Orphanhood in Manhiça district, Mozambique: causes, trends, and impacts on living arrangements and migration over 24 years of continuous demographic surveillance (1998-2021)

Abstract

Background Orphanhood is among the major socio-economic challenges in low- and middle-income countries, but measuring the trends, causes, and consequences of orphanhood on children in these countries has been difficult due to lack of adequate data. This study aimed to provide insights into the trends in prevalence, incidence, causes and consequences of orphanhood on living arrangements and migration of children in Manhiça district, Mozambique. Methods This study presents a descriptive analysis of annual prevalence and incidence of orphans, leveraging data from a Health and Demographic Surveillance System (HDSS) that followed 225,921 children < 18 years during 1998–2021 in Manhiça. It also presents cause-specific proportions of orphans using verbal autopsies. The impacts of orphanhood on living arrangements and migration of children were examined by comparing indices such as household size and composition, and annual rates of migration by orphan status. Results The results show that 8.1% of children had lost at least one biological parent before age 18 years. There were more paternal orphans (51.5%) than maternal orphans (42.1%), and double orphans (6.3%). The prevalence and incidence of orphanhood increased and decreased - with prevalence increasing from 1.8% in 1998 to 6.3% in 2021, after peaking to 9.2% in 2011–2012, a trend that appears to reflect the trend in adult mortality in Manhiça, where the ₄₅q₁₅ increased from 0.40 in 1998 to over 0.65 during 2002–2008, before decreasing in 2009–2021. HIV/AIDS and tuberculosis were the leading causes of orphanhood, with 38.8% of maternal orphans and 30.8% of paternal orphans; followed by other communicable diseases (16.2% and 15.0% of maternal and paternal orphans, respectively). Sixty-seven percent of orphans lived in female-headed households compared to 19.7% of non-orphans. Orphans had higher rates of migration (108.5 per 1,000 person-years) than non-orphans (76.0), particularly among maternal orphans and infants. Conclusions These findings quantify and describe the burden of orphanhood and its evolution over 2.5 decades and suggest a need for targeted interventions to address the socio-economic challenges stemming from orphanhood in Manhiça and, likely, in similar contexts. Furthermore, the study provides crucial insights for future research using this HDSS data, e.g. the assessment of the implications of orphanhood on child health, survival, and marriage.