Centre for Population Change Dynamics of children’s living arrangement and caregiver churn in rural communities with high HIV prevalence in South Africa Gabriela Mejia-Pailles 1,2 , Vicky Hosegood 1,2,3 Kathy Ford 4 , Ann Berrington 1,3 1 Centre for Population Change, University of Southampton, 2 Africa Health Research Institute, University of KwaZulu-Natal, 3 Department of Social Statistics and Demography, University of Southampton, 4 School of Public Health, University of Michigan International Population Conference, Cape Town, South Africa 31 st October 2017
Background • The care that children receive are associated with many aspects of their development, health and wellbeing • For the majority of children, biological parents will be centrally involved in providing care • In South Africa, three features provide particular motivation to the documentation and understanding of children’s care arrangements • Severe HIV epidemic • High levels of adult and child migration • Marriage, union instability and separation levels and patterns
Background • Family-related health and welfare policy in South Africa where identifying who is providing care to children is important • Empirical findings about caregiving arrangements in South African communities are based on cross-sectional sources of data Aim : • To describe the dynamics of children’s living arrangement and the frequency and pattern of changes or ‘ churn ’ in the people identified as being primary caregivers.
Research Questions: • RQ1. What are children’s living arrangements in a high HIV prevalence area in rural South Africa? • RQ2. How often do orphans and non-orphans experience a change in main caregiver? • RQ3. How does age at orphaning relate to the churn in caregivers? • RQ4. How soon do orphans and non-orphans experience a first change in caregiver ? • RQ5. What are the main pathways in the types of caregivers experienced by orphans and non-orphans?
Data & Methods Africa Health Research Institute (AHRI) Demographic Surveillance System Ongoing Demographic Surveillance System (DSS) collecting longitudinal data since 2000, in northern KwaZulu-Natal, South Africa on 10,000 households & approx. 90,000 household members; 30% of household member are not resident in the community Prospective cohort of over 10,000 non-orphaned children aged 0-10 years on 1 st Jan 2005 who were a member of a study household throughout 1 st Jan 2005 and 31 st Dec 2012 Main caregiver: person in charge for the child’s care on a daily basis Analytical approach Survival analysis and Sequence Analysis
RQ1. Living arrangements of all resident children <18 years in the DSS by orphaning status, 2005-2012 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Both Mother Father Neither Both Mother Father Neither Both Mother Father Neither parents only only parent parents only only parent parents only only parent Non-orphans Maternal orphans Paternal orphans 2005 2007 2010 2012
RQ2 & RQ3. Mean number of changes in caregiver and mean number of different household members acting as caregivers for children in the prospective cohort, 2005-2012 Non-orphans . 0-4 Maternal 5-9 orphans 10-14 15-17 Total 0-4 5-9 Paternal orphans 10-14 15-17 Total 0-4 5-9 orphans Double 10-14 15-17 Total 0 2 4 6 8 10 Changes in caregiving Different household members acting as caregivers
RQ4. Time to first change in caregiver by maternal orphaning status Kaplan-Meier failure estimates 1.00 0.75 0.50 0.25 0.00 0 2 4 6 8 years non-maternal orphan <1yr maternal orphan >1yr maternal orphan
RQ5. Types of caregiving trajectories considering maternal co-residency and maternal survival status Clu luster Medoid trajectory % ch chil ildren in in clu cluster 1. 1. Mos ostly (mother, resident, 11,) – (female relative, mother alive resident, 1) – (father, 40% resi esident mother alive resident, 1) – (other, mother alive resident, 1) – (mother, resident, 3) mothers 2. 2. Slo Slower (mother, alive resident, 1) – (female relative, mother alive resident, 1) – (mother 23% ch changes resident, 8) – (self, mother alive non-resident, 2) – (other, mother alive non resident, 1) – (self, mother alive non-resident, 1) - (other, mother alive non- resident, 1) - (grandmother, mother alive non-resident, 2) 3. Fas 3. ast (grandfather, mother alive non-resident, 1) – (mother, non-resident, 3) - 17% ch changers (grandfather, mother alive non-resident, 1) – (father, mother alive non-resident, 3) – (grandfather, mother, alive non-resident, 2) – (mother, non-resident, 1) – (female relative, mother alive non resident, 1) – (mother, non-resident, 2)- (female relative, mother alive non-resident, 1) – (mother, non-resident, 2) 4. 