title: The social and economic impact of parental HIV on children in northern Malawi: retrospective population-based cohort study.
abstract: From population-based surveys in the 1980s in Karonga district, northern Malawi, 197 'index individuals' were identified as HIV-positive. 396 HIV-negative 'index individuals' were selected as a comparison group. These individuals, and their spouses and children, were followed up in 1998-2000. 582 of 593 index individuals were traced. 487 children of HIV-positive, and 1493 children of HIV-negative, parents were included in analyses. Rates of paternal, maternal, and double orphanhood among children with one or both parents HIV-positive were respectively 6, 8, and 17 times higher than for children with HIV-negative parents. Around 50% of children living apart from both parents had a grandparent as their guardian; for most of the rest the guardian was an aunt, uncle, or sibling. There were no child-headed households. Almost all children aged 6-14 were attending primary school. There was no evidence that parental HIV affected primary school attainment among children <15 years old. Children of HIV-positive parents were less likely to have attended secondary school than those of HIV-negative parents. The extended family has mitigated the impact of orphanhood on children, but interventions to reduce the incidence of orphanhood, and/or which strengthen society's ability to support orphans, are essential, especially as the HIV epidemic matures and its full impact is felt.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK. sian.floyd@lshtm.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Floyd
authors.forename: A C
authors.initials: AC
authors.lastname: Crampin
authors.forename: J R
authors.initials: JR
authors.lastname: Glynn
authors.forename: N
authors.initials: N
authors.lastname: Madise
authors.forename: M
authors.initials: M
authors.lastname: Mwenebabu
authors.forename: S
authors.initials: S
authors.lastname: Mnkhondia
authors.forename: B
authors.initials: B
authors.lastname: Ngwira
authors.forename: B
authors.initials: B
authors.lastname: Zaba
authors.forename: P E M
authors.initials: PE
authors.lastname: Fine
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005581:Foster Home Care / Q000191:economics / Q000706:statistics & numerical data; D015658:HIV Infections / Q000453:epidemiology / Q000401:mortality*; D006679:HIV Seropositivity / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007223:Infant; D008295:Malawi / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012423:Rural Health / Q000592:standards*; D012923:Social Class