Child abuse and neglect among orphaned children and youth living in extended families in sub-Saharan Africa: What have we learned from qualitative inquiry?

Abstract

Researchers and aid organizations have reported that orphans in sub-Saharan Africa (SSA) are particularly vulnerable to abuse and neglect. This article is a review of qualitative studies that address experiences of maltreatment among orphaned children and youth living in extended families in SSA. It aims to inform policy and programming by providing a better understanding of the types of maltreatment encountered and the perceived risk factors. A literature search was carried out using Google, PubMed, Scholars Portal Search and Scopus. Searches of relevant bibliographies and publications of authors were also undertaken. Studies from peer-reviewed journals and the grey literature were reviewed for relevance and quality. Eligible studies had to include orphans living with extended family in SSA as participants, explore their maltreatment experiences and employ a sound qualitative methodology. Findings were coded, extracted, compared and synthesized. Twenty articles, representing 15 studies, were selected. These studies, from diverse SSAn countries, reported similar forms of maltreatment among orphaned children and youth: experiences of intra-household discrimination; material and educational neglect; excessive child labour; exploitation by family members and psychological, sexual and physical abuse. The perceived risk factors were poverty, living with a non-biological caregiver, stigma and alcohol abuse. The findings of the included studies suggest that awareness, prevention and intervention initiatives aimed to curb child abuse and neglect within communities in SSA are needed and should be coupled with efforts to promote education and reduce poverty and stigma.

Background

In sub-Saharan Africa (SSA), there are an estimated 56 million orphans (United Nations Children’s Fund [UNICEF], 2010). Compared to non-orphans, they live in households with lower incomes and higher dependency ratios (Heymann & Kidman, 2009; Howard et al., 2007; Miller, Gruskin, Subramanian, & Heymann, 2007). Even “single orphans”, who have lost one parent, are more likely than non-orphans to live with non-parents, and both single and double orphans experience more caregiver changes (Ansell & Young, 2004; Haour-Knipe, 2009; Hosegood, 2009). They report higher psychological distress (Cluver, Gardner, & Operario, 2007) and stigma and discrimination (Cluver & Orkin, 2009).

Poverty, higher dependency ratios, non-parent caregivers and psychological distress are associated with increased vulnerability to maltreatment in other contexts (Berger, 2004; Dubowitz et al., 2011; Jaudes & Mackey-Bilaver, 2008; Sidebotham & Heron, 2003, 2006; Sidebotham, Heron, & Golding, 2002). Development agencies and child protection specialists have raised concerns that orphans in SSA are at increased risk of maltreatment (Lachman et al., 2002; Strode & Barrett-Grant, 2001; United Nations Children’s Fund, United Nations Programme on HIV/AIDS, & President’s Emergency Plan for AIDS Relief, 2006).

Survivors of childhood maltreatment have a higher risk of depression, suicidality, alcohol abuse and impaired academic performance (Anda et al., 2006; Danese et al., 2009; Herrenkohl, Herrehkohl, Rupert, Egolf, & Lutz, 1995; Maniglio, 2011; Mills et al., 2011; Nanni, Uher, & Danese, 2011; Paolucci, Genuis, & Violato, 2001; Ramiro, Madrid, & Brown, 2010; Scarborough, Lloyd, & Barth, 2009; Widom, White, Czaja, & Marmorstein, 2007). Despite these effects and the sheer numbers of orphans in SSA thought to be at increased risk, little is currently known about the experiences of orphans in SSA who undergo maltreatment. A better understanding of these experiences may help inform policy, as well as prevention and intervention efforts.

Objectives

This article aims to provide a review of the qualitative literature addressing child maltreatment among orphaned children and youth in SSA and to synthesize what is known about its various manifestations and predisposing factors.

