Double Orphans Research Articles

Evaluation of Anxiety and Depression Among Orphan and Non-Orphan Adolescents in a Rural Residential School of Maharashtra

Abstract Background: Adolescence marks a critical stage of development characterized by profound physical, emotional, and social changes. This study explores the prevalence of anxiety and depression among orphan and non-orphan adolescents in a rural residential school setting, aiming to identify associated factors. Method: A community-based cross-sectional descriptive study was conducted among 100 adolescents (50 orphans and 50 non-orphans) aged 10-19 years in Warudi, Jalna from August 10 to October 10, 2022. Institutional ethical approval and written informed consent were obtained. Data collection included DSM-5 criteria for anxiety and depression assessment, using the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HDRS). Additional parameters assessed were sleep disturbances, academic performance, social interactions, duration of stay in the residential school, and type of orphanhood. Statistical analysis was performed using SPSS version 21, with qualitative parameters presented as percentages and the chi-square test used for comparisons (p<0.05 considered significant). Result: The study revealed notable disparities in mental health outcomes between orphan and non-orphan adolescents. Orphans, predominantly categorized as double orphans (54%), exhibited higher prevalence rates of anxiety (46%) and depression (30%) compared to non-orphans (anxiety 14%, depression 12%). Factors such as prolonged stays in residential schools and the duration of orphanhood were significantly associated with heightened levels of anxiety and depression among orphans. Conclusion: Orphan adolescents residing in rural residential school face significantly elevated risks of anxiety and depression compared to their non-orphan peers. The findings highlight the urgent need for targeted psychological support and interventions tailored to the unique challenges of orphanhood, including the prolonged institutional care and the emotional impact of parental loss. Future research should focus on longitudinal studies to assess the effectiveness of interventions and track mental health trajectories over time.

Effects of stressful life events on suicide risk among orphaned and left-behind adolescents in China: The mediating roles of loneliness and subjective well-being

BackgroundResearch has established a link between stressful life events and suicide risk among adolescents, but limited attention has been directed towards vulnerable groups regarding the impact of such events on suicide risk. ObjectivesThis study aimed to examine the influence of stressful life events on suicide risk among orphaned and left-behind adolescents in China and to explore potential variations in this effect across different types of adolescents. MethodsParticipants were from four schools located in four counties with high HIV/AIDS infection rates in the Liangshan Yi Autonomous Prefecture, Sichuan Province, China. A sample of 1912 students were recruited, and 1524 responses were retained for analysis. Participants completed questionnaires assessing stressful life events, suicide risk, loneliness, and subjective well-being. Orphaned and left-behind adolescents were identified through demographic questions. Multiple linear regression analyses were conducted to assess the mediating effects of loneliness and subjective well-being on the relationship between stressful life events and suicide risk, as well as to examine the moderating effect of adolescent type. ResultsStressful life events showed a significant positive association with suicide risk. Loneliness and subjective well-being played mediating roles in the relationship between stressful life events and suicide risk. Double and single orphans exhibited higher levels of loneliness and lower levels of subjective well-being. Moreover, stressful life events had a more pronounced effect on suicide risk among left-behind adolescents. ConclusionsStressful life events exerted a direct positive impact on suicide risk among adolescents, while also indirectly affecting suicide risk by elevating loneliness and diminishing subjective well-being. Adolescents who experienced parental bereavement were more susceptible to feelings of loneliness and unhappiness. However, left-behind adolescents demonstrated elevated suicide risk even when facing similar levels of stressful life events. The stress sensitization theory and the distinct effects of chronic and acute stressors may offer explanatory insights. Implications for practice were discussed.

The level of antiretroviral therapy (ART) adherence among orphan children and adolescents living with HIV/AIDS: A systematic review and meta-analysis.

