title: The incidence and prevalence of orphanhood associated with parental HIV infection: a population-based study in Rakai, Uganda.
abstract: BACKGROUND
  There are limited empirical data on the prevalence and incidence of orphanhood due to parental HIV infection.
  
  
  OBJECTIVE
  To assess the prevalence and incidence of orphanhood, and the population attributable fraction (PAF) of incident orphanhood associated with parental HIV infection, in a rural population with a 14.8% adult HIV prevalence.
  
  
  METHODS
  The data are derived from a community cohort in Rakai District, Uganda. Census data were collected on all resident members in 10,657 households, including survival of parents of resident children in 1996/1997. Consenting adults were interviewed, provided blood for HIV testing, and were followed up 10 months later to determine parental death and incident orphanhood. The incidence rate ratio (IRR) of orphanhood associated with parental HIV-infection was estimated by Poisson multivariate regression.
  
  
  RESULTS
  A total of 22,712 children aged 0-14 years were enumerated in 1996/1997. The overall prevalence of orphanhood was higher among children of HIV-infected parents (22.7%) compared with children of uninfected parents, 7.9%. The annual incidence of orphanhood was 8.2% if at least one parent was HIV positive, and 0.5% if both parents were HIV negative (adjusted IRR = 18.93). Older age of children, and older maternal age were significantly associated with an increased risk of orphanhood. The PAF of incident orphanhood due to parental HIV infection was 37.3%, and was highest among younger children (adjusted PAF = 50.6% for 0-4 year olds), and children with younger mothers aged < 25 years (adjusted PAF = 75.7%).
  
  
  CONCLUSIONS
  Parental HIV infection markedly increased the incidence of orphanhood, especially among younger children and the children of younger mothers.
authors.affiliation: Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda.
authors.forename: Fredrick E
authors.initials: FE
authors.lastname: Makumbi
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kiddugavu
authors.forename: Nelson K
authors.initials: NK
authors.lastname: Sewankambo
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001601:Bereavement; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005192:Family Health; D005260:Female; D005581:Foster Home Care / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D008875:Middle Aged; D010290:Parents; D012423:Rural Health / Q000706:statistics & numerical data; D014454:Uganda / Q000453:epidemiology