Methods

A literature review was undertaken between May and October 2011. The definition of maltreatment used was: “all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power” (World Health Organization & International Society for Prevention of Child Abuse and Neglect, 2006). Orphans were defined as individuals who have lost one or both parents (UNICEF, 2010), and children and youth were defined as those under 25 years (United Nations, n.d.).

Searching

Literature was searched using combinations of terms: orphan AND aids OR Africa; AND/OR abuse, child, childcare, child welfare, discrimin^* (^*indicates wildcard characters), exploit^*, maltreat^*, neglect, qualitative, stigma and sex. PubMed, Scholars Portal Search, Scopus and Google, as well as bibliographies of pertinent articles and publications of recognized authors, were searched. English publications within peer-reviewed journals and grey literature were reviewed. To reflect current socio-demographic trends, only studies published after 1990 were eligible. GM screened all identified records to exclude clearly irrelevant citations and read potentially relevant abstracts. Full texts thought to be relevant were reviewed by GM and eligible ones compiled in a data extraction tool. This tool was reviewed by all authors. A subset of full texts was independently reviewed by DC. Selection decisions were based on full texts and data in the extraction tool.

Relevance

Studies had to include self-report data from orphans in SSA, employ qualitative methods and discuss issues of maltreatment. Attempts were made to capture the breadth of experiences. The majority of participants had to be recruited from communities; studies of exclusively institutionalized orphans were excluded. Studies that exclusively recruited orphans living in child-headed households were also excluded, because they are thought be uniquely vulnerable (Schenk et al., 2008; Walker, 2002).

Quality

Full texts were assessed for quality based on prompts developed by Dixon-Woods, Shaw, Agarwal, and Smith (2004). These prompts include assessing the clarity and suitability of research questions, methods and analysis.

Synthesis

Study findings were coded for themes, and data were extracted using a data extraction tool (available upon request). Analysis proceeded by the three stages of meta-synthesis analysis described by Noblit and Hare (1988).

Study characteristics

Searches yielded a total of 1014 titles, of which 273 abstracts and 63 full texts were reviewed. Of the full texts reviewed, 42 were excluded for relevance and 1 for methodology. The (20) articles, representing 15 studies, reviewed are summarized in Table 1.

Table 1.

Description of included studies.

