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This is the first description of the effects of adult morbidity and mortality on children residing in Soweto, an urban African setting in South Africa, in the era of HIV/AIDS. We conducted a prospective cross-sectional household survey in Soweto identified by a stratified, two-stage cluster sample. In total, 4912 households were surveyed: 4501 households with children and 411 households with no children under the age of 16 years. We present detailed information on 22 724 individuals. Forty-four per cent of all households were classified as sick households, i.e., had at least one sick adult. Twenty-two per cent of all adults were categorized as being sick; 12% reported being ill from an HIV/AIDS or tuberculosis (TB)-related illness in the past month. Women contributed 61% of all illness. Eleven per cent of children had lost a parent. In sick households, child health was adversely affected (increased vulnerability to disease, p < 0.0001; incomplete immunizations p = 0.02). Children from sick households were less likely to have their school fees paid (p = 0.0001); were more likely to be absent from school (p < 0.0001), be unsupervised while doing homework (p = 0.01); and go hungry (p < 0.0001). Abuse occurred more frequently in sick households (p < 0.0001). Children with deceased parents were more likely to have had HIV/AIDS-related symptoms or be HIV infected (p = 0.002), go hungry (p < 0.0001) and face abuse (p = 0.03). From this study we conclude that the health, education and welfare of children is compromised in sick households and in households where parents have died. HIV infection has impacted negatively on the children in Soweto.
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