# **6. Adjust for dual parent mortality**

The above calculations suggest a certain number of children who have lost a mother and who have lost a father, but they do not account for spousal infection. If a woman dies of EVD, is it not more likely that her spouse will also die of EVD? If this is the case, then simply summing the maternal and paternal orphans will overstate the total number of orphans. No data are available for the current epidemic on spousal infection. However, evidence from an outbreak of EVD in the Democratic Republic of Congo in 1995 showed that 45% of spouses of EVD patients developed the fever.<sup>**15**</sup> The fatality rate, as calculated by the number of deaths divided by the number of confirmed, probable and suspected cases (as of February 11, 2015) ranges from 31% to 66% across the three countries.<sup>**11**</sup> So, if one parent dies in Guinea, for example, the probability that both will die is about 30% (45% * 66%), assuming that the probability of the spouse contracting EVD when the other spouse dies of EVD is the same as when the other spouse contracts EVD. The equivalent probabilities in Liberia and Sierra Leone are 19% and 14%, respectively.

This paper uses the DHS estimates for the proportion of women either married or co-habiting (henceforth “in union”) and the MNLC for women in union to calculate the maternal orphans from women in union. It is then assumed that the orphans from 30%, 19%, and 14% of unions in Guinea, Liberia, and Sierra Leone also lose a father, as in Table A5. This suggests that 643 of the total orphan count is accounted for by orphans who have lost both parents, or double orphans. This reduces the total orphan count from 10,483to 9,840.

# **7. Adjust for child mortality from EVD**

Tragically, some proportion of these children who lose parents will have been among the dying themselves. As Table 1 shows, a relatively small proportion of children die from EVD, particularly given their high share in the population. No data from the current epidemic are available on the likelihood that a child contracts EVD, conditional on a parent contracting EVD. Returning to estimates from the 1995 outbreak, it is estimated that household members under 18 had a 4% chance of contracting EVD, conditional on an adult in the household contracting it.<sup>**15**</sup> Thus, if a parent dies in Guinea, the probability of a child dying is about 2.6% (4% chance of child infection * 66% chance of fatality).

If both of a child’s parents die in Guinea, the probability of the child dying is higher, estimated at 5.2% [100%-(100%-2.6%)<sup>2</sup> ]. Unconditionally, the probability of a child dying of EVD is extremely low, ranging from 0·007% in Guinea to 0·043% in Liberia (i.e., even in Liberia, the probability is only 4 children in 10,000). Applying the country-specific probabilities of death among single and double orphans in this way would leave 9,655 surviving orphans (Table A6).

# **8. Resulting estimate of the total number of orphans**

Thus, the total number of maternal, paternal, and double orphans is estimated as 4,112, 4,925, and 618, in Guinea, Liberia, and Sierra Leone, respectively, summing to 9,655 total orphans under the age of 15, as shown in Table A6 and Figure 2.

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