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Background: The negative impact of institutionalization on children's development and well-being has led to a global recommendation for deinstitutionalization. In countries with weak infrastructure and family support, some children in institutional care have been found to have better outcomes, which may be due in part to the family-like environments created by some Charitable Children's Institutions (CCIs). Objective: The goal was to examine whether and how alternative kinship structures were reproduced in CCIs. Method: Qualitative data from 22 caregivers and 30 orphaned or separated children and adolescents (OSCAs) were collected using participant observation and in-depth interviews, and analysed using a symbolic interactionist theoretical framework. Results: Social interaction with caregivers contributed meaning towards the definition of family within some CCIs, particularly those modeled after a village and/or a single family. These CCIs created a family-like care environment, resulting in OSCAs redefining the traditional concept of family based on consanguinity to one composed of non-kin providing care and support. Social interaction through family-related activities produced novel familial identities, and some OSCAs felt they were part of a quasi-family. However, OSCAs lacked autonomy, feared consequences of not following the rules of behaviour, and felt re-traumatized and re-abandoned when they exited the CCIs at age 18. Conclusion: Some CCIs created an "alternative" kinship structure in which most children focused on their education, were provided with basic needs, and formed long-term positive relationships. Despite a number of challenges, family-like CCIs may be a supportive last resort for children without kin to care for them.

Objective To obtain an estimate of the size of, and human immunodeficiency (HIV) prevalence among, young people and children living on the streets of Eldoret, Kenya. Methods We counted young people and children using a point-in-time approach, ensuring we reached our target population by engaging relevant community leaders during the planning of the study. We acquired point-in-time count data over a period of 1 week between the hours of 08:00 and 23:00, from both a stationary site and by mobile teams. Participants provided demographic data and a fingerprint (to avoid double-counting) and were encouraged to speak with an HIV counsellor and undergo HIV testing. We used a logistic regression model to test for an association between age or sex and uptake of HIV testing and seropositivity. Findings Of the 1419 eligible participants counted, 1049 (73.9%) were male with a median age of 18 years. Of the 1029 who spoke with a counsellor, 1004 individuals accepted HIV counselling and 947 agreed to undergo an HIV test. Combining those who were already aware of their HIV-positive status with those who were tested during our study resulted in an overall HIV seroprevalence of 4.1%. The seroprevalence was 2.7% (19/698) for males and 8.9% (23/259) for females. We observed an increase in seroprevalence with increasing age for both sexes, but of much greater magnitude for females. Conclusion By counting young people and children living on the streets and offering them HIV counselling and testing, we could obtain population-based estimates of HIV prevalence. [phrase omitted] [phrase omitted] Objectif Obtenir une estimation du nombre de jeunes et d'enfants qui vivent dans les rues d'Eldoret, au Kenya, ainsi qu'une estimation de la prevalence du virus de l'immunodeficience humaine (VIH) chez ces jeunes et ces enfants. Methodes Nous avons comptabilite ces jeunes et ces enfants a l'aide d'une approche ponctuelle, en veillant a toucher notre population cible grace une cooperation avec les responsables locaux concernes lors de la planification de l'etude. Nous avons obtenu des donnees de denombrement ponctuel sur une periode d'une semaine entre 08:00 et 23:00, grace a un site fixe et a des equipes mobiles. Les participants ont fourni des donnees demographiques et leur empreinte digitale (pour eviter une double comptabilisation), et ont ete encourages a parler avec un conseiller en matiere de VIH et a se soumettre a un depistage du VIH. Nous avons utilise un modele de regression logistique pour determiner l'existence d'un lien entre l'age ou le sexe et le recours a un depistage du VIH et la seropositivite. Resultats Sur les 1419 participants admissibles comptabilises, 1049 (73,9%) etaient des individus de sexe masculin dont l'age median etait de 18 ans. Sur les 1029 individus ayant parle avec un conseiller, 1004 ont accepte de recevoir des conseils sur le VIH et 947 de se soumettre a un depistage du VIH. En combinant ceux qui etaient deja au courant de leur seropositivite a ceux qui ont ete soumis a un depistage dans le cadre de notre etude, nous avons obtenu une seroprevalence generale du VIH de 4,1%. La seroprevalence etait de 2,7% (19/698) chez les individus de sexe masculin et de 8,9% (23/259) chez les individus de sexe feminin. Nous avons constate que la seroprevalence augmentait avec l'age chez les deux sexes, mais que la magnitude etait beaucoup plus importante chez les individus de sexe feminin. Conclusion En comptabilisant les jeunes et les enfants qui vivent dans les rues et en leur proposant des conseils et un depistage du VIH, nous avons pu obtenir des estimations demographiques de la prevalence du VIH. [phrase omitted] Objetivo Obtener una estimacion del numero de jovenes y ninos que viven en las calles de Eldoret, Kenia, asi como de la prevalencia de la inmunodeficiencia humana (VIH) entre ellos. Metodos Se contaron a los jovenes y los ninos utilizando un enfoque puntual, asegurando que se llegase a la poblacion objetivo mediante la participacion de los lideres comunitarios correspondientes durante la planificacion del estudio. Se adquirieron datos de conteo puntual en un periodo de 1 semana entre las 8:00 y las 23:00 horas, tanto de un sitio estacionario como de equipos moviles. Los participantes proporcionaron datos demograficos y una huella dactilar (para evitar el doble recuento) y se les animo a hablar con un asesor del VIH y a someterse a la prueba del VIH. Se utilizo un modelo de regresion logistica para determinar la asociacion entre la edad o el sexo y la aceptacion de la prueba del VIH y la seropositividad. Resultados De los 1419 participantes elegibles contados, 1049 (73,9 %) fueron hombres con una edad media de 18 anos. De los 1029 que hablaron con un asesor, 1004 aceptaron recibir asesoramiento sobre el VIH y 947 aceptaron someterse a una prueba del VIH. La combinacion de los que ya conocian su estado VIH-positivo y aquellos que se hicieron la prueba durante el estudio resulto en una seroprevalencia general del VIH del 4,1 %. La seroprevalencia fue del 2,7 % (19/698) para los hombres y del 8,9 % (23/259) para las mujeres. Observamos un aumento de la seroprevalencia con el aumento de la edad para ambos sexos, pero de mucha mayor magnitud para las mujeres. Conclusion Al contar a los jovenes y ninos que viven en las calles y ofrecerles asesoramiento y pruebas del VIH, se puede obtener una estimacion de la prevalencia del VIH basada en la poblacion., Abstracts in [phrase omitted], Francais, [phrase omitted] and Espanol at the end of each article. Introduction The primary drivers of homelessness among children and young people globally are poverty, family [...]

