Youth Who Have Lived in Alternative Care in Nigeria, Zambia, and Zimbabwe: Mental Health and Violence Outcomes in Nationally Representative Data

Abstract

Objective

We explore whether having previously lived in alternative care (foster, kinship, and/or residential care) is linked to sexual risk taking, mental health, and experiencing violence in Nigerian, Zambian, and Zimbabwean youth 13 to 17 years of age living in households with or without their biological parents, and we assess the utility and limitations of existing data.

Method

This study is a secondary analysis of nationally representative Violence Against Children Surveys (N = 6,405). Logistic regressions examined the effect of alternative care experience on the odds of poor outcomes, controlling for covariates including parental care status, orphanhood, and household assets.

Results

In both bivariate and multivariate analyses, having lived in alternative care in the last 5 years was associated with lowered odds of mental distress (odds ratio [OR] = 0.25, 95% CI = [0.10, 0.61], p = .002), and higher odds of sexual risk taking (OR = 1.70, 95% CI = [1.11, 2.59], p = .014), caregiver physical abuse (OR = 1.81, 95% CI = [1.30, 2.50], p < .001), caregiver emotional abuse (OR = 1.75, 95% CI = [1.20, 2.54], p = .004), and peer violence (OR = 1.57, 95% CI = [1.09, 2.26], p = .015). It was not associated with suicidality, self-harm, or sexual assault after controlling for covariates.

Conclusion

Youth who have lived in alternative care in the last 5 years may benefit from programs that address violence, self-harm, and sexual risk taking behavior, even if they are now in families. To better understand children outside parental care, national data collection efforts should distinguish between residential and family-based care.