Chris Desmond

Targeting AIDS orphans and child-headed households? A perspective from national surveys in South Africa, 1995–2005

Abstract In the HIV and AIDS sphere, children remain on the margins with respect to advocacy, prevention, treatment and care. Moreover, concern is generally limited to specific categories of children, most especially children living with HIV, orphaned children and child-headed households. Excluded from view are the very large numbers of children affected by generalized HIV/AIDS epidemics, now in advanced stages, in already impoverished countries in southern Africa. In this paper, we use information from comparable national household surveys in South Africa, in five waves between 1995 and 2005, to examine the impact of HIV and AIDS on children and on the structure of the households in which they find themselves. The question posed is whether it is appropriate to target orphans and child-headed households in this context. The data indicate that orphaning, particularly loss of a mother, tripled during this period, as is to be expected from rising adult mortality. Though they remain a small proportion, child-only households also rose markedly during this time. However, difficult as their situation is, neither orphans nor child-only households appear to be the worst-off children, at least from the point of view of reported sources of financial support and per capita monthly expenditure. Households headed by single adults and young adults are economically vulnerable groups not yet included in efforts to support affected children and families. Poverty is a pitiless backdrop to the AIDS epidemic and needs to be at the heart of strategies to address the needs of all vulnerable children in hard-hit communities.

A systematic review on the meaning of the concept ‘AIDS Orphan’: confusion over definitions and implications for care

Abstract Global publications on the international AIDS epidemic report on the existence of an ever-increasing number of orphans and vulnerable children. It has been suggested that by the end of this decade there will be in excess of 25 million AIDS orphans globally, an issue which will require understanding and organisation of long-term medical, psychological and social support. This study provides a systematic review to examine the use, overuse and misuse of the term orphan and explores the benefits and limitations of this approach. It then summarises the knowledge on orphans to date. Using a search strategy of published studies and recent conference abstracts, 383 papers were identified where the concept of AIDS and Orphan was raised. The papers were systematically coded and reviewed to understand when and how a child is labelled an orphan, and to summarise the effect of orphanhood on outcome measures, most notably psychologically and physically. All controlled studies published prior to 2006 were reviewed. A consistent picture of negative effects of parental death (however defined) on a wide range of physical, socioeconomic and psychological outcomes were recorded. Seventeen studies met criteria for in-depth review (empirical, fully published, control group). The majority of studies are cross-sectional (two are longitudinal) and employ a very wide array of measures – both standardised and study specific. This detailed analysis shows a mixed picture on outcome. Although most studies report some negative effects, there are often no differences and some evidence of protective effects from quality of subsequent care and economic assistance. The lack of consistent measures and the blurring of definitions are stumbling blocks in this area.

Rethinking HIV prevention to prepare for oral PrEP implementation for young African women

HIV incidence remains high among young women in sub‐Saharan Africa in spite of scale‐up of HIV testing, behavioural interventions, antiretroviral treatment and medical male circumcision. There is a critical need to critique past approaches and learn about the most effective implementation of evidence‐based HIV prevention strategies, particularly emerging interventions such as pre‐exposure prophylaxis (PrEP).

Scaling-Up Exclusive Breastfeeding Support Programmes: The Example of KwaZulu-Natal

Background Exclusive breastfeeding (EBF) for six months is the mainstay of global child health and the preferred feeding option for HIV-infected mothers for whom replacement feeding is inappropriate. Promotion of community-level EBF requires effective personnel and management to ensure quality counselling and support for women. We present a costing and cost effectiveness analysis of a successful intervention to promote EBF in high HIV prevalence area in South Africa, and implications for scale-up in the province of KwaZulu-Natal. Methods and Findings The costing of the intervention as implemented was calculated, in addition to the modelling of the costs and outcomes associated with running the intervention at provincial level under three different scenarios: full intervention (per protocol), simplified version (half the number of visits compared to the full intervention; more clinic compared to home visits) and basic version (one third the number of visits compared to the full intervention; all clinic and no home visits). Implementation of the full scenario costs R95 million (

Exclusive breastfeeding and cognition, executive function and behavioural disorders in primary school-aged children in rural South Africa: a cohort analysis

14 million) per annum; the simplified version R47 million (

Recovery from stunting and cognitive outcomes in young children: evidence from the South African Birth to Twenty Cohort Study.

7 million) and the basic version R4 million (

Child Health and Development

2 million). Although the cost of the basic scenario is less than one tenth of the cost of the simplified scenario, modelled effectiveness of the full and simplified versions suggest they would be 10 times more effective compared to the basic intervention. A further analysis modelled the costs per increased month of EBF due to each intervention: R337 (

Decision-making strategies: ignored to the detriment of healthcare training and delivery?

48), R206 (

Does foreign aid crowd out government investments? Evidence from rural health centres in Rwanda

29), and R616 (

Catch-up growth in stunted children: Definitions and predictors

88) for the full, simplified and basic scenarios respectively. In addition to the average cost effectiveness the incremental cost effectiveness ratios associated with moving from the less effective scenarios to the more effective scenarios were calculated and reported: Nothing – Basic R616 (