Our Work
Science
Using the best available modelling and epidemiologic data, we generate global, regional, national, and subnational estimates of children affected by crises of climate, contagion, and conflict.
COVID-19 Orphanhood
Children: The Hidden Pandemic 2021 – A joint report of COVID-19-associated orphanhood and a strategy for action
Children: The Hidden Pandemic 2021 presents statistical data from 192 countries on children experiencing COVID-19-associated orphanhood and death of grandparent caregivers, a description of the trends in these data, a real-time COVID-19 Calculator for Death of Parents and Caregivers, and strategies and principles for integrating care for children bereaved by the virus into every nation’s COVID-19 response planning. This report includes data from March 1, 2020 through April 30, 2021, and provides the most extensive estimates yet on the current and projected number of children experiencing orphanhood and death of caregivers. The report is a collaboration between the U.S. Centers for Disease Control and Prevention, Imperial College London, the World Health Organization, U.S. Agency for International Development (USAID), the World Bank, University of Oxford, Harvard University, University College London, and University of Cape Town.
U.S. All-Cause Orphanhood Child Dependent Reporting
Orphanhood and Caregiver Loss Among Children Based on New Global Excess COVID-19 Death Estimates.
Deaths of parents and grandparent caregivers due to social and health crises significantly threaten child wellbeing, leading to losses in nurturance, financial support, physical safety, family stability, and care. From 2000-2021, orphanhood and grandparent caregiver loss increased by 49.2% and 8.3%, respectively. By 2021, 2.9 million children (4% of all children) experienced orphanhood and caregiver death, with disproportionately affected populations including 5.0% of adolescents; 6.5%, 4.8%, and 3.9% of non-Hispanic American Indian/Alaska Native, non-Hispanic Black, and non-Hispanic White children, respectively; and children in New Mexico and Southern and Eastern States. During the pandemic, drug overdose surpassed COVID-19 as the leading cause of orphanhood. To address this crisis, policies, programs, and practices are urgently needed to prevent orphanhood and support nearly 3 million bereaved children, with a priority on those affected by overdose-linked orphanhood.
Reauthorise PEPFAR
Reauthorise PEPFAR to prevent death, orphanhood, and suffering for millions of children.
As researchers focused on HIV, AIDS, and paediatric health, preserving children’s lives is paramount. In light of the current challenge to the 5-year reauthorisation of the US President’s Emergency Plan for AIDS Relief (PEPFAR), we used 2023 UNAIDS estimates to assess PEPFAR’s impact on child survival and health. Our focus was on sub-Saharan Africa, which receives over 90% of PEPFAR funds and is home to two-thirds of all people with HIV. PEPFAR collaborates with the Global Fund to Fight AIDS, Tuberculosis and Malaria, national governments, UNAIDS, and other UN agencies to provide support.
PEPFAR has significantly mitigated the devastating effects of HIV and AIDS on newly orphaned children. The loss of a parent often leads to education loss, child abuse, and increased risks of HIV infection. Using UNAIDS data, we estimated the number of children newly orphaned by AIDS before and after PEPFAR’s implementation. Orphanhood in sub-Saharan Africa peaked in 2004 with 1.6 million children newly orphaned by AIDS. Following PEPFAR’s rollout of antiretroviral agents in 2005, the incidence of orphanhood due to AIDS has decreased annually, reaching 382,000 in 2021.
Data Modernization
List child dependents on death certificates.
Models suggest that at least 10.5 million children experienced COVID-19–associated orphanhood and caregiver loss in the first two years of the pandemic, with numbers continuing to grow. Public health data currently cannot identify these children, but more information could facilitate the delivery of essential support and services, minimizing the negative effects of orphanhood. To obtain this data, death certificates should include the number of children under 18 living in the home of the deceased parent or caregiver. In Brazil, recording dependent children on death certificates has led to significant support for affected children, including legislation in São Paulo to identify and assist children who lost caregivers during the pandemic. This model, if adopted globally, could help identify children orphaned by any cause of death, ensuring they receive the necessary care and support. The World Health Organization (WHO) should add a question about dependent children to its international death certificate form to standardize this practice. Comprehensive death records, as aimed by the WHO CVRS Strategic Implementation Plan, could standardize aid for orphaned children worldwide.
Modelling COVID-19 Orphanhood and Caregiver Loss Among Children
Orphanhood and Caregiver Loss Among Children Based on New Global Excess COVID-19 Death Estimates.
New excess mortality data has enabled updated global estimates of COVID-19 orphanhood and caregiver death among children. The consequences for these children are severe, including institutionalization, abuse, traumatic grief, mental health issues, adolescent pregnancy, poor educational outcomes, and chronic diseases. Previous global totals and country comparisons were hindered by inconsistent COVID-19 testing and incomplete death reporting. The new estimates, based on excess deaths, provide a comprehensive measure of COVID-19’s long-term impact on orphanhood and caregiver loss.
Using age-specific death and fertility rates, the study applied the GATHER reporting guideline to update COVID-19 estimates of parent and caregiver loss. Excess mortality-derived estimates were computed for children in every country, using data from WHO, The Economist, and IHME. The study found that 10.5 million children lost parents or caregivers, with 7.5 million experiencing COVID-19–associated orphanhood by May 1, 2022. The highest numbers of bereaved children were in Africa and Southeast Asia. The study emphasizes the urgent need for pandemic responses that combine equitable vaccination with support programs for bereaved children, highlighting the importance of integrating care for these children into national pandemic response plans.
