Research on the myriad factors contributing to the health and well-being of the world's most vulnerable children is imperative to ensuring these children have the best possible outcomes. The Orphans and Vulnerable Children Research Division of Sodzo International endeavors to understand and share information related to orphans and vulnerable children and ensure they live the best lives with the most opportunities.

Find links to our peer-reviewed publications below.

 

Health and livelihood outcomes associated with participation in a community-based empowerment program for orphan families in semirural Kenya: a cross-sectional study

Publication

Vulnerable Children and Youth Studies: An International Interdisciplinary Journal for Research, Policy and Care

Volume 9, Issue 4, 2014

 

Abstract

Over 40 million African children have lost one or both parents to death or desertion for various causes. Recent unconditional cash-transfer programs in sub-Saharan countries have been found effective at mitigating financial, health, and educational challenges concomitant with parental loss. Due to constraints on governmental resources useful for oversight, however, these gains have been less pronounced than in other contexts where governmental oversight allows cash transfers to be conditioned on preset social and health goods.

The present study presents cross-sectional survey data from a community-based intervention combining elements of conditional cash transfer, empowerment- and income-generating programs in rural Kenya. Orphan and vulnerable children (OVC)-headed households in the catchment area are eligible for inclusion in the 3-year program.

Survey questions addressed monthly income, yearly financial status, food and medical access, malaria net usage, water source and purification practices, years of completed school, literacy, and sexual practices. Significant differences were found in each of these areas between the three different cohorts, categorized by year of program entry, though sexual practices only varied among females across the three cohorts.

Findings suggest an overall protective effect as a function of exposure to the program. Households with longer program exposure report statistically significant improvements in weekly income, savings rates, food security, medical security, food independence, insecticide-treated net usage, water purification practices, completing 8 years of schooling, literacy and sexual practices among females compared to households in their first year.

This study supports the use of a community-based intervention hybridizing other standard interventions to reduce health risks among OVC in Kenya.

 

Access

Article can be accessed here: http://www.tandfonline.com/doi/abs/10.1080/17450128.2014.938142#.VSiqTOTNFQJ

Self-efficacy mediates the association between partner trust and condom usage among females but not males in a Kenyan Cohort of Orphan and vulnerable youth

Publication

African Journal of Reproductive Health
Volume 20, Issue 2, Jun 2016, p. 94 - 103

Michael L. Goodman, Melissa B. Harrell, Philip H. Keiser, Lauren A. Raimer-Goodman and Stanley Gitari

ABSTRACT

Continuing gains against incidence of HIV and other unwanted consequences of unprotected sex requires deeper understanding of characteristics of condom usage among sexually active youth. The present study assesses whether partner trust predicts condom usage, and whether potential associations were mediated by general self-efficacy, among a cohort of sexually active adolescents in Meru County, Kenya. We also sought to discover associations between socio-economic status, psychological resilience and partner trust to increase understanding of trust towards one's intercourse partner. Mediation analyses, stratified by gender, reveal that condom usage is predicted by self-efficacy and partner trust among females but not males. Higher psychological resilience predicts lower partner trust among both genders. Partner trust was lower among female respondents who were not literate, but did not significantly vary by literacy among males. Reported previous monthly earnings were not significantly associated with partner trust among males or females. The present findings support further study on partner trust, and its association with protective sex behaviors. Further, interventions targeting condom usage among females may benefit from actions to increase awareness of partner sexual behavior and increasing self-efficacy.

Access

Article can be accessed here: African Journal of Reproductive Health

Exploring Pathways Between HIV+ Status and Excellent Overall Health Among Kenyan Women: Family Functioning, Meaningfulness of Life, Seroconcordance, Social Support and Considering the Need for Integrated Care

Publication

Journal of Community Health
First Online: 21 March 2016

Goodman, M.L., Serag, H., Gitari, S. et al.

ABSTRACT

As people living with HIV/AIDS (PLWHA) live longer, and HIV incidence declines, health systems are transitioning from vertical-only care delivery to horizontal integration with social and other services. This is essential to responding to the chronic nature of the disease, and health systems must respond to full-breadth of socio-economic conditions facing PLWHA. We use excellent self-rated health as a referent, and assess the role of non-biomedical conditions in mediating HIV+ status and excellent overall health among a large community sample of Kenyan women. After controlling for age and wealth, we found significant mediation by social support, partner HIV status, meaningfulness of life, family functioning, food sufficiency, and monthly income. If the goal of health systems is to help all people attain the highest level of health, integrating vertical HIV services with socio-economic support and empowerment may be required. Further investigation of the relative contribution of social support, family functioning, food and financial sufficiency should be conducted longitudinally, ideally in collaboration with HIV clinical services.

Access

Article can be accessed here: Journal of Community Health

Predictors of Child-Fostering Attitudes in a Large Cross-Section of Kenyan Women: Family, Health and Psycho-Social Factors and the Residual Presence of Childhood Adversities

Publication

The British Journal of Social Work
Published: 16 November 2016

Michael L. Goodman  Yi Zhang  Stanley Gitari  Moses Azubuike  Philip H. Keiser Sarah E. Seidel

ABSTRACT

Tens of millions of orphan and vulnerable children in sub-Saharan Africa require long-term foster-care from community families. To support decisions to foster orphan and vulnerable children, it is necessary to understand dynamics predicting fostering attitudes. In this study, we assess a range of family, health, psycho-social and childhood factors in a community sample of Kenyan women (n = 1,974) and their association with fostering attitudes. Between 52 and 60 per cent of respondents reported very willing to foster children from various backgrounds. Greater wealth predicted greater willingness to foster, though the association was entirely mediated by overall health, HIV, divorce status, family functioning and meaningfulness of life. More frequent childhood adversities predicted significantly lower fostering support. Parents with greater life meaningfulness, overall health, family functioning and who are not facing chronic diseases like HIV may be better targets for child fostering. Reduction of frequent childhood adversities may increase overall willingness to provide foster-care in later life.

Access

Article can be accessed here: The British Journal of Social Work

How can we improve healthcare access and general self-rated health among orphans and vulnerable children? Findings from a Kenyan cross-sectional study

Publication

International journal of public health,60(5), 589-597

Goodman, M. L., Seidel, S. E., Kaberia, R., & Keiser, P. H. (2015)

Abstract

Orphan and vulnerable children (OVC) often have worse educational, developmental, nutritional and behavioral outcomes than non-OVC. Much of these disparities come from reduced household earnings due to the loss of parental income. The present study used conditional process analysis to evaluate income and savings among OVC households using cross-sectional data from 1060 OVC in a 3-year Kenyan empowerment program, combining elements of cash transfer, psychosocial support, and small business entrepreneurship. Higher monthly earnings were significantly associated with program participation in a graded fashion. Approximately one third of the association was mediated by material inputs, indicating a substantial portion may be explained by other unobserved program elements. Eighty-five percent of increased rates of saving money in the past year was mediated by improved monthly income, cash transferred and improved food consumption. Data analysis highlights the need for multisectoral approaches and the need for more research to understand improving household economic stability among OVC.

Access

Article can be accessed here: http://link.springer.com/article/10.1007/s00038-015-0681-z

Child-street migration among HIV-affected families in Kenya: a mediation analysis from cross-sectional data

Publication

AIDS Care Journal
Pages 168-175 - Published online: 08 Jul 2016

Michael L. Goodman, Miriam S. Mutambudzi, Stanley Gitari, Philip H. Keiser & Sarah E. Seidel

ABSTRACT

Within Kenya, an estimated quarter of a million children live on the streets, and 1.8 million children are orphaned. In this study, we analyze how HIV contributes to the phenomenon of child-street migration. We interviewed a random community sample of caregiving women (n = 1974) in Meru County, Kenya, using a structured questionnaire in summer 2015. Items included reported HIV prevalence of respondent and her partner, social support, overall health, school enrollment of biologically related children and whether the respondent has a child currently living on the streets. Controlling for alcohol use, education, wealth, age and household size, we found a positive-graded association between the number of partners living with HIV and the probability that a child lives on the street. There was little difference in the odds of a child living on the street between maternally affected and paternally affected households. Lower maternal social support, overall health and school enrollment of biologically related children mediated 14% of the association between HIV-affected households and reporting child-street migration. Street-migration of children is strongly associated with household HIV, but the small percentage of mediated effect presents a greater need to focus on interactions between household and community factors in the context of HIV. Programs and policies responding to these findings will involve targeting parents and children in HIV-affected households, and coordinate care between clinical providers, social service providers and schools.

