Abstract
Orphans have many unmet needs. The purpose of the current study is to briefly examine the psychosocial correlates linked to being an orphan among service-seeking youth in the slums of Kampala in order to provide guidance for service provision for youth. The current analysis is based on a cross-sectional survey conducted in 2011 which consisted of a convenience sample of youth living in the slums (ages 14–24) attending a drop-in center, Uganda Youth Development Link (UYDEL). Bivariate and multivariable analyses were used to determine psychosocial correlates with being an orphan. Among the youth participants (n=444), 23.65% (n=105) reported both of their parents died, 37.39% (n=166) reported one parent died, and the remaining 38.96% (n=173) reported both of their parents are living. In the multivariable model, reporting both parents dead was significantly associated with being a female (AOR: 2.79, 95% CI: 1.27, 6.12) and parental abuse (AOR: 0.14; 95% CI: 0.07, 0.27). A large percentage of youth living in the slums of Kampala are orphans. This study presents important findings that inform interventions and policies that can be targeted toward the dire needs of youth living in the streets and slums of Kampala.
Keywords: orphans, sub-Saharan Africa, street youth, parental abuse
Background
While there are many pressing health concerns in sub-Saharan Africa, few are as devastating than the needs of the growing population of orphans and vulnerable children (OVC) (USAID, 2008). An estimated 52 million orphans live in sub-Saharan Africa, comprising 37% of the world’s total orphan population (140 million) (UNICEF, 2015). The high prevalence of orphans in sub-Saharan Africa is largely attributed to mortality from HIV/AIDS (UNICEF, 2015; Bryant & Beard, 2016). Orphans have many unmet needs including poverty and hunger, inadequate living arrangements, and lack of schooling and educational opportunities, psychosocial distress, stigma and discrimination, and posttraumatic stress (USAID, 2008; Bryant & Beard, 2016). Being an orphan has also been linked to a higher risk of acquiring HIV (Gregson et al., 2005), alcohol and drug use (Meghdadpour, Curtis, Pettifor, & MacPhail, 2012), and violence, including physical abuse (Nichols et al., 2014; Mathur, Rathore, & Mathur, 2009).
Uganda, a country with a very high population growth and a high HIV prevalence (6.4%), tackles both large populations of orphans (USAID, 2008) and street youth (Swahn, Palmier, Kasirye, & Yao, 2012; Swahn, Gressard, et al., 2012). Despite Uganda facing high rates of urbanization and a limited infrastructure, the research on either street youth or orphans living in the urban slums remains quite limited (World Bank, 2015). While research has been conducted on orphans in Uganda, few empirical studies have examined orphans living in the slums of Uganda and outlined their broader childhood context, mental health concerns, and health risk behaviors including alcohol and drug use and experiences with violence (Mathur et al., 2009; Swahn, Palmier, et al., 2012; Swahn, Gressard, et al., 2012). The purpose of the current study is to briefly examine the psychosocial correlates linked to being an orphan among service-seeking youth in the slums of Kampala. The goal of the study is to provide insight and guidance for services provision and resource planning to better accommodate the needs of this high-risk population and to ameliorate their disparate living context.
Methods
The current data analysis is based on the cross-sectional survey called the “Kampala Youth Survey,” conducted in May and June 2011. The primary purpose of this study was to assess a range of health risk behaviors and exposures in a convenience sample of urban youth living in the slums and who were between 14 and 24 years of age. The methodology and findings from this study have been previously reported (Swahn, Palmier, et al., 2012; Swahn, Gressard, et al., 2012). The youth participants were recruited from Uganda Youth Development Link (UYDEL), a drop-in center for disadvantaged street youth. Face-to-face surveys were administered by UYDEL social workers and peer educators. Participants were informed about the study and read (or were read) the consent forms to indicate their willingness to take the survey. The study protocol was approved by the Georgia State University IRB and the Uganda National Council for Science and Technology.
Data Analysis
Descriptive statistics were computed for covariates among orphan status (both parents dead, one parent living, and two parents living). Bivariate and multivariable multinomial regression analyses were computed to determine statistical association between covariates and orphan status using the SAS 9.2 and SUDAAN 10 statistical software packages.
Results
Characteristics among orphans, youth who have one parent alive, and youth with both parents alive are presented in Table 1. Among the youth participants (n=444), 23.65% (n=105) reported both of their parents died, 37.39% (n=166) reported one parent died, and the remaining 38.96% (n=173) reported both of their parents are living. A large percentage of youth who reported both parents dead also reported taking care of themselves at night (47.62%), being hungry (64.76%), currently using alcohol (44.76%), feeling hopeless or sad (77.14%), and having HIV/STIs (41.90%).
Table 1.
