Nutritional status, psychological well-being and the quality of life of AIDS orphans in rural Henan Province, China

OBJECTIVE To assess the influence of orphanhood due to AIDS on children's nutritional status, psychological well-being and life quality, and to explore appropriate intervention strategies in China. METHODS In 2005, 186 children aged 8-15 years (93 AIDS orphans and 93 non-orphans) from a rural area of Henan Province were surveyed in a cross-sectional and matched pairs study on nutritional status, psychological health and life quality. RESULTS We found no compelling evidence for poorer nutritional status in orphans. The nutritional status of both orphans and non-orphans was extremely poor according to the prevalence of stunting, underweight, wasting and anaemia. Depression, low self-esteem and lower quality of life were more frequent in orphans. These differences mainly existed in boys' groups. No significant differences were found between paternal, maternal and double orphans, or orphans in orphanages or extended families. Regression analysis revealed that orphanhood leads to low self-esteem and more depression which contributes to lower quality of life and mediates the association between orphanhood and quality of life. CONCLUSION The high prevalence of poor nutritional status indicates that basic material needs of children, including AIDS orphans, are not met in rural China. Psychological problems were prominent among orphans and had become the most important contributor of lower life quality. Boys were at least as vulnerable as girls. The living conditions of all children in rural China must be improved; schoolbased care and support are crucial and would be a cost-effective way to improve the overall life quality of AIDS orphans.