title: Poverty, AIDS and child health: identifying highest-risk children in South Africa.
abstract: BACKGROUND
  Identifying children at the highest risk of negative health effects is a prerequisite to effective public health policies in Southern Africa. A central ongoing debate is whether poverty, orphanhood or parental AIDS most reliably indicates child health risks. Attempts to address this key question have been constrained by a lack of data allowing distinction of AIDS-specific parental death or morbidity from other causes of orphanhood and chronic illness.
  
  
  OBJECTIVE
  To examine whether household poverty, orphanhood and parental illness (by AIDS or other causes) independently or interactively predict child health, developmental and HIV-infection risks.
  
  
  METHODS
  We interviewed 6 002 children aged 10 - 17 years in 2009 - 2011, using stratified random sampling in six urban and rural sites across three South African provinces. Outcomes were child mental health risks, educational risks and HIV-infection risks. Regression models that controlled for socio-demographic co-factors tested potential impacts and interactions of poverty, AIDS-specific and other orphanhood and parental illness status.
  
  
  RESULTS
  Household poverty independently predicted child mental health and educational risks, AIDS orphanhood independently predicted mental health risks and parental AIDS illness independently predicted mental health, educational and HIV-infection risks. Interaction effects of poverty with AIDS orphanhood and parental AIDS illness were found across all outcomes. No effects, or interactions with poverty, were shown by AIDS-unrelated orphanhood or parental illness.
  
  
  CONCLUSIONS
  The identification of children at highest risk requires recognition and measurement of both poverty and parental AIDS. This study shows negative impacts of poverty and AIDS-specific vulnerabilities distinct from orphanhood and adult illness more generally. Additionally, effects of interaction between family AIDS and poverty suggest that, where these co-exist, children are at highest risk of all.
authors.affiliation: Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, UK; Department of Psychiatry and Mental Health, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Health Economics and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa. lucie.cluver@spi.ox.ac.uk.
authors.forename: Lucie
authors.initials: L
authors.lastname: Cluver
authors.forename: Mark
authors.initials: M
authors.lastname: Boyes
authors.forename: Mark
authors.initials: M
authors.lastname: Orkin
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sherr
mesh_terms: D000163:Acquired Immunodeficiency Syndrome; D000293:Adolescent; D000328:Adult; D002648:Child; D002657:Child Development; D002669:Child Welfare / Q000706:statistics & numerical data*; D016241:Child of Impaired Parents / Q000523:psychology / Q000706:statistics & numerical data; D054540:Child, Orphaned / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008603:Mental Health / Q000706:statistics & numerical data*; D020380:Needs Assessment; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data; D036301:Qualitative Research; D011897:Random Allocation; D018570:Risk Assessment; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology