The government of Kenya cash transfer for orphaned and vulnerable children: cross-sectional comparison of household and individual characteristics of those with and without

BMC International Health and Human Rights

Paula Braitstein²  Allan Kamanda⁶  Rachel Vreeman³  Winstone Nyandiko⁷  Joseph Hogan⁸  Samuel Ayaya⁷  Liangyuan Hu⁸  Lukoye Atwoli⁴  Julius Koech⁹  Lonnie Embleton⁵  David Ayuku¹ 

[1] College of Health Sciences, School of Medicine, Department of Behavioral Sciences, Moi University, Eldoret, Kenya;School of Medicine, Department of Medicine, Indiana University, Indianapolis, USA;School of Medicine, Department of Pediatrics, Indiana University, Indianapolis, USA;College of Health Sciences, School of Medicine, Department of Mental Health, Moi University, Eldoret, Kenya;College of Health Sciences, School of Medicine, Department of Medicine, Moi University, Eldoret, Kenya;Moi Teaching and Referral Hospital, Eldoret, Kenya;College of Health Sciences, School of Medicine, Department of Child Health and Pediatrics, Moi University, Eldoret, Kenya;Department of Biostatistics, School of Public Health, Brown University, Providence, RI 02912, USA;Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya

关键词: Mental health;    Food security;    Nutrition;    Cash transfer;    Africa;    Orphans;   

Others  :  1113318
DOI  :  10.1186/1472-698X-14-25

 received in 2014-05-30, accepted in 2014-09-15,  发布年份 2014

【 摘 要 】

Background

The ‘Cash Transfer to Orphans and Vulnerable Children’ (CT-OVC) in Kenya is a government-supported program intended to provide regular and predictable cash transfers (CT) to poor households taking care of OVC. CT programs can be an effective means of alleviating poverty and facilitating the attainment of an adequate standard of living for people’s health and well-being and other international human rights. The objective of this analysis was to compare the household socioeconomic status, school enrolment, nutritional status, and future outlook of orphaned and separated children receiving the CT compared to those not receiving a CT.

Methods

This project analyzes baseline data from a cohort of orphaned and separated children aged <19 years and non-orphaned children living in 300 randomly selected households (HH) in 8 Locations of Uasin Gishu County, Kenya. Baseline data were analyzed using multivariable logistic and Poisson regression comparing children in CT-HH vs. non-CT HH. Odds ratios are adjusted (AOR) with 95% confidence intervals (CI) for guardian age and sex, child age and sex, and intra-HH correlation.

Results

Included in this analysis were data from 1481 children and adolescents in 300 HH (503 participants in CT, 978 in non-CT households). Overall there were 922 (62.3%) single orphans, 324 (21.9%) double orphans, and 210 (14.2%) participants had both parents alive and were living with them. Participants in CT-HH were less likely to have ≥2 pairs of clothes compared to non-CT HH (AOR: 0.32, 95% CI: 0.16-0.63). Those in CT HH were less likely to have missed any days of school in the preceding month (AOR: 0.62, 95% CI: 0.42-0.94) and those aged <1-18 years in CT-HH were less likely to have height stunting for their age (AOR: 0.65, 95% CI: 0.47-0.89). Participants aged at least 10 years in CT-HH were more likely to have a positive future outlook (AOR: 1.72, 95% CI: 1.12-2.65).

Conclusions

Children and adolescents in households receiving the CT-OVC appear to have better nutritional status, school attendance, and optimism about the future, compared to those in households not receiving the CT, in spite of some evidence of continued material deprivation. Consideration should be given to expanding the program further.

