How Does the Environment in Kenya Affect the Families

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• Published: eighteen January 2022

Outcome of care environment on educational attainment among orphaned and separated children and adolescents in Western Kenya

• Allison DeLong²,
• Edwin Sang³,
• David Ayuku^four,
• Lukoye Atwoli^iv,5,
• Omar Galárraga⁶ &
• Paula Braitstein^1,3

BMC Public Health volume 22, Article number:123 (2022) Cite this article

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Abstract

Background

There are approximately 140 million orphaned and separated children (OSCA) around the world. In Republic of kenya, many of these children live with extended family while others live in institutions. Despite evidence that orphans are less likely to be enrolled in school than non-orphans, there is petty evidence regarding the office of care environment. This prove is vital for designing programs and policies that promote access to education for orphans, which is not but their homo right simply also an important social determinant of health. The purpose of this study was to compare educational attainment among OSCA living in Charitable Children's Institutions and family unit-based settings in Uasin Gishu County, Kenya.

Methods

This study analyses follow upwards data from a cohort of OSCA living in 300 randomly selected households and 17 institutions. We used Poisson regression to judge the effect of care environs on master school completion among participants age ≥ fourteen likewise as full and partial secondary school completion among participants age ≥ xviii. Risk ratios and 95% conviction intervals were estimated using a bootstrap method with 1000 replications.

Results

The assay included 1406 participants (495 from institutions, 911 from family-based settings). At baseline, 50% were female person, the boilerplate historic period was nine.5 years, 54% were double orphans, and 3% were HIV-positive. At follow-upward, 76% of participants age ≥ 14 had completed primary school and 32% of participants age ≥ 18 had completed secondary school. Children living in institutions were significantly more than likely to consummate primary school (aRR: 1.18, 95% CI: ane.10–1.28) and at least ane twelvemonth of secondary school (aRR: 1.28, 95% CI: 1.18–one.39) than children in family-based settings. Children living in institutions were less likely to take completed all four years secondary school (aRR: 0.79, 95% CI: 0.43–i.18) than children in family unit-based settings.

Conclusion

Children living in institutional environments were more likely to consummate primary schoolhouse and some secondary school than children living in family-based care. Farther support is needed for all orphans to improve primary and secondary school completion. Policies that require orphans to leave institution environments upon their eighteenth altogether may be preventing these youth from completing secondary school.

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Introduction

Instruction is widely recognized equally a fundamental social determinant of wellness [ane,ii,3]. Education is besides recognized every bit a human being right under Article 28 of the United nations Convention on the Rights of the Child, which states that principal teaching should be free and compulsory and that secondary education should be available and accessible to all children [4]. Increased educational attainment is associated with positive wellness outcomes, college socioeconomic condition, greater admission to healthcare, increased life expectancy, and improvements in childhood mortality [5,6,7,eight,9,10].

Educational activity has been identified as a global priority in both the Millennium Development Goals and the Sustainable Development Goals [11]. However, there continue to be disparities in educational attainment both between countries and within specific population groups. While cyberspace primary school enrolment around the world increased to 91% in 2015 from 83% in 2000, children in the poorest households were four times less likely to attend schoolhouse than children in the richest households in developing countries [12]. Sub-Saharan Africa saw the greatest increases in chief schoolhouse enrolment during the Millennium Development Goals era, but continued to have the lowest literacy rates among youth compared to other regions [12].

Orphaned and separated children and youth (OSCA) have particularly low educational attainment [13, 14]. UNICEF defines an orphan as a kid under xviii years of age who has lost one or both parents to any cause of death [15]. Based on UNICEF's definition, there were an estimated 140 million orphans in the earth in 2015, of whom 15.i one thousand thousand had lost both parents [xv]. Orphans are less likely to be attention school; more likely to have lower academic accomplishment and higher absenteeism; and are less probable to be in the correct class level for their historic period than non-orphans [16,17,18]. Previous research has institute that there are many barriers to educational attainment for orphans, including the psychological trauma (i.due east. grief and depression) and material bear on (i.eastward. lack of coin for school fees) of losing a parent [17], missing time from school to intendance for a sick parent before they dice [17], nutrient insecurity (i.due east. a child may go to the street in search of food rather than going hungry all day at school) [14, 19], and the cost of school fees and coincident costs (due east.thousand. compatible, school shoes, school bag) [14]. Among OSCA who did non complete their educations, leaving school early has been identified as a source of significant psychological distress [19].

