Abstract:
Background: The effect of different types of care environment on orphaned and separated children
and adolescents’ (OSCA) experiences of abuse in sub-Saharan Africa is uncertain.
Objective: Our two primary objectives were 1) to compare recent child abuse (physical, emotional,
and sexual) between OSCA living in institutional environments and those in family-based care;
and 2) to understand how recent child abuse among street-connected children and youth
compared to these other vulnerable youth populations.
Participants and setting: This project followed a cohort of OSCA in Uasin Gishu County, Kenya
(2009–2019). This analysis includes 2393 participants aged 18 years and below, 1017 from
institutional environments, 1227 from family-based care, and 95 street-connected participants.
Methods: The primary outcome of interest was recent abuse. Multiple logistic regression was used
to estimate the odds of recent abuse at baseline, follow-up, and chronically for each abuse domain
and adjusted odds ratios (AOR) between care environments, controlling for multiple factors.
Results: In total, 47 % of OSCA reported ever experiencing any kind of recent abuse at baseline
and 54 % in follow-up. Compared to those in family-based care, street-connected participants had
a much higher reported prevalence of all types of recent abuse at baseline (AOR: 5.01, 95 % CI:
2.89, 9.35), in follow-up (AOR: 5.22, 95 % CI: 2.41, 13.98), and over time (AOR: 3.44, 95 % CI:
1.93, 6.45). OSCA in institutional care were no more likely than those in family-based care of reporting any recent abuse at baseline (AOR: 0.85 95 % CI: 0.59–1.17) or incident abuse at
follow-up (AOR: 0.91, 95 % CI: 0.61–1.47).
Conclusion: OSCA, irrespective of care environment, reported high levels of recent physical,
emotional, and sexual abuse. Street-connected participants had the highest prevalence of all kinds
of abuse. OSCA living in institutional care did not experience more child abuse than those living
in family-based care.