{"id":{"repo_id":"bielefeld","oai_identifier":"oai:pub.uni-bielefeld.de:3005983"},"canonical_url":"https://search.dev.ndltd.org/etd/bielefeld/oai:pub.uni-bielefeld.de:3005983","repository":{"repo_id":"bielefeld","name":"Universität Bielefeld","base_url":"https://pub.uni-bielefeld.de/oai"},"display":{"title":"Maltreatment experiences and mental health problems in orphaned and vulnerable children in alternative care settings in Tanzania","abstract":"The global state of violence against children indicates that more than 300 million children are victims of violence, including violent discipline and peer violence (Global Initiative to End All Corporal Punishment of Children, 2021; Heekes et al., 2020; Hoeffler, 2017). These reports indicate that violence against children is highly prevalent in low- and middle-income countries, many of which are in Africa including Tanzania. The acts of violence occur in children’s immediate settings including families and schools (Heekes et al., 2020; Hillis et al., 2016; Kim & Chun, 2020; UNICEF, 2016). More than 50% of the children aged 2-17 years in Africa experienced violence in their families in past year (Hillis et al., 2016). Orphaned and other vulnerable children (OVC) are at highest risk of experiencing maltreatment. They experience maltreatment in their family of origin, on the streets, and in institutional care (Hermenau, Hecker, Elbert, & Ruf-Leuschner, 2014; Young, 2004). The number of orphans is currently increasing worldwide (Hillis et al., 2022). With nearly 140 million orphans worldwide, Sub-Saharan Africa alone is home to 52 million children under the age of 18 who have lost at least one parent (UNICEF, 2017). Tanzania, a country with over 30 million children (Ministry of Finance and Planning, 2022), is estimated to have 1.3 million orphans due to HIV/AIDS alone (SOS Children’s Village, 2021). These children are lacking adequate care and protection or being at high risk of losing it (SOS Children’s Villages, 2015). As a result they live in alternative care, including institutional and family-based care (Gaydosh, 2019; Hecker et al., 2017; Nnama-Okechukwu & Okoye, 2019). OVC are confronted with co-occurring childhood adversities, making them especially vulnerable for mental health problems (Atilola, 2014). Poverty (Lund et al., 2011), orphanhood due to AIDS and being raised in alternative care settings are some of the risk factors that are particularly salient for OVC and may contribute to their mental health problems (Sharp, et al., 2015; SOS Children’s Villages International, 2014). While numerous studies have documented the harmful effects of maltreatment on orphaned children (Hermenau, Hecker, Elbert, & Ruf-Leuschner, 2014; Study et al., 2015), little is known about how institutional caregivers’ specific factors and their working environment contribute to their use of maltreatment. Also, the relationship between current child maltreatment in alternative care and mental health problems among children in institution care is under researched. Caregivers of OVC in family-based care in Africa face a number of challenges that can make it difficult for them to perform their daily tasks and roles effectively (Maundeni & Malinga‐Musamba, 2013). These issues include poverty, health problems, low levels of education, high numbers of children in the family, lack of social support and old age (Huang et al., 2017; Martin & Zulaika, 2016; Ministry of Health, DCommunity Development, Gender, Elderly and Children (MoHCDGEC) [Tanzania Mainland] et al., 2022). Yet, little is known about factors associated with caregiving stress among caregivers of OVC and if higher levels of caregiving stress are associated with higher levels of mental health problems in children. Overall, there is a lack of data on children living in alternative care settings (Martin & Zulaika, 2016). Some studies report on the situation and experiences of children in institutional care settings (McCall & Groark, 2013; van IJzendoorn et al., 2011), even less is known about OVC living in family-based care in Africa. To account for the above-mentioned gaps in research, this thesis investigated the individual and structural factors that may contribute to child maltreatment and prevalence of maltreatment in institutional care (Article 1). Recent exposure to maltreatment by caregivers and its relation to children mental health problems (Article 2). Factors associated with caregiving stress among caregivers of OVC and to find out if there are higher levels of caregiving stress associated with higher levels of mental health problems in children, reported by caregivers and children themselves (Article 3). In Articles 1 and 2, the participants included 373 children aged 6 to 12 years and 227 caregivers from 24 care institutions in Dar es