4. Mos ostly no non (grandmother, mother alive non-resident, 1) – (mother, non-resident, 3) – (other, 8% resi esidents s mother alive non-resident, 1) - – (mother, non-resident, 9) – (grandfather, mother mother alive non-resident, 1) - – (mother, non-resident, 1) – (grandfather, mother alive non- resident, 1) 5. 5. Mos ostly (grandmother, mother alive non-res, 10) – (mother, alive and resident, 3) – 11% gr grandmothers (grandmother, mother alive and resident, 1) – (father, mother alive resident, 1) – (mother, alive non-resident, 2)
RQ5. Medoid trajectory for “ Mostly Resident Mothers” cluster Cluster Med edoid id tr traje ajectory % % ch chil ildren in n clu cluster 1. . Mos ostly ly (m (moth ther, res resid ident, 11) 11) – (female relative, mother alive 40% resi esident resident, 1) – (father, mother alive resident, 1) – mot others (other, mother alive resident, 1) – (m (mother, re resid ident, 3)
RQ5. Medoid trajectory for “ Slow changers ” cluster Clu luster Med edoid id tr traje ajectory % % ch chil ildren in n clu cluster 2. . Slow (mother, alive resident, 1) – (female relative, mother 23% ch changers alive resident, 1 ) – (mother resident, 8 ) – (self, mother alive non-resident, 2 ) – (other, mother alive non resident, 1 ) – (self, mother alive non-resident, 1 ) - (other, mother alive non-resident, 1 ) - (grandmother, mother alive non-resident, 2 )
RQ5. Medoid trajectory for “ Fast changers ” cluster Cluster Med edoid id tr traje ajectory % % ch chil ildren in in clu cluster 3. . Fast t (grandfather, mother alive non-resident, 1 ) – 17% ch changers (mother, non-resident, 3 ) - (grandfather, mother alive non-resident, 1 ) – (father, mother alive non- resident, 3 ) – (grandfather, mother, alive non- resident, 2 ) – (mother, non-resident, 1 ) – (female relative, mother alive non resident, 1 ) – (mother, non-resident, 2 )- (female relative, mother alive non- resident, 1 ) – (mother, non-resident, 2 )
RQ5. Medoid trajectory for the “ Mostly non- resident mothers ” cluster Cluster Med edoid id tr traje ajectory % % ch chil ildren in n clu cluster 4. . Mos ostly ly (grandmother, mother alive non-resident, 1) – 8% non non (m (moth ther, non-resid ident, 3) – (other, mother alive non- resi esidents resident, 1) - – (m (mother, non-resident, 9) – mother (grandfather, mother alive non-resident, 1) - – (m (moth ther, non-resid ident, 1) – (grandfather, mother alive non-resident, 1)
RQ5. Medoid trajectory for the “ Mostly grandmothers ” cluster Cluster Med edoid id tr traje ajectory % % ch chil ildren in n clu cluster 5. . Mos ostly ly ( gra randmother, mother alive non-res, 10 ) – (mother, 11% gran and- alive and resident, 3) – ( gra randmother, mother aliv live mot others and re resid ident, 1 ) – (father, mother alive resident, 1) – (mother, alive non-resident, 2)
RQ5. Clusters characteristics considering maternal co-residency and maternal survival status Res esid ident Slo Slow w Fas ast Non resid Non ident Gr Gran andmot othe mothers mo changers changers mothers mo rs rs Orp Orphanin ing 2005-2012 (%) (%) Ne Never orph orphaned duri during g 2005-12 12 46 46 21 21 15 15 9 9 Be Became do double le duri during 2005-12 12 4 29 29 31 31 6 30 30 Be Became ma maternal l dur durin ing g 2005-12 12 4 32 32 36 36 6 22 22 Be Became pa paternal dur durin ing 2005-12 12 39 39 22 22 16 16 8 14 14 Nu Number of of changes of of caregiv ivers (me (mean) 5 7 7 6 7 Nu Number of of di different car aregi givers (me (mean) 2 3 4 3 3 Se Sex x Mal Male 40 40 23 23 17 17 8 11 11 Fem emale les 41 41 22 22 18 18 8 12 12 Ag Age e at t the the begi beginnin ing of of ob observ rvation per perio iod (%) (%) <= <=5 yr yrs 41 41 27 27 13 13 9 10 10 6-10 10 yr yrs 40 40 19 19 22 22 7 13 13
Discussion • The high levels of migration, parental mortality and low rates of marriages have resulted in disperse living arrangements for many children and their parents in rural communities in South Africa. • Our findings showed that children who became orphan and children whose parents survived during the period of observation in this community both experienced a similarly high mean number of changes in their primary caregiver • Caregiving responsibilities felt to a small number of household members, who alternate on the caregiver role • We found no evidence of a self-care trajectory
Recommend
More recommend
