An Assessment of Health Outcomes Among Orphans in the Positive Outcomes for Orphans Study in Rural Settings of Kenya and Tanzania

Abstract

Objectives: 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.Design: Cross-sectional study.Setting: Two rural districts (sites) in East Africa, Bungoma in Kenya, and Kilimanjaro in Tanzania.Participants: 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. Methods: 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.Main Outcome Measures: 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. Results: 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). Conclusion: 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.