According to UNICEF, 52 million of the world's orphans are living in Africa [15]. Globally, an estimated 16.6 million children have lost both parents to HIV/AIDS, of whom ninety% live in sub-Saharan Africa [xx]. In 2012, there were an estimated 1.8 one thousand thousand orphans living in Kenya, of whom 15% were double orphans who had lost both their parents [21]. The majority of OSCA live with their surviving parent or extended family [xv]. Yet, households caring for OSCA in Kenya are oftentimes extremely poor and many are unable to meet the basic needs of the children in their intendance [13]. The big number of children in demand of care has resulted in many children living in institutional settings (due east.g., orphanages), while enquiry from a range of countries has demonstrated negative short and long-term physical and mental wellness outcomes for children growing upward in institutional intendance environments [22, 23].

However, little is known about the bear upon of different care environments on educational attainment, despite considerable attention to both the lack of educational activity among OSCA equally well as the negative impacts of institutions [24]. Understanding the impact of institutions and other models of care on educational attainment is vital to designing programs and policies that promote access to education for OSCA. The positive, long-term health and social impacts of increased teaching are peculiarly of import OSCA, who already face bigotry and less family support [16, 25]. The objective of this assay was to investigate the impact of intendance environs on principal and secondary school completion amidst OSCA living in western Republic of kenya, a country that has affirmed the right to education and the correct of children to free and compulsory basic teaching in the constitution [26]. Due to the negative impacts of institutions in other areas of health and wellbeing, our hypothesis was that children living in institutions would complete less educational activity than children living in family unit-based settings.

Methods

Study design

The Orphaned and Separated Children's Assessments Related to their (OSCAR'southward) Wellness and Well-Being Project is a two-phase longitudinal cohort study investigating the effects of care surround on the concrete and psychosocial well-being of OSCA in Uasin Gishu County, Republic of kenya [27]. The report enrolled participants < 18 years of age from May 31, 2010 to April 24, 2013. Phase ane ran from 2010 to 2015 and Stage 2 ran from 2016 to 2019. The OSCAR accomplice comprises participants from 300 randomly selected households caring for OSCA and 19 Charitable Children's Institutions (CCIs) (of 21 in the county at the time of written report start-up). All children, both orphaned and non-orphaned, from each household or institution were eligible to participate in the report. Amongst the 300 households, recruitment was designed to include 100 households receiving the government cash transfer for the back up of orphaned children, 100 households non receiving the greenbacks transfer from within the same sub-Locations as those receiving the cash transfers, and 100 households not receiving the cash transfer from different sub-Locations than those receiving the cash transfers. Sub-Locations are administrative boundaries within Uasin Gishu Canton, each headed by an Assistant Master [27]. In-depth details most the OSCAR accomplice's written report pattern, setting, and recruitment have been previously reported [27].

Study population

This report includes all participants who were orphaned or separated at the time of enrolment into Phase 1. Separated children were defined as those whose biological female parent or begetter was potentially alive, but functionally non part of the child's life. Since questions regarding didactics were introduced in Stage 2, the sample is farther restricted to participants who completed at least one Phase 2 visit. Of the 19 CCIs recruiting in Phase i, two were non eligible to participate in Phase ii since they provided shorter-term care. Therefore, participants from these two CCIs did not enrol in Phase 2 of the OSCAR study and were not included in this analysis.

Human subjects' protections

The Moi Academy College of Wellness Sciences and Moi Didactics and Referral Infirmary Institutional Enquiry and Ethics Commission, the Indiana University Institutional Review Lath, and the University of Toronto Research Ethics Boards approved this study. This study conforms to the principles embodied in the Declaration of Helsinki. Written informed consent for participation was provided by the head of household or Director of the CCI. Individual written informed assent was provided by each child aged seven years and to a higher place. Fingerprints were used for both children and guardians who were unable to sign or write their proper name.

Patient and public involvement in research

This study utilized community-based, participatory processes to inform the research questions, hypotheses, and methods, as detailed elsewhere [27]. To summarize briefly, the Children's Officers in the region and representatives from CCIs were initially consulted prior to the funding application. They were requested to provide input equally to whether such a report would be important from their perspective, and what their priority questions and concerns were. In add-on, traditional community assemblies were held in some of the target communities to identify community concerns and priorities with respect to the intendance of orphaned and vulnerable children. These assemblies were besides held following the initiation of the report to maintain regular contact with the community and disseminate findings. Nosotros formed an Informational Board early on, consisting of representatives from communities, CCIs, and Children's Officers, and this board met regularly throughout the life of the study. Our study disseminated findings through the monthly Uasin Gishu Children's Services Forum, through additional traditional community assemblies, and through the study website [28].

