Monday, 23 May, 2022
HomeA Focus‘Heartbreaking’: South Africa has more than 134,000 orphans from COVID-19

‘Heartbreaking’: South Africa has more than 134,000 orphans from COVID-19

In what researchers describe as a “heartbreaking hidden pandemic”, up to 6.7m children globally have been orphaned or lost a caregiver due to COVID-19. In absolute numbers, South Africa was estimated to have 134,500 COVID19 orphans, with “at least one in every 200 children in every age group having experienced COVID-19-associated orphanhood.”

South Africa ranked second highest of the 21 countries modelled, with 7.22 orphans per 1,000, behind Peru (8.28), according to a study in The Lancet Child & Adolescent Health.

The countries in the study are Argentina, Brazil, Colombia, England and Wales, France, Germany, India, Iran, Italy, Kenya, Malawi, Mexico, Nigeria, Peru, Philippines, Poland, Russia, South Africa, Spain, the USA, and Zimbabwe.

In absolute numbers, South Africa was estimated to have 134,500 COVID19 orphans, with 8,400 in Kenya, 8,000 in Zimbabwe, 5,500 in Nigeria and 3,500 in Malawi.

This finding means that, globally, for every one reported COVID-19 death, at least one child experienced orphanhood or caregiver death. For regions with higher total fertility rates, such as the African, Eastern Mediterranean, and South-East Asia regions, the numbers of children affected by orphanhood and caregiver deaths exceeded numbers of COVID-19 deaths.

Globally, between at least 5.2m children have been orphaned or lost a caregiver due to COVID-19 as at October 2021, the study estimates. However, in regions such as Africa, estimates remain often vastly under-reported. “Consequently, we expect that future reports of minimum estimates will also increase as the quality of excess mortality and COVID-19 mortality data improves. New WHO mortality estimates show that the African region has under-reporting of death rates by a factor of 10.

“Consequently, the real-time global minimum estimate for the number of children affected by COVID-19-associated orphanhood and caregiver death reached more than 6.7m children by Jan 15, 2022, after adjustment for this under-reporting.”

“Children of all ages experience grief and might also experience inadequate care, altered mood of the surviving parent or caregiver, food insecurity, marginal housing, and family disintegration, but associated effects, needs, and vulnerabilities vary by age. Younger bereaved children need immediate full-time nurturing and ongoing support for early childhood development, and the quality of care affects subsequent development, health, and mental health. Adolescents face post-orphanhood risks (varying across contexts) including sexual violence, exploitation, HIV infection, suicide, child labour, adolescent pregnancy, separation from family, household poverty, and leaving school to care for younger siblings.”

The study used new excess death and COVID-19 death data to examine the increase in global minimum estimates of orphanhood and caregiver loss from the 14-month period of a previous study (March 1, 2020–April 30, 2021) – which found that 1,13m children lost a caregiver – to the following 6-month period from May 1 to Oct 31, 2021. It defined orphanhood as the death of one or both parents; primary caregiver loss as the death of one or both parents, or of one or both co-residing custodial grandparents aged 60–84 years (household composition data only included grandparents or other kin 60 years or older); and secondary caregiver loss as the death of one or more co-residing grandparents or older kin

In the US, reports real-time estimates show that just more than 200,000 children have lost a primary caregiver (either one or both of their parents or custodial grandparents).

“Our findings suggest an urgent need for pandemic responses to prioritise children affected by deaths of parents and caregivers,” Hillis and colleagues wrote, pointing out that younger children and adolescents face different challenges.

“Younger bereaved children need immediate full-time nurturing and ongoing support for early childhood development,” they said, while adolescents might deal with higher risks of sexual violence, pregnancy, and household poverty, among others.

Factors that contribute to orphanhood also “vary substantially by country and region”, wrote Dr Michael Goodman of the University of Texas Medical Branch in Galveston, and colleagues in an accompanying editorial. While vaccine hesitancy and individualistic cultures may pose challenges in high-income countries, vaccine scarcity and financial strain may contribute to orphanhood in lower-income countries.

“COVID-19 orphanhood confronts us at a time nearing resource exhaustion across multiple systems. The consequences of orphanhood linger throughout the course of a lifetime, affecting futures of families, communities, and societies,” Goodman and colleagues continued. “We determine how long our communities will suffer the effects of COVID-19 by urgently determining the quality and force of our concern for orphaned young people.”

This study followed up on a prior study on global COVID-19-associated orphanhood, which found that from March 2020 to the end of April 2021,

Using newly available data on mortality, Hillis and colleagues estimated that number to be substantially higher, at 2.73m children. In the subsequent six months also analysed in this study (May to October 2021), an additional estimated 2,46m children experienced COVID-19- associated orphanhood or caregiver death.

