RESUMO
BACKGROUND: In South Africa, large increases in early adult mortality during the 1990s and early 2000s have reversed since public HIV treatment rollout in 2004. In a rural population in KwaZulu-Natal, we investigate trends in parental mortality and orphanhood from 2000-2014. METHODS: Using longitudinal demographic surveillance data for a population of approximately 90,000, we calculated annual incidence and prevalence of maternal, paternal and double orphanhood in children and adolescents (<20 years) and, overall and cause-specific mortality of parents by age. RESULTS: The proportion of children and adolescents (<20 years) for whom one or both parents had died rose from 26% in 2000 to peak at 36% in 2010, followed by a decline to 32% in 2014. The burden of orphanhood remains high especially in the oldest age group: in 2014, 53% of adolescents 15-19 years had experienced the death of one or both parents. In all age groups and years, paternal orphan prevalence was three-five times higher than maternal orphan prevalence. Maternal and paternal orphan incidence peaked in 2005 at 17 and 27 per 1,000 person years respectively (<20 years) before declining by half through 2014. The leading cause of parental death throughout the period, HIV/AIDS and TB cause-specific mortality rates declined substantially in mothers and fathers from 2007 and 2009 respectively. CONCLUSIONS: The survival of parents with children and adolescents <20 years has improved in tandem with earlier initiation and higher coverage of HIV treatment. However, comparatively high levels of parental deaths persist in this rural population in KwaZulu-Natal, particularly among fathers. Community-level surveillance to estimate levels of orphanhood remains important for monitoring and evaluation of targeted state welfare support for orphans and their guardians.
Assuntos
Crianças Órfãs/estatística & dados numéricos , Infecções por HIV/mortalidade , População Rural/estatística & dados numéricos , Tuberculose/mortalidade , Adolescente , Causas de Morte , Criança , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pais , Vigilância da População , Prevalência , África do Sul/epidemiologiaRESUMO
Antecedentes: En 2005, UNICEF, ONUSIDA iniciaron la campaña Únete por la Niñez, Únete con la juventud, Únete para vencer al sida, que se centra en cuatro esferas clave: prevención de la transmisión de la madre al niño, tratamiento pediátrico del sida, programas educativos para fomentar la preven- ción, y el apoyo a niños y niñas huérfanos con VIH en situación de vulnerabilidad. Objetivos. El Centro de Atención Integral del Hospital Nacional Dr. Mario Catarino Rivas (CAI /HNMCR) atiende a 365 niños VIH positivos, con este estudio se pretende conocer los aspectos clínicos y epidemioló- gicos que los caracteriza. Pacientes y Métodos: Se realizó un estudio descriptivo transversal, obteniéndose una muestra aleatoria de 67 niños huérfanos VIH positivos atendidos en el CAI/HNMCR. Utilizando para la recolección de datos la revisión del expediente clínico y la entrevista, tomando en cuenta las variables clínicas y epidemiológicas escogidas. Resultados: De los niños huérfanos con VIH el 70% tienen más de 13 años de edad y el 3% tiene menos de 5 años. El 38.8% viven en hogares destinados a su cuidado. El 100% de los niños huérfanos con VIH la vía de transmisión del virus fue transmisión perinatal, El 18% de los niños huérfanos con VIH son categoría clínica e inmunológica C3 y el 40% del total de estos niños han ameritado tratamiento antirretroviral de gran actividad (TARGA) de segunda línea en algún momento. Conclusiones: Es necesaria una respuesta más diligente como política de país que garantice que los derechos de estos menores en condiciones vulnerables sean respetados...(AU)
Assuntos
Humanos , Criança , Adolescente , Síndrome da Imunodeficiência Adquirida , Crianças Órfãs/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde , Jovens em Situação de Rua/psicologiaRESUMO
In Haiti, large numbers of vulnerable children and the country's particular historical context has led to a unique phenomenon known as the "restavèk" system. An estimated 300,000 Haitian children are restavèks, living as unpaid domestic servants. Child-welfare advocates describe the restavèk system as modern slavery, but researchers and advocates lack information about restavèk children's circumstances, particularly vis-à-vis other children in Haiti. In a cross-sectional analysis of a nationally representative sample, we evaluated differences in well-being (school attendance, work responsibilities, physical abuse, and hunger) between restavèk children and: (a) all non-restavèk children; and (b) the poorest quintile of non-restavèk children. As compared to all Haitian children and the poorest Haitian children, restavèk children have statistically significantly lower school attendance rates and more labor responsibilities. However, restavèk children experience statistically significantly less physical abuse and less hunger than non-restavèk Haitian children. The restavèk system remains active in Haiti because poor families lack basic resources to support their children, and restavèk children are at risk for mistreatment due to their vulnerable social status. The surprising finding that restavèk children are better off in some respects than their non-restavèk peers highlights the desperate poverty in Haiti and suggests that structural changes for poverty reduction will be required before the restavèk system will end.
