Miller Candace Marie, Gruskin Sofia, Subramanian S V, Heymann Jody
Boston University School of Public Health, Center for International Health and Development, Boston, MA 02118, USA.
Soc Sci Med. 2007 Jun;64(12):2476-86. doi: 10.1016/j.socscimed.2007.03.002. Epub 2007 Apr 17.
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.
博茨瓦纳的艾滋病病毒感染率在世界上位居第二，孤儿率则为全球最高。尽管儿童死亡率在15年内翻了一番，但健康差距与孤儿身份之间的关联程度仍不明确。我们对2000年博茨瓦纳多指标类集调查进行了分析，以研究基于孤儿身份的健康差距是否存在。我们利用2723名五岁以下儿童（嵌套于1854个家庭和208个社区）的人体测量数据来衡量健康不平等状况。我们计算了多水平逻辑回归模型，以估计生长发育不良的儿童、家庭和地区决定因素。我们发现，在控制家庭贫困和其他因素的情况下，0至4岁的孤儿体重不足的可能性比非孤儿高49%（p<0.05）；而且孤儿不成比例地生活在最贫困的家庭中。在整个撒哈拉以南非洲地区，博茨瓦纳在应对艾滋病疫情方面处于领先地位，尤其是作为首批提供普遍抗逆转录病毒治疗的国家之一。然而，基于孤儿身份的健康差距表明，对孤儿的应对措施仍然不足。需要更好的数据来全面了解导致这些差距的机制，公共部门需要增强能力，以全面实施旨在满足孤儿需求的政策和方案。这项研究的结果对整个撒哈拉以南非洲地区，尤其是南部非洲的国家具有重要意义，在这些地区，孤儿数量在过去15年里增加了一倍至两倍。
