Research Article: 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?

Date Published: June 13, 2019

Publisher: Public Library of Science

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


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.

Partial Text

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 (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. This separation often occurs because biological parents are: (a) unable to provide food, shelter, and safety; (b) forced to leave their children to seek employment elsewhere; or (c) physically or mentally unable to care for their children.[2]

Table 1 describes the demographic characteristics of the 2,013 orphan and separated children (923 residential care-based and 1,090 community-based) included in the 36-month follow-up of the POFO study (Table 1). The mean age of the sample was 9.19 years old and there was a higher proportion of males (n = 1120, 55.6%) than females (n = 893, 44.4%). Of the four categories of orphans, the greatest number of children were paternal orphans (n = 920, 45.7%), followed by double orphans (n = 549, 27.3%), separated or abandoned children with no dead parent (n = 288, 14.3%), and finally, maternal orphans (n = 256, 12.7%). Table 1 also displays the sample sizes and means for key demographic factors across OSC care settings.

Findings from this study underscore the role of key components of quality care on child psychosocial well-being. Importantly, child psychosocial well-being did not vary by residential vs. family-based care within levels of high- and low-quality care. This study supported the hypothesis that, specifically in under-resourced societies in LMICs, psychosocial well-being for OSC may heavily depend on the quality of care provided within a setting rather than the care setting itself. Findings suggested that higher levels of all four components of quality of care (food security, quality of shelter, quality of caregiving, and access to health care services) significantly predicted more positive psychosocial well-being. Compared to the 0% variance explained by care setting in this current model, food security explained 13.4% of the variance in psychosocial well-being, while quality of shelter explained 10%, quality of caregiving explained 8.9%, and access to health care services explained 7.3%. Moreover, mean SDQ total difficulties scores across “high” and “low” levels of quality of care showed differences between care settings to be minimal, and are therefore considered null results.




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