title: Who is the vulnerable child? Using survey data to identify children at risk in the era of HIV and AIDS.
abstract: Over the past decade, there has been increasing global attention to mitigating the impacts of the HIV/AIDS epidemic on children's lives. Within this context, developing and tracking global child vulnerability indicators in relation to HIV and AIDS has been critical in terms of assessing need and monitoring progress. Although orphanhood and adult household illness (co-residence with a chronically ill or HIV-positive adult) are frequently used as markers, or definitions, of vulnerability for children affected by HIV and AIDS, evidence supporting their effectiveness has been equivocal. Data from 60 nationally representative household surveys (36 countries) were analyzed using bivariate and multivariate methods to establish if these markers consistently identified children with worse outcomes and also to identify other factors associated with adverse outcomes for children. Outcome measures utilized were wasting among children aged 0-4 years, school attendance among children aged 10-14 years, and early sexual debut among adolescent boys and girls aged 15-17 years. Results indicate that orphanhood and co-residence with a chronically ill or HIV-positive adult are not universally robust measures of child vulnerability across national and epidemic contexts. For wasting, early sexual debut, and to a lesser extent, school attendance, in the majority of surveys analyzed, there were few significant differences between orphans and non-orphans or children living with chronically ill or HIV-positive adults and children not living with chronically ill or HIV-positive adults. Of other factors analyzed, children living in households where the household head or eldest female had a primary education or higher were significantly more likely to be attending school, better household health and sanitation was significantly associated with less wasting, and greater household wealth was significantly associated both with less wasting and better school attendance. Of all marker of child vulnerability analyzed, only household wealth consistently showed power to differentiate across age-disaggregated outcomes. Overall, the findings indicate the need for a multivalent approach to defining child vulnerability, one which incorporates household wealth as a key predictor of child vulnerability.
authors.affiliation: Statistics & Monitoring Section, UNICEF, New York, NY, USA. pakwara@unicef.org
authors.forename: Priscilla Atwani
authors.initials: PA
authors.lastname: Akwara
authors.forename: Behzad
authors.initials: B
authors.lastname: Noubary
authors.forename: Patricia
authors.initials: P
authors.lastname: Lim Ah Ken
authors.forename: Kiersten
authors.initials: K
authors.lastname: Johnson
authors.forename: Rachel
authors.initials: R
authors.lastname: Yates
authors.forename: William
authors.initials: W
authors.lastname: Winfrey
authors.forename: Upjeet Kaur
authors.initials: UK
authors.lastname: Chandan
authors.forename: Doreen
authors.initials: D
authors.lastname: Mulenga
authors.forename: Jimmy
authors.initials: J
authors.lastname: Kolker
authors.forename: Chewe
authors.initials: C
authors.lastname: Luo
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D016241:Child of Impaired Parents; D054540:Child, Orphaned; D002675:Child, Preschool; D002908:Chronic Disease; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006304:Health Status; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D012725:Sexual Behavior; D035862:Vulnerable Populations; D019282:Wasting Syndrome