Variable name, description, and percentages of orphans examined in the Kampala youth survey
| Variable | Description | Orphans Percentages, n (%) | ||
|---|---|---|---|---|
|
|
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| Both Parents Dead (n=105) 23.65% |
One Parent dead (n=166) 37.39% |
Both parents Living (n=173) 38.96% |
||
| Gender | ||||
| Male | Percentage of youth who were male/female | 28 (20.44%) | 50 (36.50%) | 59 (43.07%) |
| Female | 77 (25.25%) | 116 (38.03%) | 112 (36.72%) | |
|
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| No Apprenticeship skills | Percentage of orphans who state that they have no apprenticeship skills | 19 (33.93%) | 15 (26.79%) | 22 (39.29%) |
|
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| Self-care | Percentage of youth who cares for themselves at night | 50 (26.60%) | 69 (36.70%) | 69 (36.70%) |
|
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| Hunger | Percentage of orphans who reported being hungry | 68 (25.56%) | 96 (36.09%) | 102 (38.35%) |
|
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| Parental physical abuse of child | Percentage of youth who reported that their parents ever hit/beat them (yes versus no) | 40 (14.13%) | 108 (38.16%) | 135 47.70% |
|
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| Parental neglect of child due to alcohol use | Percentage of youth who reported their parents’ alcohol use made them not able to care for them (yes versus no) | 20 (21.05%) | 35 (36.84%) | 40 (42.11%) |
|
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| Alcohol use | Percentage of youth who use alcohol | 47 (25.27%) | 66 (35.48%) | 73 (39.25%) |
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| Alcohol use initiation before age 13 | Percentage of youth who initiated alcohol use prior to age 13 | 8 (22.86%) | 11 (31.43%) | 16 (45.71%) |
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| Any drug use | Percentage of youth who have ever used drugs such as marijuana (njaga or bangi) or opium (njaye or sniffed aviation fuel) (one or more days) | 27 (33.33%) | 30 (37.04%) | 24 (29.63%) |
|
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| Sadness | Percentage of youth who ever felt so sad or hopeless almost every day for two weeks in a row in the past year that they stopped doing their usual activities (yes/no) | 81 (24.18%) | 124 (37.01%) | 130 (38.81%) |
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| Violence perpetration | Percentage of youth who reported threatening or injuring others with a weapon, such as a gun, knife, or club. | 28 (33.73%) | 30 (36.14%) | 25 (30.12%) |
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| Violence victimization | Percentage of youth who reported threatened or injured with a weapon, such as a gun, knife, or club. | 42 (27.27%) | 56 (36.36%) | 56 (36.36%) |
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| Suicidal behavior | Percentage of youth who have thought of killing themselves in the past year | 41 (30.37%) | 48 (35.56%) | 46 (34.07%) |
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| Expect to die early | Percentage of youth who think they will probably die before the age of thirty (sometimes/often versus never) | 49 (25.26%) | 64 (32.99%) | 81 (41.75%) |
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| HIV | Percentage of youth who have been told by a doctor or nurse that they have a sexually transmitted infection, such as syphilis, bolabola or gonorrhea, or that they have HIV/AIDS (yes/no) | 44 (27.50%) | 61 (38.13%) | 55 (34.38%) |
In the unadjusted multinomial models (Table 2), reporting both parents dead was associated with a reduced odds of parental abuse (OR: 0.17; 95% CI: 0.10, 0.30), an increased odds of reporting drug use (OR: 2.16; 95% CI: 1.17, 4.00), an increased odds of violence perpetration (OR: 2.14; 95% CI: 1.17, 3.92), and an increased odds of suicide (OR: 1.74; 95% CI: 1.04, 2.92), compared to both parents living. Reporting one parent dead was associated with a reduced odds of parental abuse (OR: 0.48; 95% CI: 0.29, 0.78) in the unadjusted models. In the adjusted multivariable model, reporting both parents dead was significantly associated with being a female (AOR: 2.79, 95% CI: 1.27, 6.12) and parental abuse (AOR: 0.14; 95% CI: 0.07, 0.27). Reporting one parent dead was also associated with parental abuse in the adjusted model (AOR 0.43; 95% CI: 0.24, 0.78).
Table 2.