Many children and adolescents living with HIV have ended up as orphans. Due to HIV taking away their parents leaves them deprived of their most important social network and support, which predisposes them to poor adherence to antiretroviral therapy (ART). Various studies have shown poor adherence to ART among orphaned children and adolescents. This systematic review and meta-analysis, therefore, aims to determine the level of ART adherence among orphaned children and adolescents living with HIV/AIDS. This PROSPERO registered review (CRD42022352867) included studies from PubMed, Google Scholar, Scopus, Web of Science, Africa Journal Online, and selected HIV/AIDS journals from data inception to June 01, 2022. We included articles published in all languages that report the prevalence of adherence to ART among children and adolescent orphans (single parent orphans and/or double orphans) living with HIV/AIDS. We excluded qualitative studies, case studies, opinion papers, and letters to editors. We used the random-effect model to calculate the pooled prevalence of ART adherence based on the highest prevalence provided by the various methods in a particular study. We used the Joanna Briggs Institute Appraisal tool for the prevalence study to evaluate for risk of bias in the included studies. The Egger's test was used to assess small study effects. Out of 1087 publications identified from the various databases, six met the selection criteria. The included six studies had a total 2013 orphans living with HIV/AIDS. The pooled prevalence of ART adherence was 78∙0% (95% Confidence Interval: 67.4-87.7; I2 = 82.92%, p<0∙001) and ranged between 7∙6% and >95%, using one of the following methods: pill count, caregiver's self-report, clinical attendance, and nevirapine plasma levels (above three μg/mL). The factors associated with adherence were pill burden, caregiver involvement, stunting, and caregiver relationship. There was a high level of heterogeneity in the finding. Approximately four fifth of orphan children and adolescents living with HIV/AIDS adhere to ART. Strategies to improve adherence among this group should be prioritized, especially among the double orphaned children and adolescents.

"Health Outcomes of Grandparents Caring for Double Orphans in South Africa": What Are the Determinants?

In the 21st century, grandparenthood is a significant phenomenon in the fields of demography, gerontology, and sociology. It is mainly explored in the context of ageing, as it is poised to become one of the most significant demographic phenomena and social issues in contemporary South Africa. Therefore, this study examined the determinants associated with grandparents who are parenting as caregivers and the health challenges they are exposed to as caregivers. The National Income Dynamics Study (NIDS) Wave 5 dataset was utilised, and a total of 302,476 grandparents aged 25 years and older, who were reported to be primary caregivers of double orphans, were included in the analysis. Both bivariate and multivariate binary logistic regressions were performed to determine the predictors of the determinants of grandparents parenting as caregivers and their health challenges in South Africa. Estimated odds ratios (ORs) with 95% confidence intervals (CIs) were used, and the threshold for statistical significance was established at ρ < 0.05. A majority of the male and female grandparent caregivers were aged 24-34 years, were Black Africans (69.8%), had secondary education (46.9%), reported health challenges (HC) (59.7%), with 26.4% reporting headaches in the last 30 days. Logistic regression revealed that grandparent caregivers aged 55-64 years were 8.9 times more likely to report health challenges compared to those aged 25-34 years. Non-Black African grandparent caregivers were found to be 0.61 times less likely to report health challenges, compared to Black African grandparent caregivers. Those with perceived poor health status were 3.3 times more likely to report health challenges, compared to those with excellent perceived health status. Therefore, there is an urgent need to redesign health interventions to address these health burdens among grandparent caregivers and to take cognisance of providing economic and social support for these vulnerable populations.

