{Models of care for orphaned and separated children and upholding children's rights: Cross-sectional evidence from western Kenya}

Citation:

Embleton L, Ayuku D, Kamanda A, Atwoli L, Ayaya S, Vreeman R, Nyandiko W, Gisore P, Koech J, Braitstein P. {Models of care for orphaned and separated children and upholding children's rights: Cross-sectional evidence from western Kenya}. BMC International Health and Human Rights. 2014;14.

Abstract:

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 {\textless} 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. © 2014Embleton et al.; licensee BioMed Central Ltd.

Recent Publications

Takahashi R, Wilunda C, Magutah K, Mwaura-Tenambergen W, Atwoli L, Perngparn U. {Evaluation of alcohol screening and community-based brief interventions in rural western Kenya: A quasi-experimental study}. Alcohol and Alcoholism. 2018;53.Abstract

© The Author 2017. Medical Council on Alcohol and Oxford University Press. All rights reserved. Aims: To assess the effectiveness of community-based alcohol brief interventions (ABI) implemented by community-health workers with and without motivational talks (MT) by former drinkers, in reducing harmful and hazardous alcohol consumption.Methods: We conducted a three-arm quasi-experimental study (one control and two intervention groups) between May and December 2015 in Kakamega County, Kenya. Participants were hazardous or harmful alcohol drinkers with an Alcohol Use Disorders Identification Test (AUDIT) score of 8-19 at baseline. One intervention group received only ABI while the other received ABI + MT. The interventions' effects on AUDIT scores were analysed using linear mixed models. Logistic regression was used to analyse the interventions' effects on low-risk drinking (AUDIT score {\textless} 8) after 6 months.Results: The study included 161 participants: 52 in the control group, 52 in the only ABI group and 57 in the ABI + MT group. The mean AUDIT scores were lower in the intervention groups at 1, 3 and 6 months post-intervention; the ABI + MT group showed a greater reduction. The mean AUDIT scores over a 6-month period were lower in both intervention groups compared with the control group. The odds of low-risk drinking were almost two times higher in both intervention groups than in the control group, although the effect of only ABI on low-risk drinking was not significant.Conclusions: ABI + MT and only ABI were associated with a reduced mean AUDIT score among hazardous and high-risk drinkers in this resource-limited setting. ABI + MT was also associated with low-risk drinking in this population.Short summary: Community-based alcohol brief interventions implemented by community-health workers accompanied by motivational talks by former drinkers were associated with reduced hazardous and harmful alcohol consumption in a rural setting in western Kenya.

Degenhardt L, Glantz M, Evans-Lacko S, Sadikova E, Sampson N, Thornicroft G, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, {Helena Andrade} L. {Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys}. World Psychiatry. 2017;16.Abstract

© 2017 World Psychiatric Association Substance use is a major cause of disability globally. This has been recognized in the recent United Nations Sustainable Development Goals (SDGs), in which treatment coverage for substance use disorders is identified as one of the indicators. There have been no estimates of this treatment coverage cross-nationally, making it difficult to know what is the baseline for that SDG target. Here we report data from the World Health Organization (WHO)'s World Mental Health Surveys (WMHS), based on representative community household surveys in 26 countries. We assessed the 12-month prevalence of substance use disorders (alcohol or drug abuse/dependence); the proportion of people with these disorders who were aware that they needed treatment and who wished to receive care; the proportion of those seeking care who received it; and the proportion of such treatment that met minimal standards for treatment quality (“minimally adequate treatment”). Among the 70,880 participants, 2.6{%} met 12-month criteria for substance use disorders; the prevalence was higher in upper-middle income (3.3{%}) than in high-income (2.6{%}) and low/lower-middle income (2.0{%}) countries. Overall, 39.1{%} of those with 12-month substance use disorders recognized a treatment need; this recognition was more common in high-income (43.1{%}) than in upper-middle (35.6{%}) and low/lower-middle income (31.5{%}) countries. Among those who recognized treatment need, 61.3{%} made at least one visit to a service provider, and 29.5{%} of the latter received minimally adequate treatment exposure (35.3{%} in high, 20.3{%} in upper-middle, and 8.6{%} in low/lower-middle income countries). Overall, only 7.1{%} of those with past-year substance use disorders received minimally adequate treatment: 10.3{%} in high income, 4.3{%} in upper-middle income and 1.0{%} in low/lower-middle income countries. These data suggest that only a small minority of people with substance use disorders receive even minimally adequate treatment. At least three barriers are involved: awareness/perceived treatment need, accessing treatment once a need is recognized, and compliance (on the part of both provider and client) to obtain adequate treatment. Various factors are likely to be involved in each of these three barriers, all of which need to be addressed to improve treatment coverage of substance use disorders. These data provide a baseline for the global monitoring of progress of treatment coverage for these disorders as an indicator within the SDGs.

Fayyad J, Sampson NA, Hwang I, Adamowski T, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LHSG, Borges G, de Girolamo G, Florescu S. {The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys}. ADHD Attention Deficit and Hyperactivity Disorders. 2017;9.Abstract

© 2016, Springer-Verlag Wien. We previously reported on the cross-national epidemiology of ADHD from the first 10 countries in the WHO World Mental Health (WMH) Surveys. The current report expands those previous findings to the 20 nationally or regionally representative WMH surveys that have now collected data on adult ADHD. The Composite International Diagnostic Interview (CIDI) was administered to 26,744 respondents in these surveys in high-, upper-middle-, and low-/lower-middle-income countries (68.5{%} mean response rate). Current DSM-IV/CIDI adult ADHD prevalence averaged 2.8{%} across surveys and was higher in high (3.6{%})- and upper-middle (3.0{%})- than low-/lower-middle (1.4{%})-income countries. Conditional prevalence of current ADHD averaged 57.0{%} among childhood cases and 41.1{%} among childhood subthreshold cases. Adult ADHD was significantly related to being male, previously married, and low education. Adult ADHD was highly comorbid with DSM-IV/CIDI anxiety, mood, behavior, and substance disorders and significantly associated with role impairments (days out of role, impaired cognition, and social interactions) when controlling for comorbidities. Treatment seeking was low in all countries and targeted largely to comorbid conditions rather than to ADHD. These results show that adult ADHD is prevalent, seriously impairing, and highly comorbid but vastly under-recognized and undertreated across countries and cultures.

Lukoye Atwoli

Associate Professor of Psychiatry

{Models of care for orphaned and separated children and upholding children's rights: Cross-sectional evidence from western Kenya}

Citation:

Abstract:

Recent Publications