Factors associated with guardianship planning for vulnerable children living in urban settlements in Nairobi, Kenya

Background: Over 53 million orphans live in sub-Sahara Africa. Orphaned children are exposed to crucial losses of resources and relationships that leave them at risk for poorer well-being outcomes. Urban migration has weakened the extended African family which was the traditional safety net for orphaned children. Little is known about planning for a child's placement after a caregiver's death in urban Africa. This study explores factors associated with guardianship planning in two Nairobi slums.

Methods: Using 2006-2009 enrollment data from a Kenyan non-governmental organization, this cross-sectional study evaluated 1,264 children whose families self-reported to be at-risk for losing a guardian. Logistic regression was used to obtain odds ratios and 95% confidence intervals examining the relationship between guardianship planning and selected individual and system characteristics.

Results: Among the at-risk children studied, 73% lived with parents and 27% with non-parents. Only 21% of all at-risk caregivers reported having guardianship plans. Parents were more likely than non-parent caregivers to have guardianship plans (OR=1.74, 95% CI: 1.24-2.44). Caregivers with access to health care or in very poor health were more likely to have guardianship plans (OR=1.61, 95% CI: 1.20-2.16 and OR=1.45, 95% CI: 1.07-1.95, respectively). Family size and child's age and sex were not statistically significant factors.

Conclusions: The small percentage of caregivers with guardianship plans suggests opportunities for education about the benefits of preparing for a child's future in the event of a caregiver's death. Additional research will be important to understand barriers and culturally-appropriate approaches to guardianship planning in urban African settings.