The definition of true orphan prevalence: Trends, contexts and implications for policies and programmes

This study utilizes Demographic and Health Surveys (DHS) or Multiple Indicator Cluster Surveys (MICS) data to explore paternal, maternal and double orphaning in 38 sub-Saharan African countries. The analysis allows for inclusion of older adolescents (15-17-year-olds) and also looks at predictors of double orphaning. The data suggest a population rate of double orphans of 2.1% in sub-Saharan Africa. This is five-to 10-fold greater than in other regions. It also shows an increase over time, whereas other regions are reporting stabilization or decreasing rates. In the 38 sub-Saharan African countries, 26.8 million children (7.8%) were paternal orphans (3.5% in Niger to 16.7% in Lesotho) and more than 25.3 million (7.4%) were maternal orphans (2.6 in Guinea to 21.7% in Namibia). More than one in 50 children (2.1%) in these countries have lost both parents by 2010, with double orphans accounting for 12.4% (range 4.0-26.4%) of all children who had lost one or both parents. In multiple regressions, human immunodeficiency virus (HIV) prevalence rates nine years earlier were the biggest predictor of subsequent double orphan rates. These figures clarify the size and diversity of the problem and also point to the imperative to define parental death accurately by recording maternal, paternal and parental death clearly and separately, and focus research and interventions appropriately. They also point out that in order to monitor the impact HIV/acquired immune deficiency syndrome (AIDS) interventions on orphanhood there is a need for follow-up surveys which should take into account such confounding factors as differences in urban/rural sample design and "hidden" maternal orphans.