Understanding the burden of COVID-19 orphanhood and caregiver loss among children and adolescents living in South Africa

Introduction

While caregiver loss is known to have significant repercussions for the wellbeing and developmental trajectories of children and adolescents, limited evidence has examined the impact of orphanhood due to COVID-19 on children and adolescents. To respond to this gap and support better planning for future crises, we examined the short-term impacts of COVID-19-related orphanhood on children’s and adolescents’ wellbeing through the Orphanhood and Caregiver Loss Among Adolescents and Youth (OCAY) study. No such studies exist globally and this provides a unique insight into this hidden group. We hypothesised that there would be multiple mental health impacts on children experiencing such loss.

Methods

We collected data from children and adolescents aged 9–18 years in peri-urban Khayelitsha, South Africa, including those who lost a parent/caregiver to COVID-19 and a community comparison group who did not. Trained research assistants administered questionnaires, utilising standardised inventories and validated scales, that explored young participants’ mental health, wellbeing, and social circumstances. Data was analysed using descriptive statistics, and multivariate linear and logistic regression models in STATA18 and R.

Results

Our final sample included n = 421 children and adolescents (n = 211 experiencing parental/caregiver loss, n = 210 controls) with a mean age of 12.7 years (SD = 2.3), with no significant between-group differences. Males experiencing COVID-related orphanhood were more likely to report rule breaking behaviour compared to females experiencing orphanhood (4.3 vs. 2.7, Cliff’s d = 0.34 [95 %CI: 0.07, 0.61], p = 0.04). Children experiencing the death of a primary caregiver were more likely to report a greater mental health burden compared to children experiencing the loss of a non-primary caregiver (p=<0.05). Multiple regression analyses showed that children and adolescents affected by COVID-related loss experienced significantly greater levels of food insecurity (OR = 2.14 [95 %CI: 1.04–4.40], p = 0.038), greater caregiving burdens in the household (β = 1.08 [95 %CI: 0.33–1.83], p = 0.005), poorer mental health and suicidality (β = 0.18 [95 %CI: 0.00–0.36], p = 0.047), and more social risk behaviours (β = 0.75 [95 %CI: 0.01–1.49], p = 0.046) than their control group counterparts, even after controlling for sociodemographic and household information. Children and adolescents experiencing higher levels of poverty and who had any disability were at particular disadvantage.

Conclusion

This paper presents new evidence on how caregiver loss—beyond the influence of factors such as sex, age, disability, and poverty—can increase children’s vulnerability. Such vulnerability included food insecurity, additional domestic burdens of caregiving, elevated grief, suicidality, and the tendency to engage in social risk behaviours. This data illuminates the need for planning and provision to prevent and respond to such loss.