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Background About 10% of children worldwide do not live with either of their biological parents, and although some of these children are orphans, many have living parents. While research shows that orphaned children in Sub-Saharan Africa tend to engage in more sexual risk behaviors than their peers, possibly due to decreased parental oversight and support, it is unclear if these effects also apply to children separated from their living parents. Exploring the question of whether living without parents, regardless of whether they are deceased, is linked to greater sexual risk-taking, this study is the first, to our knowledge, to examine correlates of parental care status in a multi-country, nationally-representative analysis. Methods This study was a secondary analysis of the Centers for Disease Control and Prevention’s Violence Against Children Surveys from Kenya, Malawi, Tanzania, Nigeria, and Zambia. We conducted logistic regressions on N =  6770 surveys of youth aged 13 to 17 years to determine if living with their biological parents predicted the odds of engaging in risky sexual behavior, controlling for demographic factors including orphanhood. Post-hoc regressions examined specific risk behaviors. Results Compared to those living with both parents, youth not living with either parent had heightened odds of engaging in any sexual risk behavior, even when controlling for orphanhood ( OR =  2.56, 95% CI: [1.96, 3.33]). Non-parental care predicted heightened odds of non-condom use ( OR =  3.35, 95% CI: [2.38, 4.72]), early sexual debut ( OR =  1.80, 95% CI: [1.31, 2.46]), and more sexual partners ( β =  .60, p <  .001). Conclusions This study extends prior research linking orphanhood and sexual risk behavior, lending credence to the idea that it is not parental death, but rather parental absence, that leads to sexual risk in youth. Public health programming in Sub-Saharan Africa should consider targeting not only “orphaned youth,” but all children separated from their parents.

Background and purpose Alcohol and substance use disorders (ASUD) are highly prevalent among adolescents in sub-Saharan Africa and co-occur with mental health disorders. This study aimed to understand adolescents’ awareness of and attitudes toward ASUD and their mental health literacy, with the long-term goal of informing the development of a preventive intervention. Methods An exploratory qualitative study included 144 adolescents (aged 15–19) in 12 focus group discussions (FGDs). Participants were purposely sampled from three informal settlements in Nairobi and Kiambu counties, Kenya. Separate FGDs were conducted for boys and girls in two age groups (15-17 and 18-19). FGDs were audio-recorded, transcribed, and translated into English as needed, and analyzed using deductive thematic content analysis. Results Themes were identified to guide the results from the data, including “mental health knowledge”, “Alcohol and Substance Use knowledge”, “predictors of mental health,” and “predictors of ASU usage”. Adolescents identified ASUDs as significant community problems, but at the same time, perceived that some substances like shisha (Hookah) were harmless. They also acknowledged that environmental factors, like financial and social pressures, increase the risk of ASUD. Adolescents made the connection that family members’ alcohol and substance use (ASU) and easy accessibility of alcohol and other substances of abuse in the community present a further risk for substance use. Adolescents highlighted that future interventions should include mental health and substance use education (risks and coping strategies) and access to non-stigmatizing support, including community-based support and virtual engagement via mobile technology. Conclusions and implications The findings showed that adolescents are aware of ASUD in their communities and its dangers, highlighting the critical need for effective ASU prevention and intervention among adolescents. They identified a combination of community-based support and virtual engagement via mobile technology.