Assuntos
Maus-Tratos Infantis/prevenção & controle , Proteção da Criança , Adolescente , Criança , Crianças Órfãs/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Emprego/estatística & dados numéricos , Feminino , Haiti , Humanos , Fome , Masculino , Pobreza , Instituições Acadêmicas/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricosRESUMO
Investigación cuanti-cualitativa. Se evaluó estado de salud(crecimiento y desarrollo) con normas de OMS/SAP, PruebaNacional de Pesquisa y situación social- familiar; de huérfanosmenores de 5 años, de madres fallecidas en trance obstétrico2008, mediante visitas domiciliarias, entrevistas semiestructuradas.Se identificaron 16 muertes maternas, 12 con hijosprevios, que dejaron 51 huérfanos, 7 menores de 5 años.En crecimiento: 57% eutróficos; 29% desnutridos crónicos,14% sobrepeso. En desarrollo: Área personal-social (100%);motricidad fina y gruesa (86%), lenguaje (42%) acordes aedadLa situación social-familiar frágil; 87% pobres, 13%indigentes; 100% sin cobertura de salud, con serviciosbásicos carecientes, insuficientes o inadecuados. Resolvíanproblemas de salud con remedios caseros y/o curanderos.Escasa protección social.Conclusión: Estado de salud de los huérfanos, satisfactorio.En desarrollo algunos con retrasos en motricidad y lenguaje. En las familias cuidadoras aumentó la precariedad y vulverabilidad. Mostraron fuertes lazosde protección y amparo, hacia los huérfanos.
Quanti-qualitative research. Health condition (growth and development) was evaluatedusing WHO/SAP standars, PESQUISA NATIONAL TEST*; and the social family situationof motherless children under 5, from mothers who died in obstetric situations in 2008 wasassessed through home visits and semi-structured surveys. In growth: 57% eutrophic; 29%chronic undernurished; 14% over-weight. In development: Personal-social area (100%);fine and gross motor skills (86%), language (42%) according to age. Fragile social familysituation; 87% poor; 13% indigents, 100% with no medical coverage and absense, shortageor inadequacy of basic services. They solved health problems with homemade medicineor healers. Poor social protection.Conclusion: Health condition of motherless children, satisfactory. In deveplomentsome presented delays in language and motor skills. Precariousness and vulnerabilityhave increased in carer families. They showed strong bonds of protection towards thesemotherless children.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Fatores Socioeconômicos , Família , Mortalidade Materna , Crianças Órfãs , Crianças Órfãs/estatística & dados numéricosRESUMO
OBJECTIVE: To describe how the Government of Mexico and other direct stakeholders perceive children orphaned by the drug war; to determine the current measures addressing this as a public health problem; and to compare these measures to international frameworks so that relevant recommendations can be identified. METHODS: This was an exploratory, descriptive case study using qualitative methods. Semi-structured interviews were performed with key informants at the federal, state, and municipal government levels in Mexico, as well as non-governmental organizations, and other institutes working with orphans. Participants were identified with a purposive snowball sample. RESULTS: No official definition of "orphan" was identified; nor was there a shared perception among the key informants of what constitutes being an orphan. An official, collective definition is important because it modifies the quantity of children categorized as such within the target population. Although most of the interviewees perceive that the number of orphans and vulnerable children (OVC) has increased in the last 6 years, they acknowledged there is no reliable data to prove it. The increase, they believe, is due not to the drug war, but to a loss of family cohesion. Stakeholders recommend improving public policies, currently identified as the most difficult barrier to overcome due to a perceived inability to modify existing laws. However, the General Law for Victims was recently passed by the Government of Mexico and addresses many of the challenges identified. CONCLUSIONS: When compared to the international frameworks, there are three major issues in Mexico's current situation: coordination among and within stakeholders; emphasis on using community solutions; and putting in place preventive programs. For two of these problems, the General Law of Victims offers solutions.
