Children in Malawi with HIV-positive parents are more likely to be orphaned and less likely to attend secondary school than their peers.  But extended families are stepping in to care for them and ensure they complete their primary education.

These are some of the findings of the Karonga Prevention Study, a large epidemiological research project that is led by researchers from the London School of Hygiene and Tropical Medicine. The study followed up 197 HIV-positive and 396 HIV-negative individuals, and their spouses and children, in Karonga district, northern Malawi.  The individuals were identified from population surveys from the 1980s, and the study followed them up in 1998-2000. 

The study team traced 487 children of HIV-positive and 1493 of HIV-negative parents. They collected mortality and education data for all individuals traced (including those who had migrated), as well as household composition data, and quality of housing and household assets. For children under 15 they recorded whether and when they had ever lived apart from both parents, and their relationship to their guardian. Children of the HIV-positive group of parents were found to be 17 times more likely to have lost both parents, 8 times more likely to have lost their mother, and 6 times more likely to have lost their father than those in the HIV-negative group. 

Other significant findings include:

• Thirty-three percent of the children of HIV-positive parents and twenty percent of children with HIV-negative parents had migrated out of the district.
• A much higher percentage of children of the HIV-positive parent group lived in households headed by their mother (16% compared to 4%). These households were relatively poor compared to those headed by a father, grandparent or other male relative.
• Around 20 percent of orphaned children lived away from their parents before the first parental death. This was the same for both groups.
• For 50 percent of the children living without their parents, a grandparent had taken on the role of guardian. For other children, an aunt, uncle or adult sibling provided care.
• There were no child-headed households, and only five children all of whom had lost both parents, were reported to have lived in more than one home other than that of their parents.
• Primary school achievement was the same for both groups. However, "final" educational achievement, assessed in those aged 19 to 28 at follow-up, was lower among orphans than non-orphans. Children of HIV-positive parents were less likely to have attended secondary school than children of HIV-negative parents.

The extended family has done much to protect HIV orphans from social and economic difficulties. However, policy interventions are needed both to support foster carers and to prevent children from being orphaned in the first place.

The following policy implications were drawn:

• Foster carers should be supported regardless of age or relationship to the child, in order to counteract any disincentive to fostering.
• Children living in households headed by their mother would benefit from policies to improve their economic situation.
• Disproportionate attention should not be given to child-headed households.
• Interventions to help families plan for fostering arrangements before parents’ death should be considered.
• Help is needed to improve access to secondary school education for orphaned children.
• Anti-retroviral therapy for the parent would reduce the number of children who are orphaned before the age of fifteen.  

Source(s):
‘The Social and Economic Impact of Parental HIV on Children in Northern Malawi: Retrospective Population-Based Cohort Study’ AIDS Care 19:6, pages 781 to 790, by S Floyd et al, 2007

Funded by: LEPRA, ILEP, WHO/UNDP/World Bank Special Programme for Research and Training in Tropical Diseases; Wellcome Trust

id21 Research Highlight: 11 May 2008

Further Information:
Sian Floyd
London School of Hygiene and Tropical Medicine
Keppel Street
London
WC1E 7HT

Tel: 44-207-6127888
Fax: 44-207-6368739
Contact the contributor: sian.floyd@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

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'Older people can help Tanzania fight HIV/AIDS'