Procedures

Data collection was conducted in situ at CCIs and at the OSCAR Project clinic for participants from households. Annually, participants completed a standardized clinical meet and those ≥ten years of historic period likewise completed a psychosocial encounter. The clinical come across was an enhanced well-child 'check-up' administered by the projection medical officer (i.e., physician) that included a complete physical history and review of health symptoms. A psychosocial encounter measured education and employment, material well-existence, behaviours and risks, peer and family relationships, and mental health. The psychosocial assessment was cocky-administered for those who could read and write or psychologist-administered for those that could not adequately read or write. A clinical psychologist was always bachelor during the assessments to assist in case of questions, lack of understanding, or distress. Follow-up of cases requiring individual counselling or case management took place on a example by case basis equally needed, by study staff. Household level data, including age and instruction level of the household head, and other characteristics of the intendance environments (such as shelter blazon and source of water) were obtained through annual site assessments administered by the Project Manager for CCIs, and Customs Wellness Workers in the participating households.

Independent variables

The primary exposure of interest was care surround (institutional or family-based) upon study enrolment [13]. Sociodemographic characteristics were ascertained at the baseline clinical encounter, including age, sexual practice, orphan/separated status (maternal, paternal, or both), HIV status (positive, negative, unknown), hospitalizations in the past year, area of residence (rural or urban) and time living with caregiver (< half-dozen months, half dozen months-ii years, 2–5 years, > 5 years, all the child's life). The guardian'south level of pedagogy at enrolment (none, primary, secondary, vocational, university) was assessed through a site assessment. Follow-up time was defined as the time betwixt the get-go and final encounters each individual participated in.

Educational outcomes

The Kenyan pedagogy organisation includes 8 years of primary school from ages 6 to xiii (Class one to Class 8) and 4 years of secondary schoolhouse from age 14 to 17 (Grade 1 to Course 4). Participants were asked to place the highest class they had completed in school, if they had ever attended school, if they were currently attention school, and how many days of schoolhouse they had missed in the past iv weeks (none, one–2 days, 3–5 days, > 5 days). The primary outcomes were completion of primary schoolhouse (Form 8 or higher among participants age 14 or older), completion of one or more than years of secondary schoolhouse (Grade 1 or higher among participants historic period 18 or older), and completion of all iv years of secondary school (Form 1 or higher amongst participants historic period 18 or older) at the time of the participant's terminal follow upwardly visit.

Statistical analysis

Descriptive statistics at baseline were calculated for both the initial study population and the population with at least one Phase two visit, overall and by care environment. Mean values and standard deviations are reported for normally distributed continuous characteristics, median values and interquartile ranges are reported for not-normally distributed continuous characteristics, and frequencies and percentages are reported for categorical characteristics. Differences in baseline characteristics past care surroundings were assessed using Pearson's Chi-Squared tests for categorical characteristics and ii-sample t-tests for continuous characteristics. To assess loss to follow up, Pearson's Chi-Squared tests were used to compare chiselled characteristics of participants who completed a Phase 2 visit to participants who did not consummate a Phase ii visit. Continuous characteristics were compared using a 2-sample t-test. Educational outcomes at the concluding follow-up visit were described by frequency and percentage for each care environment.

The effect of intendance environs on each educational upshot (primary school completion, partial secondary schoolhouse completion, and secondary school completion) was estimated separately using bootstrapped Poisson regression. Poisson regression was chosen to present a chance ratio, the ratio of the cumulative incidence of school completion in the exposed (children from CCIs) and unexposed (children from FBS) groups. Results are reported unadjusted and adjusted for sex, orphan status at enrolment, HIV condition at enrolment, and hospitalization in the past year. A sensitivity analysis was conducted to adapt for area (urban or rural).

