Showing papers by "Susan D. Hillis published in 2021"

COVID-19-Associated Orphanhood and Caregiver Death in the United States.

Abstract: Background: Most COVID-19 deaths occur among adults, not children, and attention has focused on mitigating COVID-19 burden among adults. However, a tragic consequence of adult deaths is that high numbers of children might lose their parents and caregivers to COVID-19-associated deaths. Methods: We quantified COVID-19-associated caregiver loss and orphanhood in the US and for each state using fertility and excess and COVID-19 mortality data. We assessed burden and rates of COVID-19-associated orphanhood and deaths of custodial and co-residing grandparents, overall and by race/ethnicity. We further examined variations in COVID-19-associated orphanhood by race/ethnicity for each state. Results: We found that from April 1, 2020 through June 30, 2021, over 140,000 children in the US experienced the death of a parent or grandparent caregiver. The risk of such loss was 1.1 to 4.5 times higher among children of racial and ethnic minorities, compared to Non-Hispanic White children. The highest burden of COVID-19-associated death of parents and caregivers occurred in Southern border states for Hispanic children, Southeastern states for Black children, and in states with tribal areas for American Indian/Alaska Native populations. Conclusions: We found substantial disparities in distributions of COVID-19-associated death of parents and caregivers across racial and ethnic groups. Children losing caregivers to COVID-19 need care and safe, stable, and nurturing families with economic support, quality childcare and evidence-based parenting support programs. There is an urgent need to mount an evidence-based comprehensive response focused on those children at greatest risk, in the states most affected.

Factors That Protect Children From Community Violence: Applying the INSPIRE Model to a Sample of South African Children.

Abstract: Community violence is a prevalent form of interpersonal violence in South Africa for children living in low-income areas. Trauma arising from violence exposure is of concern in contexts where acces...

Under the Radar: Global Minimum Estimates for COVID-19-Associated Orphanhood and Deaths Among Caregivers During 2020

Abstract: Background: The global COVID-19 pandemic and response has focused on prevention, detection, and response. Beyond morbidity and mortality of those infected, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. Such children often face adverse consequences, including poverty, abuse, delayed development, and institutionalization. We provide estimates for the magnitude of this problem resulting from COVID-19 and describe the need for resource allocation. Methods: We use mortality and fertility data to model rates of COVID-19-associated orphanhood and caregiver deaths for 18 countries in Africa, Asia, Europe, and the Americas, and extrapolate global estimates of COVID-associated deaths of parents and grandparent caregivers. Results: We estimate that globally, >1 million children were orphaned or lost a caregiver due to COVID-19-associated deaths during March–December 2020. Countries with higher rates of caregiver deaths included Peru, South Africa, Mexico, Russian Federation, Colombia, Brazil, Islamic Republic of Iran, Argentina, U.S.A., and Spain (range, 1·1–9·8/1000). For most countries, numbers of children orphaned were greater than deaths among those aged 15–44 years; 2–5 times more children had deceased fathers than deceased mothers. Conclusions: Orphanhood and caregiver deaths are a shadow pandemic resulting from COVID-19-associated deaths: we find that over one million children worldwide have lost a parent or caregiver in just ten months. Accelerating equitable vaccine delivery is key to prevention. Psychosocial and economic support can help families nurture children bereft of caregivers and promote their recovery. Strengthening family-based care can help ensure that institutionalization of these children is avoided. These data demonstrate the need for an additional pillar of our response: prevent, detect, respond, and care for children. Funding: UK Research and Innovation (Global Challenges Research Fund (GCR), Engineering and Physical Sciences Research Council, Medical Research Council), UK National Institute for Health Research, U.S. National Institutes of Health, Imperial College. Declaration of Interests: Dr. Donnelly reports grants from UK Medical Research Council and grants from NIHR during the conduct of the study. Dr. Cluver reports grants from UK Research and Innovation (UKRI) Global Challenges Research Fund, during the conduct of the study. All other authors report nothing to disclose. Ethics: We used modeled aggregate data and publicly available de-identified survey metadata.

Associations of Father and Adult Male Presence with First Pregnancy and HIV Infection: Longitudinal Evidence from Adolescent Girls and Young Women in Rural South Africa (HPTN 068)

Abstract: This study, a secondary analysis of the HPTN 068 randomized control trial, aimed to quantify the association of father and male presence with HIV incidence and first pregnancy among 2533 school-going adolescent girls and young women (AGYW) in rural South Africa participating in the trial between March 2011 and April 2017. Participants’ ages ranged from 13–20 years at study enrollment and 17–25 at the post-intervention visit. HIV and pregnancy incidence rates were calculated for each level of the exposure variables using Poisson regression, adjusted for age using restricted quadratic spline variables, and, in the case of pregnancy, also adjusted for whether the household received a social grant. Our study found that AGYW whose fathers were deceased and adult males were absent from the household were most at risk for incidence of first pregnancy and HIV (pregnancy: aIRR = 1.30, Wald 95% CI 1.05, 1.61, Wald chi-square p = 0.016; HIV: aIRR = 1.27, Wald 95% CI 0.84, 1.91, Wald chi-square p = 0.263) as compared to AGYW whose biological fathers resided with them. For AGYW whose fathers were deceased, having other adult males present as household members seemed to attenuate the incidence (pregnancy: aIRR = 0.92, Wald 95% CI 0.74, 1.15, Wald chi-square p = 0.462; HIV: aIRR = 0.90, Wald 95% CI 0.58, 1.39, Wald chi-square p = 0.623) such that it was similar, and therefore not statistically significantly different, to AGYW whose fathers were present in the household.