Trends in the prevalence and incidence of orphanhood in children and adolescents <20 years in rural KwaZulu-Natal South Africa, 2000-2014

Abstract

Background In South Africa, large increases in early adult mortality during the 1990s and early 2000s have reversed since public HIV treatment rollout in 2004. In a rural population in KwaZulu-Natal, we investigate trends in parental mortality and orphanhood from 2000–2014. Methods Using longitudinal demographic surveillance data for a population of approximately 90,000, we calculated annual incidence and prevalence of maternal, paternal and double orphanhood in children and adolescents (&lt;20 years) and, overall and cause-specific mortality of parents by age. Results The proportion of children and adolescents (&lt;20 years) for whom one or both parents had died rose from 26% in 2000 to peak at 36% in 2010, followed by a decline to 32% in 2014. The burden of orphanhood remains high especially in the oldest age group: in 2014, 53% of adolescents 15–19 years had experienced the death of one or both parents. In all age groups and years, paternal orphan prevalence was three-five times higher than maternal orphan prevalence. Maternal and paternal orphan incidence peaked in 2005 at 17 and 27 per 1,000 person years respectively (&lt;20 years) before declining by half through 2014. The leading cause of parental death throughout the period, HIV/AIDS and TB cause-specific mortality rates declined substantially in mothers and fathers from 2007 and 2009 respectively. Conclusions The survival of parents with children and adolescents &lt;20 years has improved in tandem with earlier initiation and higher coverage of HIV treatment. However, comparatively high levels of parental deaths persist in this rural population in KwaZulu-Natal, particularly among fathers. Community-level surveillance to estimate levels of orphanhood remains important for monitoring and evaluation of targeted state welfare support for orphans and their guardians.

Global and regional estimates of orphans attributed to maternal cancer mortality in 2020

“…To avoid stigmatizing children, most programs serve those who have been orphaned by any cause, which would include those orphaned due to cancer. The current estimates indicate that many HIV-endemic countries are indeed grappling with large numbers of maternal orphans due to cancer 32 . These observations agree with our estimates, as the highest corresponding risks were in East and Southern Africa.…”

The effects of HIV/AIDS family dysfunction trajectories and psychosocial wellbeing among adolescents in Ghana: the mediating role of child maltreatment

“…The correlations between parental HIV/AIDS illness or death and psychosocial wellness have not, however, been explored in a single study to test the potential mediating effect of child abuse. Research on the mechanisms through which developmental trajectories of family disruption (parental HIV/AIDS infection or death) affect psychological health in the context of child abuse is clearly lacking [27].…”

Child maltreatment mediates the relationship between HIV/AIDS family dysfunction trajectories and psychosocial problems among adolescents

“…The correlations between parental HIV/AIDS illness or death and psychosocial wellness have not, however, been explored in a single study to test the potential mediating effect of child abuse. Research on the mechanisms through which developmental trajectories of family disruption (parental HIV/AIDS infection or death) affect psychological health in the context of child maltreatment is clearly lacking [27]. In the present study, child maltreatment is defined as the abuse and neglect that are inflicted by adults to children under 18 years of age.…”