Abstract Background Community-based participatory research (CBPR) is a collaborative approach to research that involves the equitable participation of those affected by an issue. As the field of global public health grows, the potential of CBPR to build capacity and to engage communities in identification of problems and development and implementation of solutions in sub-Saharan Africa has yet to be fully tapped. The Orphaned and Separated Children’s Assessments Related to their Health and Well-Being (OSCAR) project is a longitudinal cohort of orphaned and non-orphaned children in Kenya. This paper will describe how CBPR approaches and principles can be incorporated and adapted into the study design and methods of a longitudinal epidemiological study in sub-Saharan Africa using this project as an example. Methods The CBPR framework we used involves problem identification, feasibility and planning; implementation; and evaluation and dissemination. This case study will describe how we have engaged the community and adapted CBPR methods to OSCAR’s Health and Well-being Project’s corresponding to this framework in four phases: 1) community engagement, 2) sampling and recruitment, 3) retention, validation, and follow-up, and 4) analysis, interpretation and dissemination. Results To date the study has enrolled 3130 orphaned and separated children, including children living in institutional environments, those living in extended family or other households in the community, and street-involved children and youth. Community engagement and participation was integral in refining the study design and identifying research questions that were impacting the community. Through the participation of village Chiefs and elders we were able to successfully identify eligible households and randomize the selection of participants. The on-going contribution of the community in the research process has been vital to participant retention and data validation while ensuring cultural and community relevance and equity in the research agenda. Conclusion CBPR methods have the ability to enable and strengthen epidemiological and public health research in sub-Saharan Africa within the social, political, economic and cultural contexts of the diverse communities on the continent. This project demonstrates that adaptation of these methods is crucial to the successful implementation of a community-based project involving a highly vulnerable population.

Abstract Background International collaborators face challenges in the design and implementation of ethical biomedical research. Evaluating community understanding of research and processes like informed consent may enable researchers to better protect research participants in a particular setting; however, there exist few studies examining community perspectives in health research, particularly in resource-limited settings, or strategies for engaging the community in research processes. Our goal was to inform ethical research practice in a biomedical research setting in western Kenya and similar resource-limited settings. Methods We sought to use mabaraza, traditional East African community assemblies, in a qualitative study to understand community perspectives on biomedical research and informed consent within a collaborative, multinational research network in western Kenya. Analyses included manual, progressive coding of transcripts from mabaraza to identify emerging central concepts. Results Our findings from two mabaraza with 108 community members revealed that, while participants understood some principles of biomedical research, they emphasized perceived benefits from participation in research over potential risks. Many community members equated health research with HIV testing or care, which may be explained in part by the setting of this particular study. In addition to valuing informed consent as understanding and accepting a role in research activities, participants endorsed an increased role for the community in making decisions about research participation, especially in the case of children, through a process of community consent. Conclusions Our study suggests that international biomedical research must account for community understanding of research and informed consent, particularly when involving children. Moreover, traditional community forums, such as mabaraza in East Africa, can be used effectively to gather these data and may serve as a forum to further engage communities in community consent and other aspects of research.

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