The government of Kenya cash transfer for orphaned and vulnerable children: cross-sectional comparison of household and individual characteristics of those with and without

Background: The ‘Cash Transfer to Orphans and Vulnerable Children’ (CT-OVC) in Kenya is a government-supported program intended to provide regular and predictable cash transfers (CT) to poor households taking care of OVC. CT programs can be an effective means of alleviating poverty and facilitating the attainment of an adequate standard of living for people’s health and well-being and other international human rights. The objective of this analysis was to compare the household socioeconomic status, school enrolment, nutritional status, and future outlook of orphaned and separated children receiving the CT compared to those not receiving a CT. Methods: This project analyzes baseline data from a cohort of orphaned and separated children aged \u3c19 years and non-orphaned children living in 300 randomly selected households (HH) in 8 Locations of Uasin Gishu County, Kenya. Baseline data were analyzed using multivariable logistic and Poisson regression comparing children in CT-HHvs. non-CT HH. Odds ratios are adjusted (AOR) with 95% confidence intervals (CI) for guardian age and sex, child age and sex, and intra-HH correlation. Results: Included in this analysis were data from 1481 children and adolescents in 300 HH (503 participants in CT, 978in non-CT households). Overall there were 922 (62.3%) single orphans, 324 (21.9%) double orphans, and 210 (14.2%) participants had both parents alive and were living with them. Participants in CT-HH were less likely to have≥2pairsofclothes compared to non-CT HH (AOR: 0.32, 95% CI: 0.16-0.63). Those in CT HH were less likely to have missed any days of school in the preceding month (AOR: 0.62, 95% CI: 0.42-0.94) and those aged \u3c1-18 years in CT-HH were less likely to have height stunting for their age (AOR: 0.65, 95% CI: 0.47-0.89). Participants aged at least 10 years in CT-HH were more likely to have a positive future outlook (AOR: 1.72, 95% CI: 1.12-2.65). Conclusions: Children and adolescents in households receiving the CT-OVC appear to have better nutritional status, school attendance, and optimism about the future, compared to those in households not receiving the CT, in spite of some evidence of continued material deprivation. Consideration should be given to expanding the program further

Impact of domestic care environment on trauma and posttraumatic stress disorder among orphans in western Kenya

Objective:The aim of this study was to determine the impact of the domestic care environment on the prevalence of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) among orphaned and separated children in Uasin Gishu County, western Kenya. Methods:A total of 1565 (55.5% male) orphaned and separated adolescents aged 10–18 years (mean 13.8 years, sd 2.2),were assessed for PTSD and PTEs including bullying, physical abuse and sexual abuse. In this sample, 746 lived in extended family households, 746 in Charitable Children’s Institutions (CCIs), and 73 on the street. Posttraumatic stress symptom (PTSS)scores and PTSD were assessed using the Child PTSD Checklist. Results:Bullying was the commonest PTE in all domestic care environments, followed by physical and sexual abuse. All PTEs were commonest among the street youth followed by CCIs. However, sexual abuse was more prevalent in households than in CCIs. Prevalence of PTSD was highest among street youth (28.8%), then households (15.0%) and CCIs (11.5%). PTSS scores were also highest among street youth, followed by CCIs and households. Bullying was associated with higher PTSS scores and PTSD odds than either sexual or physical abuse. Conclusion:This study demonstrated differences in distribution of trauma and PTSD among orphaned and separated children in different domestic care environments, with street youth suffering more than those in CCIs or households.Interventions are needed to address bullying and sexual abuse, especially in extended family households. Street youth, a heretofore neglected population, are urgently in need of dedicated mental health services and support

Models of care for orphaned and separated children and upholding children’s rights: cross-sectional evidence from western Kenya

Background Sub-Saharan Africa is home to approximately 55 million orphaned children. The growing orphan crisis has overwhelmed many communities and has weakened the ability of extended families to meet traditional care-taking expectations. Other models of care and support have emerged in sub-Saharan Africa to address the growing orphan crisis, yet there is a lack of information on these models available in the literature. We applied a human rights framework using the United Nations Convention on the Rights of the Child to understand what extent children’s basic human rights were being upheld in institutional vs. community- or family-based care settings in Uasin Gishu County, Kenya. Methods The Orphaned and Separated Children’s Assessments Related to their Health and Well-Being Project is a 5-year cohort of orphaned children and adolescents aged ≤18 year. This descriptive analysis was restricted to baseline data. Chi-Square test was used to test for associations between categorical /dichotomous variables. Fisher’s exact test was also used if some cells had expected value of less than 5. Results Included in this analysis are data from 300 households, 19 Charitable Children’s Institutions (CCIs) and 7 community-based organizations. In total, 2871 children were enrolled and had baseline assessments done: 1390 in CCI’s and 1481 living in households in the community. We identified and described four broad models of care for orphaned and separated children, including: institutional care (sub-classified as ‘Pure CCI’ for those only providing residential care, ‘CCI-Plus’ for those providing both residential care and community-based supports to orphaned children , and ‘CCI-Shelter’ which are rescue, detention, or other short-term residential support), family-based care, community-based care and self-care. Children in institutional care (95%) were significantly (p < 0.0001) more likely to have their basic material needs met in comparison to those in family-based care (17%) and institutions were better able to provide an adequate standard of living. Conclusions Each model of care we identified has strengths and weaknesses. The orphan crisis in sub-Saharan Africa requires a diversity of care environments in order to meet the needs of children and uphold their rights. Family-based care plays an essential role; however, households require increased support to adequately care for children