Salaam, Tanzania. The sample was obtained from the baseline assessment of a parallel group randomised controlled study, which was designed to examine the effectiveness of a maltreatment prevention intervention (Hecker et al., 2021a; Hecker, Mkinga, et al., 2022a). Findings of Article 1 showed that caregivers work under extreme and exhausting conditions, with very high caregiver-child ratios, low salaries, and almost no possibility to recover. Results also indicated significant differences in the maltreatment level and structural and individual factors (e.g., payment and days of entitlement) between the orphanages. Caregiver’s positive attitudes towards violence (ƒ2attitudes = 0.19) and difficulties in the relationship with children (ƒ2relationship = 0.05) significantly predicted maltreatment with moderate and small effects. Results of the Article 2 showed that almost all children experienced maltreatment by different perpetrators (caregivers, peers, family of origin). About one-fifth of all children reported mental health problems. Maltreatment by caregivers (β = 0.14) and peer violence (β = 0.18) were significantly associated with mental health problems. In a second model including only children reporting on the family of origin, maltreatment in the family of origin (β = 0.24) and peer violence (β = 0.16) were significantly associated with mental health problems (Article 2). In Article 3 the sample consisted of 99 children of age 3 to 17 and 78 caregivers from family-based care in 62 households in Dar es Salaam. This study was conducted in the context of a caregiver training programme delivered by SOS Children’s Villages in two rural wards, Chanika and Zingiziwa, in the outskirts of Dar es Salaam City Council, Tanzania. Shifting the focus from institutional to family-based care for OVC, the results of Article 3 showed that around 40% of caregivers reported an increased level of psychological distress and around 13% reported a high level of caregiving stress. The number of children with increased level of mental health problems was higher in the children’ self-report than in the caregivers’ report, especially for internalizing problems. Higher levels of psychological distress were significantly associated with higher levels of caregiving stress, while higher levels of perceived caregiving competence were significantly related to lower levels of caregiving stress. Higher levels of caregiving stress were significantly associated with the internalizing and externalizing problems reported by the children themselves and by their caregivers (Article 3). The overall results of the thesis indicate that OVC are at risk of developing mental health problems in all alternative care settings due to various reasons such as their history of maltreatment, current maltreatment, caregivers’ mental distress and work-related stress. In order to improve the quality of care and the wellbeing of the OVC, child protection stakeholders including NGOs, psychologists, decision makers and the government should consider child care trainings and interventions for the caregivers to ensure the ability and wellbeing of caregivers. In addition, public awareness campaigns for changing social norms and attitudes towards child maltreatment as well as policies enforcing registrations, monitoring and evaluation of care facilities are important structural measures to protect children. Investing in the quality of care for children is essential to helping children thrive and realize their full potentials.","abstract_html":"The global state of violence against children indicates that more than 300 million children are victims of violence, including violent discipline and peer violence (Global Initiative to End All Corporal Punishment of Children, 2021; Heekes et al., 2020; Hoeffler, 2017). These reports indicate that violence against children is highly prevalent in low- and middle-income countries, many of which are in Africa including Tanzania. The acts of violence occur in children’s immediate settings including families and schools (Heekes et al., 2020; Hillis et al., 2016; Kim & Chun, 2020; UNICEF, 2016). More than 50% of the children aged 2-17 years in Africa experienced violence in their families in past year (Hillis et al., 2016). Orphaned and other vulnerable children (OVC) are at highest risk of experiencing maltreatment. They experience maltreatment in their family of origin, on the streets, and in institutional care (Hermenau, Hecker, Elbert, & Ruf-Leuschner, 2014; Young, 2004). The number of orphans is currently increasing worldwide (Hillis et al., 2022). With nearly 140 million orphans worldwide, Sub-Saharan Africa alone is home to 52 million children under the age of 18 who have lost at least one parent (UNICEF, 2017). Tanzania, a country with over 30 million children (Ministry of Finance and Planning, 2022), is estimated to have 1.3 million orphans due to HIV/AIDS alone (SOS Children’s Village, 2021). These children are lacking adequate care and protection or being at high risk of losing it (SOS Children’s Villages, 2015). As a result they live in alternative care, including institutional and family-based care (Gaydosh, 2019; Hecker et al., 2017; Nnama-Okechukwu & Okoye, 2019). OVC are confronted with co-occurring childhood adversities, making them especially vulnerable for mental health problems (Atilola, 2014). Poverty (Lund et al., 2011), orphanhood due to AIDS and being raised in alternative care settings are some of the risk factors that are particularly salient for OVC and may contribute to their mental health problems (Sharp, et al., 2015; SOS Children’s Villages International, 2014). While numerous studies have documented the harmful effects of maltreatment on orphaned children (Hermenau, Hecker, Elbert, & Ruf-Leuschner, 2014; Study et al., 2015), little is known about how institutional caregivers’ specific factors and their working environment contribute to their use of maltreatment. Also, the relationship between current child maltreatment in alternative care and mental health problems among children in institution care is under researched. Caregivers of OVC in family-based care in Africa face a number of challenges that can make it difficult for them to perform their daily tasks and roles effectively (Maundeni & Malinga‐Musamba, 2013). These issues include poverty, health problems, low levels of education, high numbers of children in the family, lack of social support and old age (Huang et al., 2017; Martin & Zulaika, 2016; Ministry of Health, DCommunity Development, Gender, Elderly and Children (MoHCDGEC) [Tanzania Mainland] et al., 2022). Yet, little is known about factors associated with caregiving stress among caregivers of OVC and if higher levels of caregiving stress are associated with higher levels of mental health problems in children. Overall, there is a lack of data on children living in alternative care settings (Martin & Zulaika, 2016). Some studies report on the situation and experiences of children in institutional care settings (McCall & Groark, 2013; van IJzendoorn et al., 2011), even less is known about OVC living in family-based care in Africa. To account for the above-mentioned gaps in research, this thesis investigated the individual and structural factors that may contribute to child maltreatment and prevalence of maltreatment in institutional care (Article 1). Recent exposure to maltreatment by caregivers and its relation to children mental health problems (Article 2). Factors associated with caregiving stress among caregivers of OVC and to find out if there are higher levels of caregiving stress associated with higher levels of mental health problems in children, reported by caregivers and children themselves (Article 3). In Articles 1 and 2, the participants included 373 children aged 6 to 12 years and 227 caregivers from 24 care institutions in Dar es Salaam, Tanzania. The sample was obtained from the baseline assessment of a parallel group randomised controlled study, which was designed to examine the effectiveness of a maltreatment prevention intervention (Hecker et al., 2021a; Hecker, Mkinga, et al., 2022a). Findings of Article 1 showed that caregivers work under extreme and exhausting conditions, with very high caregiver-child ratios, low salaries, and almost no possibility to recover. Results also indicated significant differences in the maltreatment level and structural and individual factors (e.g., payment and days of entitlement) between the orphanages. Caregiver’s positive attitudes towards violence (ƒ2attitudes = 0.19) and difficulties in the relationship with children (ƒ2relationship = 0.05) significantly predicted maltreatment with moderate and small effects. Results of the Article 2 showed that almost all children experienced maltreatment by different perpetrators (caregivers, peers, family of origin). About one-fifth of all children reported mental health problems. Maltreatment by caregivers (β = 0.14) and peer violence (β = 0.18) were significantly associated with mental health problems. In a second model including only children reporting on the family of origin, maltreatment in the family of origin (β = 0.24) and peer violence (β = 0.16) were significantly associated with mental health problems (Article 2). In Article 3 the sample consisted of 99 children of age 3 to 17 and 78 caregivers from family-based care in 62 households in Dar es Salaam. This study was conducted in the context of a caregiver training programme delivered by SOS Children’s Villages in two rural wards, Chanika and Zingiziwa, in the outskirts of Dar es Salaam City