Orphanhood vulnerabilities for violence and HIV by education, sex, and orphan type among 18-24-year-old youth: findings from the 2018 Lesotho violence against children and youth survey

ABSTRACT HIV and violence among orphans are key measures of vulnerability in low-resource settings. Although Lesotho has the second highest HIV adult prevalence rate (21.1%) in the world, and the prevalence of orphanhood (44.2%) and violence exposure (67.0%) is high, little research exist on orphanhood vulnerabilities for violence and HIV in Lesotho. Using data from 4,408 youth (18–24 years old) from Lesotho’s 2018 Violence Against Children and Youth survey, a nationally representative cross-sectional household survey, the study examined associations among orphan status, violence, and HIV and assessed how associations differed by education, sex, and orphan type, using logistic regression. Orphans had higher odds of violence (aOR, 1.21; 95% CI, 1.01–1.46) and HIV (aOR, 1.69; 95% CI, 1.24–2.29). Having primary education or less (aOR, 1.43; 95% CI, 1.02–2.02), male sex (aOR, 1.74; 95% CI, 1.27–2.36), and being a paternal orphan (aOR, 1.43; 95% CI, 1.14–1.80) were significant interaction terms for violence. Orphans who completed primary school or less (aOR, 1.61; 95% CI, 1.09–2.39), female (aOR, 3.08; 95% CI, 2.14–4.42) and double orphans (aOR, 2.54; 95% CI, 1.56–4.13) had higher odds of HIV. These relationships highlight the importance of comprehensive strategies to support education and family strengthening for orphans as core violence and HIV prevention efforts.

HIV Incidence and Death Among Orphaned and Nonorphaned Children and Adolescents Living in Family-Based Settings in Western Kenya: A Prospective Cohort Analysis

To compare the incidence of HIV, death, and abuse among orphaned children to nonorphaned children living in households caring for orphaned children in Western Kenya. A random sample was taken of 300 households caring for at least one orphaned child in Uasin Gishu County, Kenya. All orphaned and nonorphaned children in each selected household were enrolled in a prospective cohort study between 2010 and 2013. A total of 1488 children (487 double orphans, 743 single orphans, and 258 nonorphans) were followed up annually until 2019. Survival analysis was used to estimate hazard ratios and 95% confidence intervals (CIs) of the association between the number of parents the child had lost (none, 1, or 2), and HIV incidence, death, combined HIV incidence or death, and incident abuse. Among 1488 children enrolled, 52% of participants were females, 23 were HIV positive, and the median age was 10.4years. Over the course of the study, 16 orphaned children died and 11 acquired HIV. No deaths or incident HIV infections were observed among the nonorphaned children. Among children who were HIV negative at enrollment, loss of a parent was strongly associated with incident HIV (adjusted hazard ratio: 2.21 per parent lost, 95% CI: 1.03-4.73) and HIV or death (adjusted hazard ratio: 2.46 per parent lost, 95% CI: 1.37-4.42). There were no significant associations between orphan level and abuse. In similar households, orphaned children experience a higher risk of HIV and death than nonorphaned children. Both orphaned children and the families caring for them need additional support to prevent adverse health outcomes.

Socioeconomic status and other factors associated with HIV status among OVC in Democratic Republic of Congo (DRC).

BackgroundOrphans and vulnerable children (OVC) are a high-risk group for HIV infection, particularly in Sub-Saharan Africa.PurposeThis study aims to portray the socioeconomic profile of OVC and examine the association of household and parent/guardian characteristics with the HIV status of OVC.MethodsFor this quantitative retrospective study, we obtained data from ICAP/DRC for a total of 1,624 OVC from households enrolled for social, financial, and clinical services between January 2017 and April 2020 in two provinces of the Democratic Republic of Congo, Haut-Katanga and Kinshasa. We computed descriptive statistics for OVC and their parents' or guardians' characteristics. We used the chi-square test to determine bivariate associations of the predictor variables with the dichotomous dependent variable, HIV positivity status. To analyze the association between these independent variables and the dichotomous dependent variable HIV status after controlling for other covariates, we performed firth's logistic regression.ResultsOf the OVC included in this study, 18% were orphans, and 10.9% were HIV+. The chi-square analysis showed that among parents/guardians that were HIV+, a significantly lower proportion of OVC (11.7%) were HIV+ rather than HIV- (26.3%). In contrast, for parents/guardians with HIV- status, 9.0% of OVC were HIV-negative, and 11.7% of OVC were OVC+. The firth's logistic regression also showed the adjusted odds of HIV+ status were significantly lower for OVC with parents/guardians having HIV+ status themselves (AOR, 0.335; 95% CI, 0.171–0.656) compared with HIV-negative parents/guardians. The adjusted odds of HIV+ status were significantly lower for OVC with a monthly household income of < $30 (AOR, 0.421; 95% CI, 0.202–0.877) compared with OVC with a monthly household income > $30.ConclusionsOur results suggest that, with the exception of a few household and parent/guardian characteristics, the risk of HIV+ status is prevalent across all groups of OVC within this study, which is consistent with the existing body of evidence showing that OVC are in general vulnerable to HIV infection. With a notable proportion of children who are single or double orphans in DRC, HIV+ OVC constitute a high-risk group that merits customized HIV services. The findings of this study provide data-driven scientific evidence to guide such customization of HIV services.