The 2013-2016 Ebola virus disease (EVD) epidemic resulted in more infections and deaths than all prior outbreaks in the 40-year history of this virus combined. This study examines how experiences of EVD infection, and preventive measures such as social distancing, were linked to experiences of stigma and social exclusion among those reintegrating into their communities. Key informant interviews (n = 42) and focus group discussions (n = 27) were conducted in districts with a high prevalence of EVD and representing geographical and ethnic diversity (n = 228 participants). The final sample was composed of adults (52%) and children (48%) who were EVD-infected (46%) and -affected (42%) individuals, and community leaders (12%). Data were coded using a Grounded Theory approach informed by Thematic Content Analysis, and analyzed using NVivo. Interrater reliability was high, with Cohen's κ = 0.80 or higher. Participants described two main sources of EVD-related stress: isolation from the community because of social distancing and other prevention measures such as quarantine, and stigma related to infected or affected status. Participants linked experiences of social isolation and stigma to significant distress and feelings of ostracization. These experiences were particularly pronounced among children. Sources of support included community reintegration over time, and formal community efforts to provide education and establish protection bylaws. This study found that social distancing and EVD-related stigma were each prominent sources of distress among participants. These results suggest that isolation because of infection, and the enduring stigmatization of infected individuals and their families, demand coordinated responses to prevent and mitigate additional psychosocial harm. Such responses should include close engagement with community leaders to combat misinformation and promote community reintegration.

With worldwide prevalence rates between 10% and 20%, mental illness in children and adolescents is an issue for which culturally sensitive screening tools are needed. The Strengths & Difficulties Questionnaire (SDQ) is a commonly used measure that has been translated into numerous languages, although some research suggests issues with cross-cultural validity. Only four other studies have tested the Spanish-language SDQ in Latin America. In this study, we aimed to help fill this gap by assessing the factor structure of the parent or teacher version of the Spanish-language SDQ (for children ages 4-17) with 967 parent or other caregiver respondents of primary school-aged children (ages 4 to 17) in the Department of Intibucá, Honduras. When unable to find a good fitting factor model previously identified in the literature, we conducted split sample exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), along with measurement invariance testing with the best fitting EFA-extracted model based on gender for caregiver respondent and child gender. Results showed that while many EFA models had a good fit, CFI and TLI was < .90 for all extracted models when confirmed in the second sample with CFA. We then modified the best fitting extracted three-factor, 24-item model, which dropped item 15, by allowing select item residuals to correlate, increasing CFI and TLI to > .90 for female child gender. This modified three-factor model was partially invariant for configural and scalar models between child genders. Configural and scalar models would not converge for adult genders. Of note, metric models were not produced in Mplus related to items' cross-loading on more than one factor. These findings suggest that the SDQ Spanish language parent or teacher version may not perform optimally cross-culturally in this area of Honduras. Future research should confirm these findings with other Honduran populations.

Online distance learning is rapidly becoming a mainstay in higher education. Yet, there still exists unequal access to internet technology among the world’s most vulnerable populations. This article reviews the implementation of an online pilot program that provided tertiary education to refugees in Africa and the Middle East, using a unique blend of brick-and-mortar and virtual instruction. Faculty experiences mirrored much of the experiences of instructors in more traditional online education – while onsite staff provided a unique perspective on the embedded nature of the program, based in local contexts. The results of this study helped point the way towards important program modifications to increase the quality of faculty communication and the cultural relevance of the curriculum. Future research is needed to identify whether such programs lead to improved outcomes for refugees.

Background Children with disabilities face unique challenges in humanitarian aid settings and education may provide protective measures against abuse and exploitation. There are growing calls for inclusive education of children with disabilities in formal education, but little guidance exists on how to enhance inclusion in complex and resource-constrained contexts of humanitarian settings. Case presentation This study used a community-based system dynamics approach to understand key stakeholders’ perspectives of the drivers and effects of inclusion and wellbeing for children with disabilities, and to elicit recommendations to enhance educational inclusion in a refugee camp in Eastern Africa. Community-based system dynamics sessions, designed based on group model building scripts and facilitated by a team of four people, took place with organization staff, community leaders, and parents and caregivers of children with disabilities. The process produced a causal loop diagram depicting the stakeholders’ perspectives of how multiple components interact in a system to drive inclusion and wellbeing of children with disabilities over time. Conclusions Findings indicate participants have a broad conceptualization of inclusion, highlighting the value of community interaction and importance of meeting basic needs, and also demonstrate that including children in mainstream educational settings in a complex humanitarian context requires a more nuanced approach given the lack of existing resources to support Western models of educational inclusion fully.

