Youth Who Have Lived in Alternative Care in Nigeria, Zambia, and Zimbabwe: Mental Health and Violence Outcomes in Nationally Representative Data

Abstract

We explore whether having previously lived in alternative care (foster, kinship, and/or residential care) is linked to sexual risk-taking, mental health, and experiencing violence in Nigerian, Zambian, and Zimbabwean youth ages 13-17 living in households with or without their biological parents, and assess the utility and limitations of existing data. This study is a secondary analysis of nationally-representative Violence Against Children Surveys (N=6,405). Logistic regressions examined the effect of alternative care experience on the odds of poor outcomes, controlling for covariates including parental care status, orphanhood, and household assets. In both bivariate and multivariate analyses, having lived in alternative care in the last five years was associated with lowered odds mental distress (OR=0.25, 95% CI: [0.10, 0.61], p=.002), and higher odds of sexual risk taking (OR=1.70, 95% CI: [1.11, 2.59], p=.014), caregiver physical abuse (OR=1.81, 95% CI: [1.30, 2.50], p<.001), caregiver emotional abuse (OR=1.75, 95% CI: [1.20, 2.54], p=.004), and peer violence (OR=1.57, 95% CI: [1.09, 2.26], p=.015). It was not associated with suicidality, self harm, or sexual assault after controlling for covariates. Youth who have lived in alternative care in the last five years may benefit from programs that address violence, self-harm, and sexual risk taking behavior, even if they are now in families. To better understand children outside parental care, national data collection efforts should distinguish between residential and family-based care.