Assuntos
Crianças Órfãs/estatística & dados numéricos , Tráfico de Drogas , Saúde Pública , Criança , Humanos , Internacionalidade , MéxicoRESUMO
OBJECTIVE: To compare vocal function, school performance, and vocal discomfort between sheltered and nonsheltered school children in Aracaju, Brazil. METHODS: A controlled cross-sectional study was carried out on 7- to 10-year-old children who attended school regularly. Two groups of children were studied: the study group (SG), with children who lived in a shelter, and the control group (CG) containing children who lived with their families. We interviewed 44 children for the SG and 15 (34%) revealed vocal discomfort (SG = 15). Concomitantly, we interviewed 400 regular school children from the same geographical area and 45 (11.25%) were selected for the control group (CG). They were paired by sex and age with the sheltered children using a 3:1 ratio. Both groups were interviewed about school performance and vocal discomfort and were evaluated using perceptual and acoustic measurements for the voice and larynx. RESULTS: Children from both groups had started public school late. There were more individuals with vocal discomfort in the SG and individuals in this group also had a slower speech rate and inadequate pneumophonic coordination compared with the CG. The Dysphonia Severity Index (DSI) revealed mild-moderate deviation for both groups. Upper harmonics and palatal tonsil hypertrophy were higher in the CG, whereas laryngeal constriction was more common in the SG. CONCLUSION: All the SG children revealed mild-moderate deviance on the DSI, a higher level of vocal discomfort, a slow speech rate, inadequate pneumophonic coordination, and laryngeal constriction. The results here presented suggest that social conditions are important for voice behavior in children.
Assuntos
Crianças Órfãs/estatística & dados numéricos , Fonação , Voz , Brasil , Criança , Estudos Transversais , Avaliação Educacional , Feminino , Humanos , Masculino , Acústica da FalaRESUMO
The aims of this paper were to evaluate the nutritional status of children orphaned by aids or homicides in the city of São Paulo and to estimate the association of nutritional indexes with orphanhood-related variables. The study was a household survey carried out between 2006 and 2007. We sampled 484 children representative of São Paulo, 5-14 years old who lost either or both of their parents from aids or homicides between 2000 and 2004. We selected body-mass-index-for-age (BMI) and height-for-age (height) as outcomes for analysis. Multiple linear regression in the light of a conceptual hierarchical approach was used for estimating BMI-for-age and height-for-age associated factors. Children from aids and homicides groups differed in terms of orphanhood-related variables and age. Economic, household, health and nutritional conditions were similar between groups. Underweight accounted for 1.3% and 2.1% of children under the age of 10 and adolescents, respectively. Stunting accounted for 0.7% and 4.0% of children and adolescents, respectively. Overweight accounted for 19% and 20% of children and adolescents, respectively. BMI and height were unaffected by orphanhood-related variables after adjusting for selected classical determinants of nutritional status in the hierarchical model. Economic status was the main determinant of the nutritional profile. Nutritional status of children orphaned by aids or homicides in São Paulo was similar and mainly influenced by economic status. The nutritional profile, characterized by being overweight, suggests that these orphans have not shown additional risks due to those orphanhood-related variables.