Council, Tanzania. Shifting the focus from institutional to family-based care for OVC, the results of Article 3 showed that around 40% of caregivers reported an increased level of psychological distress and around 13% reported a high level of caregiving stress. The number of children with increased level of mental health problems was higher in the children’ self-report than in the caregivers’ report, especially for internalizing problems. Higher levels of psychological distress were significantly associated with higher levels of caregiving stress, while higher levels of perceived caregiving competence were significantly related to lower levels of caregiving stress. Higher levels of caregiving stress were significantly associated with the internalizing and externalizing problems reported by the children themselves and by their caregivers (Article 3). The overall results of the thesis indicate that OVC are at risk of developing mental health problems in all alternative care settings due to various reasons such as their history of maltreatment, current maltreatment, caregivers’ mental distress and work-related stress. In order to improve the quality of care and the wellbeing of the OVC, child protection stakeholders including NGOs, psychologists, decision makers and the government should consider child care trainings and interventions for the caregivers to ensure the ability and wellbeing of caregivers. In addition, public awareness campaigns for changing social norms and attitudes towards child maltreatment as well as policies enforcing registrations, monitoring and evaluation of care facilities are important structural measures to protect children. Investing in the quality of care for children is essential to helping children thrive and realize their full potentials.","abstract_has_math":false,"creators":["Mkinga, Getrude"],"institution":"Universität Bielefeld","degree_name":null,"degree_level":"thesis.doctoral","degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2025,"date_issued":"2025-07-08","date_published":"2025-07-08","updated_at":"2026-07-27T18:50:09Z","subjects":[],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://pub.uni-bielefeld.de/record/3005983","outbound_label":"Repository record","outbound_source":"source_url"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Mkinga, Getrude"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:publisher","label":"Institution","values":["Universitätsbibliothek Bielefeld"]},{"key":"dc:type","label":"Dc Type","values":["doctoralThesis"]},{"key":"thesis:degree_level","label":"Degree Level","values":["thesis.doctoral"]},{"key":"thesis:institution_name","label":"Thesis Institution Name","values":["Universität Bielefeld"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["The global state of violence against children indicates that more than 300 million children are victims of violence, including violent discipline and peer violence (Global Initiative to End All Corporal Punishment of Children, 2021; Heekes et al., 2020; Hoeffler, 2017). These reports indicate that violence against children is highly prevalent in low- and middle-income countries, many of which are in Africa including Tanzania. The acts of violence occur in children’s immediate settings including families and schools (Heekes et al., 2020; Hillis et al., 2016; Kim & Chun, 2020; UNICEF, 2016). More than 50% of the children aged 2-17 years in Africa experienced violence in their families in past year (Hillis et al., 2016). Orphaned and other vulnerable children (OVC) are at highest risk of experiencing maltreatment. They experience maltreatment in their family of origin, on the streets, and in institutional care (Hermenau, Hecker, Elbert, & Ruf-Leuschner, 2014; Young, 2004). The number of orphans is currently increasing worldwide (Hillis et al., 2022). With nearly 140 million orphans worldwide, Sub-Saharan Africa alone is home to 52 million children under the age of 18 who have lost at least one parent (UNICEF, 2017). Tanzania, a country with over 30 million children (Ministry of Finance and Planning, 2022), is estimated to have 1.3 million orphans due to HIV/AIDS alone (SOS Children’s Village, 2021). These children are lacking adequate care and protection or being at high risk of losing it (SOS Children’s Villages, 2015). As a result they live in alternative care, including institutional and family-based care (Gaydosh, 2019; Hecker et al., 2017; Nnama-Okechukwu & Okoye, 2019). OVC are confronted with co-occurring childhood adversities, making them especially vulnerable for mental health problems (Atilola, 2014). Poverty (Lund et al., 2011), orphanhood due to AIDS and being raised in alternative care settings are some of the risk factors that are particularly salient for OVC and may contribute to their mental health