Poorer health and nutritional outcomes in orphans and vulnerable young children not explained by greater exposure to extreme poverty in Zimbabwe Helen Watts 1 , Simon Gregson 1,2 , Suzue Saito 3 , Ben Lopman 1 , Michael Beasley 1 and Roeland Monasch 3 1 Imperial College London, UK 2 Biomedical Research and Training Institute, Harare, Zimbabwe 3 UNICEF, Harare, Zimbabwe Summary objective To describe patterns of association between different groups of young orphans and vulnerable children (OVC) and their nutritional and health outcomes; and to develop a theoretical framework to analyse the determinants of child malnutrition and ill-health, and identify the different mechanisms which contribute to these outcomes in such children. methods We developed and tested a theoretical framework to explain why orphans and vulnerable children experience more ill-health and malnutrition based on statistical analysis of data on 31 672 children aged 0–17 years (6753 aged under 5 years) selected from the Zimbabwe OVC Baseline Survey 2004. results 28% of children aged 0–4 years at last birthday were either orphans or vulnerable children. They were more likely than non-vulnerable children to have suffered recently from diarrhoeal illness (age- and sex–adjusted odds ratio, AOR, 1.27; 95% CI 1.09–1.48) and acute respiratory infection (1.27; 1.01–1.59) and to be stunted (1.24; 1.09–1.41) and underweight (1.18; 1.02–1.36). After further adjustment for exposure to extreme poverty, OVC remained at greater risk of diarrhoeal disease (AOR 1.25; 1.07–1.46) and chronic malnutrition (1.21; 1.07–1.38). In 0–17-year-olds, OVC with acute res- piratory infection were more likely not to have received any treatment even after adjusting for poverty (AOR 1.29; 95% CI 1.16–1.43). conclusion Differences in exposure to extreme poverty among young children by OVC status were relatively small and did not explain the greater malnutrition and ill-health seen in OVC. keywords orphans, vulnerable children, malnutrition, diarrhoea, respiratory infections, Zimbabwe Introduction In Zimbabwe, more than 23% of children were orphans in 2003; this is one of the highest rates in sub-Saharan Africa UNICEF (2005). The HIV/AIDS epidemic is the main cause of this orphan crisis. Even if the incidence of HIV is brought under control, the number of orphans will continue to increase for some years because of the long incubation period of the disease (Gregson et al. 1994; Whiteside et al. 2003). Orphans and vulnerable children (OVC) are potentially at greater risk of poor health and nutrition because they are more likely to be extremely poor, may receive less care and may themselves be HIV-infected via parent-to-child transmission. One of the main causes of early child morbidity and mortality in developing countries is malnutrition (Pelletier et al. 1995; Muller et al. 2003; Sarker et al. 2005). The effects of poverty and hunger are intertwined and undoubtedly impinge on child survival, but the dynamics of interaction are poorly understood (Atinmo & Oyediran 2005). Many OVC suffer from cycles of poverty as a result of the illness and death of their parents Matshalaga and Powell (2002). The picture emerging is that OVC are especially vulnerable and are at increased risk of malnu- trition and ill-health (Ayieko 1997; Sarker et al. 2005). However, the evidence for the effect of orphanhood and child vulnerability on child nutrition is weak and variable (Nalwanga-Seboina & Sengendo 1987; Panpanich et al. 1999; Lindblade et al. 2003; Sarker et al. 2005). Our aims were to describe patterns of association between different forms of OVC experience and nutritional and health outcomes in Zimbabwe, and to develop a Tropical Medicine and International Health doi:10.1111/j.1365-3156.2007.01832.x volume 12 no 5 pp 584–593 may 2007 584 ª 2007 Blackwell Publishing Ltd