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Orphanhood and Caregiver Loss Among Children Based on New Global Excess COVID-19 Death Estimates

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

The availability of new excess mortality data enables us to update global minimum estimates of COVID-19 orphanhood and caregiver death among children.14 Consequences for children can be devastating, including institutionalization, abuse, traumatic grief, mental health problems, adolescent pregnancy, poor educational outcomes, and chronic and infectious diseases.4,5 Global totals and country comparisons were previously hampered by inconsistencies in COVID-19 testing and incomplete death reporting. The new orphanhood estimates derived here based on excess deaths provide a comprehensive measure of COVID-19’s long-term impact on orphanhood and caregiver loss.

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Article Information

Accepted for Publication: June 28, 2022.

Published Online: September 6, 2022. doi:10.1001/jamapediatrics.2022.3157

Corresponding Authors: Joel-Pascal Ntwali N’konzi, MSc, African Institute for Mathematical Sciences, KN 3 Rd, Kigali, Rwanda (joelpascal.ntwali@aims.ac.rw); Susan Hillis, PhD, University of Oxford, 32 Wellington Square, OX1 1NF, Oxford, United Kingdom (susanhillis12@gmail.com).

Correction: This article was corrected on October 3, 2022, to fix an error in the Table.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Hillis S et al. JAMA Pediatrics.

Author Contributions: Dr Unwin and Mr Ntwali N’konzi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Hillis, Villaveces, Flaxman, Unwin.

Acquisition, analysis, or interpretation of data: Hillis, Ntwali N’konzi, Msemburi, Villaveces, Flaxman, Unwin.

Drafting of the manuscript: Hillis, Villaveces, Flaxman, Unwin.

Critical revision of the manuscript for important intellectual content: Hillis, Ntwali N’konzi, Msemburi, Villaveces, Flaxman, Unwin.

Statistical analysis: Hillis, Ntwali N’konzi, Flaxman, Unwin.

Obtained funding: Flaxman.

Administrative, technical, or material support: Hillis, Msemburi, Villaveces.

Supervision: Unwin.

Conflict of Interest Disclosures: Dr Cluver reports grants from UK Research and Innovation, Oak Foundation, and Wellspring Philanthropic Fund during the conduct of the study. No other disclosures were reported.

Funding/Support: We acknowledge the following sources of funding support: UKRI Global Challenges Research Fund (L.C. and J.-P.N.N.), Wellspring Philanthropic Fund (L.C.), Oak Foundation (L.C.), and Engineering and Physical Sciences Research Council (S.F.). Dr Unwin acknowledges funding from the MRC Centre for Global Infectious Disease Analysis (grant MR/R015600/1), jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO concordant agreement and is also part of the EDCTP2 programme supported by the European Union and acknowledges funding by Community Jameel. Dr Cluver thanks an anonymous family foundation for their support for the University of Oxford.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention or of the World Health Organization.

Additional Contributions: We acknowledge Jon Wakefield, PhD, University of Washington, with permission, for his help with accessing data and comments on the manuscript. Dr Wakefield did not receive compensation.

Wong H. Estimation of total mortality due to COVID-19. Institute for Health Metrics and Evaluation. Published October 15, 2021. Accessed June 24, 2021. https://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths
Tracking covid-19 excess deaths across countries. The Economist. Published October 20, 2021. Accessed April 24, 2022. https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker
World Health Organization. 14.9 Million excess deaths associated with the COVID-19 pandemic in 2020 and 2021 [press release]. World Health Organization. May 5, 2022. Accessed May 5, 2022. https://www.who.int/news/item/05-05-2022-14.9-million-excess-deaths-were-associated-with-the-covid-19-pandemic-in-2020-and-2021
Unwin  HJT , Hillis  S , Cluver  L ,  et al.  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.   Lancet Child Adolesc Health. 2022;6(4):249-259. doi:10.1016/S2352-4642(22)00005-0PubMedGoogle ScholarCrossref
Thomas  T , Tan  M , Ahmed  Y , Grigorenko  EL .  A Systematic review and meta-analysis of interventions for orphans and vulnerable children affected by HIV/AIDS worldwide.   Ann Behav Med. 2020;54(11):853-866. doi:10.1093/abm/kaaa022PubMedGoogle ScholarCrossref
Global Orphanhood estimates real time calculator. Imperial College London. Published February 14, 2022. Accessed May 6, 2022. https://imperialcollegelondon.github.io/orphanhood_calculator/#/country/Global
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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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