The association between internal migration and teenage fertility control: A South African study

This study investigated the association between internal migration, as a form of residential mobility, and teenage fertility in South Africa. Data were from the 2001 and 2011 South African censuses, n 2001 = 335 065 and n 2011 = 316 640, age range 12 to 19, black teenagers= 83.5% and 84.3%, respectively. Results showed that between 2001 and 2011 residential mobility increased by 12%. The teenage fertility rate significantly decreased from 47 to 39 births per 1 000 12-19-year-old females between the same period. In both years teenage fertility was at higher levels among girls that were older, employed, double orphans, and who had no schooling. Random-intercept multilevel binary logistic regression revealed that the risk of teenage fertility independently decreased as the level of residential mobility increased in communities. The protective effect of residential mobility on the risk of teenage fertility remained in 2011 but was approximately halved in magnitude compared to the effect in 2001. Findings suggest residential mobility has a protective nature that assists with teenage fertility control, and are consistent with the residential move social capital hypothesis about households that migrate to areas with better opportunities for teenagers.

Effect of care environment on educational attainment among orphaned and separated children and adolescents in Western Kenya

BackgroundThere are approximately 140 million orphaned and separated children (OSCA) around the world. In Kenya, many of these children live with extended family while others live in institutions. Despite evidence that orphans are less likely to be enrolled in school than non-orphans, there is little evidence regarding the role of care environment. This evidence is vital for designing programs and policies that promote access to education for orphans, which is not only their human right but also an important social determinant of health. The purpose of this study was to compare educational attainment among OSCA living in Charitable Children’s Institutions and family-based settings in Uasin Gishu County, Kenya.MethodsThis study analyses follow up data from a cohort of OSCA living in 300 randomly selected households and 17 institutions. We used Poisson regression to estimate the effect of care environment on primary school completion among participants age ≥ 14 as well as full and partial secondary school completion among participants age ≥ 18. Risk ratios and 95% confidence intervals were estimated using a bootstrap method with 1000 replications.ResultsThe analysis included 1406 participants (495 from institutions, 911 from family-based settings). At baseline, 50% were female, the average age was 9.5 years, 54% were double orphans, and 3% were HIV-positive. At follow-up, 76% of participants age ≥ 14 had completed primary school and 32% of participants age ≥ 18 had completed secondary school. Children living in institutions were significantly more likely to complete primary school (aRR: 1.18, 95% CI: 1.10–1.28) and at least 1 year of secondary school (aRR: 1.28, 95% CI: 1.18–1.39) than children in family-based settings. Children living in institutions were less likely to have completed all 4 years secondary school (aRR: 0.79, 95% CI: 0.43–1.18) than children in family-based settings.ConclusionChildren living in institutional environments were more likely to complete primary school and some secondary school than children living in family-based care. Further support is needed for all orphans to improve primary and secondary school completion. Policies that require orphans to leave institution environments upon their eighteenth birthday may be preventing these youth from completing secondary school.

