title: Gender (in) differences in prevalence and incidence of traumatic experiences among orphaned and separated children living in five low- and middle-income countries.
abstract: BACKGROUND
  Approximately 153 million children worldwide are orphaned and vulnerable to potentially traumatic events (PTEs). Gender differences in PTEs in low- and middle-income countries (LMIC) are not well-understood, although support services and prevention programs often primarily involve girls.
  
  
  METHODS
  The Positive Outcomes for Orphans study used a two-stage, cluster-randomized sampling design to identify 2837 orphaned and separated children (OSC) in five LMIC in sub-Saharan Africa and Asia. We examined self-reported prevalence and incidence of several PTE types, including physical and sexual abuse, among 2235 children who were ≥10 years at baseline or follow-up, with a focus on gender comparisons.
  
  
  RESULTS
  Lifetime prevalence by age 13 of any PTE other than loss of a parent was similar in both boys [91.7% (95% confidence interval (CI) (85.0-95.5)] and girls [90.3% CI (84.2-94.1)] in institutional-based care, and boys [92.0% (CI 89.0-94.2)] and girls [92.9% CI (89.8-95.1)] in family-based care; annual incidence was similarly comparable between institution dwelling boys [23.6% CI (19.1, -29.3)] and girls [23.6% CI (18.6, -30.0)], as well as between family-dwelling boys [30.7% CI (28.0, -33.6)] and girls [29.3% CI (26.8,-32.0)]. Physical and sexual abuse had the highest overall annual incidence of any trauma type for institution-based OSC [12.9% CI (9.6-17.4)] and family-based OSC [19.4% CI (14.5-26.1)], although estimates in each setting were no different between genders.
  
  
  CONCLUSIONS
  Prevalence and annual incidence of PTEs were high among OSC in general, but gender-specific estimates were comparable. Although support services and prevention programs are essential for female OSC, programs for male OSC are equally important.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB #7435, Chapel Hill, North Carolina, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Gray
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB #7435, Chapel Hill, North Carolina, USA ; Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Box 90519, Durham, North Carolina, USA.
authors.forename: B W
authors.initials: BW
authors.lastname: Pence
authors.affiliation: Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Box 90519, Durham, North Carolina, USA.
authors.forename: J
authors.initials: J
authors.lastname: Ostermann
authors.affiliation: Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Box 90519, Durham, North Carolina, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Whetten
authors.affiliation: Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Box 90519, Durham, North Carolina, USA ; Departments of Psychiatry and Pediatrics, DUMC #3364, Duke University Medical Center, Durham, North Carolina, USA ; Center for Child and Family Health, Duke University, 411 West Chapel Hill Street, Suite 908, Durham, North Carolina, USA.
authors.forename: K
authors.initials: K
authors.lastname: O'Donnell
authors.affiliation: Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Box 90519, Durham, North Carolina, USA ; Department of Medicine, DUMC #3152, Division of Infectious Diseases and International Health, Duke University, Durham, North Carolina, USA.
authors.forename: N M
authors.initials: NM
authors.lastname: Thielman
authors.affiliation: Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Box 90519, Durham, North Carolina, USA ; Terry Sanford Institute of Public Policy, Duke University, Box 90239, Durham, North Carolina, USA.
authors.forename: K
authors.initials: K
authors.lastname: Whetten
keywords: gender; incidence; low- and middle-income countries (LMIC); orphans; potentially traumatic events; prevalence