Orphanhood and self-esteem : an 18-year longitudinal study from an HIV-affected area in Tanzania

Abstract

Background: The HIV epidemic exacerbated the prevalence of prime-aged adult death in many parts of sub-Saharan Africa, resulting in increased rates of orphanhood. Little is known about whether this will coincide with adverse psychosocial wellbeing in adulthood for those who were orphaned at childhood. Methods: We studied a cohort of 1,108 children from Kagera, a region of Tanzania that was heavily affected by HIV early in the epidemic. During the baseline data collection in 1991-94 these children were aged 0-16 years and had both parents alive. We followed them roughly 16-19 years later in 2010, by which time 531 children (36%) had lost either one or both parents before their 19th birthday. We compared the 2010 10-item Rosenberg Self-Esteem Scale (RSES) score between children who lost a parent before the age of 19 and those who did not. We used the baseline data to control for pre-orphanhood confounders. This is important, since we find that children who will lose their fathers in the future before age 19 came from somewhat lower socioeconomic backgrounds. Results: We found no correlation between maternal death and self-esteem measured through RSES. Paternal death was strongly correlated to lower levels of self-esteem (0.2 standard deviations lower RSES CI95% 0.059-0.348) and the correlation was stronger when the death occurred during the child’s teenage years. These effects are net of socioeconomic differences that existed before the orphanhood event. Conclusions: Our study supports the further development and piloting of programmes that address psychosocial problems of orphans.