الفهرس 
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Abstract
Orphanhood is a serious phenomenon worldwide in both developed and developing
countries alike. Adolescent orphans are a large and growing section of the population. They
are placed in residential institutions during the most critical stage of their life, which is the
adolescence stage. So, adolescent orphans are a particularly risky group, and they suffer from
miserable living.
Orphans and vulnerable adolescents struggle to achieve their basic needs and
requirements that are indispensable demands for their healthy lives. Every day, these orphans
fight for biological survival, love and affection, and safety from exploitative abuse.
Accordingly, they need comprehensive research and significant sustainable interventions to
discover their needs, resolve their problems, and provide a better quality of life in the future.
Hence, this study was conducted to identify the needs and problems of adolescent orphans at
governmental residential institutions in Alexandria.
A cross-sectional descriptive research design was used to accomplish this study. The
study was carried out in all 22 governmental residential institutions which provide services for
adolescent orphans affiliated with the Ministry of Social Solidarity in Alexandria.
By using the convenient sampling technique, the current study subjects were included,
the total subjects accounted for 250 adolescent orphans of both sexes aged from 10 to 18
years, additionally, 60 residential institution personnel including caregivers, social workers,
and health care personnel who are responsible for the adolescent orphans.
Tools for data collection
Five tools were used in this study to collect the necessary data.
Tool I: Adolescent orphans’ socio-demographic and profile structured interview schedule,
Tool II: Anthropometric measurement,
Tool III: Strength and Difficulties Questionnaire,
Tool IV: Residential institution personnel socio-demographic data questionnaire, &
Tool V: Residential institution physical environment observation checklist.
Before data collection, the study tools were tested for content validity through a jury
consisting of five experts in the fields of community health, pediatric, psychiatric, and mental
health nursing. Recommended modifications were made accordingly. Approvals were
obtained for conducting the study in the specified settings. A pilot study was carried out on 25
adolescent orphans and 6 residential institution personnel who were not included in the study
subjects who. Data was collected over 6 months (from May to November 2022).
The main findings obtained from the study were as follows:
Part I: Adolescent Orphans’ Socio-demographic characteristics and Profile:
❖ Section A: Demographic characteristics of institutionalized adolescent orphans
• Adolescent orphans’ ages ranged from 10 to 18 years, with a mean of 14.79±2.56 and
14.61±2.49 years for males and females respectively. Slightly more than half (53.2%) of
institutionalized adolescents aged 10 to less than 16 years old (53.5% males and 52.7% females).
• More than three-quarters (77.6%) of males as compared to 86.8% of females were
placed in residential institutions due to honorable (unknown) parentage.
• More than two-thirds (71.6%) of institutionalized adolescents were living in the
institution for more than 10 years (69.6% for males and 76.3% for females), with a
mean of 12.77 ± 4.68 and 13.09±4.91 years for males and females respectively.
• Concerning the work status of institutionalized adolescents, more than one-tenth
(14.4%) of males as compared to 6.6% of females were working. Out of them, all
females (100%) as compared to 44% of males worked in skilled work. However, 56%
of working males worked in unskilled work, with a statistically significant difference
between males and females (FET= 5.250, P=0.045).
❖ Section B: Health profile of institutionalized adolescent orphans
• Slightly more than two-fifths (42.4%) of institutionalized adolescents had previous
health problems.
• Slightly less than half (47.1%) of institutionalized male adolescents as compared to
47.4% of females were exposed to accidents.
• Less than half (45.1%) of males as compared to 69.4% of females were exposed to
slipping while 32.9%, and 22.2% of males and females respectively were exposed to
road traffic accidents. Meanwhile, one-fifth (22%) of males as compared to 8.4% of
females were exposed to sharp objects, with a statistically significant difference
between both groups (X2= 6.390, P=0.041).
• More than two-fifths (42%) of studied adolescents (39.7% of males and 47.4% of
females) complained of health problems such as acne and headache.
• Around half (46.5%) of studied adolescent orphans had IDA.
• Nearly one-third (32.8%) of studied adolescent orphans utilized health services.