Similar to the first study, there were major differences in rates of paternal and maternal orphanhood. Maternal orphanhood accounted for one-quarter of cases, while paternal orphanhood made up three-quarters of cases. “Increased risks for children of paternal death appear to be linked to trends of later fertility and greater risk of death from COVID-19,” the researchers explained.

Hillis and team acknowledged a major caveat to their study: “The most important limitation is that our estimates are generated by modelling and thus cannot measure actual numbers of children affected by parent or caregiver death. Future pandemic responses should include surveillance of numbers of children affected for every parental and caregiver death, to track needs for services and provide referral platforms.”

Study details

Global, regional, and national minimum estimates of children affected by COVID-19-associated orphanhood and caregiver death, by age and family circumstance up to Oct 31, 2021: an updated modelling study

Juliette Unwin, Susan Hillis, Prof Lucie Cluver, Seth Flaxman, Philip Goldman,
Alexander Butchart, et al.

Published in The Lancet on 24 February 2022

Summary

Background
In the six months following our estimates from March 1, 2020, to April 30, 2021, the proliferation of new coronavirus variants, updated mortality data, and disparities in vaccine access increased the amount of children experiencing COVID-19-associated orphanhood. To inform responses, we aimed to model the increases in numbers of children affected by COVID-19-associated orphanhood and caregiver death, as well as the cumulative orphanhood age-group distribution and circumstance (maternal or paternal orphanhood).

Methods
We used updated excess mortality and fertility data to model increases in minimum estimates of COVID-19-associated orphanhood and caregiver deaths from our original study period of March 1, 2020–April 30, 2021, to include the new period of May 1–Oct 31, 2021, for 21 countries. Orphanhood was defined as the death of one or both parents; primary caregiver loss included parental death or the death of one or both custodial grandparents; and secondary caregiver loss included co-residing grandparents or kin. We used logistic regression and further incorporated a fixed effect for western European countries into our previous model to avoid over-predicting caregiver loss in that region. For the entire 20-month period, we grouped children by age (0–4 years, 5–9 years, and 10–17 years) and maternal or paternal orphanhood, using fertility contributions, and we modelled global and regional extrapolations of numbers of orphans. 95% credible intervals (CrIs) are given for all estimates.

Findings
The number of children affected by COVID-19-associated orphanhood and caregiver death is estimated to have increased by 90·0% (95% CrI 89·7–90·4) from April 30 to Oct 31, 2021, from 2 737 300 (95% CrI 1 976 100–2 987 000) to 5 200 300 (3 619 400–5 731 400). Between March 1, 2020, and Oct 31, 2021, 491 300 (95% CrI 485 100–497 900) children aged 0–4 years, 736 800 (726 900–746 500) children aged 5–9 years, and 2 146 700 (2 120 900–2 174 200) children aged 10–17 years are estimated to have experienced COVID-19-associated orphanhood. Globally, 76·5% (95% CrI 76·3–76·7) of children were paternal orphans, whereas 23·5% (23·3–23·7) were maternal orphans. In each age group and region, the prevalence of paternal orphanhood exceeded that of maternal orphanhood.

Interpretation
Our findings show that numbers of children affected by COVID-19-associated orphanhood and caregiver death almost doubled in 6 months compared with the amount after the first 14 months of the pandemic. Over the entire 20-month period, 5·0m COVID-19 deaths meant that 5·2 million children lost a parent or caregiver. Our data on children’s ages and circumstances should support pandemic response planning for children globally.

 

The Lancet article – Global, regional, and national minimum estimates of children affected by COVID-19-associated orphanhood and caregiver death (Open access)

 

The Lancet commentary on above article – Integrative approaches required to support children affected by COVID-19 (Michael Goodman, Rachel Kidman, Linda Theron) Open access

 

NIDA article – More than 1.5 million children lost a primary or secondary caregiver due to the COVID-19 pandemic (Open access)

 

See more from MedicalBrief archives:

 

Higher COVID-19 mortality in young Africans than European and US counterparts

 

SA and world COVID deaths 3x higher than official figures — The Economist

 

COVID1-9 pandemic is the deadliest event in US history

 

UCT Centre for Actuarial Research: SA’s COVID death toll almost 3x official figure

 

SAMRC: Eastern Cape COVID death rate may be world's worst

 

 

MedicalBrief — our free weekly e-newsletter

We'd appeciate as much information as possible, however only an email address is required.