Abstract
The 14-year civil conflict in Liberia resulted in the separation of many children from their families. A population-based, multi-stage random cluster knowledge, attitudes, and practices (KAP) survey of 1157 child caregivers was conducted in 12 districts in Liberia. Knowledge of alternative care and adoption is low and varies significantly by residence. Common misunderstandings include thinking that biological parents may migrate in cases of inter-country adoption (42% of rural and Greater Monrovia (GM); p = 0.2138), and that there is a legal obligation to place children in institutions whenever they cannot be cared for by their parents (42% urban, 35% rural; p = 0.0009). Willingness is high to foster children across all settings; and to send children to live with relatives, non-relatives, or in orphanages, particularly in rural areas (p < 0.0001). Willingness to foster children with special needs is higher in GM (p < 0.0001). Access to schooling is the main reason children are separated from their parents. Relocating with spouse is common in GM (p = 0.0540) and to assist relatives or friends in rural and urban areas (p = 0.5047). Financial need drives child separation, mostly in GM (p = 0.0723). Regulatory measures and public education campaigns must be developed and evaluated overtime with due consideration of residence.