Child work and labour among orphaned and abandoned children in five low and middle income countries.


BACKGROUND: The care and protection of the estimated 143,000,000 orphaned and abandoned children (OAC) worldwide is of great importance to global policy makers and child service providers in low and middle income countries (LMICs), yet little is known about rates of child labour among OAC, what child and caregiver characteristics predict child engagement in work and labour, or when such work infers with schooling. This study examines rates and correlates of child labour among OAC and associations of child labour with schooling in a cohort of OAC in 5 LMICs. METHODS: The Positive Outcomes for Orphans (POFO) study employed a two-stage random sampling survey methodology to identify 1480 single and double orphans and children abandoned by both parents ages 6-12 living in family settings in five LMICs: Cambodia, Ethiopia, India, Kenya, and Tanzania. Regression models examined child and caregiver associations with: any work versus no work; and with working <21, 21-27, and 28+ hours during the past week, and child labour (UNICEF definition). RESULTS: The majority of OAC (60.7%) engaged in work during the past week, and of those who worked, 17.8% (10.5% of the total sample) worked 28 or more hours. More than one-fifth (21.9%; 13% of the total sample) met UNICEF's child labour definition. Female OAC and those in good health had increased odds of working. OAC living in rural areas, lower household wealth and caregivers not earning an income were associated with increased child labour. Child labour, but not working fewer than 28 hours per week, was associated with decreased school attendance. CONCLUSIONS: One in seven OAC in this study were reported to be engaged in child labour. Policy makers and social service providers need to pay close attention to the demands being placed on female OAC, particularly in rural areas and poor households with limited income sources. Programs to promote OAC school attendance may need to focus on the needs of families as well as the OAC.






Published Version (Please cite this version)


Publication Info

Whetten, Rachel, Lynne Messer, Jan Ostermann, Kathryn Whetten, Brian Wells Pence, Megan Buckner, Nathan Thielman, Karen O'Donnell, et al. (2011). Child work and labour among orphaned and abandoned children in five low and middle income countries. BMC Int Health Hum Rights, 11. p. 1. 10.1186/1472-698X-11-1 Retrieved from

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Jan Ostermann

Adjunct Associate Professor of Global Health

Kathryn Whetten

Professor in the Sanford School of Public Policy

Director, Center for Health Policy and Inequalities Research
Research Director, Hart Fellows Program,
Professor, Public Policy and Global Health 
Professor, Nursing and Community & Family Medicine 
Pronouns: they/them

Kathryn Whetten is the Principal Investigator on multiple grants and publishes numerous scientific articles every year. In addition, they mentor many students and give guest lectures and presentations throughout the year.

Brian Wells Pence

Adjunct Associate Professor in the Department of Family Medicine and Community Health

Brian Wells Pence, PhD MPH, is trained as an infectious diseases epidemiologist. His research interests focus primarily on the impact of trauma, mental illness, and other psychosocial characteristics on HIV-related behaviors and clinical outcomes and on the development of effective and practical interventiosn to address mental illness in HIV patients.


Nathan Maclyn Thielman

Professor of Medicine

Broadly, my research focuses on a range of clinical and social issues that affect persons living with or at risk for HIV infection in resource-poor settings. In Tanzania, our group is applying novel methods to optimize HIV testing uptake among high-risk groups. We recently demonstrated that the Discrete Choice Experiment (DCE), a form of stated preference survey research, is a robust tool for identifying (a) which characteristics of HIV testing options are most preferred by different populations and (b) which tradeoffs individuals make in evaluating testing options. Building on more than a decade of productive HIV testing research in the Kilimanjaro Region, the next phase of our NIMH funded project will test the hypothesis that DCE-derived HIV testing options significantly increases rates of testing among groups at high risk for HIV infection. This work holds promise not only for optimizing HIV testing uptake in the Kilimanjaro Region, but also for applying novel tools in the service of translational epidemiology and implementation research.


Karen O'Donnell

Duke Temporary Service

My research interests are in early development risk: drug exposure, HIV infection, and iodine deficiency. I have ongoing research in developmental outcomes of children exposed prenatally to drugs and alcohol. They include the Infant Care Project (Pediatrics) and the Family Care Project (Psychiatry). I am co-investigator on a NIDA study of SIDS risk with prenatal cocaine exposure. I am involved at Duke and nationally in the study of the neurodevelopmental effects of pediatric HIV infection. I Chair the Pediatric Neurology Scientific Committee for the AIDS Clinical Trials Group (NIAID) coordinating the development of protocols for new drug trials and data analysis of completed ones. Currently at Duke, I have one federally funded study of the developmental needs of HIV infected children. The third area of work is in iodine deficiency in China. We have completed the fieldwork, with two publications for 1993-1994, one in Lancet from this year; and the NEJM paper will be published 29 December 1994.

I am completing the first of two semesters for a MPH in Epidemiology at UNC-Chapel Hill. The goal is to expand my research skills to population based studies. We are planning a proposal to NIDA to study our now 3 and 4 year old drug exposed group. The original Infant Care Project is being replicated in the Franklin County Health Department for the next two years, with a subcontract from our Duke grant. Anticipated shifts in direction are not major; but I have an interest in the perinatal transmission of HIV in developing countries.

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