problems (Sharp, et al., 2015; SOS Children’s Villages International, 2014). While numerous studies have documented the harmful effects of maltreatment on orphaned children (Hermenau, Hecker, Elbert, & Ruf-Leuschner, 2014; Study et al., 2015), little is known about how institutional caregivers’ specific factors and their working environment contribute to their use of maltreatment. Also, the relationship between current child maltreatment in alternative care and mental health problems among children in institution care is under researched. Caregivers of OVC in family-based care in Africa face a number of challenges that can make it difficult for them to perform their daily tasks and roles effectively (Maundeni & Malinga‐Musamba, 2013). These issues include poverty, health problems, low levels of education, high numbers of children in the family, lack of social support and old age (Huang et al., 2017; Martin & Zulaika, 2016; Ministry of Health, DCommunity Development, Gender, Elderly and Children (MoHCDGEC) [Tanzania Mainland] et al., 2022). Yet, little is known about factors associated with caregiving stress among caregivers of OVC and if higher levels of caregiving stress are associated with higher levels of mental health problems in children. Overall, there is a lack of data on children living in alternative care settings (Martin & Zulaika, 2016). Some studies report on the situation and experiences of children in institutional care settings (McCall & Groark, 2013; van IJzendoorn et al., 2011), even less is known about OVC living in family-based care in Africa. To account for the above-mentioned gaps in research, this thesis investigated the individual and structural factors that may contribute to child maltreatment and prevalence of maltreatment in institutional care (Article 1). Recent exposure to maltreatment by caregivers and its relation to children mental health problems (Article 2). Factors associated with caregiving stress among caregivers of OVC and to find out if there are higher levels of caregiving stress associated with higher levels of mental health problems in children, reported by caregivers and children themselves (Article 3). In Articles 1 and 2, the participants included 373 children aged 6 to 12 years and 227 caregivers from 24 care institutions in Dar es Salaam, Tanzania. The sample was obtained from the baseline assessment of a parallel group randomised controlled study, which was designed to examine the effectiveness of a maltreatment prevention intervention (Hecker et al., 2021a; Hecker, Mkinga, et al., 2022a). Findings of Article 1 showed that caregivers work under extreme and exhausting conditions, with very high caregiver-child ratios, low salaries, and almost no possibility to recover. Results also indicated significant differences in the maltreatment level and structural and individual factors (e.g., payment and days of entitlement) between the orphanages. Caregiver’s positive attitudes towards violence (ƒ2attitudes = 0.19) and difficulties in the relationship with children (ƒ2relationship = 0.05) significantly predicted maltreatment with moderate and small effects. Results of the Article 2 showed that almost all children experienced maltreatment by different perpetrators (caregivers, peers, family of origin). About one-fifth of all children reported mental health problems. Maltreatment by caregivers (β = 0.14) and peer violence (β = 0.18) were significantly associated with mental health problems. In a second model including only children reporting on the family of origin, maltreatment in the family of origin (β = 0.24) and peer violence (β = 0.16) were significantly associated with mental health problems (Article 2). In Article 3 the sample consisted of 99 children of age 3 to 17 and 78 caregivers from family-based care in 62 households in Dar es Salaam. This study was conducted in the context of a caregiver training programme delivered by SOS Children’s Villages in two rural wards, Chanika and Zingiziwa, in the outskirts of Dar es Salaam City Council, Tanzania. Shifting the focus from institutional to family-based care for OVC, the results of Article 3 showed that around 40% of caregivers reported an increased level of psychological distress and around 13% reported a high level of caregiving stress. The number of children with increased level of mental health problems was higher in the children’ self-report than in the caregivers’ report, especially for internalizing problems. Higher levels of psychological distress were significantly associated with higher levels of caregiving stress, while higher levels of perceived caregiving competence were significantly related to lower levels of caregiving stress. Higher levels of caregiving stress were significantly associated with the internalizing and