Author of study and year of publication	Location of study and year (if reported)	Aim of study	Sampling method	Participants	Data collection + data analysis
Ansell and Young (2004) Young and Ansell (2003) van Blerk and Ansell (2007)	Maseru and Tlali, Lesotho, and Blantyre and Mpando, Malawi	Examine the migration experiences of orphans	Orphans with migratory experiences identified by questionnaire in schools, others sampled from institutions and streets through NGOs	FGD with orphaned children aged 10–17 years n = 226 orphaned school-children n = 70 orphans living on streets or in institutions n = 40 caregivers Storyboards with n = 65 orphans	FGD and storyboards with orphans, interviews with caregivers +Identification of themes
Chase et al. (2006) Wood, Chase, and Aggleton (2006)	Zimbabwe (2004)	Describe the daily lives of orphaned and non-orphaned children and youth affected by HIV/AIDS	Recruitment through NGOs, included households with orphans and child-headed households	Case studies: n = 18 households Participants: n = 52 children and youth aged 10–19 years (26 males) n = 6 youth head of households (2 males) n = 40 adults	Case studies and key informant interviews +Thematic analysis
Cluver and Gardner (2007)	Cape Town	Explore the perceptions of orphans and caregivers on factors related to their well-being	Orphans identified by teachers and social workers through schools, streetchild-centres, and welfare services	n = 60 AIDS-orphans aged 8–19 years (26 males) 14 maternal orphans, 16 paternal orphans, 12 double orphans, 18 unknown n = 42 caregivers n = 20 care professionals	Self-report or interviewer assisted worksheet based semi-structured interviews with verbal or writing or drawing responses +Grounded theory
Foster et al. (1997)	Rural area near Mutare, Zimbabwe	Describe the impact of the HIV pandemic on a community and its response	Cross-sectional household sampling in FOCUS (a CBO) programme area	n = 40 orphans aged 9–16 years (21 males) 7 maternal orphans, 30 paternal orphans, 3 double orphans n = 25 caregivers n = 33 community workers	FGD and interviews +Identification of themes
Funkquist et al. (2007)	Thyolo District, Malawi	Examine the life situation of orphans in rural Southern Malawi	Orphans identified by community leaders and teachers	n = 23 orphans aged 10–15 years (13 males) n = 4 community leaders and teachers (key informants)	In-depth interviews and case study +Identification of themes
Harms, Kizza, Sebunnya, and Jack (2009) Harms et al. (2010)	Kampala, Uganda (January to June 2006)	Describe the experiences of becoming an orphan and the impact on mental health	Purposeful sample of youth attending two NGOs	n = 13 AIDS-orphans aged 12–18 years (5 males) 1 maternal orphan, 5 paternal orphans, 7 double orphans	In-depth, semi-structured interviews +Qualitative content analysis
Mangoma, Chimbari, and Dhlomo (2008)	Kariba, Zimbabwe	Identify and assess needs of orphans and coping strategies	Participants identified by concurrent household survey, included youth-headed households; snowball technique	8 FGD with orphans, 2 FGD with sex workers, 3 FGD with caregivers and, 2 FGD with community leaders	FGD, in-depth interviews, and case studies +Identification of themes
McGraw and Wameyo (2005)	Masaka district, Uganda (2005)	Examine the nature of the violence against orphans in communities affected by HIV/AIDS	Orphans identified by NGO and through schools	Interviews: n = 16 orphans aged 11–15 years (8 males) n = 4 non-orphans aged 11–15 years (2 males) Group workshops with n = 16 orphans aged 5–15 years (8 males) Interviews and FDG with key informants	In-depth interviews, group workshops with drawings +Identification of themes
Mmari (2011)	Kisesa Ward, Tanzania (2006)	Explore caregiving for orphan and non-orphan adolescents and the impact of parental loss on sexual behaviours	Random stratified sample of household survey	Interviews: n = 25 orphans (15 males), n = 27 non-orphans (10 males), aged 14–19 years 11 FGD with n = 17 orphans (males 8) and n = 66 non-orphans (males 32) 2 FGD with n = 17 female widowed caregivers	FGD and in-depth interviews +Identification of themes
Mojola (2011)	Nyanza Province, Kenya (2005–2006)	Explore the factors predisposing orphaned and non-orphaned girls to HIV infection	Random selection from 10 schools	Interviews with n = 56 secondary school girls aged 15–19	Interviews +Identification of themes
Nyambedha et al. (2003)	Western Kenya (1998–2001)	Describe the care of and support systems for orphans in the community	Household surveys and community organizations	In-depth interviews: n = 20 orphans aged 10–17 years Narratives: n = 5 orphans FGD with orphans 10–15 years Longitudinal monitoring: n = 5 households	In-depth interviews, narratives, FGD, longitudinal household monitoring, observations +Content analysis
Nyamukapa et al. (2010)	8 rural locations in Manicaland Province, Eastern Zimbabwe (2002–2004)	Identify locally acceptable strategies for improving mental health of orphans	Recruited by community workers	4 FGD with children, including orphans, each FDG with 8–13 children 4 FGD with caregivers 2 FGD with community members, 2 FGD adult orphans 1 FGD with interviewers	FGD +Content theme analysis
Oleke et al. (2006, 2007)	Lira District, Uganda (2002–2004)	Investigate differences in vulnerabilities between types of orphans	Purposeful sampling of participants identified by local leaders	Interviews: n = 35 orphans aged 10 years and older n = 21 community leaders n = 45 caregivers 5 FGD with male orphans, female orphans, community leaders, men, women	Ethnographic fieldwork, in-depth interviews and FGD +Thematic content analysis
Seloilwe and Thupayagale- Tshweneagae (2009)	Botswana	Explore risk factors for sexual abuse and its mental health impact	Cases identified by discovery method during family assessments	Orphans living in a youth-headed household	Home visits and interviews +Case study
Snipstad et al. (2005)	Moshi, Tanzania (2003)	Explore the concerns of Tanzanian school-children	Students selected from grades 2, 4 and 6 from 3 schools	n = 254 children, including orphans (112 males)	Children asked to write a list of their worries +Identification of themes