Assuntos
Síndrome da Imunodeficiência Adquirida , Crianças Órfãs , Homicídio , Estado Nutricional , Adolescente , Criança , Crianças Órfãs/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Fatores SocioeconômicosRESUMO
O artigo tem como objetivos avaliar o estado nutricional de órfãos por aids ou homicídios residentes em São Paulo e estimar a associação de índices nutricionais com variáveis relacionadas à orfandade. Trata-se de estudo transversal de base domiciliar que utilizou amostra representativa de 484 indivíduos de 5 a 14 anos que perderam um ou ambos os pais durante os anos de 2000 e 2004 devido à aids ou a homicídio no município de São Paulo. A avaliação nutricional foi feita com o índice de massa corporal-para-idade (IMC) e da altura-para-idade (altura). A associação entre os índices nutricionais e as variáveis relacionadas à orfandade foi estimada em análise hierárquica, com uso de modelo de regressão linear múltiplo. Órfãos por aids ou homicídios diferiram quanto às características da orfandade e à idade média. As condições econômicas, domiciliares, o estado de saúde e o estado nutricional foram semelhantes entre os grupos. O déficit de IMC ocorreu em 1,3% das crianças abaixo de 10 anos e em 2,1% dos adolescentes. O déficit de altura ocorreu em 0,7% das crianças e em 4,0% dos adolescentes. O excesso de peso ocorreu em 19% e 20% das crianças e adolescentes, respectivamente. A análise hierárquica indicou ausência de efeito das variáveis relacionadas à orfandade sobre o IMC ou a altura; o principal determinante do estado nutricional foi de natureza econômica. Os órfãos por aids ou homicídio de São Paulo apresentaram estado nutricional semelhante e majoritariamente influenciado pela situação econômica. O perfil nutricional identificado no grupo, caracterizado pelo excesso de peso, sugere que os órfãos de São Paulo não apresentam riscos adicionais decorrentes da orfandade.
The aims of this paper were to evaluate the nutritional status of children orphaned by aids or homicides in the city of São Paulo and to estimate the association of nutritional indexes with orphanhood-related variables. The study was a household survey carried out between 2006 and 2007. We sampled 484 children representative of São Paulo, 5-14 years old who lost either or both of their parents from aids or homicides between 2000 and 2004. We selected body-mass-index-for-age (BMI) and height-for-age (height) as outcomes for analysis. Multiple linear regression in the light of a conceptual hierarchical approach was used for estimating BMI-for-age and height-for-age associated factors. Children from aids and homicides groups differed in terms of orphanhood-related variables and age. Economic, household, health and nutritional conditions were similar between groups. Underweight accounted for 1.3% and 2.1% of children under the age of 10 and adolescents, respectively. Stunting accounted for 0.7% and 4.0% of children and adolescents, respectively. Overweight accounted for 19% and 20% of children and adolescents, respectively. BMI and height were unaffected by orphanhood-related variables after adjusting for selected classical determinants of nutritional status in the hierarchical model. Economic status was the main determinant of the nutritional profile. Nutritional status of children orphaned by aids or homicides in São Paulo was similar and mainly influenced by economic status. The nutritional profile, characterized by being overweight, suggests that these orphans have not shown additional risks due to those orphanhood-related variables.
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Síndrome da Imunodeficiência Adquirida , Crianças Órfãs , Homicídio , Estado Nutricional , Estudos Transversais , Crianças Órfãs/estatística & dados numéricos , Fatores SocioeconômicosRESUMO
OBJECTIVE: Several longitudinal studies had shown that early deprivation and institutionalization during the first six months of life affects the emotional, cognitive, social and neurophysiologic development. Nevertheless, our understanding of possible similar effects of delayed institutionalization, in preschool-age remains unclear to this day. The goal of this study is to evaluate the cognitive performance of institutionalized children with history of preschool-age physical abandonment. METHOD: 18 male institutionalized children with history of abandonment during the preschool-age (2-5 years old) and comparison group matched by age, handedness, gender, educational and socioeconomic level were tested on multiple tasks of attention, memory and executive functions. RESULTS: We found a cognitive impairment in the institutionalized children in several measures of attention, memory and executive functions. This is the first report of cognitive impairment related to late abandonment and institutionalization effects (after 2 years old), extending the already known effects on early institutionalization. CONCLUSIONS: This preliminary study suggests that environmental factors including abandonment and institutional care, can affect not only the infancy period, but also the preschool period providing new insights into our understanding of neurocognitive development.
