Organization reference in a Nationally-Representative Sample of pediatric population in the Middle-East and North Africa (MENA): The CASPIAN-III Study. BMC Pediatr 12: doi: –––10.1186/1471–2431–1112–1149.
[41]
Rivers J, Mason JB, Rose DD, Eisele TP, Gillespie S, et al. (2010) The impact of orphanhood on food security in the high-HIV context of Blantyre, Malawi. Food Nutr Bull 31: S264–271.
[42]
Kimani-Murage EW, Holding PA, Fotso JC, Ezeh A, Madise N, et al. (2011) Food security and nutritional outcomes among urban poor orphans in Nairobi, Kenya. Journal of Urban Health 88: S282–297.
[43]
Thielman N, Ostermann J, Whetten K, Whetten R, O’Donnell K (2012) Correlates of poor health among orphans and abandoned children in less wealthy countries: the importance of caregiver health. PLoS ONE 7: e38109.
[44]
Kapavarapu PK, Bari O, Perumpil M, Duggan C, Dinakar C, et al. (2012) Growth patterns and anaemia status of HIV-infected children living in an institutional facility in India. Trop Med Int Health 17: 962–971.
[45]
Isaranurug S, Chompikul J (2009) Emotional development and nutritional status of HIV/AIDS orphaned children aged 6–12 years old in Thailand. Matern Child Health J 13: 138–143.
[46]
Mushtaq MU, Gull S, Khurshid U, Shahid U, Shad MA, et al. (2011) Prevalence and socio-demographic correlates of stunting and thinness among Pakistani primary school children. BMC Public Health 11: 790.
[47]
Wamani H, Astrom AN, Peterson S, Tumwine JK, Tylleskar T (2007) Boys are more stunted than girls in sub-Saharan Africa: a meta-analysis of 16 demographic and health surveys. BMC Pediatr 7: 17.
[48]
Whetten K, Ostermann J, Whetten RA, Pence BW, O’Donnell K, et al. (2009) A comparison of the wellbeing of orphans and abandoned children ages 6–12 in institutional and community-based care settings in 5 less wealthy nations. PLoS ONE 4: e8169.
[49]
Whetten K, Whetten RA, Ostermann J, Itemba D (2008) Trauma, anxiety and reported health among HIV-positive persons in Tanzania and the US Deep South. AIDS Care 20: 1233–1241.
