AUTHOR=Gray Christine L. , Whetten Kathryn , Daniels Julie L. , Hudgens Michael G. , Pettifor Audrey E. , Hobbie Amy M. , Thielman Nathan M. , Dubie Misganaw E. , Itemba Dafrosa , Madan Ira , Vann Vanroth , Wasonga Augustine I. , Manongi Rachel , Ostermann Jan , Whetten Rachel A. , Pence Brian W.
TITLE=Family Composition and Stability for Orphans: A Longitudinal Study of Well-Being in 5 Low- and Middle-Income Countries
JOURNAL=International Journal of Public Health
VOLUME=66
YEAR=2021
URL=https://www.ssph-journal.org/journals/international-journal-of-public-health/articles/10.3389/ijph.2021.1604057
DOI=10.3389/ijph.2021.1604057
ISSN=1661-8564
ABSTRACT=Objectives: Many orphaned children in low- and middle-income countries live with family. Yet, their household composition and its stability are not well-characterized, nor is impact of stability on longer-term outcomes.
Methods: We used the longitudinal, multi-country Positive Outcomes for Orphans cohort to describe adult family living with orphans. Stability was measured by changes in presence of six familial relations over time, and related to three outcomes: 1) incident abuse, 2) cognitive functioning, 3) emotional difficulties. Associations were estimated using generalized linear models fit with generalized estimating equations. For abuse, Poisson regression estimated risk ratios. For continuous scores of cognitive functioning and emotional difficulties, linear models estimated mean differences (MDs) with 95% confidence intervals.
Results: Among 1,359 orphans, 53–61% reported living with their mother each year; 7–13% with father; nearly 60% reported ≥1 change in composition over follow-up. Compared to 0 changes, difficulties increased with 1 change [MD: 0.23 (−0.33, 0.79)], 2 changes [MD: 0.57 (0.00, 1.16)] and ≥3 changes [MD: 0.73 (0.18, 1.29)]. No associations were found with abuse or cognitive functioning.
Conclusion: Orphan well-being may be improved through supports stabilizing household composition or targeting emotional resilience.