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Best interest of the child: Improving health, well-being of low resource country orphans

  • Aug. 12, 2015

INDIANAPOLIS -- With the support of a second grant of more than $3 million from the National Institutes of Health, researchers from the Regenstrief Institute, Indiana University, Brown University, the University of Toronto, and Moi University in Eldoret, Kenya are building upon their landmark study of Kenyan orphans which found that those living in orphanages were healthier, both physically and mentally, than those living with extended family members. The new study will investigate the causes of this disparity.

Care for orphans is a major issue throughout Africa. An estimated 153 million children and adolescents, the majority in low- and middle-income countries, have lost one or more parents. Compared to those living with parents, orphans are at a higher risk of HIV infection, malnutrition, childhood diseases, stigma and discrimination.

The new research is a 5-year extension of the Orphaned and Separated Children's Assessment Related to their Health and Well-Being study, known as OSCAR. Half of the 2,859 Kenyan orphans (age less than one year to 18 years when initially enrolled in OSCAR) in the study reside in orphanages and half live with extended family members.  

From data acquired during the first 5 years of the Orphaned and Separated Children's Assessment Related to their Health and Well-Being study, now known as OSCAR 1.0, the researchers compared the physical and mental health, nutrition and education of institutionalized orphans with orphans living with family members. With the new funding, the researchers plan to determine what it is about these dissimilar environments that account for differing outcomes. They will also investigate the cost-effectiveness of the different care structures.

"The stakes for orphans are so high. With the new NIH support we hope to determine how these children and millions of other orphans -- many of whom are now in their teens and 20s -- can become healthy, productive adults," said Paula Braitstein, Ph.D., the principal investigator of OSCAR 1.0 and co-principal investigator of OSCAR 2.0, as the five year extension of the study is known.

"There isn't going to be a one-size-fits-all solution for all situations and for all kids," said Dr. Braitstein, associate professor and the Canadian Institutes of Health Research Chair of Applied Public Health at the University of Toronto and a Regenstrief Institute affiliated scientist. "While a growing number of policy makers, social activists and others favor placing orphans with family members, we found that for many children this was not a good solution in terms of health and overall well-being and may not be in the best interest of the child.

"These are typically poor families. Often orphans placed with relatives are the end of the line in a large number of family members to be fed and clothed. Frequently they are not allowed to attend school. We repeatedly found that, unlike many orphanages, families were very often unable to adequately respond to the physical, social and psychological support orphans, many of whom are stigmatized because of the loss or one or both parents to HIV, need."

Dr. Braitstein notes that this is not necessarily an indictment of family care for orphans. Families, often a grandmother responsible for many grandchildren, are not given the financial and other support they need to care for orphaned family members. Orphanages, which often rely upon charitable support from higher income countries, can provide services that families, even with the modest stipends some receive for orphan care, cannot.

"This is the first study to shed light on a common human problem that has been shoved under the rug throughout Africa, a problem that people, wherever in the world they live, don't want to know about. OSCAR 2.0 will scientifically determine the costs of differing care models -- not only to the orphans themselves but to their communities and their countries -- in terms of physical health, mental health, nutrition, abuse, education, future employment prospects and other life changing factors," William Tierney, M.D., co-principal investigator of OSCAR 2.0, said.  He is the president and CEO of the Regenstrief Institute and Indiana University School of Medicine associate dean of clinical effectiveness research.

Grant 2R01HD060478-06A1 to Indiana University was awarded by NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development in July 2015.

Young children outside Lewa Homes, an orphanage on the outskirts of Eldoret, Kenya.

Young children outside Lewa Homes, an orphanage on the outskirts of Eldoret, Kenya. | Photo by Paula Braitstein

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Lewa Homes in Eldoret, Kenya, is home to a number of orphans.

Lewa Homes in Eldoret, Kenya, is home to a number of orphans. | Photo by Paula Braitstein

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Cindy Fox Aisen