• Concerning the menstrual history of Institutionalized adolescent girls, 22.4% of females
reported that, they didn’t menstruate yet.
❖ Section C: Educational profile of institutionalized adolescent orphans.
• Less than half (44%) of studied adolescents had school difficulties; this was either
difficult school curriculum or fear of teachers that was mentioned by 76.6%, 23.4% for
males as compared to 97%, and 3% for females respectively, with statistically
significant difference between both groups (X2=6.692, P=0.009).
• The majority (89.6%) of institutionalized adolescent orphans reported that they had
good academic achievement while the rest (10.4%) of them had bad academic
achievement.
• There was a statistically significant difference between males and females regarding
attempts to escape from school (X2=10.199, P=0.001) as one-fifth (19.5%) of males as
compared to 3.9% of females stated that they attempted to escape from school. Out of
them, slightly more than half (54.1%) reported that they did that due to joining
recreational activities with their friends, while the rest (45.9%) reported that this was
done because they hated school.
Part II: Adolescent Orphans’ Anthropometric Measurements.
• More than half (60%) of the studied adolescents had normal BMIs (63.2% males and
52.6% females respectively). On the other hand, about one-quarter (24.4%) of them
were overweight (22.4% males and 28.9% females respectively), and more than onetenth
(12.8%) of them were obese (12.6% males and 13.2% females respectively).
However, a very few percentage (2.8%) of them were underweight (1.7% males and
5.3% females respectively).
Part III: Adolescent Orphans’ Needs Assessed Through Their Lifestyle.
• Nearly two-thirds (63.6%) of institutionalized adolescents consumed more than three
meals per day.
• The majority (90%) of both males and females (88.5% and 93.4% respectively)
consumed fast food.
• More than half (58.6%) of males as compared to more than three-quarters (76.3%) of
females were sleeping more than 8 hours.
• One-fifth (20.1%) of males as compared to 40.8% of females did not practice any
sporting activities.
• Nearly two-thirds (60.4) % of the institutionalized adolescents weren’t brushing their
teeth.
• Slightly more than two-thirds (67.2%) of the total studied institutionalized adolescents
didn’t make periodic medical checkups.
• Three-quarters (75.6%) of institutionalized adolescents stated that they were feeling
safe. On the other hand, 17.2% of them mentioned sometimes while less than one-tenth
(7.2%) stated that they were feeling unsafe.
• More than one-quarter (26.4%) of studied adolescents had problems in their social
relationships.
• Nearly all (97.2%) of adolescents stated that they had leisure time activities inside or
outside the institution.
Part IV: Adolescent Orphans’ Problems Assessed Through Their Strength and
Difficulties Questionnaire (SDQ) Score, Risk Taking and Violent Behaviors.
• Regarding SDQ, the total difficulties score showed that half (51.2%) of institutionalized
adolescents were normal. Nearly one-third (30%) of them were abnormal. While, about
one-fifth (18.8%) were on the borderline to these difficulties, with a mean of 15.13± 6.46.
• Regarding cigarette smoking, a few percentage (4%) of males as compared to none of
the females were current smokers, with a mean of 9.43±8.56 cigarettes/day.
• Regarding substance abuse, a very few percentage (0.6%) of males as compared to none
of the females reported that they had a previous trial of substance. In addition, a few
percentage (6.9%, 2.6%) of males and females respectively reported that they had addict
colleagues.
• One-third (33.3%) of males as compared to 36.8% of females had suicidal feelings,
while 9.2% of males as compared to 21.1% of females had suicidal thoughts, with a
statistically significant difference between both groups (X12=6.663, P=0.018).
• A few percentage (2.9%) of males as compared to 11.8% of females committed a
previous suicidal attempt.
• Regarding the perpetration of violence, more than two-thirds (70%) of institutionalized
adolescents (67.8% & 75% for males and females respectively) reported that they
perpetrated it sometimes or most of the time as stated by 60% and 29.1% of them
respectively (57.6%, 31.4% for males and 64.9%, 24.6% for females respectively).
• More than half (56.4%) of institutionalized adolescents reported that they were exposed
to abuse. Out of them, 50.4% of them were exposed to abuse in the schools.