Bivariate and Multivariable Regression Results for Orphans in the Slums of Kampala, (n=444)
| Unadjusted OR (95% CI) |
Adjusted OR (95% CI) |
|||
|---|---|---|---|---|
|
|
||||
| Both parents dead |
One parent dead | Both parents dead |
One parent dead | |
| Gender | ||||
| Boys | Ref | Ref | Ref | Ref |
| Girls | 1.45 (.85, 2.47) | 1.22 (.77, 1.93) | 2.79 (1.27, 6.12) | 1.65 (.91, 2.99) |
|
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| Apprenticeship | ||||
| No | Ref | Ref | Ref | Ref |
| Yes | .69 (.36, 1.36) | 1.52 (.76, 3.05) | .96 (.40, 2.32) | 1.44 (.65, 3.18) |
|
| ||||
| Self-care | ||||
| No | Ref | Ref | Ref | Ref |
| Yes | 1.37 (.84, 2.24) | 1.07 (.70, 1.65) | 1.35 (.67, 2.70) | 1.11 (.65, 1.92) |
|
| ||||
| Hunger | ||||
| No | Ref | Ref | Ref | Ref |
| Yes | 1.24 (.74, 2.07) | .93 (.60, 1.44) | 1.30 (.64, 2.63) | .98 (.57, 1.69) |
|
| ||||
| Parental abuse | ||||
| No | Ref | Ref | Ref | Ref |
| Yes | .17 (.10, .30) | .48 (.29, .78) | 14 (.07, .27) | .43 (.24, .78) |
|
| ||||
| Parental neglect | ||||
| No | Ref | Ref | Ref | Ref |
| Yes | .83 (.45, 1.53) | .89 (.53, 1.49) | .70 (.31, 1.60) | 1.05 (.55, 2.02) |
|
| ||||
| Drunkenness | ||||
| No | Ref | Ref | Ref | Ref |
| Yes | 1.11 (.68, 1.81) | .90 (.59, 1.39) | 1.00 (.45, 2.26) | .81 (.43, 1.52) |
|
| ||||
| Alcohol use before age 13 | ||||
| No | Ref | Ref | Ref | Ref |
| Yes | .81 (.33, 1.96) | .70 (.31, 1.55) | .55 (.14, 2.13) | .64 (.22, 1.85) |
|
| ||||
| Drug use | ||||
| No | Ref | Ref | Ref | Ref |
| Yes | 2.16 (1.17, 4.00) | 1.33 (.74, 2.40) | 2.70 (.99, 7.40) | 1.64 (.71, 3.74) |
|
| ||||
| Sadness | ||||
| No | Ref | Ref | Ref | Ref |
| Yes | 1.22 (.66, 2.23) | .98 (.59, 1.63) | 1.17 (.54, 2.56) | 1.40 (.75, 2.58) |
|
| ||||
| Violence perpetration | ||||
| No | Ref | Ref | Ref | Ref |
| Yes | 2.14 (1.17, 3.92) | 1.32 (.74, 2.35) | 1.58 (.60, 4.18) | 1.24 (.56, 2.74) |
|
| ||||
| Violence victimization | ||||
| No | Ref | Ref | Ref | Ref |
| Yes | 1.40 (.85, 2.33) | 1.06 (.68, 1.68) | 1.20 (.51, 2.83) | 1.06 (.54, 2.10) |
|
| ||||
| Suicidal behavior | ||||
| No | Ref | Ref | Ref | Ref |
| Yes | 1.74 (1.04, 2.92) | 1.12 (.69, 1.80) | 1.87 (.90, 3.88) | 1.17 (.65, 2.12) |
|
| ||||
| Anticipate early death | ||||
| No | Ref | Ref | Ref | Ref |
| Yes | 1.03 (.63, 1.68) | .71 (.46, 1.10) | .81 (.42, 1.56) | .73 (.44, 1.22) |
Note. Both parents living is the referent group. Significant associations at p<0.05 are bolded.
Discussion
Being an orphan was statistically associated with drug use, violence perpetration, suicide, and a reduced odds of parental abuse in the unadjusted models. However, in the final adjusted model, being an orphan was only associated with being female and a reduced odds of parental abuse.
The reduced odds of parental abuse among orphans is expected. It’s possible that the majority of orphans experienced the death of their parents early in life, which is why a large proportion reported no parental abuse. There was also a significant difference in gender in the multivariable model with females being significantly associated with reporting both parents dead. Some studies have found that girl orphans are more likely to take over household chores in the event of parental death (Chae, 2013; Yamin et al., 2015); however, some girl orphans are also susceptible to early sexual debut and early marriage (Chae, 2013; Yamin et al., 2015). Girls that experience adverse health outcomes from early sexual debut and early marriage, such as HIV, unplanned pregnancy, and other mental health outcomes (Chae, 2013; Yamin et al., 2015), may be more likely to seek services, such as UYDEL, due to these experiences. This may explain our association between females and reporting both parents dead. Additionally, the bivariate associations between orphans and drug use (Meghdadpour et al., 2012), violence perpetration (Nichols et al., 2014; Swahn, Gressard, et al., 2012), and suicide (Swahn, Palmier, et al., 2012) are consistent with the literature.
Limitations of this study include the convenience sampling method and limited sample size. However, it should be noted that this population is very hard to reach, and a convenience sample may be the only adequate way to study this population. Another limitation includes the lack of information regarding the gender of the surviving parent and deceased parent, the timing of death, reasons for orphaning, and the potential causes of parental death, including HIV, violence, road traffic accidents or other illnesses. While these limitations are worth noting, this study is the first to report on the psychosocial correlates of being an orphan among youth living in the slums of Kampala. Additionally, this study presents findings that will inform the targeted interventions towards orphans of the service center in order to provide programs to prevent and address drug use, violence perpetration, HIV/STI’s and suicide.
Acknowledgments
Funding: Funding to conduct the study were obtained from the [Georgia State University Office of International Initiatives] and also from funds leveraged through collaboration with the [Emory Center for Injury Control], funded by the Centers for Disease Control and Prevention. Dr. Staton would like to acknowledge salary support funding from the [Fogarty International Center] under grant [K01 TW010000-01A1].
Footnotes
Disclosure statement: The authors have no conflicts of interest to disclose and acknowledge no financial interest or benefit that has arose from the direct applications of this research.
We affirm that we have no additional acknowledgements for individuals who have contributed to this manuscript. Research was conducted through Georgia State University.
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