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

Gabriela Mejia-Pailles · Ann M. Berrington · Nuala M. McGrath · Victoria Hosegood

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Poverty, Education, and Child Welfare HIV/AIDS Research and Interventions Grief, Bereavement, and Mental Health

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.

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2004Orphans in Africa: parental death, poverty, and school enrollment 2011South African Child Gauge 2008/2009 n.d.Labor Supply Responses to Large Social Transfers: Longitudinal Evidence from South Africa 2006The impact of parental death on school outcomes: Longitudinal evidence from South Africa 2009Dispensing with marriage: Marital and partnership trends in rural KwaZulu-Natal, South Africa 2000-2006 2005The reach and impact of Child Support Grants: evidence from KwaZulu-Natal 2011Persisting mental health problems among AIDS‐orphaned children in South Africa 1998Households, gender and rural-urban migration: reflections on linkages and considerations for policy

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