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Poverty, AIDS and child health: identifying highest-risk children in South Africa
Lucie Cluver1, Mark Boyes, Mark Orkin
1Centre 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.
Insights
Poverty and parental AIDS, not just orphanhood, are key indicators of child health risks in Southern Africa. Children facing both poverty and parental AIDS face the highest risks.
Area of Science:
- Public Health
- Child Health and Development
- Epidemiology
Background:
- Effective public health policies in Southern Africa require identifying children at highest risk.
- A key debate exists on whether poverty, orphanhood, or parental AIDS most reliably indicates child health risks.
- Previous studies lacked data to distinguish AIDS-specific parental death from other causes of orphanhood and illness.
Purpose of the Study:
- To investigate the independent and interactive effects of household poverty, orphanhood, and parental illness (AIDS-related or other) on child health, development, and HIV infection risks.
- To differentiate risks associated with AIDS-specific parental factors versus general orphanhood or parental illness.
Main Methods:
- A study involving 6,002 children aged 10-17 years in South Africa (2009-2011).
- Stratified random sampling across urban and rural sites in three provinces.
- Regression models analyzed child mental health, educational, and HIV infection risks, controlling for socio-demographic factors and testing impacts of poverty, AIDS-specific orphanhood, and parental illness.
Main Results:
- Household poverty independently predicted increased risks in child mental health and education.
- AIDS orphanhood independently predicted mental health risks; parental AIDS illness independently predicted mental health, educational, and HIV infection risks.
- Significant interaction effects were observed between poverty and AIDS orphanhood/parental AIDS illness across all measured outcomes. AIDS-unrelated orphanhood or parental illness showed no significant effects or interactions with poverty.
Conclusions:
- Identifying children at highest risk necessitates measuring both poverty and parental AIDS.
- Poverty and AIDS-specific vulnerabilities pose distinct negative impacts on children, separate from general orphanhood or adult illness.
- The co-existence of family AIDS and poverty places children at the greatest overall risk, highlighting the need for integrated interventions.
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.
Objectives:
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.
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