Access

Article can be accessed here: AIDS Care

Sexual Behavior Among Young Carers in the Context of a Kenyan Empowerment Program Combining Cash-Transfer, Psychosocial Support, and Entrepreneurship

Publication

The Journal of Sex Research, 1-15

Goodman, M. L., Selwyn, B. J., Morgan, R. O., Lloyd, L. E., Mwongera, M., Gitari, S., & Keiser, P. H. (2015)

Abstract

Orphan and vulnerable children (OVC) often have worse educational, developmental, nutritional and behavioral outcomes than non-OVC. Much of these disparities come from reduced household earnings due to the loss of parental income. The present study used conditional process analysis to evaluate income and savings among OVC households using cross-sectional data from 1060 OVC in a 3-year Kenyan empowerment program, combining elements of cash transfer, psychosocial support, and small business entrepreneurship. Higher monthly earnings were significantly associated with program participation in a graded fashion. Approximately one third of the association was mediated by material inputs, indicating a substantial portion may be explained by other unobserved program elements. Eighty-five percent of increased rates of saving money in the past year was mediated by improved monthly income, cash transferred and improved food consumption. Data analysis highlights the need for multisectoral approaches and the need for more research to understand improving household economic stability among OVC.

Access

Article can be accessed here: http://www.tandfonline.com/doi/abs/10.1080/00224499.2015.1035429

Adverse Childhood Experiences Predict Alcohol Consumption Patterns Among Kenyan Mothers

Publication

Substance Use & Misuse Journal
Pages 1-7 | Published online: 27 Dec 2016

Michael L. Goodman, Astrid Grouls, Catherine X. Chen, Philip H. Keiser & Stanley Gitari

ABSTRACT

Objective: We analyze whether adverse childhood experiences predict weekly alcohol consumption patterns of Kenyan mothers and their partners. Method: Randomly selected respondents (n = 1,976) were asked about adverse childhood experiences and alcohol consumption patterns for themselves and their partners. Fixed effect models were used to determine odds of reporting weekly alcohol consumption and the number of beverages typically consumed, controlling for wealth, age, education, and partner alcohol consumption. Results: Cumulative adverse childhood experiences predicted higher odds of weekly alcohol consumption of the respondent and her partner. Childhood exposure to physical abuse, emotional neglect, and mental illness in the household significantly increased odds of weekly alcohol consumption by the respondent. More drinks consumed per typical session were higher among respondents with more cumulative adversities. Physical and emotional abuse significantly predicted number of drinks typically consumed by the respondent. Conclusions: To our knowledge, this is the first study to explore and find associations between adverse childhood experiences and alcohol consumption in Kenya. Consistent with high-income settings, exposure to childhood adversities predicted greater alcohol consumption among Kenyan women.

Access

Article can be accessed here: Substance Use & Misuse

Stitching the fabric back together: child fostering attitudes in the transition to a chronic HIV epidemic

Publication

Child Abuse & Neglect
Pages 366-378 | Published online: 31 Aug 2016

Michael L. Goodman, Miriam S. Mutambudzi, Stanley Gitari, Philip H. Keiser & Sarah E. Seidel

ABSTRACT

There are an estimated 56 million orphans and vulnerable children across sub-Saharan Africa. Communities typically care for orphan children through informal caring arrangements – either within or outside of kinship networks. Within Kenya, an estimated 250,000 children live on the streets. There is less research related to fostering attitudes of this special population than orphans and vulnerable children generally. Important research over the past decade has illuminated multiple ways in which children are made more vulnerable because of HIV, including parental death and street-migration from HIV-affected households. As HIV transitions from a terminal illness to a chronic, manageable one, research is also required to establish how parents living with HIV can be an asset to children. In this study, we assess whether mothers living with HIV were very willing to foster biologically-related children, and street-involved children, how these fostering attitudes differed from mothers not living with HIV, and whether differences in fostering attitudes by reported HIV status were mediated by social support, family functioning and general self-rated health. Approximately 40% of mothers living with HIV were very willing to provide long-term foster care to biologically-related or street-involved children. This was less than the percentage of mothers not living with HIV, who were very willing to foster biologically-related children (61%) or street-involved children (58%). Significant portions of these differences were explained by social support, family functioning and general self-rated health. Multi-sectoral approaches are suggested by these findings in order to improve the child-fostering capacity of mothers living with HIV. Improving social support, family functioning and general self-rated health among HIV-infected mothers may not only provide protective benefits for the mothers and their children, but also expand the community’s capacity to care for orphan and vulnerable children.