Orphans in post-conflict Liberia: Seeking care in fractured communities.

Orphans in post-conflict settings have unique needs that have not been well-characterized. In post-conflict Liberia, maternal orphans are more likely to be without care than paternal orphans. This study examined the experiences of maternal orphans in Liberia, as they attempted to care for themselves and seek care from others, and the barriers they faced. In-depth interviews were conducted with 75 post-conflict Liberian orphans. We performed a secondary narrative analysis of interview transcripts from all maternal or double orphans (n = 17). We identified similar elements across narratives: traumatic loss, disconnection from family and community, and the desire for a savior. Female high-risk orphans were more likely to have formal substitute caregiving arrangements in which they were living with someone who was a relative or had been selected by a relative. Male orphans more commonly lacked arranged substitute care, but this allowed them to form relationships with substitute caregivers of their choosing. Sex also played a role in the provision of caregiving; substitute care was provided by women. Findings highlighted the syndemic relationship between poverty, violence, transactional sex, trauma, and substance use that traps high-risk Liberian orphans. Interventions are needed to improve access to mental health care, sober communities, housing, and education support. The need to integrate these services into indigenous institutions and address barriers related to stigma is explored.

Stunting, double orphanhood and unequal access to public services in democratic South Africa

Orphans who lack household or community support face significant socio-economic disadvantages. In particular, they are at greater risk of malnutrition and stunting in developing countries. Children who have no living parents, also called double orphans, are most likely to require support from extended families or public institutions. This paper explores how WASH infrastructure, and public health and social services relate to stunting. It is one of the first studies to analyse these factors with a specific focus on double orphans, who tend to live in under-serviced areas with high stunting rates and poor access to public resources. We collate a cross sectional spatial dataset with local child stunting rates from 2013, rates of double orphanhood, private household resources, and public services from 2011 for South Africa, a country where the HIV/AIDS pandemic has led to high rates of double orphanhood. We estimate spatial econometric models that account for unobserved regional shocks and measurement bias, but which do not address other biases. Our results show that high stunting rates, particularly in areas with high proportions of double orphans, overlap strongly with poor provision of WASH and the availability of household resources. By contrast, other softer services accessed outside the home, such as access to health, social welfare and early childhood development facilities are not correlated with stunting in the same way. WASH is more strongly related to reduced stunting when infrastructure covers larger geographic areas and with the combined use of services from adjacent areas. This occurs because of economies of scale in provision and preventing transmission of disease across regions. Policy makers can explore the option to reduce stunting by expanding geographic networks of WASH service delivery into under-serviced areas where double orphans tend to locate.

Prevalence of Depression Symptoms amongst Orphaned Adolescents at Secondary Schools in Townships of South Africa

Introduction: Depression among orphans is a matter of concern due to its impairing effect on functioning and emotions. This study determined the prevalence of depression symptoms and the extent of emotional and functional problems among orphaned adolescents in secondary schools. Methods: A cross-sectional descriptive observational design using a Children’s Depression Inventory 2 (CDI 2) test was conducted. The CDI 2 was used to measure the prevalence of depression symptoms among 301 orphaned adolescents. The CDI 2 T-scores of more than 65 indicated the presence of depression symptoms. Among 301 participants aged between 13 and 17 years old, 176 (58.4%) were females, 61% (n = 184) were double orphans, and 39% (n = 117) were maternal orphans. Results: The prevalence of depression symptoms was 21%, with 63 (20.9%) having elevated emotional problems, 77 (25.5%), elevated functional problems, 9.9% (n=30) very low self-esteem and 90% (n = 271) no self-esteem problems. Elevated negative mood was 20.6% (n = 26), 14.6% (n = 44) had an elevated level of ineffectiveness and 32.5% (n = 98) had elevated interpersonal problems. Conclusion: The results of this study preclude any conclusions about the comparison of common characteristics between orphaned and non-orphaned adolescents. The standardised tool used narrowed the number of participants of interest due to the cut-off age.

