Publication: The Intergenerational Impact of the African Orphans Crisis : A Cohort Study from an HIV/AIDS Affected Area
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Date
2009
ISSN
1464-3685 (Electronic)
0300-5771 (Linking)
Published
2009
Author(s)
Dercon, S.
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Abstract
BACKGROUND: In sub-Saharan Africa, the prevalence of orphanhood among children has been greatly exacerbated by the HIV/AIDS pandemic. If orphanhood harms a child's development and these effects perpetuate into adult life, then the African orphan crisis could seriously jeopardize the continent's future generations. Whether or not there exists an adverse, causal and intergenerational effect of HIV/AIDS on development is of crucial importance for setting medical priorities. This study is the first to empirically investigate the impact of orphanhood on health and schooling using long-term longitudinal data following children into adulthood. METHODS: We examined a cohort of 718 children interviewed in the early 1990s and again in 2004. Detailed survey questionnaires and anthropometric measurements were administered at baseline and during a follow-up survey. Final attained height and education (at adulthood) between children who lost a parent before the age of 15 and those who did not were compared. RESULTS: On average, children who lose their mother before the age of 15 suffer a deficit of around 2 cm in final attained height (mean 1.96; 95% CI 0.06-3.77) and 1 year of final attained schooling (mean 1.01; 95% CI 0.39-1.81). This effect is permanent and the hypothesis that it is causal cannot be rejected by our study. Although father's death is a predictor of lower height and schooling as well, we reject the hypothesis of a causal link. CONCLUSIONS: The African orphan crisis, exacerbated by the HIV/AIDS epidemic will have important negative intergenerational effects.
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Publication The Long-run Impact of Orphanhood(World Bank, Washington, DC, 2007-09)This paper presents unique evidence that orphanhood matters in the long run for health and education outcomes, in a region of Northwestern Tanzania. The paper studies a sample of 718 non-orphaned children surveyed in 1991-94, who were traced and re-interviewed as adults in 2004. A large proportion, 19 percent, lost one or more parents before the age of 15 in this period, allowing the authors to assess the permanent health and education impacts of orphanhood. The analysis controls for a wide range of child and adult characteristics before orphanhood, as well as community fixed effects. The findings show that maternal orphanhood has a permanent adverse impact of 2 cm of final height attainment and one year of educational attainment. Expressing welfare in terms of consumption expenditure, the result is a gap of 8.5 percent compared with similar children whose mother survived till at least their 15th birthday.Publication Demographic and Socioeconomic Patterns of HIV/AIDS Prevalence in Africa(2009-10-01)Understanding the demographic and socioeconomic patterns of the prevalence and incidence of HIV/AIDS in Sub-Saharan Africa is crucial for developing programs and policies to combat HIV/AIDS. This paper looks critically at the methods and analytical challenges to study the links between socioeconomic and demographic status and HIV/AIDS. Some of the misconceptions about the HIV/AIDS epidemic are discussed and unusual empirical evidence from the existing body of work is presented. Several important messages emerge from the results. First, the study of the link between socioeconomic status and HIV faces a range of challenges related to definitions, samples, and empirical methods. Second, given the large gaps in evidence and the changing nature of the epidemic, there is a need to continue to improve the evidence base on the link between demographic and socioeconomic status and the prevalence and incidence of HIV/AIDS. Finally, it is difficult to generalize results across countries. As the results presented here and in other studies based on Demographic and Health Survey datasets show, few consistent and significant patterns of prevalence by socioeconomic and demographic status are evident.Publication The New HIV/AIDS Program in Peru : The Role of Prioritizing and Budgeting for Results(World Bank Group, Washington, DC, 2015-01)This study aims to evaluate and develop recommendations on how the HIV/AIDS program in Peru can achieve better Value for Money. In Peru, the HIV epidemic concentrates mostly among men who have sex with men (MSM), with AIDS being the first cause of death for men ages 30-49 in 2010 and the second cause of death for women aged 25-34 (BOD, 2013). UNAIDS (2013) estimates there were 76,000 people living with HIV/AIDS (PLWA) in 2012, and this study estimates 67,000 PLWA in 2013. The Ministry of Health reports that 27,502 PLWA currently receive ART, a 43-48 percent coverage of eligible people, and 66 percent coverage of all diagnosed eligible individuals (WHO, 2013 guidelines). In 2011, there was a transition from international to domestic public funding, which increased from US$17.7 million in 2005-10 to US$57.8 million in 2011-13. The main achievements of the Peru HIV/AIDS program to date include: (i) collaboration with NGOs to provide ART; (ii) free provision of ART; (iii) educating poor women on mother to child HIV transmission; and (iv) access to reduced ARV prices through the PAHO Drug Fund. Major challenges include: (i) limited testing and laboratory capacity in the provinces; (ii) less than half of the budget is allocated to high-risk groups; (iii) wage bill issued by other programs and; (iv) limited number of community health workers (CHWs) for IEC.Publication The Determinants of Child Health and Nutrition : A Meta-analysis(World Bank, Washington, DC, 2004-05-31)The reduction of infant and child death is one of the eight millennium development goals (MDGs). In addition, one of the goal one indicators is child malnutrition. A central question for the development community is to understand the factors underlying child health and nutritional status. What are the determinants of these indicators, which of these determinants are amenable to policy intervention, and which are the most effective channels for influencing health and nutrition outcomes? Potentially more insightful is analysis using data collected from household surveys which can include such variables. This paper summarizes the conclusions from these statistical studies of the determinants of child health (infant and child mortality) and nutritional status. The results from the various studies are combined using meta-analysis, which calculates the statistical significance of a variable included in more than one study by combining the results of those studies. In this context, the report is structured as follows: part one gives introduction. Part two briefs review of theory to introduce the relevant variables and their classification. Part three discusses data and variable definition and econometric issues, including the use of meta-analysis. The results are presented in part four and part five concludes. Annexes provide more details of the studies reviewed in this paper.Publication Adult Mortality and Consumption Growth in the Age of HIV/AIDS(World Bank, Washington, DC, 2006-12)The authors use a 13-year panel of individuals in Tanzania to assess how adult mortality shocks affect both short and long-run consumption growth of surviving household members. Using unique data which tracks individuals from 1991 to 2004, they examine consumption growth, controlling for a set of initial community, household and individual characteristics. The effect is identified using the sample of households in 2004 which grew out of baseline households. The authors find robust evidence that an affected household will see consumption drop 7 percent within the first five years after the adult death. With high growth in the sample over this time period, this creates a 19 percentage point growth gap with the average household. There is some evidence of persistent effects of these shocks for up to 13 years, but these effects are imprecisely estimated and not significantly different from zero. The impact of female adult death is found to be particularly severe.
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