Poorer health and nutritional outcomes in orphans and vulnerable young children not explained by greater exposure to extreme poverty in Zimbabwe

• Published in: Tropical medicine & international health 2007-05, Vol.12 (5), p.584-593
• Main Authors: Watts, Helen, Gregson, Simon, Saito, Suzue, Lopman, Ben, Beasley, Michael, Monasch, Roeland
• Format: Article
• Language: English
• Subjects: Acute Disease; Adolescent; Age Distribution; At risk youth; Biological and medical sciences; Child; Child Nutrition Disorders - epidemiology; Child, Preschool; Chronic Disease; Cross-Sectional Studies; diarrea; Diarrhea - epidemiology; diarrhoea; diarrhée; enfants vulnérables; Female; Foster Home Care; General aspects; Growth Disorders - epidemiology; Health; Health Status; Humans; huérfanos; Infant; Infant, Newborn; infecciones respiratorias; infections respiratoires; Male; malnutrición; Malnutrition; Medical sciences; Medical treatment; Metabolic diseases; niños vulnerables; Orphans; orphelins; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...); Poverty; Prevalence; respiratory infections; Respiratory Tract Infections - epidemiology; Risk Factors; Thinness - epidemiology; vulnerable children; Vulnerable Populations; Zimbabwe; Zimbabwe - epidemiology
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/j.1365-3156.2007.01832.x

Summary Objective  To describe patterns of association between different groups of young orphans and vulnerable children (OVC) and their nutritional and health outcomes; and to develop a theoretical framework to analyse the determinants of child malnutrition and ill‐health, and identify the different mechanisms which contribute to these outcomes in such children. Methods  We developed and tested a theoretical framework to explain why orphans and vulnerable children experience more ill‐health and malnutrition based on statistical analysis of data on 31 672 children aged 0–17 years (6753 aged under 5 years) selected from the Zimbabwe OVC Baseline Survey 2004. Results  28% of children aged 0–4 years at last birthday were either orphans or vulnerable children. They were more likely than non‐vulnerable children to have suffered recently from diarrhoeal illness (age‐ and sex–adjusted odds ratio, AOR, 1.27; 95% CI 1.09–1.48) and acute respiratory infection (1.27; 1.01–1.59) and to be stunted (1.24; 1.09–1.41) and underweight (1.18; 1.02–1.36). After further adjustment for exposure to extreme poverty, OVC remained at greater risk of diarrhoeal disease (AOR 1.25; 1.07–1.46) and chronic malnutrition (1.21; 1.07–1.38). In 0–17‐year‐olds, OVC with acute respiratory infection were more likely not to have received any treatment even after adjusting for poverty (AOR 1.29; 95% CI 1.16–1.43). Conclusion  Differences in exposure to extreme poverty among young children by OVC status were relatively small and did not explain the greater malnutrition and ill‐health seen in OVC. Objectif  Décrire les profiles des associations entre différentes sortes d'orphelins et jeunes enfants vulnérables (OEV) et les résultats de leur état nutritionnel et de santé; développer un cadre théorique pour analyser les déterminants de la malnutrition et des maladies infantiles; et identifier les différents mécanismes qui contribuent à ces résultats chez les OEV. Methodes  Développement et test d'un cadre théorique pour expliquer les mécanismes par lesquels l'expérience vécue par les OEV résulte en un accroissement la de malnutrition et des maladies infantiles sur base de l'analyse statistique de données collectées chez 31672 enfants âgés de 0 à 17 ans (comprenant 6753 enfants de moins de 5 ans) choisis dans une enquête de ligne de base sur les OEV en 2004 au Zimbabwe. Resultats  28% des enfants âgés 0 à 4 ans à leur récent anniversaire étaient soit des orphelins ou des enfants vulnérables. Les OEV