【 授权许可】

   
2014 Ayuku et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Embleton L, Ayuku D, Kamanda A, Atwoli L, Ayaya S, Vreeman R, Nyandiko W, Gisore P, Koech J, Braitstein P: Models of care for orphaned and separated children and upholding children's rights: cross-sectional evidence from western Kenya. BMC Int Health Hum Rights 2014, 14(1):9. BioMed Central Full Text
• [2]Rights UDoH: Universal Declaration of Human Rights. 1948.
• [3]UN: Convention on the Rights of the Child. Geneva: Geneva United Nations Office of the High Commissioner for Human Rights; 1990.
• [4]The World Factbook: Africa - Kenya. [https://www.cia.gov/library/publications/the-world-factbook/geos/ke.html webcite]
• [5]Kenya at a Glance [http://www.unicef.org/kenya/overview_4616.html webcite]
• [6]Kenya Country Profile: Human Development Indicators. [http://hdr.undp.org/en/countries/profiles/KEN webcite]
• [7]Kimani-Murage EW, Holding PA, Fotso JC, Ezeh A, Madise N, Kahurani E, Zulu E: Food security and nutritional outcomes among urban poor orphans in Nairobi, Kenya. J Urban Health 2011, 88(Supplement 2):S282-S297.
• [8]Lindblade KA, Odhiambo F, Rosen DH, DeCock KM: Health and nutritional status of orphans <6 years old cared for by relatives in western Kenya. Trop Med Int Health 2003, 8(1):67-72.
• [9]Bryant JH: Kenya's cash transfer program: protecting the health and human rights of orphans and vulnerable children. Heallth and Human Rights 2009, 11(2):65-76.
• [10]World Bank: Implementation Status and Results of the Kenya Cash Transfer for Orphans and Vulnerable Children. Edited by Bank TW. World Bank; 2012.
• [11]Council UNHR: Promotion and Protection of All Human Rights. Political, Economic, Social and Cultural Rights, Including The Right To Development. Geneva: Civil; 2009.
• [12]Künnemann R, Leonhard R: A human rights view of social cash transfers for achieving the millennium development goals. Stuttgart 2008
• [13]Adato M, Bassett L: Social protection to support vulnerable children and families: the potential of cash transfers to protect education, health and nutrition. AIDS Care 2009, 21(Suppl 1):60-75.
• [14]World Bank WDC: Conditional Cash Transfers: Reducing Present and Future Poverty Washington The International Bank for Reconstruction and Development / The World Bank. 2009.
• [15]Bassani DG, Arora P, Wazny K, Gaffey MF, Lenters L, Bhutta ZA: Financial incentives and coverage of child health interventions: a systematic review and meta-analysis. BMC Public Health 2013, 13(Suppl 3):S30. BioMed Central Full Text
• [16]Wakoli AB, Ettyang GA, Lakati AS: Undernutrition of orphans and vulnerable children: a comparison of cash transfer beneficiaries and non beneficiaries in Korogocho slums, Nairobi. East Afr J Public Health 2012, 9(3):132-138.
• [17]Handa S, Halpern CT, Pettifor A, Thirumurthy H: The government of Kenya's cash transfer program reduces the risk of sexual debut among young people age 15-25. PLoS One 2014, 9(1):e85473.
• [18]Welcome to the county of champions [http://uasingishu.go.ke/ webcite]
• [19]Government of Kenya: Demographic and Health Survey, 2008-2009. Edited by Kenya G. Nairobi; 2010.
• [20]Habitat UN: The State of African Cities: A framework for addressing urban challenges in Africa. Geneva: Edited by Programme UNHS; 2008.
• [21]Kamanda A, Embleton L, Ayuku D, Atwoli L, Gisore P, Ayaya S, Vreeman R, Braitstein P: Harnessing the power of the grassroots to conduct public health research in sub-Saharan Africa: a case study from western Kenya in the adaptation of community-based participatory research (CBPR) approaches. BMC Public Health 2013, 13:91. BioMed Central Full Text
• [22]Naanyu V, Sidle JE, Frankel RM, Ayuku D, Nyandiko WM, Inui TS: Rooting inquiry in tradition: the health baraza as a tool for social research in Kenya. Qual Health Res 2010, 21(1):14-26.
• [23]Schenk K, Williamson J: Ethical Guidelines for Gathering Information from Children and Adolescents in International Settings. Edited by Council P. Washington, D.C: Population Council; 2005.
• [24]UNICEF: Africa's Orphaned and Vulnerable Generations: Children Affected by HIV/AIDS. Geneva, CH: Washington, DC: UNICEF, UNAIDS, PEPFAR; 2006:16.
• [25]Coates J, Swindale A, Bilinsky P: Household Food Insecurity Access Scale (HFIAS) for Measurement of Household Food Access: Indicator Guide. Washington, D.C.: In Food and Nutrition Technical Assistance Project. Edited by Development AfE; 2006.
