Prevalence and number of children living in institutional care: global, regional, and country estimates
Prevalence and number of children living in institutional care: global, regional, and country estimates
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DOI：
10.1016/s2352-4642(20)30022-5
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发表时间：
2020-05-01
影响因子：
36.4
通讯作者：
Lu, Chunling
中科院分区：
文献类型：
--
作者：
Desmond, Chris;Watt, Kathryn;Lu, Chunling
生活在机构环境中的儿童面临着负面健康和发展结果以及身体和情感虐待的风险，但关于他们数量的信息很少。因此，我们的研究的目的是估计全球层面，区域层面和国家层面的数量和百分比的儿童生活在机构carry.Methods在这项估计研究中，我们做了同行评议的出版物和全面审查的调查和未发表的文献，以构建一个数据集的儿童生活在机构照顾从136个国家之间的2001年和2018年。我们采用了多种方法来估计2015年191个国家中生活在机构照顾中的儿童的数量和百分比，这一年是通过可持续发展目标的一年。我们为每个数据集生成了98组估计值，并为具有不同可用数据点的国家提供了可能的插补方法组合。在这98组数据中，我们在这里报告了五种全球水平的估计：最高值的估计值，最低值的估计值，中值的估计值，不确定性水平的估计值，以及从最小均方根误差（RMSE）方法得出的估计值。结果2015年生活在机构中的儿童的全球估计值对所使用的方法和数据高度敏感，从318万到942万儿童不等，估计中值为537万。当选择具有最低RMSE的方法时，总体估计值为421万，而使用负二项回归和自举法时，总体估计值为752万（95%CI 7.48-7.56）。我们还观察到国家一级的估计数存在很大差异。与其他区域相比，南亚、撒哈拉以南非洲和拉丁美洲的估计数在不同估计方法之间切换时数值变化较大。高收入国家的平均住院率最高，而低收入国家的平均住院率最低。用最小均方根误差法对全部数据进行的估计表明，南亚的儿童收容机构估计人数最多（113万），其次是欧洲和中亚（101万），东亚和太平洋地区（78万），撒哈拉以南非洲（65万）、中东和北非（30万）、拉丁美洲和加勒比（23万）和北美（09万）。在全球范围内，机构照料使数百万儿童面临更高的健康和发育不良风险，这凸显了非机构化的必要性。然而，生活在机构中的儿童人数存在很大的不确定性。为了改善对这一人口规模的估计，我们需要重新定义机构护理的定义，并改善数据收集，特别是在儿童人口众多的国家。版权所有（C）2020爱思唯尔有限公司保留所有权利。
Background Children living in institutionalised settings are at risk of negative health and developmental outcomes, as well as physical and emotional abuse, yet information on their numbers is scarce. Therefore, the aim of our study was to estimate global-level, regional-level, and country-level numbers and percentages of children living in institutional care.Methods In this estimation study, we did a systematic review of peer-reviewed publications and a comprehensive review of surveys and unpublished literature to construct a dataset on children living in institutional care from 136 countries between 2001 and 2018. We applied a wide range of methods to estimate the number and percentages of children living in institutional care in 191 countries in 2015, the year the Sustainable Development Goals were adopted. We generated 98 sets of estimates for each dataset, with possible combinations of imputation methods for countries with different available data points. Of these 98 sets, we report here five types of global-level estimates: estimates with the highest values, those with the lowest values, those with median values, those with uncertainty levels, and those derived from methods with the smallest root-mean-square errors (RMSE).Findings Global estimates of children living in institutions in 2015 was highly sensitive to the methods and data used, ranging from 3.18 million to 9.42 million children, with a median estimate of 5.37 million. When selecting the method with the lowest RMSE, the global estimate was 4.21 million, whereas with negative binomial regression with bootstrapping, the global estimate was 7.52 (95% CI 7.48-7.56) million. We also observed large variations in country-level estimates. Compared with other regions, estimates in south Asia, sub-Saharan Africa, and Latin America had larger variations in values when switching between estimation methods. High-income countries had the highest average prevalence of institutionalisation, whereas low-income countries had the lowest average prevalence. Estimates from the full data with the smallest RMSE method showed that south Asia had the largest estimated number of children living in institutions (1.13 million), followed by Europe and central Asia (1.01 million), east Asia and Pacific (0.78 million), sub-Saharan Africa (0.65 million), Middle East and North Africa (0.30 million), Latin America and the Caribbean (0.23 million), and North America (0.09 million). North America consistently had the lowest estimates among all regions.Interpretation Worldwide, institutional care places millions of children at elevated risk of negative health and developmental outcomes, highlighting the need for deinstitutionalisation. However, there is considerable uncertainty regarding the number of children living in institutions. To improve estimates of the size of this population, we need to standardise the definition of institutional care and improve data collection, particularly in countries with large child populations. Copyright (C) 2020 Elsevier Ltd. All rights reserved.