Contrasting causal pathways contribute to poorer health and nutrition outcomes in orphans in Zimbabwe

Abstract

Orphaned children have been found to be at greater risk of poor health and malnutrition compared to non-orphans in sub-Saharan African countries. However, levels of disadvantage vary by location and little is known about the causal pathways that lead from orphanhood to poorer health and malnutrition. Aggregate data from recent Demographic and Health Surveys in 22 countries were used to compare overall levels of ill-health and malnutrition by orphan status. Data from the Manicaland Child Cohort Study in Zimbabwe - a closed cohort study with detailed longitudinal information on orphan's experience - were used to describe how patterns of ill-health and malnutrition alter over the child's life-course and to test causal pathways between orphanhood and ill-health and malnutrition, hypothesized in a previously published theoretical frame-work. Modest increases in ill-health and malnutrition were found in orphans in the Demographic and Health Surveys data, with maternal and double orphans being worst affected. Non-significant associations were found between orphanhood and ill-health in the Manicaland Child Cohort Study data, but no associations with malnutrition were found. None the less, smaller increases in body mass index with age were seen among orphans (ologit test for difference: adjusted odds ratio = 0.68; = 0.07) and maternal orphans (ologit test for difference: adjusted odds ratio = 0.67; = 0.03) than among non-orphans. Stigma and discrimination contributed to poor diet, malnutrition and ill-health in children whose mothers had died, while heightened poverty was a more important factor for paternal orphans. These results suggest social and psychological support for orphans and their families could be as important as material support in preventing malnutrition and ill-health.

Household and community HIV/AIDS status and child malnutrition in sub-Saharan Africa: Evidence from the demographic and health surveys

“…It is interesting to note that the analysis presented here provides no evidence that paternal orphans or children in household where other adult household members (other than mother) are HIV positive, or living in communities or countries with higher HIV prevalence are more undernourished than those in less affected households or communities. These findings, though consistent with patterns observed in specific settings in sub-Saharan Africa ( Bridge et al., 2006; Owen et al., 2009; Zidron et al., 2009 ), call for further research to better understand the possible mechanisms. Possible explanations for lack of differences in nutritional status between orphans and non-orphans have included the possibility that orphans live in wealthier households than non-orphans ( Zidron, et al., 2009 ).…”

“…The second limitations relates to the data on parents’’survivorship status. The analysis has only included paternal survivorship, even though previous studies have suggested that it is maternal or double orphans who are more likely to suffer ill-health and malnutrition ( Owen et al. 2009 ).…”

“…Furthermore, many studies have shown that orphans do not usually have poorer health than non-orphans in the same community. Although modest increases in ill-health and malnutrition were found in orphans in the Demographic and Health Surveys data, with maternal and double orphans being worst affected (Owen et al, 2009), no association between orphanhood and nutritional status have been found in various settings in sub-Saharan Africa (Owen et al., 2009; Zidron, Juma, & Ice, 2009). …”

“…However, evidence from existing studies conducted in various settings in sub-Saharan Africa have produced different results and remain inconclusive. For instance, some have shown that orphans are more likely to be underweight, wasted or stunted than non-orphans, while other studies have failed to show any significant difference ( Owen et al., 2009; Zidron et al., 2009 ). The lack of conclusive patterns from previous studies is mainly attributable to the fact that most of these studies have focused on specific settings, and sometimes involving small samples with limited statistical power to detect significant associations.…”

Association of Care Environment With HIV Incidence and Death Among Orphaned, Separated, and Street-Connected Children and Adolescents in Western Kenya

“…10 Numerous studies from sub-Saharan Africa have found that these constraints on families and traditional caregiving may be associated with worse educational, health, and other outcomes among orphaned children, which have been widely documented in family-based settings. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19…”