Paternal Orphans Research Articles

Comparison of household-survey estimates with projections of mortality and orphan numbers in sub-Saharan Africa in the era of HIV/AIDS

The United Nations publishes estimates of HIV prevalence, AIDS mortality, and orphan numbers for all countries of the world. It is important to assess the validity of these model-based estimates since they underpin much policy concerned with care and prevention. Household surveys that ask questions about the survival of children’s parents (orphanhood) offer an independent source of data with which these estimates can be compared. Survey estimates of maternal and paternal orphans are significantly lower than model estimates for 40 surveys in 36 countries of sub-Saharan Africa (p < 0.001, p = 0.002). This is probably because adult mortality from causes other than AIDS is lower than assumed in the models, although under-reporting of orphanhood in surveys may also play a role. Reducing adult mortality from causes other than AIDS brings the model estimates into close agreement with the surveys. This suggests that the fraction of orphans attributable to AIDS is greater than estimated previously.

Orphanhood and childcare patterns in sub-Saharan Africa: an analysis of national surveys from 40 countries.

Assess the impact of AIDS on prevalence of orphanhood and care patterns. Descriptive analysis of nationally representative household surveys from 40 countries in sub-Saharan Africa. Overall 9% of children under 15 years have lost at least one parent in sub-Saharan Africa. On average one in six households with children are caring for orphans. Orphans more frequently live in households that are female-headed, larger, and have a less favourable dependency ratio. The head of the household is considerably older. Child caring practices differ between countries, and between non-orphans and orphans. Based on the country medians, almost nine out of 10 non-orphans live with their mother and eight out of 10 non-orphans live with their father. Single orphans are less likely to live with their surviving parent: three out of four paternal orphans live with their mother and just over half of maternal orphans live with their father. The (extended) family takes care of over 90% of the double orphans. Orphans are approximately 13% less likely to attend school than non-orphans. Double orphans are most likely to be disadvantaged. The epidemic has caused rapid recent increases in the prevalence of orphanhood. Prevailing childcare patterns have dealt with large numbers of orphans in the past, and to date there is no consistent evidence that this system is not absorbing the increase in orphans on a large scale. Yet, there is some evidence that orphans as a group are especially vulnerable, as they live in households with less favourable demographic characteristics and have lower school attendance.

Orphans' household circumstances and access to education in a maturing HIV epidemic in eastern Zimbabwe

Levels of orphanhood and patterns of different forms of orphanhood (namely, double, paternal and maternal) will change as an HIV epidemic progresses. The implications of different forms of orphanhood for children's development will also change as the cumulative impact of a period of sustained high morbidity and mortality takes its toll on the adult population. In this article we describe patterns of orphanhood and orphans' educational experience in populations in eastern Zimbabwe subject to a major HIV epidemic which is maturing into its endemic phase. Levels of orphanhood have grown recently but rates of maternal and double orphanhood, in particular, are likely to continue to increase for several years to come. Orphans are found disproportionately in rural, female-, elderly- and adolescent-headed households. Each of these is a risk factor for more extreme poverty. The over-representation in rural areas could reflect urban-rural migration around the time of death of the parent due to loss of income and the high cost of living in towns. Over-representation in female-, elderly- and adolescent-headed households reflects the predisposition of men to seek employment in towns, estates and mines; the higher level of paternal orphanhood; the reluctance of second wives to take responsibility for their predecessors' children and stress in the extended family system. The death of the mother was found to have a strong detrimental effect on a child's chances of completing primary school education-the strength of effect increasing with time since maternal death. The death of the father had no detrimental effect, despite the fact that paternal orphans were typically found in the poorest households. African Journal of Social Work Vol.18(2) 2003: 7-32

