Three-year change in the wellbeing of orphaned and abandoned children in institutional and family-based care settings in five low and middle income countries
METHODS: A two-stage random sampling methodology identified community representative samples of 1,357 institution-dwelling orphaned and abandoned children (OAC) and 1,480 family-dwelling OAC aged 6-12 from 5 low and middle income countries. Data were collected from the children and their primary caregivers at baseline and twice annually for 3 years. Survey-analytic techniques and linear mixed effects models describe child wellbeing at baseline and at 36 months and the variation in outcomes between children, care settings, and study sites.
RESULTS: At the 36-month follow-up, institution-dwelling OAC had statistically significantly higher mean height for age and health; family-dwelling OAC did not have statistically significantly better outcomes on any of the measures. At both baseline and follow-up, the magnitude of the differences between the institution- and family-dwelling groups was small. Relatively little variation in outcomes was attributable to differences between sites (11-27% of total variation) or care settings within sites (8-14%), with most variation attributable to differences between children within settings (60-75%). The percent of variation in outcomes attributable to the care setting type, institution- versus family-based care, ranged from 0-4% at baseline, 0-3% at 36-month follow-up, and 0-4% for changes between baseline and 36 months.
CONCLUSIONS: These findings contradict the hypothesis that group home placement universally adversely affects child wellbeing. Without substantial improvements in and support for family settings, the removal of institutions, broadly defined, would not significantly improve child wellbeing and could worsen outcomes of children who are moved from a setting where they are doing relatively well to a more deprived setting.