UNICEF estimates there are 153 million children and adolescents in the world for whom one or both parents are deceased; millions more have been abandoned. The majority live in low- and middle-income countries such as Kenya. Compared to non-orphans, orphaned youth are at higher risk of HIV, malnutrition, other childhood morbidities, and stigma and discrimination. Our long-term goal is to gather and disseminate evidence on how to improve the health and well- being of orphans and vulnerable children so they can become healthy, well-adjusted adults. A variety of governmental and non-governmental programs and care models have emerged in an effort to fill the gap in care for the millions of orphaned children and adolescents in need. Phase I of our cohort study described models of care for orphaned and separated (abandoned) children and adolescents (OSCA) living in institutional and family-based settings and evaluated the effect of care environment on their physical and mental health. Now in its 4th round of annual assessments, Phase I suggests that OSCA in CCI's are healthier and possibly happier than those in FBS. The primary objective of Phase II is to better understand and explain these differences. We will maintain the cohort and examine specific aspects of their care environments, their cost-effectiveness, and the inter-personal characteristics that predict better physical and mental health outcomes over time and across the developmental spectrum. Enabling the present and future generations of orphaned children, adolescents and youth to develop into healthy, well-adjusted, and productive adults will yield dividends in the economic and political stability of nations such as Kenya. This work directly responds to the mission of NICHD in its aim to ensure that all children, including orphans, have the chance to achieve their full potential for healthy and productive lives, free from disease or disability, and to ensure the health, productivity, independence, and well-being of them through optimal care environments.

Public Health Relevance

UNICEF estimates there are 153 million children and adolescents in the world for whom one or both parents are deceased and they are at high risk of HIV infection, malnutrition, other childhood morbidities, and stigma and discrimination. Empirical evidence is urgently needed to inform optimal and cost-effective care environments for this vulnerable population. The public health, demographic, and economic implications are far-reaching, may be multi-generational in scope, and have relevance to high-risk youth in the United States.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
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Haverkos, Lynne
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Indiana University-Purdue University at Indianapolis
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United States
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Embleton, Lonnie; Ayuku, David; Makori, Dominic et al. (2018) Causes of death among street-connected children and youth in Eldoret, Kenya. BMC Int Health Hum Rights 18:19
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
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Embleton, Lonnie; Braitstein, Paula (2016) An Important Cause of Child and Youth Homelessness-Reply. JAMA Pediatr 170:909-10
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
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
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

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