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

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.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 19 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.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.Our study supports the further development and piloting of programmes that address psychosocial problems of orphans.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal