This study provides estimates of the size and distribution of orphans and vulnerable children (OVC) in eight sub-Saharan African countries with relatively high HIV prevalence (Cameroon, Cote d’Ivoire, Kenya, Lesotho, Malawi, Tanzania, Uganda, and Zimbabwe), and assesses their situation over several dimensions including schooling and health care. The study uses data collected in recent nationally-representative Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS) that included HIV testing
of adult women and men. The study finds that substantial proportions of children in these countries are OVC, and that the prevalence of OVC varies widely across countries and across different population sub-groups—with countries and sub-regions with a higher prevalence of HIV having a higher prevalence of OVC as well. Regarding dimensions of OVC’s well-being, the study finds that OVC are disadvantaged in schooling compared to non-OVC. The study also finds that orphans are disadvantaged in the use of mosquito nets and thus are more vulnerable than non-orphans to morbidity and mortality associated with malaria. The study analyzes specific vulnerabilities of adolescent OVC and finds that the main vulnerability of orphaned adolescents concerns their schooling: orphaned adolescents are less likely to be in school than non-orphaned adolescents, although they do not seem to be more exploited for their work than non-orphans. In all countries considered and regardless of sex, orphaned adolescents who are not in school are much less likely to be working than non-orphaned adolescents who are not in school. Adolescent OVC are also less likely to practice sexual abstinence than non-OVC, but they are not necessarily more prone than non-OVC to other risky sexual behaviors or vulnerable to sexual exploitation. The study finds little evidence that OVC are disadvantaged in health, nutritional status, and health care compared to non-OVC. Nor does the study find a clear disadvantage of OVC in having their basic material needs met, although controlling for unobserved household characteristics by focusing on households with both orphans and non-orphans, the study finds that orphans seem disadvantaged compared to non-orphans in this respect.Finally, the study finds that in the countries considered not only few primary caregivers of children make arrangements for succession planning but also that most OVC and their families are not receiving the necessary care and support. The study highlights the heavy burden and the multi-dimensional nature of the OVC problem in sub-Saharan Africa. While considerable attention is already being given to the needs of orphaned children, the findings of this study reinforce the need to strengthen child welfare programs in sub-Saharan Africa. Notably in urgent need are children made vulnerable by parental HIV infection or chronic household illness. Our finding regarding the disadvantage of orphans in mosquito-net use has implications for malaria control programs in the region. Our findings regarding vulnerabilities of adolescent OVC suggest the need to strengthen programs to promote continued schooling and sexual abstinence among youth. Finally, the levels of external care and support for OVC remain unacceptably low, needing vigorous efforts to reach a large and growing population of OVC and their families in the region.