Association Between Family Composition and the Well-Being of Vulnerable Children in Nairobi, Kenya

The objective of this study is to examine the relationship between a vulnerable child’s family composition (family size and
primary caregiver) and three child well-being indicators (immunization status, access to food, educational security). Using
2006–2009 intake data from a Kenyan non-governmental aid agency, this cross-sectional study evaluated a population of 1,424
children in two urban slum settlements in Nairobi. Logistic regression was used to obtain adjusted odds ratios and 95% confidence
intervals to examine the relationship between family composition measures and child well-being. Multivariate results were
also stratified by orphan status. Vulnerable children who live in household sizes of 4–6 members and vulnerable children who
live with non-relatives had greater odds of inadequate immunization (OR = 1.51, 95% CI: 1.13–2.01, OR = 9.02, 95% CI: 4.62–17.62).
Paradoxically, vulnerable children living with non-relative caregivers were at lower risk for inadequate food (OR = 0.19,
95% CI 0.07–0.33). Single orphans with an HIV positive parent were less likely to be fully immunized than single orphans with
an HIV negative parent. The results provide information on specific groups which could benefit from increased attention related
to childhood immunization education and intervention programs. The findings also underscore the need for policies which support
families as a means of supporting vulnerable children. Finally, findings reinforce the wisdom of programs which target vulnerable
children based on needs, rather than orphan status. These findings can be useful for informing future program and policy development
designed to meet needs of vulnerable children.