Assuntos
Criança Institucionalizada/psicologia , Criança Institucionalizada/estatística & dados numéricos , Crianças Órfãs/psicologia , Crianças Órfãs/estatística & dados numéricos , Testes Neuropsicológicos , Carência Psicossocial , Atenção/fisiologia , Pré-Escolar , Colômbia , Interpretação Estatística de Dados , Emoções/fisiologia , Função Executiva , Feminino , Humanos , Testes de Inteligência , Aprendizagem/fisiologia , Masculino , Memória/fisiologia , Memória de Curto Prazo/fisiologia , Pais , Projetos Piloto , Escalas de Graduação Psiquiátrica , Percepção Espacial/fisiologia , Percepção Visual/fisiologiaRESUMO
The emergence of child-headed households (CHH) is considered an indicator of the erosion of the traditional safety nets in sub-Saharan African countries and a direct consequence of the increasing number of orphans in the region. Using four available waves of the Zimbabwe Demographic and Health Surveys (1988, 1994, 1999, 2005/2006), we find that the proportion of households with no adults remained stable in the last years, although the number of orphans increased significantly. In fact, a large number of children living in CHH are nonorphans, which suggests that this kind of living arrangement is not always a direct consequence of parental death. Moreover, our analysis shows that children living in CHH and young adult households are less likely to have unmet basic needs than children in households headed by working-age adults and in other vulnerable households.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Proteção da Criança/estatística & dados numéricos , Filho de Pais com Deficiência/estatística & dados numéricos , Crianças Órfãs/estatística & dados numéricos , Características da Família , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Adolescente , Criança , Proteção da Criança/economia , Pré-Escolar , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Masculino , Fatores Socioeconômicos , Populações Vulneráveis , Zimbábue/epidemiologiaRESUMO
BACKGROUND: Maternal mortality is a public health problem reflecting lack of infrastructure in health facilities or poor obstetrical training of those caring for pregnant women. OBJECTIVE: To report the results of a comprehensive program of the Health System of San Luis Potosi State, aimed at reducing maternal mortality in the period 2004-2008. MATERIAL AND METHODS: An observational and retrospective study based on information provided by the State Committee for the Study and Prevention of Maternal Mortality in the 58 municipalities, hospitals and medical units of the state of San Luis Potosi. RESULTS: During the period 2004-2008, maternal mortality was reduced by 55% as a result of increased postpartum contraception coverage from 32 to 74% in general and community hospitals, and from 47 to 58% in health care units located in risk areas. In 2004, births fell by 5.8%. Between 1990 and 2003, 2,929 newborns were left maternal orphans, with an annual average of 209. During the study period, 423 infants were in the same situation, with an average of 70. CONCLUSIONS: The present conditions of the social environment of San Luis Potosi are favourable to further reduce maternal mortality.
Assuntos
Serviços de Saúde Materna/organização & administração , Mortalidade Materna , Crianças Órfãs/estatística & dados numéricos , Anticoncepção , Feminino , Programas Governamentais/organização & administração , Política de Saúde , Humanos , Recém-Nascido , Mortalidade Materna/tendências , México/epidemiologia , Ocitocina/análogos & derivados , Ocitocina/uso terapêutico , Hemorragia Pós-Parto/prevenção & controle , Período Pós-Parto , Gravidez , Estudos Retrospectivos , População Rural , Contração Uterina/efeitos dos fármacos , Hemorragia Uterina/prevenção & controleRESUMO
BACKGROUND: The Spectrum program is used to estimate key HIV indicators from the trends in incidence and prevalence estimated by the Estimation and Projection Package or the Workbook. These indicators include the number of people living with HIV, new infections, AIDS deaths, AIDS orphans, the number of adults and children needing treatment, the need for prevention of mother-to-child transmission and the impact of antiretroviral treatment on survival. The UNAIDS Reference Group on Estimates, Models and Projections regularly reviews new data and information needs, and recommends updates to the methodology and assumptions used in Spectrum. METHODS: The latest update to Spectrum was used in the 2009 round of global estimates. This update contains new procedures for estimating: the age and sex distribution of adult incidence, new child infections occurring around delivery or through breastfeeding, the survival of children by timing of infection and the number of double orphans.