externalizing problems reported by the children themselves and by their caregivers (Article 3). The overall results of the thesis indicate that OVC are at risk of developing mental health problems in all alternative care settings due to various reasons such as their history of maltreatment, current maltreatment, caregivers’ mental distress and work-related stress. In order to improve the quality of care and the wellbeing of the OVC, child protection stakeholders including NGOs, psychologists, decision makers and the government should consider child care trainings and interventions for the caregivers to ensure the ability and wellbeing of caregivers. In addition, public awareness campaigns for changing social norms and attitudes towards child maltreatment as well as policies enforcing registrations, monitoring and evaluation of care facilities are important structural measures to protect children. Investing in the quality of care for children is essential to helping children thrive and realize their full potentials."]},{"key":"dc:format.medium","label":"Dc Format Medium","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["Maltreatment experiences and mental health problems in orphaned and vulnerable children in alternative care settings in Tanzania"]}]}],"canonical_facts":{"dc:creator":["Mkinga, Getrude"],"dc:description.abstract":["The global state of violence against children indicates that more than 300 million children are victims of violence, including violent discipline and peer violence (Global Initiative to End All Corporal Punishment of Children, 2021; Heekes et al., 2020; Hoeffler, 2017). These reports indicate that violence against children is highly prevalent in low- and middle-income countries, many of which are in Africa including Tanzania. The acts of violence occur in children’s immediate settings including families and schools (Heekes et al., 2020; Hillis et al., 2016; Kim & Chun, 2020; UNICEF, 2016). More than 50% of the children aged 2-17 years in Africa experienced violence in their families in past year (Hillis et al., 2016). Orphaned and other vulnerable children (OVC) are at highest risk of experiencing maltreatment. They experience maltreatment in their family of origin, on the streets, and in institutional care (Hermenau, Hecker, Elbert, & Ruf-Leuschner, 2014; Young, 2004). The number of orphans is currently increasing worldwide (Hillis et al., 2022). With nearly 140 million orphans worldwide, Sub-Saharan Africa alone is home to 52 million children under the age of 18 who have lost at least one parent (UNICEF, 2017). Tanzania, a country with over 30 million children (Ministry of Finance and Planning, 2022), is estimated to have 1.3 million orphans due to HIV/AIDS alone (SOS Children’s Village, 2021). These children are lacking adequate care and protection or being at high risk of losing it (SOS Children’s Villages, 2015). As a result they live in alternative care, including institutional and family-based care (Gaydosh, 2019; Hecker et al., 2017; Nnama-Okechukwu & Okoye, 2019). OVC are confronted with co-occurring childhood adversities, making them especially vulnerable for mental health problems (Atilola, 2014). Poverty (Lund et al., 2011), orphanhood due to AIDS and being raised in alternative care settings are some of the risk factors that are particularly salient for OVC and may contribute to their mental health problems (Sharp, et al., 2015; SOS Children’s Villages International, 2014). While numerous studies have documented the harmful effects of maltreatment on orphaned children (Hermenau, Hecker, Elbert, & Ruf-Leuschner, 2014; Study et al., 2015), little is known about how institutional caregivers’ specific factors and their working environment contribute to their use of maltreatment. Also, the relationship between current child maltreatment in alternative care and mental health problems among children in institution care is under researched. Caregivers of OVC in family-based care in Africa face a number of challenges that can make it difficult for them to perform their daily tasks and roles effectively (Maundeni & Malinga‐Musamba, 2013). These issues include poverty, health problems, low levels of education, high numbers of children in the family, lack of social support and old age (Huang et al., 2017; Martin & Zulaika, 2016; Ministry of Health, DCommunity Development, Gender, Elderly and Children (MoHCDGEC) [Tanzania Mainland] et al., 2022). Yet, little is known about factors associated with caregiving stress among caregivers of OVC and if higher levels of caregiving stress are associated with higher levels of mental health problems in children. Overall, there is a lack of data on children living in alternative care settings (Martin & Zulaika, 2016). Some studies report on the situation and experiences