AIDS orphans in Kinshasa, Zaïre: incidence and socioeconomic consequences.
OBJECTIVE
To determine the incidence, morbidity, mortality, and socioeconomic consequences of becoming an AIDS orphan (a child with an HIV-1-seropositive mother who has died) in Kinshasa, Zaïre.


METHODS
A longitudinal cohort study was undertaken between 1986 and 1990. Within this cohort, a nested case-control study of AIDS orphans was performed. AIDS orphan cases were children with an HIV-1-seropositive mother who had died. Two groups of control children were identified. The first group of control children were age-matched children with HIV-1-seropositive mothers who were alive at the time of death of the AIDS orphan case mother. The second group of control children were children with HIV-1-seronegative mothers who were also alive at the time of death of the AIDS orphan case mother.


METHODS
Obstetric ward and follow-up clinic at two large municipal hospitals in Kinshasa, Zaïre.


METHODS
A total of 466 HIV-1-seropositive women, their children, and the fathers of these children; 606 HIV-1-seronegative women, their children, and the fathers of these children.


METHODS
AIDS orphan incidence, HIV-1 vertical transmission rate, morbidity, mortality and socioeconomic indicators of the consequences of becoming an AIDS orphan.


RESULTS
The AIDS orphan incidence rate was 8.2 per 100 HIV-1-seropositive women-years of follow-up. Vertical transmission of HIV-1 was higher in AIDS orphan cases (41%) than in control children with HIV-1-seropositive mothers (26%; P < 0.05). Among children without vertically acquired HIV-1 infection, morbidity rates and indices of social and economic well-being were similar in AIDS orphans and control children. Five out of 26 (19%) AIDS orphan cases died during follow-up, compared with three out of 52 (6%) control children (P < 0.05).


CONCLUSIONS
During a 3-year follow-up period, children with HIV-1-seropositive mothers had a considerable risk of becoming an AIDS orphan. However, the presence of a concerned extended family appeared to minimize any adverse health and socioeconomic effects experienced by orphan children.
Ryder
R W
RW
Project SIDA, Department of Public Health, Kinshasa, Zaïre.
Kamenga
M
M
Nkusu
M
M
Batter
V
V
Heyward
W L
WL
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology*; D000293:Adolescent; D000300:Adoption; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002668:Child Rearing; D016241:Child of Impaired Parents; D002675:Child, Preschool; D015331:Cohort Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005192:Family Health; D005260:Female; D015658:HIV Infections / Q000151:congenital / Q000453:epidemiology / Q000635:transmission; D015497:HIV-1; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010298:Parity; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D012306:Risk; D012959:Socioeconomic Factors; D014505:Urban Population