• [26]Kazdin AE, Rodgers A, Colbus D: The Hopelessness Scale for Children: Psychometric Characteristics and Concurrent Validity. J Consult Clin Psychol 1986, 54(2):241-245.
• [27]UNICEF, Save the Children UK: Progress in Child Well-Being: Building on What Works. Children UaSt; 2012.
• [28]Foster RH, Russell CC, Dillon R, Bitsko MJ, Godder K, Stern M: Relations among optimism, perceived health vulnerability, and academic, self-regulatory, and social self-efficacy in adolescent survivors of childhood cancer. J Psychosocial Oncol 2014, 32(2):207-223.
• [29]Ames ME, Rawana JS, Gentile P, Morgan AS: The Protective Role of Optimism and Self-esteem on Depressive Symptom Pathways Among Canadian Aboriginal Youth. J Youth Adolesc 2013. Advance Online Publication. doi: 10.1007/s10964-013-0016-4
• [30]Smokowski PR, Evans CB, Cotter KL, Webber KC: Ethnic identity and mental health in American Indian youth: examining mediation pathways through self-esteem, and future optimism. J Youth Adolesc 2014, 43(3):343-355.
• [31]Africa Strategic Research Corporation/Kaiser Family Foundation: The 2001 National Survey of South African Youth (conducted October-November 2001). Volume http://www.lovelife.org.za/corporate/files/4913/3849/8821/lovelifesforus.pdf webcite. South Africa; 2001
• [32]Pettifor AE, Rees HV, Kleinschmidt I, Steffenson AE, MacPhail C, Hlongwa-Madikizela L, Vermaak K, Padian NS: Young people's sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey. AIDS (London, England) 2005, 19:1525-1534.
• [33]Cluver L, Gardner F: The psychological well-being of children orphaned by AIDS in Cape Town, South Africa. Ann Gen Psychiatry 2006, 5:8. BioMed Central Full Text
• [34]Cluver L, Gardner F, Operario D: Psychological distress amongst AIDS-orphaned children in urban South Africa. J Child Psychol Psychiatry 2007, 48(8):755-763.
• [35]Aber LaR LG: North-South knowledge sharing on incentive-based conditional cash transfer programs. 2011.
• [36]Rasella D, Aquino R, Santos CA, Paes-Sousa R, Barreto ML: Effect of a conditional cash transfer programme on childhood mortality: a nationwide analysis of Brazilian municipalities. Lancet 2013, 382:57-64.
• [37]Luseno WK, Singh K, Handa S, Suchindran C: A multilevel analysis of the effect of Malawi's Social Cash Transfer Pilot Scheme on school-age children's health. Health Policy Plan 2013, 29:421-432.
• [38]Skovdal M, Mushati P, Robertson L, Munyati S, Sherr L, Nyamukapa C, Gregson S: Social acceptability and perceived impact of a community-led cash transfer programme in Zimbabwe. BMC Public Health 2013, 13:342. BioMed Central Full Text
• [39]Gilmour S, Hamakawa T, Shibuya K: Cash-transfer programmes in developing countries. Lancet 2013, 381(9874):1254-1255.
• [40]Behrman JR, Parker SW: Is Health of the Aging Improved by Conditional Cash Transfer Programs?. Evidence From Mexico; 2013. Demography
• [41]Paes-Sousa R, Santos LM, Miazaki ES: Effects of a conditional cash transfer programme on child nutrition in Brazil. Bull World Health Org 2011, 89(7):496-503.
• [42]Wakadha H, Chandir S, Were EV, Rubin A, Obor D, Levine OS, Gibson DG, Odhiambo F, Laserson KF, Feikin DR: The feasibility of using mobile-phone based SMS reminders and conditional cash transfers to improve timely immunization in rural Kenya. Vaccine 2012, 31(6):987-993.
• [43]Robertson L, Mushati P, Eaton JW, Dumba L, Mavise G, Makoni J, Schumacher C, Crea T, Monasch R, Sherr L, Garnett GP, Nyamukapa C, Gregson S: Effects of unconditional and conditional cash transfers on child health and development in Zimbabwe: a cluster-randomised trial. Lancet 2013.
• [44]Ranganathan M, Lagarde M: Promoting healthy behaviours and improving health outcomes in low and middle income countries: a review of the impact of conditional cash transfer programmes. Prev Med 2011, 55(Suppl):S95-S105.
• [45]Lagarde M, Haines A, Palmer N: The impact of conditional cash transfers on health outcomes and use of health services in low and middle income countries. Cochrane Data Syst Rev 2009, 4:CD008137.
• [46]Lagarde M, Haines A, Palmer N: Conditional cash transfers for improving uptake of health interventions in low- and middle-income countries: a systematic review. Jama 2007, 298(16):1900-1910.
• [47]Baird SJ, Garfein RS, McIntosh CT, Ozler B: Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. Lancet 2012, 379(9823):1320-1329.
• [48]Shei A, Costa F, Reis MG, Ko AI: The impact of Brazil's Bolsa Familia conditional cash transfer program on children's health care utilization and health outcomes. BMC Int Health Hum Rights 2014, 14:10. BioMed Central Full Text