Notes: CBO, community-based organization; FGD, focus group discussion; NGO, non-governmental organization.

Findings

Throughout the studies, orphaned children and youth in SSA described their experiences with multiple forms of maltreatment and factors predisposing them to maltreatment. Figure 1 illustrates themes that emerged. The following sections explore their experiences of maltreatment and include direct quotations.

Figure 1.

Ranked themes within each domain.

Forms of maltreatment

Intra-household discrimination

Most studies (12/15) reported intra-household discrimination. Participants described being treated less well than other children, most often the caregivers’ biological children. This involved being deprived of resources such as food, clothing and schooling (Ansell & Young, 2004; Cluver & Gardner, 2007; Foster, Makufa, Drew, Mashumba, & Kambeu, 1997; Funkquist, Eriksson, & Muula, 2007; Harms, Jack, Ssebunnya, & Kizza, 2010; McGraw & Wameyo, 2005; Nyambedha, Wandibba, & Aagaard-Hansen, 2003; Nyamukapa et al., 2010; Oleke, Blystad, Fylkesnes, & Tumwine, 2007; Oleke, Blystad, Moland, Rekdal, & Heggenhougen, 2006; Snipstad, Lie, & Winje, 2005; van Blerk & Ansell, 2007; Young & Ansell, 2003) or being made to engage in excess chores or paid work (Ansell & Young, 2004; Harms et al., 2010; McGraw & Wameyo, 2005; Mojola 2011; Nyambedha et al., 2003; van Blerk & Ansell, 2007; Young & Ansell, 2003): “[My uncle] had many children, and he favoured them when we shared food and gifts, and I was overworked like a slave” (Ansell & Young, 2004).

Material neglect

The majority of studies (10/15) reported severe material deprivation such as hunger, tattered clothing and inadequate conditions: “At times I go to school, but not often because I don’t have clothes and food” (Funkquist et al., 2007). Several studies depicted experiences of overt neglect (Cluver & Gardner, 2007; McGraw & Wameyo, 2005; Nyamukapa et al., 2010; Oleke et al., 2006; Young & Ansell, 2003). Young orphans were left alone at home or locked in a shack (Cluver & Gardner, 2007; Foster et al., 1997; Oleke et al., 2006).

School neglect

Many studies (8/15) discussed participants’ experiences with reduced schooling during their parents’ illness or after their death (Ansell & Young, 2004; Chase, Wood, & Aggleton, 2006; Foster et al., 1997; Funkquist et al., 2007; Harms et al., 2009; Harms et al., 2010; Mangoma et al., 2008; Mmari, 2011; Oleke et al., 2006, 2007; van Blerk & Ansell, 2007; Young & Ansell, 2003). This was due to an inability to pay school fees or uniforms (Funkquist et al., 2007; Mangoma et al., 2008; Oleke et al., 2007; Young & Ansell, 2003) or being required to engage in paid work or chores (Chase et al., 2006; Foster et al., 1997; Mmari, 2011; Oleke et al., 2006, 2007; van Blerk & Ansell, 2007; Young & Ansell, 2003): “[My uncle] said: ‘you are not my child so I cannot send you to school’” (Foster et al., 1997).