Models of care for orphaned and separated children and upholding children\u27s rights: cross-sectional evidence from western Kenya

Background: Sub-Saharan Africa is home to approximately 55 million orphaned children. The growing orphan crisis has overwhelmed many communities and has weakened the ability of extended families to meet traditional care-taking expectations. Other models of care and support have emerged in sub-Saharan Africa to address the growing orphan crisis, yet there is a lack of information on these models available in the literature. We applied a human rights framework using the United Nations Convention on the Rights of the Child to understand what extent children\u27s basic human rights were being upheld in institutional vs. community- or family-based care settings in Uasin Gishu County, Kenya. Methods: The Orphaned and Separated Children\u27s Assessments Related to their Health and Well-Being Project is a 5-year cohort of orphaned children and adolescents aged ≤18 year. This descriptive analysis was restricted to baseline data. Chi-Square test was used to test for associations between categorical /dichotomous variables. Fisher\u27s exact test was also used if some cells had expected value of less than 5. Results: Included in this analysis are data from 300 households, 19 Charitable Children\u27s Institutions (CCIs) and 7 community-based organizations. In total, 2871 children were enrolled and had baseline assessments done: 1390 in CCI\u27s and 1481 living in households in the community. We identified and described four broad models of care for orphaned and separated children, including: institutional care (sub-classified as \u27Pure CCI\u27 for those only providing residential care, \u27CCI-Plus\u27 for those providing both residential care and community-based supports to orphaned children , and \u27CCI-Shelter\u27 which are rescue, detention, or other short-term residential support), family-based care, community-based care and self-care. Children in institutional care (95%) were significantly (p \u3c 0.0001) more likely to have their basic material needs met in comparison to those in family-based care (17%) and institutions were better able to provide an adequate standard of living. Conclusions: Each model of care we identified has strengths and weaknesses. The orphan crisis in sub-Saharan Africa requires a diversity of care environments in order to meet the needs of children and uphold their rights. Family-based care plays an essential role; however, households require increased support to adequately care for children

Prevalence of sexually transmitted infections including HIV in street-connected adolescents in western Kenya

PURPOSE: The objectives of this study were to characterise the sexual health of street-connected adolescents in Eldoret, Kenya, analyse gender disparity of risks, estimate the prevalence of sexually transmitted infections (STIs), and identify factors associated with STIs. METHODS: A cross-sectional study of street-connected adolescents ages 12-21 years was conducted in Eldoret, Kenya. Participants were interviewed and screened for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, herpes simplex virus-2, syphilis and HIV. Descriptive statistics and logistic regression were used to identify factors associated with having any STI. RESULTS: Of the 200 participants, 81 (41%) were female. 70.4% of females and 60.5% of males reported sexual activity. Of those that participated in at least one STI test, 28% (55/194) had ≥1 positive test, including 56% of females; 14% (28/194) had >1 positive test. Twelve females and zero males (6% overall, 14.8% of females) were HIV positive. Among females, those with HIV infection more frequently reported transactional sex (66.7% vs. 26.1%, p=0.01), drug use (91.7% vs. 56.5%, p=0.02), and reported a prior STI (50.0% vs. 14.7%, p<0.01). Having an adult caregiver was less likely among those with HIV infection (33.3% vs. 71.0%, p=0.04). Transactional sex (AOR 3.02, 95% CI (1.05 to 8.73)), a previous STI (AOR 3.46 95% CI (1.05 to 11.46)) and ≥2 sexual partners (AOR 5.62 95% (1.67 to 18.87)) were associated with having any STI. CONCLUSIONS: Street-connected adolescents in Eldoret, Kenya are engaged in high-risk sexual behaviours and females in particular have a substantial burden of STIs and HIV. There is a need for STI interventions targeted to street-connected youth

Nutritional Status of Orphaned and Separated Children and Adolescents Living in Community and Institutional Environments in Uasin Gishu County, Kenya

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 theprevious 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

Application of ARIMA, and hybrid ARIMA Models in predicting and forecasting tuberculosis incidences among children in Homa Bay and Turkana Counties, Kenya.

