UNICEF estimates that by 2010, sub-Saharan Africa will have over 53 million orphaned children. Over 30% of these will be orphaned by AIDS. Two-thirds of double orphans are adolescents, reflecting the coming of age of Africa's children orphaned by the AIDS epidemic. Due to their young age and life circumstances, orphaned and separated children are very vulnerable to economic and sexual exploitation, sexual risk taking behaviour, excessive drug and alcohol use, depression, post-traumatic stress disorder, malnutrition, and tuberculosis. Although orphaned children are not yet recognized by UNAIDS as a high risk population for acquiring HIV, these young people are at an especially heightened risk precisely because of their social and economic vulnerability. Although strengthening the capacity of families and communities to protect and care for orphans is the ideal strategy for mitigating the impact of AIDS on family and community structures, there are numerous indicators that families and communities are overwhelmed by the numbers of orphans requiring care. Thus, the quality of care and support these children receive may be compromised. In addition to various configurations of care provided by extended family, several additional care models are emerging. These include formal and informal foster homes, orphanages, community-based programs, government detention centres, homes and schools run by religious institutions or other non-governmental organizations. The overall goal of this study is to improve the health and well-being of orphaned children.
The specific aims of the study are therefore to: A.1. Describe existing models of care for children who are orphaned or separated (i.e. actual or virtual orphaned children) in the Uasin Gishu District of Western Kenya;A.2. Investigate the effect of care environment characteristics on key socioeconomic indicators for orphaned and separated children;and A.3. Measure the effect of care environment characteristics on the physical and mental health of the resident children.

Public Health Relevance

More than two thirds (68%) of all people living with HIV live in sub-Saharan Africa, and more than three quarters (76%) of all AIDS deaths in 2007 occurred in this region. AIDS alone has left approximately 15 million children and adolescents without parents, and half of these are adolescents. These children and adolescents are at extraordinarily high risk of adverse physical, social, and psychological outcomes including HIV-infection. The child's home or care environment is a primary target for interventions and support aimed at reducing their risk, and improving their health and well-being.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
Project #
Application #
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Haverkos, Lynne
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Indiana University-Purdue University at Indianapolis
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
Embleton, Lonnie; Nyandat, Joram; Ayuku, David et al. (2017) Sexual Behavior Among Orphaned Adolescents in Western Kenya: A Comparison of Institutional- and Family-Based Care Settings. J Adolesc Health 60:417-424
Shangani, Sylvia; Operario, Don; Genberg, Becky et al. (2017) Unconditional government cash transfers in support of orphaned and vulnerable adolescents in western Kenya: Is there an association with psychological wellbeing? PLoS One 12:e0178076
Embleton, Lonnie; Lee, Hana; Gunn, Jayleen et al. (2016) Causes of Child and Youth Homelessness in Developed and Developing Countries: A Systematic Review and Meta-analysis. JAMA Pediatr 170:435-44
Wachira, Juddy; Kamanda, Allan; Embleton, Lonnie et al. (2016) 'Pregnancy Has Its Advantages': The Voices of Street Connected Children and Youth in Eldoret, Kenya. PLoS One 11:e0150814
Szkwarko, D; Mercer, T; Kimani, S et al. (2016) Implementing intensified tuberculosis case-finding among street-connected youth and young adults in Kenya. Public Health Action 6:142-6
Rachlis, Beth; Naanyu, Violet; Wachira, Juddy et al. (2016) Community Perceptions of Community Health Workers (CHWs) and Their Roles in Management for HIV, Tuberculosis and Hypertension in Western Kenya. PLoS One 11:e0149412
Embleton, Lonnie; Wachira, Juddy; Kamanda, Allan et al. (2016) Eating sweets without the wrapper: perceptions of HIV and sexually transmitted infections among street youth in western Kenya. Cult Health Sex 18:337-48
Ndege, Samson; Washington, Sierra; Kaaria, Alice et al. (2016) HIV Prevalence and Antenatal Care Attendance among Pregnant Women in a Large Home-Based HIV Counseling and Testing Program in Western Kenya. PLoS One 11:e0144618
Embleton, L; Ott, M A; Wachira, J et al. (2015) Adapting ethical guidelines for adolescent health research to street-connected children and youth in low- and middle-income countries: a case study from western Kenya. BMC Med Ethics 16:89
Winston, Susanna E; Chirchir, Amon K; Muthoni, Lauryn N et al. (2015) Prevalence of sexually transmitted infections including HIV in street-connected adolescents in western Kenya. Sex Transm Infect 91:353-9

Showing the most recent 10 out of 29 publications