Child labour

Many studies (8/15) described experiences of child labour: excessive domestic chores; wage labour; livestock tending; being lent out as domestic workers and work in fields or markets (Ansell & Young, 2004; Chase et al., 2006; Foster et al., 1997; Funkquist et al., 2007; Mangoma et al., 2008; McGraw & Wameyo, 2005; Mojola, 2011; Oleke et al., 2006, 2007; van Blerk & Ansell, 2007; Young & Ansell, 2003). Participants living with grandparents were sometimes required to take on tasks because of their caregiver’s frailty (Ansell & Young, 2004; Chase et al., 2006; Funkquist et al., 2007; van Blerk & Ansell, 2007; Young & Ansell, 2003): “[My grandmother] was so old that I had to do it all” (van Blerk & Ansell, 2007). Many reported increased responsibilities since their parents’ death and perceived excessive demands, exceeding those of other children and interfering with schooling (Ansell & Young, 2004; Chase et al., 2006; Foster et al., 1997; Funkquist et al., 2007; Harms et al., 2010; Mangoma et al., 2008; McGraw & Wameyo, 2005; Mmari, 2011; Mojola, 2011; Oleke et al., 2006, 2007; van Blerk & Ansell, 2007; Young & Ansell, 2003).

Exploitation

A number of studies (7/15) discussed “property grabbing” by family members – removing goods from family homes, appropriating land or denying orphans their inheritance (Chase et al., 2006; Foster et al., 1997; Harms et al., 2010; Mangoma et al., 2008; Nyambedha et al., 2003; Oleke et al., 2006; Seloilwe & Thupayagale-Tshweneagae, 2009; Wood et al., 2006): “Auntie only came when she wanted to take the property” (Foster et al., 1997). “Property grabbing” often occurred soon after bereavement, resulted in further impoverishment and created family divisions (Foster et al., 1997; Harms et al., 2010; Mangoma et al., 2008; Oleke et al., 2006; Seloilwe & Thupayagale-Tshweneagae, 2009; Wood et al., 2006).

Emotional abuse

Participants in many studies (10/15) described emotional abuse. They reported being threatened or made to feel like a burden (Chase et al., 2006; Foster et al., 1997; Harms et al., 2010; McGraw & Wameyo, 2005; Wood et al., 2006). Often this abuse was directed towards the loss of their parents (Foster et al., 1997; McGraw & Wameyo, 2005; Oleke et al., 2006): “Our stepmother frequently beats us, and uses bad expressions like ‘Am I the one who killed your mother?’” (Oleke et al., 2006). Orphans incorporated into households with biological children sometimes encountered bullying and rejection by them because of jealousy or the belief that their families’ resources were overstretched (Ansell & Young, 2004; Oleke et al., 2006; Young & Ansell, 2003). Participants also reported harassment by community members and children at school (Cluver & Gardner, 2007; Foster et al., 1997; Funkquist et al., 2007; McGraw & Wameyo, 2005).

Sexual abuse

According to many studies (10/15), orphans seemed vulnerable to sexual abuse and exploitation. Several reported experiences of sexual abuse by family members (Chase et al., 2006; Cluver & Gardner, 2007; Foster et al., 1997; Oleke et al., 2006). A number reported instances of orphaned girls forming relationships with older men, “sugar-daddies” (Foster et al., 1997; Mojola 2011; Oleke et al., 2006, 2007), or being forced to marry young, either to secure a dowry or to unburden the family (Foster et al., 1997; McGraw & Wameyo, 2005; Oleke et al., 2006). Participants described being forced into prostitution by care-givers or because of poverty (Mangoma et al., 2008; McGraw & Wameyo, 2005; Mmari, 2011; Mojola, 2011; Seloilwe & Thupayagale-Tshweneagae, 2009): “I just found myself doing sex so that I could get some money” (Mmari, 2011).