OCAY Study
Protocol for the OCAY study: a cohort study of orphanhood and caregiver loss in the COVID-19 era to explore the impact on children and adolescents.
The COVID-19 pandemic affects everyone globally, yet children and adolescents often receive little attention in policy, provision, and services. This study aims to provide early insights into the mental health and well-being of children and adolescents in South Africa who experience orphanhood or caregiver loss due to COVID-19, addressing the significant knowledge gap in this area.
Data is drawn from a quantitative longitudinal study in Cape Town, South Africa, involving children aged 9 to 18 years who have lost a parent or caregiver to COVID-19, alongside a comparison group who have not experienced such loss. The study recruits 500 children in each group. Mental health and well-being are assessed using validated measures, with data collected at two time points, 12-18 months apart. Various analytical techniques are employed to understand the experiences of these children and to inform future policy and service provision.
Hope Groups
Hope Groups: a protocol for a cluster randomized controlled trial of psychosocial, mental health, and parenting support groups for Ukrainian caregivers during war and conflict.
In 2021, over two-thirds of the world’s children lived in conflict-affected countries, and in 2022, 13 million Ukrainians were displaced due to Russia’s invasion. Hope Groups, a 12-session intervention, aim to support parents, caregivers, and children affected by war. This study evaluates the effectiveness of Hope Groups among war-affected Ukrainians, using a decentralized intervention model and innovative research design to estimate the causal effects while ensuring prompt delivery of services.
The study involves a cluster randomized controlled trial (RCT) with approximately 450 participants across 90 clusters. Intervention clusters receive Hope Groups led by peer facilitators, while control clusters are wait-listed. Primary outcomes include caregiver mental health, violence against children, and positive parenting practices, with secondary outcomes focusing on violence prevention and well-being. Data is collected at baseline, endline, and follow-up intervals, using various analytical techniques to assess the impact of Hope Groups compared to wait-list controls. If effective, this model could be adapted for other war-affected populations globally.
Institutionalisation and Deinstitutionalisation of Children
Institutionalisation and deinstitutionalisation of children: the Executive Summary from a Lancet Group Commission.
This Lancet Group Commission advocates global reform of the care of separated children through the progressive replacement of institutional provision with safe and nurturing family-based care. It provides essential information on both the global scale of institutionalisation and its physical, social, and mental health consequences. It presents a pragmatic roadmap for carefully managed change.
Momentum to move children from institutions and into families is building, led by welcomed evidence and practical leadership from many sectors within child health, child protection, and social welfare. It is essential that governments, voluntary organisations, and health and social care professionals work together so that action is not taken precipitately, with potentially unintended adverse consequences, but is instead timely, sustainable, and child-centred.
Publications
Orphanhood and caregiver death among children in the United States due to all-cause mortality 2000-2021: A Modeling Study
Nature Portfolio (Pre-Print, April 2024)
Hope Groups: A protocol for a cluster randomized controlled trial for a psychosocial, mental health, and parenting support groups for Ukrainian caregivers during war and conflict
BMC Trials (July 2024)
The Effectiveness of Hope Groups, a Mental Health, Parenting Support, and Violence Prevention Program for Families Affected by the War in Ukraine: Findings from a Pre-Post Study
Journal of Migration and Health (July 2024)
Reauthorize PEPFAR to prevent death, orphan hood, and suffering for millions of children
The Lancet (2023)
The association between youth violence and mental health outcomes in Colombia: A cross-sectional analysis
Child Abuse & Neglect (July 2023)
Impacts of intimate partner violence and sexual abuse on antiretroviral adherence among adolescents living with HIV in South Africa
AIDS (2023)
List child dependents on death certificates
Science (May 2023)
A conceptual framework and exploratory model for health and social intervention acceptability among African adolescents and youth
Social Science and Medicine (2023)
Protocol for the OCAY study: a cohort study of orphanhood and caregiver loss in the COVID-19 era to explore the impact on children and adolescents
British Medical Journal (BMJ) (May 2023)
Urgent help needed for children affected by the earthquake in Syria and Türkiye
The Lancet: Psychiatry (2023)
From surviving to thriving: integrating mental health care into HIV, community, and family services for adolescents living with HIV
The Lancet: Child and Adolescent Health (2022)
Food security reduces multiple HIV infection risks for high-vulnerability adolescent mothers and non-mothers in South Africa: a cross sectional study
JIAS (2022)
Covid-19 as a long multi-wave event: implications for responses to safeguard younger generations
British Medical Journal (2022)
Ukraine’s children: use evidence to support child protection in emergencies
British Medical Journal (2022)
Orphanhood and Caregiver Loss Among Children Based on New Global Excess COVID-19 Death Estimates
JAMA Pediatrics (September 2022)
Global, regional, and national minimum estimates of children affected by COVID-19-associated orphanhood and caregiver death, by age and family circumstance up to Oct 31, 2021: an updated modelling study
The Lancet Child and Adolescent Health (February 2022)
COVID-19–Associated Orphanhood and Caregiver Death in the United States
American Academy of Pediatrics (December 2021)
Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study
The Lancet (July 2021)