Access

Article can be accessed here: Vulnerable Children and Youth Studies

Childhood exposure to emotional abuse and later life stress among Kenyan women: a mediation analysis of cross-sectional data

Publication

Journal of Anxiety, Stress, & Coping

09 September 2016

Michael L. Goodman, Claudia Gutarra, Katherine M. Billingsley, Philip H. Keiser & Stanley Gitari

Abstract

Background and objective:

We explore whether perceived stress among Kenyan mothers is predicted by childhood exposure to emotional abuse – both witnessed among parents and experienced directly. Further, we explore whether this association is mediated by social support, family functioning and polygynous marriage.

Design:

We used cross-sectional data from a systematic random sample (n?=?1974) of mothers in semi-rural Kenya.

Methods:

Data were collected using validated scales and trained interviewers. Analyses were conducted using bootstrapped structural equation models and fixed-effects linear regression models, controlling for age and household wealth.

Results: Reported experience of emotional abuse – both directly experienced and observed among household adults – was high in the present population (72.5% and 69%, respectively). Perceived stress among women was significantly higher if they were exposed to more emotional abuse during childhood (p?<?.001). Lower social support, worse family functioning and higher rates of polygynous marriage mediated pathways between emotional abuse exposure during childhood and adult perceived stress.

Conclusion:

Future research should investigate whether social integration, identity formation and self-esteem underlie observed dynamics in sub-Saharan Africa. Efforts to promote social integration and support should target children currently experiencing emotional abuse, and may include child-targeted high quality television programing and adult-targeted media and celebrity campaigns.

Access

Article can be accessed here: Journal of Anxiety, Stress, & Coping

Improved food quality, quantity and security among Kenyan orphans and vulnerable children: associations with participation in a multisectoral community-based program, age, gender, and sexual risk

Publication

Food Security,8(2), 427-442

Goodman, M. L., Selwyn, B. J., Morgan, R. O., Lloyd, L. E., Mwongera, M., Gitari, S., & Keiser, P. H. (2016)

Abstract

Orphan and vulnerable children (OVC) often have worse educational, developmental, nutritional and behavioral outcomes than non-OVC. Much of these disparities come from reduced household earnings due to the loss of parental income. The present study used conditional process analysis to evaluate income and savings among OVC households using cross-sectional data from 1060 OVC in a 3-year Kenyan empowerment program, combining elements of cash transfer, psychosocial support, and small business entrepreneurship. Higher monthly earnings were significantly associated with program participation in a graded fashion. Approximately one third of the association was mediated by material inputs, indicating a substantial portion may be explained by other unobserved program elements. Eighty-five percent of increased rates of saving money in the past year was mediated by improved monthly income, cash transferred and improved food consumption. Data analysis highlights the need for multisectoral approaches and the need for more research to understand improving household economic stability among OVC.

Access

Article can be accessed here: http://link.springer.com/article/10.1007/s12571-016-0561-2

Testing and testing positive: childhood adversities and later life HIV status among Kenyan women and their partners

Publication

Journal of Public Health

03 December 2016

Michael L. Goodman, Lauren Raimer-Goodman, Catherine X. Chen, Astrid Grouls, Stanley Gitari, Philip H. Keiser

Abstract

Background

Adverse childhood experiences are a critical feature of lifelong health. No research assesses whether childhood adversities predict HIV-testing behaviors, and little research analyzes childhood adversities and later life HIV status in sub-Saharan Africa.

Methods

We use regression models with cross-sectional data from a representative sample (n = 1974) to analyze whether adverse childhood experiences, separately or as cumulative exposures, predict reports of later life HIV testing and testing HIV+ among semi-rural Kenyan women and their partners.

Results

No significant correlation was observed between thirteen cumulative childhood adversities and reporting prior HIV testing for respondent or partner. Separately, childhood sexual abuse and emotional neglect predicted lower odds of reporting having previously been tested for HIV. Witnessing household violence during one's childhood predicted significantly higher odds of reporting HIV+. Sexual abuse predicted higher odds of reporting a partner tested HIV+.

Conclusions

Preventing sexual abuse and household violence may improve HIV testing and test outcomes among Kenyan women. More research is required to understand pathways between adverse childhood experiences and partner selection within Kenya and sub-Saharan Africa, and data presented here suggest understanding pathways may help improve HIV outcomes.