Physical abuse

Many studies (8/15) reported disclosures of physical abuse. Although physical discipline is commonly practiced within much of SSA, several participants described experiences of overt physical abuse (Cluver & Gardner, 2007; Harms et al., 2010; McGraw & Wameyo, 2005; Oleke et al., 2006; Seloilwe & Thupayagale-Tshweneagae, 2009; Young & Ansell, 2003): “And sometimes she beats me. When she beats me, she uses a lot of force” (Harms et al., 2010).

Predisposing factors

Poverty

Many studies (9/15) cited poverty as a contributory factor. A scarcity of resources predisposed to intra-household discrimination, material and educational neglect, child labour and exploitation (Ansell & Young, 2004; Cluver & Gardner, 2007; Foster et al., 1997; Funkquist et al., 2007; Harms et al., 2010; Mangoma et al., 2008; McGraw & Wameyo, 2005; Oleke et al., 2006; van Blerk & Ansell, 2007; Young & Ansell, 2003). Poverty and the cost of additional dependents contributed to caregiver desperation, stress and feelings of resentment. This sometimes incited caregivers to commit or fail to protect against acts of emotional and physical abuse, as well as sexual abuse and exploitation (Ansell & Young, 2004; McGraw & Wameyo, 2005; Mmari, 2011; Oleke et al., 2006; Young & Ansell, 2003).

Non-biological caregivers

Several studies (7/15) reported that orphans living with non-biological caregivers, primarily stepparents, were most at risk of abuse and neglect (Ansell & Young, 2004; Foster et al., 1997; Mangoma et al., 2008; McGraw & Wameyo, 2005; Nyambedha et al., 2003; Oleke et al., 2006; van Blerk & Ansell, 2007; Wood et al., 2006). Orphans were thought to be particularly susceptible to discrimination and neglect if non-biological caregivers had their own children (Ansell & Young, 2004; Foster et al., 1997; Funkquist et al., 2007; McGraw & Wameyo, 2005; Nyambedha et al., 2003; Oleke et al., 2006; van Blerk & Ansell, 2007). In particular, maternal orphans, whose fathers remarried, were often perceived as the most vulnerable (Ansell & Young, 2004; Foster et al., 1997; Mangoma et al., 2008; Oleke et al., 2006; Snipstad et al., 2005).

Stigma

A number of studies (6/15) identified stigma as predisposing to maltreatment (Ansell & Young, 2004; Funkquist et al., 2007; Harms et al., 2009, 2010; McGraw & Wameyo, 2005; Snipstad et al., 2005; Wood et al., 2006; Young & Ansell, 2003). Stigma contributed to intra-household discrimination, neglect and emotional abuse (Funkquist et al., 2007; Harms et al., 2009, 2010; McGraw & Wameyo, 2005; Snipstad et al., 2005; Young & Ansell, 2003):

When my father comes home she [my stepmother] tells him that she will give me food on the plate where the dog feeds. I should not stay near her children in case I poison them. (Snipstad et al., 2005)

Orphans experienced stigma by family but also by community members and other children (Ansell & Young, 2004; Cluver & Gardner, 2007; Funkquist et al., 2007; Harms et al., 2010; McGraw & Wameyo, 2005). Participants attributed stigma to their status as an orphan and their change in financial circumstances (Foster et al., 1997; Funkquist et al., 2007; Harms et al., 2010; Wood et al., 2006; Young & Ansell, 2003). A few participants alluded directly to experiencing stigma associated with HIV/AIDS (Funkquist et al., 2007; Harms et al., 2009, 2010; McGraw & Wameyo, 2005; Oleke et al., 2006): “[I’ve been told] your mother brought AIDS and shame to our family” (McGraw & Wameyo, 2005).

Alcohol abuse

Several studies (5/15) reported that alcohol abuse by caregivers predisposed orphans to maltreatment. Alcohol abuse was identified as contributing to neglect (Cluver & Gardner, 2007; McGraw & Wameyo, 2005; Oleke et al., 2006, 2007; Seloilwe & Thupayagale-Tshweneagae, 2009; Wood et al., 2006), physical abuse (McGraw & Wameyo, 2005) and sexual exploitation (Seloilwe & Thupayagale-Tshweneagae, 2009): “The older brother sold the younger siblings into prostitution and used the proceeds to buy drugs and alcohol” (Seloilwe & Thupayagale-Tshweneagae, 2009).

