The availability of new excess mortality data enables us to update global minimum estimates of COVID-19 orphanhood and caregiver death among children.1- 4 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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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
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 (email@example.com); Susan Hillis, PhD, University of Oxford, 32 Wellington Square, OX1 1NF, Oxford, United Kingdom (firstname.lastname@example.org).
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.
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.
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