{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T00:50:32Z","timestamp":1775868632260,"version":"3.50.1"},"reference-count":79,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,24]],"date-time":"2020-11-24T00:00:00Z","timestamp":1606176000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000269","name":"Economic and Social Research Council","doi-asserted-by":"publisher","award":["ES\/J021 202\/1"],"award-info":[{"award-number":["ES\/J021 202\/1"]}],"id":[{"id":"10.13039\/501100000269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["(#082384\/Z\/07\/Z"],"award-info":[{"award-number":["(#082384\/Z\/07\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["WT083495MA"],"award-info":[{"award-number":["WT083495MA"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010877","name":"ViiV Healthcare","doi-asserted-by":"publisher","award":["ITCRZF51"],"award-info":[{"award-number":["ITCRZF51"]}],"id":[{"id":"10.13039\/100010877","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["082384\/Z\/07\/Z"],"award-info":[{"award-number":["082384\/Z\/07\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>In South Africa, large increases in early adult mortality during the 1990s and early 2000s have reversed since public HIV treatment rollout in 2004. In a rural population in KwaZulu-Natal, we investigate trends in parental mortality and orphanhood from 2000\u20132014.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Using longitudinal demographic surveillance data for a population of approximately 90,000, we calculated annual incidence and prevalence of maternal, paternal and double orphanhood in children and adolescents (&lt;20 years) and, overall and cause-specific mortality of parents by age.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The proportion of children and adolescents (&lt;20 years) for whom one or both parents had died rose from 26% in 2000 to peak at 36% in 2010, followed by a decline to 32% in 2014. The burden of orphanhood remains high especially in the oldest age group: in 2014, 53% of adolescents 15\u201319 years had experienced the death of one or both parents. In all age groups and years, paternal orphan prevalence was three-five times higher than maternal orphan prevalence. Maternal and paternal orphan incidence peaked in 2005 at 17 and 27 per 1,000 person years respectively (&lt;20 years) before declining by half through 2014. The leading cause of parental death throughout the period, HIV\/AIDS and TB cause-specific mortality rates declined substantially in mothers and fathers from 2007 and 2009 respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The survival of parents with children and adolescents &lt;20 years has improved in tandem with earlier initiation and higher coverage of HIV treatment. However, comparatively high levels of parental deaths persist in this rural population in KwaZulu-Natal, particularly among fathers. Community-level surveillance to estimate levels of orphanhood remains important for monitoring and evaluation of targeted state welfare support for orphans and their guardians.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0238563","type":"journal-article","created":{"date-parts":[[2020,11,24]],"date-time":"2020-11-24T23:09:36Z","timestamp":1606259376000},"page":"e0238563","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Trends in the prevalence and incidence of orphanhood in children and adolescents &lt;20 years in rural KwaZulu-Natal South Africa, 2000-2014"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8832-8136","authenticated-orcid":true,"given":"Gabriela","family":"Mejia-Pailles","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann","family":"Berrington","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nuala","family":"McGrath","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2244-2518","authenticated-orcid":true,"given":"Victoria","family":"Hosegood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2020,11,24]]},"reference":[{"issue":"3","key":"pone.0238563.ref001","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1353\/dem.2004.0019","article-title":"Orphans in Africa: parental death, poverty, and school enrollment","volume":"41","author":"A Case","year":"2004","journal-title":"Demography"},{"issue":"Suppl 3","key":"pone.0238563.ref002","doi-asserted-by":"crossref","first-page":"S251","DOI":"10.1097\/QAD.0000000000000327","article-title":"Evidence of impact: health, psychological and social effects of adult HIV on children","volume":"28","author":"L Sherr","year":"2014","journal-title":"AIDS"},{"issue":"Suppl 3","key":"pone.0238563.ref003","doi-asserted-by":"crossref","first-page":"S261","DOI":"10.1097\/QAD.0000000000000328","article-title":"Predicting long-term outcomes for children affected by HIV and AIDS: perspectives from the scientific study of children's development","volume":"28","author":"A Stein","year":"2014","journal-title":"AIDS"},{"key":"pone.0238563.ref004","article-title":"Orphanhood and Self-esteem: an 18-year longitudinal study from an HIV affected area in Tanzania","author":"J De Weerdt","year":"2017","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"8","key":"pone.0238563.ref005","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1136\/jech-2015-206744","article-title":"Are adolescent orphans more likely to be HIV-positive? 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