title: Models of care for orphaned and separated children and upholding children's rights: cross-sectional evidence from western Kenya.
abstract: BACKGROUND
  Sub-Saharan Africa is home to approximately 55 million orphaned children. The growing orphan crisis has overwhelmed many communities and has weakened the ability of extended families to meet traditional care-taking expectations. Other models of care and support have emerged in sub-Saharan Africa to address the growing orphan crisis, yet there is a lack of information on these models available in the literature. We applied a human rights framework using the United Nations Convention on the Rights of the Child to understand what extent children's basic human rights were being upheld in institutional vs. community- or family-based care settings in Uasin Gishu County, Kenya.
  
  
  METHODS
  The Orphaned and Separated Children's Assessments Related to their Health and Well-Being Project is a 5-year cohort of orphaned children and adolescents aged ≤18 year. This descriptive analysis was restricted to baseline data. Chi-Square test was used to test for associations between categorical /dichotomous variables. Fisher's exact test was also used if some cells had expected value of less than 5.
  
  
  RESULTS
  Included in this analysis are data from 300 households, 19 Charitable Children's Institutions (CCIs) and 7 community-based organizations. In total, 2871 children were enrolled and had baseline assessments done: 1390 in CCI's and 1481 living in households in the community. We identified and described four broad models of care for orphaned and separated children, including: institutional care (sub-classified as 'Pure CCI' for those only providing residential care, 'CCI-Plus' for those providing both residential care and community-based supports to orphaned children , and 'CCI-Shelter' which are rescue, detention, or other short-term residential support), family-based care, community-based care and self-care. Children in institutional care (95%) were significantly (p < 0.0001) more likely to have their basic material needs met in comparison to those in family-based care (17%) and institutions were better able to provide an adequate standard of living.
  
  
  CONCLUSIONS
  Each model of care we identified has strengths and weaknesses. The orphan crisis in sub-Saharan Africa requires a diversity of care environments in order to meet the needs of children and uphold their rights. Family-based care plays an essential role; however, households require increased support to adequately care for children.
authors.forename: Lonnie
authors.initials: L
authors.lastname: Embleton
authors.forename: David
authors.initials: D
authors.lastname: Ayuku
authors.forename: Allan
authors.initials: A
authors.lastname: Kamanda
authors.forename: Lukoye
authors.initials: L
authors.lastname: Atwoli
authors.forename: Samuel
authors.initials: S
authors.lastname: Ayaya
authors.forename: Rachel
authors.initials: R
authors.lastname: Vreeman
authors.forename: Winstone
authors.initials: W
authors.lastname: Nyandiko
authors.forename: Peter
authors.initials: P
authors.lastname: Gisore
authors.forename: Julius
authors.initials: J
authors.lastname: Koech
authors.affiliation: Department of Medicine, Moi University, College of Health Sciences, Eldoret, Kenya. pbraitst@iupui.edu.
authors.forename: Paula
authors.initials: P
authors.lastname: Braitstein
mesh_terms: D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D002654:Child Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D002669:Child Welfare / Q000706:statistics & numerical data*; D054540:Child, Orphaned / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005581:Foster Home Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D006078:Government Programs; D018453:Homeless Youth / Q000706:statistics & numerical data; D006806:Human Rights; D006801:Humans; D007630:Kenya; D008137:Longitudinal Studies; D008962:Models, Theoretical; D019372:Orphanages / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D014480:United Nations; D035862:Vulnerable Populations / Q000706:statistics & numerical data