Impact of the HIV-1 epidemic on orphan mortality in a rural Ugandan population cohort.

AIDS-related mortality is responsible for the creation of more than 40% of orphans in Ugandas rural populations. The HIV epidemic also contributes directly to childhood mortality. Children under age 15 years in a rural population cohort in southwest Uganda of approximately 10000 people in 15 neighboring villages were followed from 1990/91 to 1994/95 to establish mortality rates for the period. 4975 children were identified of whom 10.4% were orphans. 6.3% of all children had lost their father 2.8% had lost their mother and 1.3% had lost both parents. Overall HIV-1 prevalence for all ages and among children remained at 5% and 1% respectively throughout the study period. 10 of the 32 HIV-seropositive and 110 of the 4562 HIV-seronegative children died over the 4-year follow-up period. 2 of the 10 HIV-seropositive deaths and 9 of the 110 HIV-seronegative deaths were of orphans. Data presented and analyzed indicate the existence of an association between HIV-1 and orphanhood and child and mothers mortality. However no convincing evidence was found of increased mortality for orphans after allowing for age and HIV status. The current capacity of this community to cope with its orphans could be overwhelmed if the burden of orphans increases.