The impact of care environment on the mental health of orphaned, separated and street-connected children and adolescents in western Kenya: a prospective cohort analysis

IntroductionThe effect of care environment on orphaned and separated children and adolescents’ (OSCA) mental health is not well characterised in sub-Saharan Africa. We compared the risk of incident post-traumatic stress...

Disciplinary practices among orphaned children in Sub-Saharan Africa.

ObjectivesThis study considers whether orphans’ experiences with physically and psychologically violent discipline differ from non-orphans in sub-Saharan Africa, and to what extent national, community, household, caretaker, and child characteristics explain those differences.MethodsWe use cross-sectional Multiple Indicator Cluster Surveys (MICS) administered between 2010–2017 in 14 sub-Saharan African countries. The sample included 125,197 children, of which 2,937 were maternal orphans, 9,113 were paternal orphans, and 1,858 were double orphans. We estimate the difference between orphans and non-orphans experience of harsh discipline using multivariable logistic regressions with country fixed effects and clustered standard errors.ResultsFindings show that orphaned children experience less harsh discipline in the home. With the exception of double orphans’ experience with physically violent discipline, these differences persisted even after controlling for a rich set of child, household, and caretaker characteristics.ConclusionsWe propose two alternative explanations for our surprising findings and provide a supplementary analysis to help arbitrate between them. The evidence suggests that orphaned children (especially those with a deceased mother) are less likely to experience harsh discipline because of lower caretaker investment in their upbringing. We encourage future research to draw on in-depth interviews or household surveys with discipline data from multiple children in a home to further unpack why orphans tend to experience less harsh punishment than other children.

"I was tricked": understanding reasons for unintended pregnancy among sexually active adolescent girls

BackgroundWhile the Kenya government is mobilizing high-level strategies to end adolescent pregnancy by 2030, a clear understanding of drivers of early unintended pregnancy in the country is a necessary precursor. In this study, we determine the prevalence, associated factors, and reasons for unintended pregnancy among sexually active adolescent girls (aged 15–19 in two Kenya counties with the highest rate of teenage pregnancy.MethodsWe used the “In Their Hands” (ITH) program's baseline evaluation data. The study adopted a mixed-methods design with 1110 sexually active adolescent girls in the quantitative component and 19 girls who were either pregnant or nursing a child in the qualitative. We used adjusted and unadjusted logistic regression to model factors associated with unintended pregnancy among respondents. We used a thematic analysis of qualitative data to examine girls’ reasons for having unintended pregnancy.ResultsOverall, 42% of respondents have had an unintended pregnancy; however, higher proportions were observed among girls who were 19 years (49.4%), double orphans (53.6%), never used contraceptive (49.9%), out-of-school (53.8%), and married (55.6%). After adjusting for relevant covariates, the odds of unintended pregnancy were higher among girls who resided in rural areas (AOR 1.64, 95% CI 1.22–2.20), had primary or no formal education (AOR 1.50 95% CI 1.11–2.02), and had never used contraceptive (AOR 1.69 95% CI 1.25–2.29) compared with their counterparts. Current school attendance was associated with a 66% reduction in the probability of having an unintended pregnancy. Participants of the qualitative study stated that the desire to maintain a relationship, poor contraceptive knowledge, misinformation about contraceptive side effects, and lack of trusted mentors were the main reasons for their unintended pregnancies.ConclusionA massive burden of unintended pregnancy exists among sexually active adolescent girls in the study setting. Adolescent boys and girls need better access to sexuality education and contraceptives in the study setting to reduce early unintended pregnancy.

