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Global health researcher finds Oliver Twist narrative does not apply to orphans in low-​and-​middle-​income countries

August 26/2015

Orphanages, or other institutional environments, may be better equipped to care for children in need than extended families or other family-based care configurations in low-and-middle-income countries, according to researchers at the University of Toronto, Indiana University and Moi University in Eldoret, Kenya.

Global health researcher Paula Braitstein published an editorial on August 26, 2015 in Global Health: Science and Practice discussing how different care environments impact an orphaned or vulnerable child’s physical and mental health. She says there is a rapidly growing body of evidence that challenges the conventional wisdom of Oliver Twist.

“While many policy makers, social activists and others favor placing orphans with family members, we are finding that for many children this was not a good solution in terms of health and overall well-being and may not be in the best interest of the child,” said Braitstein, Associate Professor in the Dalla Lana School of Public Health.

Braitstein received a $3-million National Institutes of Health (NIH) grant in August 2015 to continue her cohort study, Orphaned and Separated Children’s Assessments Related to their Health and Well-Being, which follows nearly 3,000 orphaned and separated children.

“Often orphans placed with relatives are the end of the line in a large number of family members to be fed and clothed. Frequently they are not allowed to attend school. We repeatedly found that, unlike many orphanages, families were very often unable to adequately respond to the material, physical, social and psychological needs of orphans, many of whom are stigmatized because of the loss or one or both parents to HIV,” said Braitstein, who also holds a Canadian Institutes of Health Research Applied Public Health Chair.

Regardless of which side of the deinstitutionalization debate one takes, reported rates of traumatic experiences among orphans and vulnerable children are high in both institutions and extended families.

Recent studies illustrate that more than 90 per cent of children in both environments experience at least one potentially traumatic event other than the death of a parent, with more than 50 per cent of both groups reporting at least one episode of physical or sexual abuse by age 13.

“In many ways, the debate on institutionalization is asking the wrong question. We should be asking how can we improve care and prevent traumatic events among vulnerable children regardless of the care environment?” said Braitstein.

With the NIH grant, Braitstein and her team will evaluate the cost effectiveness of different care models and examine how various factors, including the quality of the relationship between child and caregiver, and other sources of resilience like involvement in sports and civic activities, impact on the physical health, mental health, nutrition, abuse, education and employment of orphaned children and adolescents.