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

Trends in the prevalence and incidence of orphanhood in children and adolescents <20 years in rural KwaZulu-Natal South Africa, 2000-2014.
Trends in the prevalence and incidence of orphanhood in children and adolescents <20 years in rural KwaZulu-Natal South Africa, 2000-2014.
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 (<20 years) and, overall and cause-specific mortality of parents by age.

Results

The proportion of children and adolescents (<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 (<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 <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.

1932-6203
Mejia-Pailles, Gabriela
522e038a-d83d-433c-8132-c25009239948
Berrington, Ann
bd0fc093-310d-4236-8126-ca0c7eb9ddde
Mcgrath, Nuala
b75c0232-24ec-443f-93a9-69e9e12dc961
Hosegood, Victoria
c59a89d5-5edc-42dd-b282-f44458fd2993
Mejia-Pailles, Gabriela
522e038a-d83d-433c-8132-c25009239948
Berrington, Ann
bd0fc093-310d-4236-8126-ca0c7eb9ddde
Mcgrath, Nuala
b75c0232-24ec-443f-93a9-69e9e12dc961
Hosegood, Victoria
c59a89d5-5edc-42dd-b282-f44458fd2993

Mejia-Pailles, Gabriela, Berrington, Ann, Mcgrath, Nuala and Hosegood, Victoria (2020) Trends in the prevalence and incidence of orphanhood in children and adolescents <20 years in rural KwaZulu-Natal South Africa, 2000-2014. PLoS ONE, 15 (11), [PONE-D-19-23466R2].

Record type: Article

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 (<20 years) and, overall and cause-specific mortality of parents by age.

Results

The proportion of children and adolescents (<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 (<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 <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.

Text
PONE-D-19-23466R2_FTC (1) - Accepted Manuscript
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More information

Accepted/In Press date: 11 November 2020
e-pub ahead of print date: 24 November 2020

Identifiers

Local EPrints ID: 443704
URI: http://eprints.soton.ac.uk/id/eprint/443704
ISSN: 1932-6203
PURE UUID: dd85e308-0786-4c87-8c3d-9f7c8155b6df
ORCID for Ann Berrington: ORCID iD orcid.org/0000-0002-1683-6668
ORCID for Nuala Mcgrath: ORCID iD orcid.org/0000-0002-1039-0159
ORCID for Victoria Hosegood: ORCID iD orcid.org/0000-0002-2244-2518

Catalogue record

Date deposited: 09 Sep 2020 16:32
Last modified: 18 Feb 2021 17:21

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Contributors

Author: Gabriela Mejia-Pailles
Author: Ann Berrington ORCID iD
Author: Nuala Mcgrath ORCID iD

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