The risk ratios and 95% confidence intervals were estimated using bootstrap resampling with thousand replications. Sampling of participants with replacement was conducted within each original sampling stratum (CCI, non-cash transfer household, same sub-Location household, and unlike sub-Location household) to business relationship for clustering. The regression models were fit using inverse probability-of-censoring weights to reduce choice bias from the differential loss to follow past simulating a pseudo-population where the loss to follow upwardly was random [29]. These weights estimate the probability of each participant completing a Phase 2 visit based on their characteristics. The weights were calculated using generalized additive models (GAM) stratified by CCI, non-cash transfer household, same sub-Location household, and different sub-Location household. The GAMs predicted the probability of a participant completing a Stage 2 visit using a smoothed function on age at enrolment and adjusted for sex, area (urban or rural), orphan status at baseline, time with guardian at baseline, contempo hospitalization at baseline, and HIV status at baseline.

Results

Characteristics of participants

Table 1 describes the baseline characteristics of the 2099 participants enrolled in the OSCAR study who were eligible to participate in Phase 2 (i.e. excluding participants from the 2 CCIs that were not invited to participate in Phase 2). At baseline, 45% (due north = 939) of participants were living in a CCI while 55% (north = 1160) of participants were living in a family unit-based setting (FBS). Among the participants living in a FBS, 36% (n = 738) were living in households that received the government cash transfer (data not shown). The mean age was 10.3 years,49% of participants were female, and there were 65 participants (three%) who were HIV-positive at baseline.

Table ane Population characteristics at baseline among all OSCAR participants

Full size tabular array

Among participants who completed at to the lowest degree one Stage 2 visit, the mean age of participants from CCIs at their final Phase 2 visit was fifteen.5 years, while participants from FBS had a mean age of 17.3 years at their last Phase 2 visit (Table 2). Among OSCA in FBS, the majority (65%) were living in rural areas, while 48% of OSCA in a CCI were living in rural areas. At baseline, 762 (54%) participants were double orphans, with nigh double orphans living in a CCI. In FBS, 76% of OSCA had lived with their guardian for their whole life at baseline, while 75% of OSCA from CCIs had lived with their guardian for less than five years at baseline. Most guardians in a CCI had vocational (47%) or academy education (36.2%), while about guardians in a FBS had either no education (20%) or but primary education (55%).

Tabular array 2 Population characteristics amidst participants with at least one Phase two visit

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Tabular array 3 compares participants who completed a Phase 2 visit to participants who did not consummate a Stage two visit. OSCA from FBS were significantly more than likely to have completed a Phase 2 visit than OSCA from CCIs (P <  0.001). Participants who were younger when they enrolled in the written report, living in rural areas, had at least i parent, and had lived with their guardians for longer were more than likely to participate in Phase two (P <  0.001). HIV status at baseline and gender were not significantly associated with Stage 2 participation.

Tabular array 3 Comparison of participants with at least ane Stage ii visit to participants that did non participate in Phase 2

Full size tabular array

Educational outcomes

Tabular array 4 presents educational characteristics at follow-upward stratified by care surround and historic period group. All merely 2 participants reported that they had previously attended school. Almost all participants aged six–13 (99%) and xiv–17 (96%) reported that they were currently attention school. Among participants over the age of 18, 94% of those from CCIs were currently attention school while 56% of those from FBS were currently attending schoolhouse. Beyond all historic period groups and care environments, over 90% of participants currently attending schoolhouse reported missing two or fewer days of school in the by 4 weeks.

Tabular array 4 Educational participation in school-aged children and youth at last follow up visit

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For OSCA living in a CCI, 105 participants age 14–17 (63%) and 154 participants age 18 or older (99%) completed primary school. For OSCA living in a FBS, 118 participants age 14–17 (48%) and 391 participants age 18 or older (88%) completed primary school. Among participants age 18 or older from a CCI, 30 (19%) completed all 4 years of secondary school compared to 163 (37%) of those from FBS. Still, 112 (25%) of participants age 18 or older from FBS had not completed whatsoever secondary schoolhouse compared to viii (5.1%) participants from a CCI.

The results of the Poisson regression with changed probability weights are presented in Table v. Surface area (rural/urban) did non change the main effect and was not included in the final model. Among participants aged xiv and over, OSCA living in a CCI were i.18 times more likely to complete master school (95% CI 1.10–i.28) than OSCA living in a FBS afterwards adjusting for potential confounders. Among participants aged 18 and over, OSCA living in a CCI were also more likely to complete one or more years of secondary school compared to OSCA living in a FBS (aRR = 1.28, 95% CI 1.18–1.39). Although OSCA historic period xviii+ in a CCI were 0.79 times every bit likely to complete all 4 years of secondary school when compared to those in a FBS (95% CI 0.43–1.eighteen) after adjustment, this result was non statistically pregnant.