of children in institutional care settings (McCall & Groark, 2013; van IJzendoorn et al., 2011), even less is known about OVC living in family-based care in Africa. To account for the above-mentioned gaps in research, this thesis investigated the individual and structural factors that may contribute to child maltreatment and prevalence of maltreatment in institutional care (Article 1). Recent exposure to maltreatment by caregivers and its relation to children mental health problems (Article 2). Factors associated with caregiving stress among caregivers of OVC and to find out if there are higher levels of caregiving stress associated with higher levels of mental health problems in children, reported by caregivers and children themselves (Article 3). In Articles 1 and 2, the participants included 373 children aged 6 to 12 years and 227 caregivers from 24 care institutions in Dar es Salaam, Tanzania. The sample was obtained from the baseline assessment of a parallel group randomised controlled study, which was designed to examine the effectiveness of a maltreatment prevention intervention (Hecker et al., 2021a; Hecker, Mkinga, et al., 2022a). Findings of Article 1 showed that caregivers work under extreme and exhausting conditions, with very high caregiver-child ratios, low salaries, and almost no possibility to recover. Results also indicated significant differences in the maltreatment level and structural and individual factors (e.g., payment and days of entitlement) between the orphanages. Caregiver’s positive attitudes towards violence (ƒ2attitudes = 0.19) and difficulties in the relationship with children (ƒ2relationship = 0.05) significantly predicted maltreatment with moderate and small effects. Results of the Article 2 showed that almost all children experienced maltreatment by different perpetrators (caregivers, peers, family of origin). About one-fifth of all children reported mental health problems. Maltreatment by caregivers (β = 0.14) and peer violence (β = 0.18) were significantly associated with mental health problems. In a second model including only children reporting on the family of origin, maltreatment in the family of origin (β = 0.24) and peer violence (β = 0.16) were significantly associated with mental health problems (Article 2). In Article 3 the sample consisted of 99 children of age 3 to 17 and 78 caregivers from family-based care in 62 households in Dar es Salaam. This study was conducted in the context of a caregiver training programme delivered by SOS Children’s Villages in two rural wards, Chanika and Zingiziwa, in the outskirts of Dar es Salaam City Council, Tanzania. Shifting the focus from institutional to family-based care for OVC, the results of Article 3 showed that around 40% of caregivers reported an increased level of psychological distress and around 13% reported a high level of caregiving stress. The number of children with increased level of mental health problems was higher in the children’ self-report than in the caregivers’ report, especially for internalizing problems. Higher levels of psychological distress were significantly associated with higher levels of caregiving stress, while higher levels of perceived caregiving competence were significantly related to lower levels of caregiving stress. Higher levels of caregiving stress were significantly associated with the internalizing and externalizing problems reported by the children themselves and by their caregivers (Article 3). The overall results of the thesis indicate that OVC are at risk of developing mental health problems in all alternative care settings due to various reasons such as their history of maltreatment, current maltreatment, caregivers’ mental distress and work-related stress. In order to improve the quality of care and the wellbeing of the OVC, child protection stakeholders including NGOs, psychologists, decision makers and the government should consider child care trainings and interventions for the caregivers to ensure the ability and wellbeing of caregivers. In addition, public awareness campaigns for changing social norms and attitudes towards child maltreatment as well as policies enforcing registrations, monitoring and evaluation of care facilities are important structural measures to protect children. Investing in the quality of care for children is essential to helping children thrive and realize their full potentials."],"dc:format.medium":["application/pdf"],"dc:publisher":["Universitätsbibliothek Bielefeld"],"dc:title":["Maltreatment experiences and mental health problems in orphaned and vulnerable children in alternative care settings in Tanzania"],"dc:type":["doctoralThesis"],"thesis:degree_level":["thesis.doctoral"],"thesis:institution_name":["Universität Bielefeld"]},"updated_at":"2026-07-27T18:50:09Z"}