title: Orphan care in Botswana's working households: growing responsibilities in the absence of adequate support.
abstract: OBJECTIVE
  Botswana has one of the world's highest HIV-prevalence rates and the world's highest percentages of orphaned children among its population. We assessed the ability of income-earning households in Botswana to adequately care for orphans.
  
  
  METHODS
  We used data from the Botswana Family Health Needs Study (2002), a sample of 1033 working adults with caregiving responsibilities who used public services, to assess whether households with orphan-care responsibilities encountered financial and other difficulties. Thirty-seven percent of respondents provided orphan care, usually to extended family members. We applied logistic regression models to determine the factors associated with experiencing problems related to orphan caregiving.
  
  
  RESULTS
  Nearly half of working households with orphan-care responsibilities reported experiencing financial and other difficulties because of orphan care. Issues of concern included caring for multiple orphans, caring for sick adults and orphans simultaneously, receiving no assistance, and low income.
  
  
  CONCLUSIONS
  The orphan crisis is impoverishing even working households, where caregivers lack sufficient resources to provide basic needs. Neither the public sector nor communities provide adequate safety nets. International assistance is critical to build capacity within the social welfare infrastructure and to fund community-level activities that support households. Lessons from Botswana's orphan crisis can provide valuable insights to policymakers throughout sub-Saharan Africa.
authors.affiliation: Department of Society, Human Development, and Health at the Harvard School of Public Health, Boston, Mass, USA. candace_miller@post.harvard.edu
authors.forename: Candace M
authors.initials: CM
authors.lastname: Miller
authors.forename: Sofia
authors.initials: S
authors.lastname: Gruskin
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.forename: Divya
authors.initials: D
authors.lastname: Rajaraman
authors.forename: S Jody
authors.initials: SJ
authors.lastname: Heymann
mesh_terms: D000293:Adolescent; D000328:Adult; D001902:Botswana / Q000453:epidemiology; D017028:Caregivers / Q000191:economics* / Q000706:statistics & numerical data; D002648:Child; D002654:Child Care / Q000191:economics*; D002675:Child, Preschool; D017281:Cost of Illness; D005191:Family Characteristics; D005382:Financing, Personal; D005581:Foster Home Care / Q000191:economics*; D015658:HIV Infections / Q000191:economics / Q000401:mortality*; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000191:economics; D007231:Infant, Newborn; D011203:Poverty / Q000706:statistics & numerical data*; D015995:Prevalence; D011632:Public Assistance / Q000706:statistics & numerical data*; D011640:Public Policy; D012946:Social Welfare / Q000191:economics*