Table 5 Issue of Intendance Surround on Educational Attainment at terminal follow-up visit from Poisson regression analyses

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Word

Our findings propose that there is room for comeback in both master and secondary school completion for OSCA in Uasin Gishu County, Kenya, regardless of intendance environment. While most school-aged OSCA were currently attending school, many had non achieved the educational milestones expected for their historic period. This was particularly pronounced in OSCA over the age of xviii, of whom only a third had completed high school. OSCA living in a CCI were significantly more than probable to complete primary school (among participants aged 14 and over) and at least i year of secondary school (among participants aged 18 and over) than those living in family unit-based intendance, afterward adjusting for potential confounding variables. In that location was no statistically significant upshot of care environs on secondary school completion amidst participants aged eighteen and over after adjustment.

Previous research has found that orphans are less likely to be in the correct grade for their age than non-orphans [30]. While we did not compare orphans to non-orphans in this written report, our results suggest that many OSCA are completing primary school subsequently than expected, despite loftier attendance and low absenteeism. This somewhat contradicts other studies that found high absenteeism among orphans and lower school enrollment and omnipresence [xiv, 30, 31]. These differences may be explained by Kenya'due south system of free primary teaching, which was re-introduced in 2003 during the era of the Millennium Development Goals [32]. Even so, there continue to be concerns regarding quality, class sizes, other fees, and physical capacity in schools [32]. There too continue to exist financial barriers to attending secondary school, especially for OSCA who oftentimes live in low-income households [fourteen, 31]. Very few OSCA in our study completed all 4 years of secondary school and one fifth had completed no secondary school at all past the time they had turned 18.

Although institutions accept been associated with a broad range of negative impacts on OSCA, some inquiry has found that health, emotional, and cognitive functioning were no worse for children living in institutions compared to those living in the community [33, 34]. Consequent with these findings, we establish that OSCA living in a CCI were more than likely to complete primary school and 1 or more years of secondary school compared to children living in family unit-base intendance. Potential explanations for this include higher education levels amongst guardians in institutions compared to guardians in FBS and fewer financial barriers to attention school due to fees existence covered past the CCI [35]. In addition, OSCA living in a CCI may have more than fourth dimension for school due to fewer responsibilities at home and less need to earn income [13].

Despite consistently higher primary schoolhouse and partial secondary school completion, OSCA from CCIs were less likely to fully complete secondary school, though this effect was not statistically significant. It is possible that their education is existence interrupted due to "crumbling out" of care when they plow xviii and needing to discover their own shelter and employment [36]. In dissimilarity, OSCA from FBS may exist able to stay in their households and continue attending school with the support of their extended family. While regime policy requires that CCI's develop get out plans for youth, the transition tin can be difficult and youth may lack the back up needed to complete their studies [25]. In dissimilarity, youth living in a FBS are not necessarily required to motility out upon turning 18. This impact of "crumbling out" of care is not unique to Kenya'south CCI system. Youth crumbling out of state foster care in Canada have low rates of academic achievement and report a sense of anxiety and abandonment [37, 38]. In the United states, one quarter of old foster youth age 23–24 did not have a loftier school diploma. Youth who remained in intendance after the age of xviii reported ameliorate educational and employment outcomes [39].

This study has several strengths. The sampling pattern allows us to compare educational outcomes for OSCA living in institutions to those of OSCA living in family unit-based settings within the same geographical region. Detailed data was collected on study participants, allowing united states of america to conform for many important confounding variables. This study also has some limitations. Educational outcomes were self-reported by participants and are subject to remember bias and reporting bias. We were also unable to measure education quality or accomplishment. In addition, follow upwardly time was shorter for OSCA from CCIs compared to those from family-based settings due to difficulties in following youth in one case they aged out of care. Thus, these results reflect the participants who remained in the OSCAR study long enough to complete at least i Phase ii visit.

In determination, our results demonstrate that OSCA living in institutional environments are significantly more than probable to consummate main schoolhouse and nourish secondary school merely are somewhat less likely to consummate secondary school than OSCA living in family-based care. For these children and youth who already face bigotry and very footling to no support from their families, teaching may be especially of import for futurity success. Further action is needed to reduce barriers to secondary school and improve completion rates amongst all OSCA. Policies forcing youth living in CCIs to go out upon turning 18 may pose a significant barrier to secondary school completion. Lessons from other countries demonstrate that OSCA keep to need back up later turning eighteen. Efforts to ameliorate care for OSCA in Republic of kenya must build on strengths in the systems that currently exist and avert replicating limitations seen in other jurisdictions.

