The objectives of this study were to describe the care and living arrangements of children in rural South Africa, focusing on differences between maternal, paternal and double orphans and non-orphans and to assess the prevalence and characteristics of 'child-only' households and 'child- and elderly-only' households in this setting. We analysed data from a longitudinal demographic information system using Mantel-Haenszel adjusted odds ratios and logistic regression. The prevalence of orphanhood almost doubled over the period 2000-2005. Maternal and double orphanhood prevalence increased more rapidly than paternal orphanhood, although most orphans are paternal orphans. Responsibility for paternal orphans' school fees and households is taken disproportionately by mothers. There is no evidence that it falls disproportionately to the young or elderly. Responsibility for maternal and double orphans' care is spread between different individuals with different ages, although the elderly have increased odds and fathers have decreased odds compared to non-orphans. Sixteen per cent of double orphans live in sibling-headed households, and most of these heads are over 18 years old. A high proportion of all children are responsible for their own day-to-day care and maternal orphans are more likely than non-orphans to care for themselves (age-adjusted). Seven per cent of maternal and double orphans and 2% of non- and paternal orphans live in 'child- and elderly-only' households. Two per cent of maternal and paternal orphans live in 'child-only' households, compared to 1% of non-orphans. Most of these children's school fees are the responsibility of non-resident parents. Understanding the reality of care and living arrangements is important to ensure that the needs of all children are met
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