Many refugee children face challenges accessing education, but refugee children with disabilities are especially vulnerable to exclusion from school environments as well as social settings. Mainstreaming is considered a best practice but may not always be feasible given the limited resources available in refugee camps. The purpose of this study is to examine the extent to which school setting (i.e., special needs vs. mainstream classrooms) is associated with changes in children’s prosocial behaviors (i.e., social skills and ability to get along well with peers) and behavioral difficulties, accounting for disability status. In Kakuma Refugee Camp in Kenya, researchers collected two waves of data (approximately 2.5 years apart) for students enrolled in special needs schools ( n  = 78) and students who had transitioned from special needs schools into mainstream classrooms ( n  = 51). Children’s average prosocial scores decreased between wave 1 and wave 2, but scores from children in special needs schools decreased at a lower rate indicating potential protective factors in these settings. While children’s average total difficulties decreased over time, children’s difficulties in special needs schools decreased at a faster rate, also indicating potential protective factors. Neither severity of disability nor gender significantly predicted change in prosocial or difficulties scores. In the context of a refugee camp, mainstreaming alone may not fully address the needs of children with disabilities. Specific factors seen in special education settings, such as individualized services, accessible accommodations, and infrastructure supports, must be considered as a means of creating inclusive educational environments.

Background Unconditional and conditional cash transfer programmes (UCT and CCT) show potential to improve the well-being of orphans and other children made vulnerable by HIV/AIDS (OVC). We address the gap in current understanding about the extent to which household-based cash transfers differentially impact individual children’s outcomes, according to risk or protective factors such as orphan status and household assets. Methods Data were obtained from a cluster-randomised controlled trial in eastern Zimbabwe, with random assignment to three study arms – UCT, CCT or control. The sample included 5,331 children ages 6-17 from 1,697 households. Generalized linear mixed models were specified to predict OVC health vulnerability (child chronic illness and disability) and social protection (birth registration and 90% school attendance). Models included child-level risk factors (age, orphan status); household risk factors (adults with chronic illnesses and disabilities, greater household size); and household protective factors (including asset-holding). Interactions were systematically tested. Results Orphan status was associated with decreased likelihood for birth registration, and paternal orphans and children for whom both parents’ survival status was unknown were less likely to attend school. In the UCT arm, paternal orphans fared better in likelihood of birth registration compared with non-paternal orphans. Effects of study arms on outcomes were not moderated by any other risk or protective factors. High household asset-holding was associated with decreased likelihood of child’s chronic illness and increased birth registration and school attendance, but household assets did not moderate the effects of cash transfers on risk or protective factors. Conclusion Orphaned children are at higher risk for poor social protection outcomes even when cared for in family-based settings. UCT and CCT each produced direct effects on children’s social protection which are not moderated by other child- and household-level risk factors, but orphans are less likely to attend school or obtain birth registration. The effects of UCT and CCT are not moderated by asset-holding, but greater household assets predict greater social protection outcomes. Intervention efforts need to focus on ameliorating the additional risk burden carried by orphaned children. These efforts might include caregiver education, and additional incentives based on efforts made specifically for orphaned children.

Purpose: While many studies address immigrant integration, few focus on the adjustment process for unaccompanied immigrant children in foster care in the United States- and even fewer look at community level prevention and intervention strategies for positive youth adjustment. This study uses a human rights framework to examine community level facilitators- both prevention and interventions- that aid the adjustment for unaccompanied immigrant children in foster care as they navigate life in the US. Method: Seventy-nine service providers that work with unaccompanied immigrant children participated in 22 focus groups/interviews. Open coding was used to create a codebook, and then data were qualitatively analyzed using deductive and axial coding. Results: The major prevention strategies for community adjustment include welcoming communities and inter-agency collaborations. The major intervention strategies for systems level adjustment include community relationships, access to healthcare, and the church as an institution. Discussion: Implications include advocating for funding and programming to support mentors for every child, advocating for welcoming policies, and engaging unaccompanied immigrant children in research using participatory approaches.