An Assessment of Health Outcomes Among Orphans in the Positive Outcomes for Orphans Study in Rural Settings of Kenya and Tanzania
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<bold>Objectives</bold>: To compare measures of health and health quality between Orphans and Vulnerable Children (OVC) in different living arrangements-- institutional and community care; and to correlate different measures of OVC health and health quality using clinical, laboratory and quality of life instruments.
<bold>Design</bold>: Cross-sectional study.
<bold>Setting</bold>: Two rural districts (sites) in East Africa, Bungoma in Kenya, and Kilimanjaro in Tanzania.
<bold>Participants</bold>: 77 male and 45 female OVC aged 16-18 years (N=122). Participants, who had attained a minimum age of 16 at the date of interview, were selected from the larger sample of OVC in the Positive Outcomes for Orphans (POFO) study. POFO, a longitudinal study in five less wealthy countries that started in 2006, obtained its sample through cluster randomization.
<bold>Methods</bold>: To obtain self-ratings of OVC physical health, OVC responded to an interviewer administered SF-36 questionnaire, a multipurpose generic measure of health status. A neutral examiner then measured OVC physical health using 4 clinical variables: a physical health examination, body mass index, hemoglobin level, and the Harvard physical fitness score.
<bold>Main Outcome Measures</bold>: SF-36 scores presented as a two component score- the physical health and mental health composite sub-scores. For physical health, normal findings for age were considered as meeting the threshold for good physical health.
<bold>Results</bold>: Of the 122 OVC, 89 (73%) lived in the community while 33 (27%) lived in institutional settings. For the SF-36, the mean physical composite score for the entire study population was 50.6 (SD=6.2). Mean body mass index (BMI) was 19.3 (SD=2.4). Mean hemoglobin was found to be 13.2g/dl (SD=1.8). The average Harvard physical fitness score was found to be 40.7(SD=16.9). Pearson's correlations between SF-36 Physical Functioning and hemoglobin, BMI, and the Harvard Step-Test fitness score were 0.1, 0.1, and -0.1 respectively. There was no evidence that self-rating of OVC health outcomes differed by living arrangement. Using paired t-tests for continuous variables and chi-square tests for categorical variables, no significant p- values were obtained at the 95% level. Using a threshold of vision 20/20 for normal vision, 91.0% of community OVC and 78.8% of OVC in institutions had normal vision (p=0.07).
<bold>Conclusion</bold>: Although this study did not detect significant differences in self-reported measures of health among OVC in different living arrangements, physical examination revealed a slightly high incidence of poor vision among those living in institutions. In this sample, the correlations between SF-36 physical functioning sub-score and 3 physical health outcomes of BMI, hemoglobin, and the Harvard Step-test fitness score were weak.
CitationAchwoka, Dunstan Eugine (2011). An Assessment of Health Outcomes Among Orphans in the Positive Outcomes for Orphans Study in Rural Settings of Kenya and Tanzania. Master's thesis, Duke University. Retrieved from http://hdl.handle.net/10161/5052.
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