Access

Article can be accessed here: Journal of Public Health

Why do Kenyan children live on the streets? Evidence from a cross-section of semi-rural maternal caregivers

Publication

Child Abuse & Neglect
Volume 63, January 2017, Pages 51–60

Michael L. Goodman, Kelli Martinez, Philip H. Keiser, Stanley Gitari, Sarah E. Seidel

Abstract

Globally, study of factors contributing to the street-migration of the tens of millions of street-involved children focus almost exclusively on children’s perspectives. In this study, we assess household and maternal factors associated with street-migration of children through self-report of 1974 randomly selected women in semi-rural Kenya. Contributing new perspectives on this global phenomenon, data show a statistically significant association between increased maternal childhood adversities and street-migration of children (p < 0.001). Higher household wealth (p < 0.01) and maternal education (p < 0.05) were associated with lower odds of street-migration of children. Social support, reporting HIV+, school enrollment of biologically-related children, overall health, reported alcohol use, and functional literacy significantly mediated these pathways. Protecting children from street-migration in the next generation requires reducing childhood adversities in the present generation.

Access

Article can be accessed here: ScienceDirect

Improved water and household water purification practices among orphans and vulnerable children in a multi-sectoral empowerment program in Eastern province, Kenya

Publication

Journal of Water and Health, wh2016230

Goodman, M., Elliott, A., Gitari, S., Keiser, P. H., & Raimer-Goodman, L. A. (2016)

Abstract

Orphan and vulnerable children (OVC) often have worse educational, developmental, nutritional and behavioral outcomes than non-OVC. Much of these disparities come from reduced household earnings due to the loss of parental income. The present study used conditional process analysis to evaluate income and savings among OVC households using cross-sectional data from 1060 OVC in a 3-year Kenyan empowerment program, combining elements of cash transfer, psychosocial support, and small business entrepreneurship. Higher monthly earnings were significantly associated with program participation in a graded fashion. Approximately one third of the association was mediated by material inputs, indicating a substantial portion may be explained by other unobserved program elements. Eighty-five percent of increased rates of saving money in the past year was mediated by improved monthly income, cash transferred and improved food consumption. Data analysis highlights the need for multisectoral approaches and the need for more research to understand improving household economic stability among OVC.

Access

Article can be accessed here: http://jwh.iwaponline.com/content/early/2016/01/05/wh.2016.230.abstract

Economic empowerment or cash-dependency for orphans and vulnerable children in Kenya: Evidence from an alternative to cash-only models

Publication

International Journal of Social Welfare

Goodman, M.L., Gitari, S., Keiser, P. & Raimer-Goodman, L.A. (2016, in press)

Abstract

Orphan and vulnerable children (OVC) often have worse educational, developmental, nutritional and behavioral outcomes than non-OVC. Much of these disparities come from reduced household earnings due to the loss of parental income. The present study used conditional process analysis to evaluate income and savings among OVC households using cross-sectional data from 1060 OVC in a 3-year Kenyan empowerment program, combining elements of cash transfer, psychosocial support, and small business entrepreneurship. Higher monthly earnings were significantly associated with program participation in a graded fashion. Approximately one third of the association was mediated by material inputs, indicating a substantial portion may be explained by other unobserved program elements. Eighty-five percent of increased rates of saving money in the past year was mediated by improved monthly income, cash transferred and improved food consumption. Data analysis highlights the need for multisectoral approaches and the need for more research to understand improving household economic stability among OVC.

Access

Article can be accessed here: In Press

Factors associated with general self-efficacy and resilience among youth heads of households in Kenya

Publication

Journal of  Health Psychology

March 18, 2015

 

Abstract

This study assesses resilience and general self-efficacy among Kenyan orphans and vulnerable children (n = 1060) active in a community-based program combining economic household strengthening with psychosocial support. Quantile regression analyses modeled associations between the 25th, 50th, and 75th percentiles of resilience and general self-efficacy and multiple covariates. Program participation positively predicted increased general self-efficacy at all levels. Program participation predicted increased resilience at the 25th percentile but decreased resilience at the 75th percentile. Other significant predictors included economic, educational, sexual behavior and other demographic factors. This study suggests support for an integrated approach to economic and psychosocial empowerment.

 

Access

Article can be accessed here: http://hpq.sagepub.com/content/early/2015/03/17/1359105315573443.abstract