• Concerning the needs and problems of institutionalized adolescents as mentioned by
themselves and their guardians. More than one-third (34.8%) of the studied adolescents
as compared to 58.3% of their guardians mentioned psychosocial care. Slightly more
than one-third (34.8%) of adolescents mentioned that they had no needs as compared to
only 3.3% of their guardians, with a statistically significant difference between both
groups (X2= 38.379, P=0.000).
• Psychosocial problems such as stigma were the first problem mentioned by 32% of
studied adolescents as compared to two-thirds (66.7%) of their guardians, with a
statistically significant difference between both groups (X2 = 46.460, P=0.000).
Part V: Socio-demographic characteristics of Residential Institution Personnel.
• The age of the residential institution personnel ranged between twenty to sixty-five
years with a mean of 38.20±10.03 years. Slightly more than half (55%) of the studied
residential institution personnel were aged more than thirty-five years.
• Slightly more than three-quarters (76.7%) of the studied residential institution personnel
were females.
• More than two-thirds (68.3%) of the studied residential institution personnel had
baccalaureate degree, and one- quarter (25%) of them had secondary/ diploma degrees,
while only 6.7% of them had a postgraduate degree.
• Slightly more than two-fifths (41.7%) of the studied residential institution personnel had
experience working with orphans for ten years or more.
• More than half (55%) of the studied residential institution personnel attended training
courses to help them in dealing with orphans.
Part VI: Physical Environment of Observed Residential Institutions.
• Regarding the administrative zone, half (50%) of institutions were in El Montazah,
followed by East, El-Agamy, and El Ameria 27.3%, 18.2%, and 4.5% respectively.
• Regarding the number of working personnel and adolescents, it was found that the
number of working personnel in the range between 5-30 person. Also, the number of
adolescents in each institution is in the range between 3-25 adolescents.
• The majority (81.8%) of institutions were easily accessed, more than two-thirds (68.2%)
of them had safe external locations, and more than half (54.5%) of the institutions were
surrounded by safe gates.
• Regarding health services, it was found that more than one-quarter (27.3%) of observed
institutions had physicians, and only 9.1% of them had nurses.
• Around two-thirds (63.6%) of the observed residential institutions had fair
environments while the rest (36.4%) of them had good environments.
Part VII: Relations between Adolescent Orhans’ SDQ Scores and Different Variables
• There weren’t significant relationships among the institutionalized adolescents’ SDQ
scores and their selected socio-demographic characteristics.
• There were significant relationships among the institutionalized adolescents’ SDQ
scores and their violent behaviors (suicide & perpetration of violence).
• There were significant relationships among the institutionalized adolescents’ SDQ
scores and their exposure to abuse.
In light of the current study findings, the following recommendations could be
suggested:
For fulfilling all orphans’ needs through enhancing the role of many ministries such as
MOHP Social Solidarity and Youth and Sports
• Support the development of effective monitoring and evaluation through conducting
regular supervision and evaluation of all residential institutions based on international
and national quality standards of care to build a basis for all evaluations of the care
given and guidelines for effective planning.
• Providing continuous needs assessment of adolescent orphans and developing programs
based on their needs and health promotion.
• Assign psychiatric nurses to develop continuous psychological counseling programs for
assessing the psychological status of orphans and helping them cope effectively.
• Continuous efforts to establish, upgrade, and attach youth-friendly clinics to residential
institutions.
• Encourage the provision of mental health clinics in the schools which help in
developing programs to promote orphans’ coping skills.
• Support mass media and campaigns to raise more awareness about the rights of orphans
and vulnerable adolescents to ensure respect for their identity.
• Promote participation in sports, arts, and recreational activities to enhance the physical
and mental well-being of orphans.
• MCIT measures should be taken to enhance the role of the parents and family
obligations.
Recommendations for Further Studies
• Assessment of factors that contribute to family breakdown and identifying strategies to
prevent these factors.
• Implementing a protocol of care among orphan adolescents at residential institutions.
• A longitudinal study to examine the long-term outcomes of adolescent orphans who
have transitioned out of governmental residential institutions.