Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study

Christine L Gray; Brian W Pence; Jan Ostermann; Rachel A Whetten; Karen O’Donnell; Nathan M Thielman; Kathryn Whetten

doi:10.9745/GHSP-D-15-00093

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FIGURE
Prevalence and Incidence of Any Trauma and of Abuse by Age in Institution‐Based vs. Family‐Based Settings

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TABLE 1 Characteristics of OSC in Institution-Based and Family-Based Care (N = 2,235)

Characteristic	No. (%) of Institution-Dwelling OSC (n = 1,053)	No. (%) of Family-Dwelling OSC (n = 1,182)
Sex
Male	614 (58.3)	631 (53.4)
Female	439 (41.7)	551 (46.6)
Site
Cambodia	112 (10.6)	199 (16.8)
Ethiopia	175 (16.6)	192 (16.2)
Hyderabad (India)	209 (19.8)	222 (18.8)
Kenya	188 (17.9)	192 (16.2)
Nagaland (India)	150 (14.2)	163 (13.8)
Tanzania	219 (20.8)	214 (18.1)
Age at first trauma interview, years
10	395 (37.5)	457 (38.7)
11	379 (36.0)	462 (39.1)
12	214 (20.3)	210 (17.8)
13	56 (5.3)	45 (3.8)
14	4 (0.4)	7 (0.6)
15	5 (0.5)	1 (0.1)
OSC deceased parent
Neither (separated)	178 (16.9)	120 (10.2)
Mother	105 (10.0)	188 (15.9)
Father	358 (34.0)	663 (56.1)
Both	412 (39.1)	211 (17.9)

Abbreviation: OSC, orphaned or separated children.

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TABLE 2 Prevalence of Lifetime Trauma by Age 13 Among Orphaned or Separated Children (OSC) by Care Setting, 6 Sites in 5 Low- and Middle-Income Countries^a

	Institution-Based OSC		Family-Based OSC		Prevalence Difference^b
	%	95% CI	%	95% CI	%	95% CI
Any trauma	91.0	(85.6, 94.5)	92.4	(90.3, 94.0)	0.0	(−4.4, 4.4)
Witnessing a family death	72.5	(67.6, 76.9)	71.8	(68.5, 74.9)	−2.7	(−9.0, 3.5)
Physical or sexual abuse	50.3	(42.5, 58.0)	54.0	(50.2, 57.7)	3.5	(−7.9, 15.0)
Violence in family or care setting	30.9	(25.1, 37.4)	36.8	(33.1, 40.7)	6.6	(−3.6, 16.8)
Forced to leave home or care setting	27.6	(21.2, 35.2)	15.0	(12.5, 17.9)	−14.8	(−24.8, −4.8)
War, riots, killings	20.0	(14.6, 26.8)	22.0	(19.2, 25.0)	−1.6	(−9.1, 5.9)
Disaster or accidents	5.9	(3.7, 9.5)	9.5	(7.5, 11.9)	3.5	(−1.7, 8.8)

↵^a Battambang District, Cambodia; Addis Ababa, Ethiopia; Hyderabad, India; Nagaland, India; Bungoma District, Kenya; and Kilimanjaro Region, Tanzania.
↵^b Differences were modeled separately from the prevalence estimates and may be slightly different than an exact subtraction of the institution-based and family-based prevalences. Institution-based OSC were the referent; positive differences indicate family-based OSC had higher prevalence while negative differences indicate institution-based OSC had higher prevalence.

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TABLE 3 Annual Trauma Incidence Among Orphaned and Separated Children (OSC) Over the Course of the Study,^a by Care Setting, 6 Sites in 5 Low- and Middle-Income Countries^b

	Institution-Based OSC		Family-Based OSC		Risk Difference^c
	%	95% CI	%	95% CI	%	95% CI
Any trauma	23.6	(19.4, 28.7)	30.0	(28.1, 32.2)	6.4	(−0.2, 13.0)
Witnessing a family death	3.6	(2.5, 5.2)	6.0	(5.1, 7.0)	2.3	(0.5, 4.2)
Physical or sexual abuse	12.9	(9.6, 17.3)	19.4	(17.7, 21.3)	6.5	(1.4, 11.7)
Violence in family or care setting	6.6	(4.9, 9.0)	9.1	(7.7, 10.6)	2.4	(−0.5, 5.4)
Forced to leave home or care setting	3.4	(1.9, 6.1)	1.0	(0.7, 1.6)	−2.4	(−4.6, −0.1)
War, riots, killings	5.1	(3.4, 7.5)	5.8	(4.9, 7.0)	0.8	(−2.4, 3.9)
Disaster or accidents	0.7	(0.3, 1.5)	0.9	(0.6, 1.4)	0.2	(−0.5, 0.9)

↵^a Data collection began between May 2006 and February 2008, depending on the site, and continued for 36 months of follow-up.
↵^b Battambang District, Cambodia; Addis Ababa, Ethiopia; Hyderabad, India; Nagaland, India; Bungoma District, Kenya; and Kilimanjaro Region, Tanzania.
↵^c Differences were modeled separately from the incidence estimates and may be slightly different than an exact subtraction of the incidence-based and family-based incidences. Institution-based OSC were the referent; positive differences indicate family-based OSC had higher risk while negative differences indicate institution-based OSC had higher risk.

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GHSP-D-15-00093 Supplementary Material

Gray et al. doi: 10.9745/GHSP-D-15-00093

Supplementary Material - Gray et al. doi: 10.9745/GHSP-D-15-00093
Supplementary Material - Gray et al. doi: 10.9745/GHSP-D-15-00093