Factors affecting the psychosocial well-being of orphan and separated children in five low- and middle-income countries: Which is more important, quality of care or care setting?

Hy V Huynh,Christine L Gray,Kathryn Whetten,Misganaw Eticha,Susan P Limber,Ira Madan,Vanroth Vann,Martie P Thompson,Dafrosa Itemba,Augustine I Wasonga,Kannan Navaneetham

doi:10.1371/journal.pone.0218100

Hy V Huynh, Christine L Gray + Show 9 more

Open Access

https://doi.org/10.1371/journal.pone.0218100

Copy DOI

Journal: PloS one	Publication Date: Jun 13, 2019
Citations: 24	License type: CC BY 4.0

Affiliation: Duke University, Clemson University

Abstract

As millions of children continue to live without parental care in under-resourced societies in low- and middle-income countries (LMICs), it is important for policymakers and practitioners to understand the specific characteristics within different care settings and the extent to which they are associated with outcomes of orphan and separated children (OSC). This study was designed to (1) examine if the psychosocial well-being of OSC in under-resourced societies in LMICs is more dependent on the availability of certain components of quality of care rather than the care setting itself (i.e. the residential care-based or community family-based setting), and (2) identify the relative significance of certain components of quality of care that are associated with a child’s psychosocial well-being across different OSC care settings. This study drew from 36-month follow-up data from the Positive Outcomes for Orphans (POFO) Study and used a sample population of 2,013 (923 institution- and 1,090 community-based) OSC among six diverse study sites across five LMICs: Cambodia, India (Hyderabad and Nagaland), Kenya, Tanzania, and Ethiopia. Analyses showed that all four components of quality of care significantly predicted child psychosocial well-being. Child psychosocial well-being across “high” and “low” levels of quality of care showed negligible differences between residential- and community-based care settings, suggesting the important factor in child well-being is quality of care rather than setting of care. Practical and policy implications and future research are discussed.

Highlights

Global, national, and local leaders are struggling to find care solutions for the estimated 140,000,000 children worldwide who have lost one or both parents and millions more who have been separated from both parents.[1]
The majority of orphan and separated children (OSC) live in sub-Saharan Africa and Southern and Southeastern Asia, with Southern and Southeastern Asia having the largest number of orphans (61 million) while estimates for sub-Saharan Africa indicate that over 52 million children have been orphaned.[1]
This study was designed to: (1) examine if the psychosocial well-being of OSC in underresourced societies in low- and middle-income countries (LMICs) is more dependent on the availability of certain components of quality of care rather than the care setting itself, and (2) identify the relative importance of certain components of quality of care that are associated with a child’s psychosocial well-being across different OSC care settings

Summary

Introduction

National, and local leaders are struggling to find care solutions for the estimated 140,000,000 children worldwide who have lost one or both parents and millions more who have been separated from both parents (hereafter defined as orphan and separated children [OSC]).[1] High mortality among young adults from conditions such as malaria, tuberculosis, HIV/AIDS, pregnancy complications, accidents and natural disasters are responsible for the increasing number of orphans in low- and middle-income countries (LMICs).[2] Millions of non-orphaned children are separated from their biological parents either permanently or semi-permanently and are in need of supportive living environments. Research suggests there are numerous negative outcomes associated with being an OSC in an under-resourced society, including traumatic grief, compromised cognitive and emotional development, less access to education, and a greater probability of being exploited for child labor.[3,4,5,6,7,8,9,10] Poverty extends into all areas of children’s lives and prevents children from having the security and structures required to grow, thrive, and develop.[9,11,12,13,14] OSC are in need of living environments that protect and promote their well-being

Methods

Results

Conclusion