Health and nutritional status of orphans

One of the consequences of the HIV/AIDS epidemic in sub-Saharan Africa is the increase in the number of orphans, estimated to have reached 6-11% of children <15 years old in 2000. Orphans who stay in their communities may be at increased risk for poor health due to reduced circumstances and loss of parental care. We have used data from a population-based study in rural western Kenya to compare basic health and nutritional indicators between non-orphaned children <6 years old and children who lost either or both of their parents. In June 2000, all children <6 years old who had been recruited for a cross-sectional survey in 60 villages of Rarieda Division, western Kenya, in June 1999 were invited to return for a follow-up survey. Basic demographic characteristics, including the vital status of the child's parents, and health histories were requested from all 1190 participants of the follow-up survey, along with a finger-prick blood sample for determination of malaria parasite status and haemoglobin (Hb) levels. Height-for-age (H/A) and weight-for-height (W/H) Z-scores were also calculated from anthropometric measurements. Overall, 7.9% of the children had lost one or both their parents (6.4% had lost their father, 0.8% had lost their mother and 0.7% had lost both parents). While there was no difference between orphans and non-orphans regarding most of the key health indicators (prevalence of fever and malaria parasitaemia, history of illness, Hb levels, H/A Z scores), W/H Z-scores in orphans were almost 0.3 standard deviations lower than those of non-orphans. This association was more pronounced among paternal orphans and those who had lost a parent more than 1 year ago. These results suggest that the health status of surviving orphans living in their community is similar to that of the non-orphan population, but longitudinal cohort studies should be conducted to determine better the overall impact of orphanhood on child health.

Estimation of Adult Mortality From Orphanhood Before and Since Marriage

The orphanhood method has proved an important source of adult mortality estimates in countries without adequate vital registration systems, but produces rather out-of-date results and is prone to under-reporting of orphanhood at young ages (the ‘adoption effect’). In this paper we investigate whether a brief and straightforward supplementary question about the timing of the deaths of women's parents relative to first marriage can be used to study these problems. Coefficients are presented for estimating adult mortality from maternal and paternal orphanhood before and since marriage. Estimation of the time location of the results is discussed, and the methods are applied to data from Morocco, Burundi and Uganda. The results are promising. Data on orphanhood since marriage reflect more recent mortality than lifetime data and are less subject to the adoption effect. When it is accurately reported, information on orphanhood before marriage yields a series of mortality estimates that extends back at least 30 y...

Aids-related kaposi’s sarcoma in a four year old child: the challenge of a missed opportunity

Background: AIDSrelated Kaposi’s sarcoma (KS) is an AIDS-defining illness and is now increasingly recognized in children infected with HIV. Many of these cases are missed due to low index of suspicion. Vertical transmission of HIV is the commonest route of transmission in children and this is preventable by early maternal antenatal diagnosis, early commencement of HAART by the mother and adoption of the safest possible mode of delivery. The index case did not benefit from these services, making her acquire HIV and then develop AIDS-defining illness (KS) at a tender age of 4 years.Aim and objective: The study is aimed at emphasizing the need for all pregnant women to have antenatal screening as soon as pregnancy is confirmed so as to prevent vertical transmission of HIV to the unborn child. It is also aimed at creating awareness in clinical practice so as to increase index of suspicion among clinicians when evaluating chronically ill children.Case Description: GG was a 4year old girl who presented at 108 Nigerian Air force Hospital, Abuja with non-itchy skin rashes of two weeks duration, generalized body swelling, cough and haematochezia of one week duration, and fever of four days duration. She was a paternal orphan having lost her father a year prior to presentation to Acquired immunodeficiency syndrome (AIDS)-related illness. Her mother also tested positive to Human Immunodeficiency virus (HIV) and has been on highly active anti-retroviral therapy (HAART) for a year. Physical examination revealed moderate pallor, bilateral pitting pedal oedema, and matted non-tender peripheral lymphadenopathy. There were papular and nodular skin lesions with a reddish solid lesion on the hard palate. She tested positive to HIV. Abdominal ultrasound scan revealed moderate hepatomegaly with ascites, while chest x-ray showed bilateral interstitial pneumonitis, right hilar lymphadenopathy, right pulmonary nodule and ipsilateral pleural effusion. Excisional biopsy of one of the skin nodules confirmed the diagnosis of Kaposi’s sarcoma. She was commenced on HAART and antibiotics, with a unit of blood transfused. Her condition deteriorated, which necessitated referral to university of Abuja Teaching Hospital where she eventually died after a day of admission.Conclusion: Paediatric AIDSrelated KS is becoming increasingly common in Nigeria and as such, high index of suspicion is required while evaluating pediatric patients. This, coupled with early commencement of HAART is required to avert the pitfalls observed in this case; bearing in mind that childhood AIDSrelated KS is lethal.Keywords: Generalized lymphadenopathy; Kaposi’s sarcoma; Missed opportunity; Paediatric AIDS; Skin rashes