Availability of data and materials

The datasets analysed during this written report are non publicly available to protect individual privacy simply are bachelor from the corresponding author on reasonable request.

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Acknowledgements

We wish to gratefully admit the Chiefs, Assistant Chiefs, and Village Elders of the Locations of Pioneer, Kapsoya, Koisagat, Ol'Lenguse, Olare, Tarakwa, Kipsinende and Kapyemit for their support and leadership. We also wish to acknowledge all the residents of these Locations and particularly the many households caring for vulnerable members of their community, notably orphaned and separated children, children with physical and mental disabilities, and the elderly. We especially want to acknowledge the County and District Children's Officers, particularly Mr. Philip Nzenge, for their dedication to protecting the children of Uasin Gishu Canton, every bit well as the Uasin Gishu Children'south Services Forum. This study would not take been possible without the willing participation of the children and youth participants and their guardians and we would similar to acknowledge and give thanks them. The enthusiasm and commitment of the staff and volunteers of the OSCAR project have non gone unnoticed and we the authors wish to thank them for their efforts and engagement with this project.

Funding

This project was supported by the Eunice Kennedy Shriver National Constitute of Kid Health & Human Evolution [R01HD060478]. The content is solely the responsibleness of the authors and does non necessarily represent the official views of the Eunice Kennedy Shriver National Plant of Kid Health & Man Development or the National Institutes of Health. The funder of the report had no role in study design, information drove, data analysis, data estimation, or writing of the report.

Author data

Affiliations

1. Division of Epidemiology, Dalla Lana Schoolhouse of Public Health, University of Toronto, 155 Higher Street, Toronto, ON, M5T 3M7, Canada

   Dorothy Apedaile & Paula Braitstein

2. Section of Biostatistics, Schoolhouse of Public Health, Brownish University, Providence, RI, U.s.

   Allison DeLong

3. Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya

   Edwin Sang & Paula Braitstein

4. Section of Mental Wellness and Behavioural Sciences, College of Wellness Sciences, School of Medicine, Moi University, Eldoret, Republic of kenya

   David Ayuku & Lukoye Atwoli

5. Aga Khan University Medical College, Due east Africa, Nairobi, Kenya

   Lukoye Atwoli

6. Department of Health Policy, Services, and Practice, School of Public Health, Brown University, Providence, RI, U.s.a.

   Omar Galárraga

Contributions

D. Ayuku, LA, OG, and Atomic number 82 contributed to the conceptualization and design of the report, data conquering, and interpretation of the results. D. Apedaile and AD conducted the analysis and contributed to the conceptualization of the enquiry question. ES contributed to the information acquisition. D. Apedaile wrote the first typhoon of the manuscript. All authors contributed to the interpretation of the results, revised the manuscript, and canonical the final manuscript for submission.

Corresponding author

Correspondence to Paula Braitstein.

Ethics declarations

Ethics approval and consent to participate

The Moi Academy College of Wellness Sciences and Moi Pedagogy and Referral Hospital Institutional Research and Ethics Committee, the Indiana Academy Institutional Review Lath, and the Academy of Toronto Research Ethics Boards approved this study. This study conforms to the principles embodied in the Declaration of Helsinki. Written informed consent for participation was provided by the head of household or Director of the CCI. Individual written informed assent was provided by each child aged 7 years and above. Fingerprints were used for both children and guardians who were unable to sign or write their name.

Consent for publication

Non applicable.

Competing interests

The authors declare that they have no competing interests.

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Apedaile, D., DeLong, A., Sang, E. et al. Outcome of care environs on educational attainment among orphaned and separated children and adolescents in Western Republic of kenya. BMC Public Health 22, 123 (2022). https://doi.org/10.1186/s12889-022-12521-5

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• Received: thirty July 2021

• Accustomed: ten December 2021

• Published: 18 January 2022

• DOI : https://doi.org/10.1186/s12889-022-12521-5

Keywords

• Education
• Orphans
• Children's rights
• Kenya
• Residential intendance
• Institutions
• Foster care
• Family-based care

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Source: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12521-5

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