Today's children--challenges to child health promotion in countries with severe AIDS epidemics

Recent declines in infant and child mortality rates (IMR and CMR) are being reversed due to AIDS. Greatest impacts are in southern African countries with severe HIV epidemics and lower non-AIDS IMR/CMR. Zimbabwe and Zambia's IMR were estimated to be 40% and 30% higher in 1996; CMR by 2010 was projected to increase fourfold in Zimbabwe, threefold in Botswana and to double in Kenya and Zambia due to AIDS. HIV indirectly impacts children through orphanhood, TB and poverty. By 1996, life expectancy fell to 36 in Zambia, 42 in Zimbabwe and 40 in Uganda. One-third of children may become vulnerable after maternal orphanhood since elderly and juvenile caregivers are frequently uninformed about nutrition, oral rehydration, immunization and diagnosing serious illness. Resurgence of adult and paediatric TB affects children through increasing orphanhood and increased child mortality. AIDS-induced poverty among survivors leads to deterioration in children's health and increased vulnerability of adolescent survivors to HIV infection. The situation is set to worsen, especially in communities experiencing the cumulative impact of repeated parental deaths. Reducing the number and vulnerability of children and adolescents becoming HIV infected and increasing support to affected children are important strategies to improve child health in countries with severe epidemics.