Orphans and their living arrangement in Indian households: Understanding their educational and nutritional status

Absence of biological parents affects a child's growth and well-being. This study examines the status of children living in the households, whose parents or either of the parents was not alive by considering their living arrangement, educational performance, and nutritional status. Orphans are mainly of three types classified by UNICEF as paternal orphans (absence of the father), maternal orphans (absence of mother), and double orphans (absence of both the parents). This study has done the comparative analysis between the orphans and non-orphans by considering their educational performances and nutritional status. The study used the data provided by the National Family Health Survey, India, 2015–16. This survey is a large scale sample survey conducted in households throughout the nation. Based on the data provided by the survey, in the age group 0 to 18 years there were 5 percent orphans (including all three types of orphans) living in the households. Living arrangement of orphans indicated that paternal and maternal orphans were found to be living with either of their alive parents, followed by grandparents, whereas double orphans were living with their extended family members or grandparents. Educational performances were compared for both the types of children and it was found that children who never attended school and the school dropout rates, both were higher among the orphans compared to non-orphans. In terms of nutritional status orphans were lagging behind the non-orphans, in all three indicators, i.e. stunting, wasting and underweight. Thus focused interventions are required for the betterment and welfare of orphans living within the households as the demise of either of the parent creates a void in the early years of life which ultimately affects the child’s overall development.

Psychological Distress Among Orphaned Youth and Youth Reporting Sexual Exploitation in Kampala, Uganda.

Psychological distress is a priority health issue in low- and middle-income countries; however, it is inadequately addressed among vulnerable youth living in extremely underserved communities (i.e., on the streets and in the slums) who are at a high risk of experiencing adversity. The purpose of this study was to compute the prevalence of self-reported psychological distress among youth living in the slums of Kampala, Uganda, and examine how orphan status and commercial sexual exploitation (CSE) are related to youth psychological distress. Analyses are based on a 2014 cross-sectional survey of service-seeking youth (N = 1134) in Kampala, Uganda. Bivariate and multivariable multinomial regression analyses were used to determine associations between orphan status, sexual exploitation, and psychological distress (defined as experiencing the following proxy variables for more complex psychopathology: hopelessness and/or worry). Among all youth participants, 83.2% (n = 937) reported at least one type of psychological distress; 51.3% (n = 578) reported experiencing both types. The reported prevalence of any type of psychological distress was highest among youth who reported experiencing sexual exploitation (91.2%), double orphans (90.0%), and single orphans (83.8%); however, a high prevalence (76.7%) of any type of distress was also found among youth who reported both parents alive. Experiencing both types of distress was associated with being a double orphan (adjusted odds ratio [AOR] = 2.92, 95% confidence interval [CI] = [1.77, 4.81]), reporting CSE (AOR = 2.71, 95% CI = [1.67, 4.41]), and increased age (AOR = 1.31, 95% CI = [1.20, 1.44]). Psychological distress is prevalent among all youth living in the slums of Kampala and is independently associated with being a double orphan and experiencing CSE. These findings underscore the urgent need to intervene with all youth who reside in this particular underserved community, especially those who have lost both parents, and to prevent CSE among this vulnerable, underserved population.

Evaluation of a savings-led family-based economic empowerment intervention for AIDS-affected adolescents in Uganda: A four-year follow-up on efficacy and cost-effectiveness.

Children who have lost a parent to HIV/AIDS, known as AIDS orphans, face multiple stressors affecting their health and development. Family economic empowerment (FEE) interventions have the potential to improve these outcomes and mitigate the risks they face. We present efficacy and cost-effectiveness analyses of the Bridges study, a savings-led FEE intervention among AIDS-orphaned adolescents in Uganda at four-year follow-up. Intent-to-treat analyses using multilevel models compared the effects of two savings-led treatment arms: Bridges (1:1 matched incentive) and BridgesPLUS (2:1 matched incentive) to a usual care control group on the following outcomes: self-rated health, sexual health, and mental health functioning. Total per-participant costs for each arm were calculated using the treatment-on-the-treated sample. Intervention effects and per-participant costs were used to calculate incremental cost-effectiveness ratios (ICERs). Among 1,383 participants, 55% were female, 20% were double orphans. Mean age was 12 years at baseline. At 48-months, BridgesPLUS significantly improved self-rated health, (0.25, 95% CI 0.06, 0.43), HIV knowledge (0.21, 95% CI 0.01, 0.41), self-concept (0.26, 95% CI 0.09, 0.44), and self-efficacy (0.26, 95% CI 0.09, 0.43) and lowered hopelessness (-0.28, 95% CI -0.43, -0.12); whereas Bridges improved self-rated health (0.26, 95% CI 0.08, 0.43) and HIV knowledge (0.22, 95% CI 0.05, 0.39). ICERs ranged from $224 for hopelessness to $298 for HIV knowledge per 0.2 standard deviation change. Most intervention effects were sustained in both treatment arms at two years post-intervention. Higher matching incentives yielded a significant and lasting effect on a greater number of outcomes among adolescents compared to lower matching incentives at a similar incremental cost per unit effect. These findings contribute to the evidence supporting the incorporation of FEE interventions within national social protection frameworks.

The orphan impact: HIV-AIDS and student test scores from sub-Saharan Africa

ABSTRACT In sub-Saharan Africa over 52 million children are living with the death of one or both parents. Drivers of this parental mortality include afflictions at levels endemic to the region, including: HIV; malaria and other parasites; lower respiratory infections; diarrhoeal illnesses; and road accidents, among others. This paper examines the impact of orphanhood on learning outcomes among girls and boys in sub-Saharan Africa, conditional on school enrolment. By analysing test scores for approximately 60,000 pupils in 12 countries, we estimate the effect on student test scores by comparing paternal, maternal, and double orphans to non-orphans in the sample, specifically for the subjects of reading, mathematics, and HIV-AIDS knowledge. No previous study has analysed how orphanhood might influence learning by using student test score data, making this paper’s approach unique in the literature. This study employs two estimation techniques: Coarsened exact matching calculates the sample average treatment effect on the treated, while matching on students’ family structure, household wealth, school resources, and geographic location; and double lasso (DL) regression applies applying machine-learning for variable selection with high-dimensional controls for regional and school identifiers, school location, and student age. Our results show both CEM and DL consistently report a significant negative impact of orphanhood on test scores among specific countries, especially those which faltered in addressing the HIV-AIDS crisis.

Clinico-Epidemiological Profile of Children Orphaned due to AIDS Residing in Care Giving Institutions in Coastal South India.

Background HIV/AIDS has a greater impact on children. Besides being orphaned by the untimely demise of one or both parents due to the disease, these children are more prone for discrimination by the society. Methods In this cross-sectional study 86 children orphaned by AIDS residing in care giving institutions for HIV positive children in Mangalore were assessed for their clinico-epidemiological profile and nutritional status. Institutional Ethics Committee clearance was obtained before the commencement of the study. The collected data were analyzed using SPSS (Statistical Package for Social Sciences) version 11.5 and the results expressed in mean (standard deviation) and proportions. BMI was calculated and nutritional status assessed using WHO Z scores (BMI for Age) for children between 5 and 19 years separately for boys and girls. Results The mean age of the children was 13.2 ± 3 years. Majority (n = 56, 65.1%) of the children were double orphans. Most of the children orphaned by AIDS (n = 78, 90.7%) had a history of both the parents being HIV positive. The median CD4 count of participants at the time of our study was 853.5 (IQR 552–1092) cells/microliter. A higher percentage of orphans were malnourished compared to nonorphans. (41.1% vs. 36.7%). All the educational institutions, wherein the children orphaned by AIDS were enrolled, were aware about their HIV status. Five of the participants felt discriminated in their schools. Only two of the participants felt discriminated by their friends because of their HIV status. Conclusion From our study we draw conclusion that even though the children orphaned due to AIDS are rehabilitated in terms of having shelter and provision of education and health care, much needs to be done in terms of improving the nutritional status of these children and alleviating the discriminatory attitude of the society towards them.