Discussion

From a variety of disciplinary perspectives and studying diverse communities throughout SSA, the reviewed studies are remarkably consistent in finding orphaned children and youth vulnerable to multiple forms of maltreatment. Their self-reported experiences help validate the concerns raised by development agencies and child protection specialists (Lachman et al., 2002; Strode & Barrett-Grant, 2001; UNICEF et al., 2006).

In recent years, the educational neglect of orphans in SSA has received much attention and efforts have been undertaken to reduce disparities in education (Ainsworth & Filmer, 2006; Bennell, 2005; Case, Paxson, & Ableidinger, 2004; UNICEF et al., 2006). However, adequate child welfare services, public awareness and interventions to curb and intervene in cases of neglect, child labour, exploitation and physical and sexual abuse are lacking. Government services, community-based organizations and non-governmental agencies should escalate their child protection efforts (Lachman et al., 2002; UNICEF et al., 2006). Child labour and physical abuse require particular consideration for intensified awareness campaigns as they are poorly understood constructs (Ayaya, Rotich, Vreeman, & Nyandiko, 2011; Chisholm, 2008; Lachman, 2004; Oleke et al., 2006; Pierce & Bozalek, 2004; Shumba, 2001; Whetten et al., 2011).

This review identified several perceived risk factors for orphan’s maltreatment: poverty, stigma, non-biological caregivers and alcohol-abuse. Interventions to curtail child maltreatment will likely only be partially successful unless they are coupled with poverty-reduction and income-generating projects (Ansell & Young, 2004; Cluver, Bowes, & Gardner, 2010; Desmond, 2009; Funkquist et al., 2007; Lachman et al., 2002; Nyambedha et al., 2003; Young & Ansell, 2003) and stigma-reduction campaigns (Delva 2010; Harms et al., 2010; Lachman et al., 2002; Nyamukapa et al., 2010; Strode & Barrett-Grant, 2001). Tackling poverty and stigma should also help to curb maltreatment of orphans living with non-biological caregivers, as these two factors appear to underlie much of the increased vulnerability (Ansell & Young, 2004; McGraw & Wameyo, 2005; Nyambedha et al., 2003; Oleke et al., 2007). High rates of alcohol abuse have been found in several communities within SSA (Acuda, Othieno, Obondo, & Crome, 2011; Suliman, Seedat, Williams, & Stein, 2010). The findings of this review lend support to the need for improved programmes for alcohol abuse.

This review had several limitations. One of the main limitations was a paucity of literature on this topic. Only one of the included studies had the primary aim of exploring maltreatment among orphans (McGraw & Wameyo, 2005). Similarly, little research has been conducted on the maltreatment of non-orphaned children and youth in SSA, but studies suggest abuse and neglect are prevalent (Akmatov, 2011; Berry & Guthrie, 2003; Reza et al., 2009; Stoltenborgh, van Ijzendoorn, Euser, & Bakermans-Kranenburg, 2011). Future research focused on child maltreatment within SSA should be a priority. Because of the qualitative nature of the included studies, this review is not able to determine the prevalence of maltreatment, or whether orphans are subjected to higher rates of maltreatment than non-orphans. Nevertheless, the qualitative approach allowed for a rich description of maltreatment experiences to emerge.

Conclusions

A review of the qualitative literature exploring the experiences of orphaned children and youth living in communities within SSA revealed their vulnerability to several forms of maltreatment. This review suggests that intensified prevention and early intervention efforts are needed to protect and mitigate against abuse and neglect, combined with community-based programmes to reduce poverty, school absenteeism and dropout, alcohol abuse and stigma associated with orphanhood.