Tuberculosis (TB) infections among children (below 15 years) is a growing concern, particularly in resource-limited settings. However, the TB burden among children is relatively unknown in Kenya where two-thirds of estimated TB cases are undiagnosed annually. Very few studies have used Autoregressive Integrated Moving Average (ARIMA), and hybrid ARIMA models to model infectious diseases globally. We applied ARIMA, and hybrid ARIMA models to predict and forecast TB incidences among children in Homa Bay and Turkana Counties in Kenya. The ARIMA, and hybrid models were used to predict and forecast monthly TB cases reported in the Treatment Information from Basic Unit (TIBU) system by health facilities in Homa Bay and Turkana Counties between 2012 and 2021. The best parsimonious ARIMA model that minimizes errors was selected based on a rolling window cross-validation procedure. The hybrid ARIMA-ANN model produced better predictive and forecast accuracy compared to the Seasonal ARIMA (0,0,1,1,0,1,12) model. Furthermore, using the Diebold-Mariano (DM) test, the predictive accuracy of ARIMA-ANN versus ARIMA (0,0,1,1,0,1,12) model were significantly different, p<0.001, respectively. The forecasts showed a TB incidence of 175 TB cases per 100,000 (161 to 188 TB incidences per 100,000 population) children in Homa Bay and Turkana Counties in 2022. The hybrid (ARIMA-ANN) model produces better predictive and forecast accuracy compared to the single ARIMA model. The findings show evidence that the incidence of TB among children below 15 years in Homa Bay and Turkana Counties is significantly under-reported and is potentially higher than the national average

Application of ARIMA, and hybrid ARIMA Models in predicting and forecasting tuberculosis incidences among children in Homa Bay and Turkana Counties, Kenya

Tuberculosis (TB) infections among children (below 15 years) is a growing concern, particularly in resource-limited settings. However, the TB burden among children is relatively unknown in Kenya where two-thirds of estimated TB cases are undiagnosed annually. Very few studies have used Autoregressive Integrated Moving Average (ARIMA), and hybrid ARIMA models to model infectious diseases globally. We applied ARIMA, and hybrid ARIMA models to predict and forecast TB incidences among children in Homa Bay and Turkana Counties in Kenya. The ARIMA, and hybrid models were used to predict and forecast monthly TB cases reported in the Treatment Information from Basic Unit (TIBU) system by health facilities in Homa Bay and Turkana Counties between 2012 and 2021. The best parsimonious ARIMA model that minimizes errors was selected based on a rolling window cross-validation procedure. The hybrid ARIMA-ANN model produced better predictive and forecast accuracy compared to the Seasonal ARIMA (0,0,1,1,0,1,12) model. Furthermore, using the Diebold-Mariano (DM) test, the predictive accuracy of ARIMA-ANN versus ARIMA (0,0,1,1,0,1,12) model were significantly different, p<0.001, respectively. The forecasts showed a TB incidence of 175 TB cases per 100,000 (161 to 188 TB incidences per 100,000 population) children in Homa Bay and Turkana Counties in 2022. The hybrid (ARIMA-ANN) model produces better predictive and forecast accuracy compared to the single ARIMA model. The findings show evidence that the incidence of TB among children below 15 years in Homa Bay and Turkana Counties is significantly under-reported and is potentially higher than the national average. Author summary Tuberculosis remains a disease of major public health concern especially in resource limited settings. Despite this, tuberculosis is still characterized by high morbidity and mortality from a single infectious disease, particularly among children in developing countries. The actual burden of tuberculosis among children is relatively unknown and about two-thirds of cases are either unreported or undiagnosed in Kenya. The use of novel mathematical models is critical and can be leveraged to guide policymakers in the prevention and control of infectious diseases such as tuberculosis. We use autoregressive moving average and hybrid forms of these models to model and forecast tuberculosis infections among children. We found out that hybrid autoregressive moving average models provide more accurate predictions and forecasts of tuberculosis infections among children. We also found out and confirmed that the actual burden of tuberculosis among children is still under-estimated. Our study highlights on the ever existing gap in the under-estimation of tuberculosis among children and points to the importance of novel modelling methods in the understanding of the actual burden of tuberculosis among children

Forecasted TB cases for 2022.

Forecasted TB cases for 2022.</p

Comparison of Seasonal ARIMA fitted versus actual TB cases.

Comparison of Seasonal ARIMA fitted versus actual TB cases.</p