肯尼亚西部孤儿、分离和街头流浪儿童和青少年中虐待儿童的流行率、发生率和慢性率：照料环境有何影响？
Prevalence, incidence and chronicity of child abuse among orphaned, separated, and street-connected children and adolescents in western Kenya: What is the impact of care environment?
机构信息
Department of Child Health and Paediatrics, Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
Department of Biostatistics, School of Public Health, Brown University, Providence, RI, USA.
出版信息
Child Abuse Negl. 2023 May;139:104920. doi: 10.1016/j.chiabu.2020.104920. Epub 2021 Jan 21.
BACKGROUND
The effect of different types of care environment on orphaned and separated children and adolescents' (OSCA) experiences of abuse in sub-Saharan Africa is uncertain.
OBJECTIVE
Our two primary objectives were 1) to compare recent child abuse (physical, emotional, and sexual) between OSCA living in institutional environments and those in family-based care; and 2) to understand how recent child abuse among street-connected children and youth compared to these other vulnerable youth populations.
PARTICIPANTS AND SETTING
This project followed a cohort of OSCA in Uasin Gishu County, Kenya (2009-2019). This analysis includes 2393 participants aged 18 years and below, 1017 from institutional environments, 1227 from family-based care, and 95 street-connected participants.
METHODS
The primary outcome of interest was recent abuse. Multiple logistic regression was used to estimate the odds of recent abuse at baseline, follow-up, and chronically for each abuse domain and adjusted odds ratios (AOR) between care environments, controlling for multiple factors.
RESULTS
In total, 47 % of OSCA reported ever experiencing any kind of recent abuse at baseline and 54 % in follow-up. Compared to those in family-based care, street-connected participants had a much higher reported prevalence of all types of recent abuse at baseline (AOR: 5.01, 95 % CI: 2.89, 9.35), in follow-up (AOR: 5.22, 95 % CI: 2.41, 13.98), and over time (AOR: 3.44, 95 % CI: 1.93, 6.45). OSCA in institutional care were no more likely than those in family-based care of reporting any recent abuse at baseline (AOR: 0.85 95 % CI: 0.59-1.17) or incident abuse at follow-up (AOR: 0.91, 95 % CI: 0.61-1.47).
CONCLUSION
OSCA, irrespective of care environment, reported high levels of recent physical, emotional, and sexual abuse. Street-connected participants had the highest prevalence of all kinds of abuse. OSCA living in institutional care did not experience more child abuse than those living in family-based care.
背景
不同类型的照料环境对撒哈拉以南非洲孤儿和失散儿童（OSCA）遭受虐待的影响尚不确定。
目的
我们的两个主要目标是 1）比较生活在机构环境中的 OSCA 与生活在家庭为基础的照料中的 OSCA 最近遭受身体、情感和性虐待的情况；2）了解与这些其他弱势青年群体相比，街头流浪儿童和青少年的最近虐待情况。
参与者和环境
本项目对肯尼亚乌辛古鲁县的 OSCA 进行了队列研究（2009-2019 年）。本分析包括 2393 名 18 岁及以下的参与者，其中 1017 名来自机构环境，1227 名来自家庭为基础的照料，95 名来自街头流浪的参与者。
方法
主要关注的结果是最近的虐待情况。采用多变量逻辑回归来估计每个虐待领域的基线、随访和慢性期的最近虐待的几率，并调整了不同照料环境之间的调整后比值比（AOR），同时控制了多种因素。
结果
共有 47%的 OSCA 报告在基线时有过任何类型的最近虐待，在随访时有 54%的 OSCA 报告过最近虐待。与家庭为基础的照料中的 OSCA 相比，街头流浪的参与者在基线时（AOR：5.01，95%CI：2.89，9.35）、随访时（AOR：5.22，95%CI：2.41，13.98）以及随时间推移（AOR：3.44，95%CI：1.93，6.45）报告的所有类型最近虐待的发生率均高得多。机构照料中的 OSCA 报告最近基线期（AOR：0.85，95%CI：0.59-1.17）或随访时（AOR：0.91，95%CI：0.61-1.47）发生任何最近虐待的可能性并不高于家庭为基础的照料中的 OSCA。
结论
OSCA，无论照料环境如何，均报告了高水平的近期身体、情感和性虐待。街头流浪的参与者报告的各种虐待的发生率最高。生活在机构照料中的 OSCA 经历的儿童虐待并不比生活在家庭为基础的照料中的 OSCA 多。
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