Botswana has the second highest HIV prevalence rate and highest rate of orphanhood in the world. Although child mortality rates have doubled in 15 years, the extent to which health disparities are connected to orphan status remains unclear. We conducted an analysis of the 2000 Botswana Multiple Indicator Cluster Survey to examine whether orphan-based health disparities exist. We measured health inequalities using anthropometric data among 2723 under-five year olds, nested in 1854 households, and 208 communities. We calculated multilevel logistic regression models to estimate the child, household, and regional determinants of growth failure. We found that orphaned children aged 0-4 are 49% more likely to be underweight than nonorphans (p<0.05) controlling for household poverty and other factors; and orphans disproportionately live in the poorest households. Throughout sub-Saharan Africa (SSA), Botswana is a leader in responding to the AIDS epidemic, in particular as one of the first countries to offer universal antiretroviral treatment. However, orphan-based health disparities confirm that the orphan response is still insufficient. Better data are needed to fully understand the mechanisms that lead to these disparities, and the public sector needs an increased capacity to fully implement the policies and programs designed to meet the needs of orphans. Findings from this study have important implications for countries throughout SSA, and Southern Africa in particular, where the number of orphans has doubled to tripled over the past 15 years.

译文

:博茨瓦纳的艾滋病毒感染率是全球第二高,孤儿率最高。尽管儿童死亡率在15年内翻了一番,但健康差异与孤儿状况有关的程度仍不清楚。我们对2000年博茨瓦纳多指标类集调查进行了分析,以检查是否存在基于孤儿的健康差异。我们使用人体测量学数据测量了2854名1854个家庭和208个社区的5岁以下儿童的健康不平等状况。我们计算了多级逻辑回归模型来估计儿童,家庭和区域性成长失败的决定因素。我们发现,在控制家庭贫困和其他因素的情况下,0-4岁的孤儿比非孤儿的体重过轻的可能性高49%(p <0.05);孤儿不成比例地生活在最贫穷的家庭中。在整个撒哈拉以南非洲地区(SSA),博茨瓦纳是应对艾滋病流行的领导者,特别是作为首批提供普遍抗逆转录病毒治疗的国家之一。但是,基于孤儿的健康差异证实了孤儿的反应仍然不足。需要更好的数据来充分理解导致这种差距的机制,公共部门需要增强能力,以充分执行旨在满足孤儿需求的政策和方案。这项研究的发现对整个撒哈拉以南非洲地区尤其是南部非洲的国家都具有重要意义,在过去的15年中,这些国家的孤儿人数翻了一番,达到了两倍。

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