Discrepancies between UN models and DHS survey estimates of maternal orphan prevalence: insights from analyses of survey data from Zimbabwe
- 1Department of Infectious Disease Epidemiology, Imperial College, London, UK
- 2Biomedical Research and Training Institute, Harare, Zimbabwe
- 3Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Dr Laura Robertson, St Mary’s Campus, Norfolk Place, London W2 1PG, UK;
- Accepted 5 April 2008
Objectives: Model-based estimates of maternal (but not paternal) orphanhood are higher than those based on data from demographic and health surveys (DHS). We investigate the consistency of reporting of parental survival status in data from Manicaland, Zimbabwe.
Methods: We compared estimates of paternal and maternal orphan prevalence in three rounds of a prospective household census in Manicaland (1998–2005) with estimates from DHS surveys and UNAIDS model projections. We investigated the consistency of reporting of parental survival status across the three rounds and compared estimates of adult mortality from the orphan data with direct estimates from concurrent follow-up of a general population cohort. Qualitative data were collected on possible reasons for misreporting.
Results: Paternal and maternal orphan prevalence is increasing in Zimbabwe. Mothers reported as deceased in round 1 of the Manicaland survey were more likely than fathers to be reported as alive in rounds 2 or 3 (33.3% vs 13.4%). This pattern was most apparent among younger children. The qualitative findings suggest that foster parents sometimes claim adopted children as their natural children.
Conclusions: These results are consistent with misreporting of foster parents as natural parents. This appears to be particularly common among foster mothers and could partly explain the discrepancy between mathematical model and DHS estimates of maternal orphanhood.
Funding: The study was funded by the Wellcome Trust and the Medical Research Council.
Competing interests: None.
Contributors: LR and SG designed the study, planned and conducted the data analysis and drafted the manuscript. CM conducted the qualitative work. NW contributed to the data analysis. PM and CN organised the quantitative data collection (Manicaland Study). All authors reviewed and critically appraised the manuscript.