Children Have Faced Several Challenges: Analyzing Reports of Children Who Became Orphans Caused by COVID-19

: Many children have become orphans due to COVID-19. Their experiences have been under reported due to focus on other areas. This study explores adverse social consequences of children who became orphans due to COVID-19. With the aid of a documentary review approach, this study extracts and analyzes reports from 11 highly ranked news reporting sites in the United States of America that contained expert opinions and narratives on the negative social consequences of being orphaned by COVID-19. Analysis of data followed the narrative thematic analysis procedure. The outstanding themes identified are the loss of caregivers and primary social support system, and increased risk of mental health concerns. The findings demonstrate the need for emergency financial support for COVID-19 related orphaned children and the involvement of experts trained in Trauma-Focused Cognitive-Behavior Therapies (TF-CBT) to help children‟s psychosocial needs.


INTRODUCTION
UNICEF defines an orphan as anyone who has lost one or both parents (UNAIDS, 2009).
Ebola, HIV/AIDS, SARs-COV 2 and other epidemics have taught the world that children who are orphaned due to pandemics and epidemics are on top of the list of persons who experience the highest forms of effects on their well-being, health, and safety consequent to losing their caregivers (primary and secondary) (Denis-Ramirez et al., 2017;Mbamba et al., 2022;Mbamba & Ndemole, 2021;Nyamukapa et al., 2004;Urassa et al., 1997). In every 12 seconds, a child under the age of 18 loses a caregiver to COVID-19 . Lessons from previous pandemics point to the fact that children orphaned due to global health crisis are challenged with adjustment, acceptance, isolation and social exclusion and mental health issues (Atwine et al., 2005;Bennell, 2005;Miller et al., 2007). Left-behind children go to the extent of attempting to, and for some, committing suicide (Guldin et al., 2017). The risks of suicide are higher among children because of high levels of attachment and the difficulty in living with the conception of their parent or caregivers" absence (Mbamba & Ndemole, 2021;Melhem, 2011;Yeboaa et al., 2022). Referring to a 7-year study on youth bereavement, Melhem and colleagues highlighted that, children who were younger than twelve (12) years following the death of their parents and caregivers struggled the most (Melhem, 2011).
Children orphaned by HIV developed anxiety, post-traumatic stress disorder (PTSD) and depression (Chi & Li, 2013). These disorders, when unaddressed, Cluver and colleagues posited, could persist for years in the child"s life, with the tendencies of worsening as orphaned adolescents move through the developmental phases (Cluver et al., 2012). Hong Kong for example, orphaned children of SARSs-COV 2 suffered long term emotional trauma due to social experiences of alienation, social stigmatization and rejection (Siu, 2016). Recent studies on the number of children becoming orphans to COVID-19 globally postulate that the numbers continue to rise exponentially (Hillis, Blenkinsop, et al., 2021;. For example, between April 2020 and June 2021 in the United States alone, Hillis and colleagues estimated the number of COVID-related orphaned children to be around 140,000 which should have increased by today"s date (Hillis, Blenkinsop, et al., 2021).
While previous studies have highlighted some consequences of crisis on orphaned children, and recently, studies consolidating the numbers of children of different identities and different countries affected by COVID-19, little exist specifically delving deeply into the social consequences of COVID-19 on orphaned children in the United States at the time this research was being conducted. Even though Kentor and Thompson have attempted to offer some recommendations on how to deal with the rising issues of orphaned children globally, scholarship on practical ways to help children through the daunting experiences is scanty considering the enormous numbers of children orphaned by COVID-19 in the United States (Kentor & Thompson, 2021). Therefore, the aim of this study is to explore the specific adverse social consequences of COVID-19 on children orphaned by COVID-19 in the United States in order to highlight some policy and practice implications. Hence, the researcher sought to answer the following questions;

METHOD Documentary Review
Following the pediatrics publication of the maiden paper which explored COVID-19 related orphans and caregiver death in the United States, several news reporting sites released articles discussing potential social impacts on COVID-19 related Orphaned children. Like every other pandemic, face-to-face interactions have been hampered due to COVID-19. This has left the researcher with little alternatives to collect and curate data. Therefore, the use of online news portals to gather reports and current information to inform policies, practice and research remains one of the best options. This study uses a documentary review approach to collect data on narratives that showcase the social consequences of covid-19 related orphanhood on children (Mogalakwe, 2009). Utilizing records from online news sites for scientific analysis is a widely used and accepted data collection approach. Many studies on previous pandemics and crisis situations like conflicts have employed the documentary review approach (Hoogeveen & Pape, 2020;Mogalakwe, 2009), because of the difficulty with face-to-face interactions and risks to health and life.

Search Procedure and Summary of Results
Published reports and news articles focusing on the United States on negative social consequences of being orphaned due to COVID-19 were extracted and analysed. Reporting portals were selected based on their credibility raking in the United States (see table 1 for the list of news portals). The researcher used the search button of news portals and websites to search for the reports. This was done with key word combinations (see list of keyword combinations in table 2). The researcher did not restrict the search to date of publication as long as reports were on possible social consequences of being orphaned by COVID-19.
After a careful and thorough search eleven (11) news portals and websites reporting on COVID-19 related orphanhood and the negative social consequences in the United States, the researcher recovered thirty-five (35) reports. Out of this, twelve (12) reports from eleven (11) portals were considered for the study because they met the specific inclusion criterion for the study. Eligible reports contained expert accounts (interviews or reports) on children who have lost their caregivers to COVID-19 and the challenges they are facing or are likely to face. Twenty-three (23) articles were excluded from the study because they did not meet the eligibility criteria. Table   1 below presents the summary of data sources and number of reports.

Quality Control
Records with the same URL were considered duplicated and only one was included. Also, articles reporting on the same event were considered duplicates, and only one entry was considered. However, information from the different websites reporting on the same event (with different URLs) was used to supplement or confirm the included information reported.

Data Analysis
The data that was extracted was imported into Excel spreadsheet for organization. The file was structured into two categories; verbatim quotes, and news/report sources. When this was done, the researcher extracted the data and cross-checked multiple times with the links for validation and corroboration. Afterwards, the thematic narrative analysis procedure was followed to analyze narratives (Fraser, 2004). First, verbatim quotes were labeled to represent individual stories. The researcher read and re-read these stories closely to identify similar and contradictory segments.
Following this, segments were organized into themes based on commonalities from actual narratives as well as derived meanings from the narratives. Throughout the process, the researcher was conscious of contradictions that could deepen the findings.

RESULTS AND DISCUSSION
From the thematic analysis of the narratives, two essential themes were identified in this study: 1) Increased Risks of Mental Health 2) Loss of primary support system and caregivers

Loss of primary support system and caregivers
Findings from the narratives reveal that orphaned children loss their fundamental social support systems when their parents die. Unlike non-pandemic times, this is particularly a bigger challenge for them since many families are already grappling with the challenges COVID-19 comes with. Losing a grandparent can be more than merely upsetting. The death of grandparents can also reduce the psychosocial, practical, and/or financial support for their grandchildren (Q3)

Increased risks of mental health
Narratives reveal that children who become orphans due to losing a parent to COVID-19 are at higher risks of mental health complications. Some of these include experiences like depression, sadness and post-traumatic stress disorder (PTSD) which can often translate into other undesired consequences like suicide. Additionally, narratives from reports indicated that, because children need care and support, even after losing their parents, chances are, they are either placed with kin and kith or in foster care systems which usually comes with adjustment challenges. Some children also have the tendency of becoming homeless because they are unable to cope with living with relatives or in foster care which increases their chances of being traumatized through the exposure to navigating their way around life on the streets.

Discussion and Implications
Findings of this study reveal that being orphaned due to COVID-19 presents a double challenge of living and livelihood to children. This is because the pandemic has already widened inequalities and exacerbated suffering everywhere; undermining progress on global poverty, clean water, social welfare and more (Hoyt et al., 2021;Marmot, 2020;Mbamba & Ndemole, 2021;Stantcheva, 2022;Yeboaa et al., 2022). This leaves children who lose their caregivers at the mercy of alternative care systems like foster or kinship care. Already, a plenitude of studies have highlighted the congestion in the foster care system (Berrick & Skivenes, 2012;Collins et al., 2018;Lockwood et al., 2015;Rolock et al., 2019;Yi et al., 2020) (Elston et al., 2017;Kamara et al., 2017).
This essentializes the need for emergency financial and nutritional support for the children and their host families. This is also a clarion call on actors like Save the Children-USA, UNICEF-USA, Compassion International-USA among others to uptick support for these children with urgency. In line with the White House"s commitment to eliminating barriers leading to difficult Additionally, since the reliance on kinship care system becomes one of the best options for children upon the loss of their caregivers as revealed in the findings and corroborated by previous studies (Hillis, Blenkinsop, et al., 2021;Mbamba & Ndemole, 2021;Yeboaa et al., 2022), it is important to engage in careful background investigation of kin and kith of orphaned children before they are placed in such places. This is particularly important because children are already plagued with a complex intersection of the struggle with their loss and only kinship ties who are in the capacity to properly provide and care for them should be allowed to do so.
The risk of mental health challenges is also presented as a stupendous consequence experienced by COVID-19 related orphans. In line with evidence from previous health epidemics which led to the decease of caregivers (Denis-Ramirez et al., 2017;Nyamukapa et al., 2004;Urassa et al., 1997), the current study reveals that losing a primary caregiver increases the risk of mental health concerns, neglect and even abuse. This is also congruent with the findings of (Siu, 2016) in Hong Kong which posited that orphaned victims of SARS in Hong Kong suffered long term emotional trauma due to social experiences of alienation, social stigmatization and rejection.
Findings reveal that traumatic scars resulting from some of the children watching their parents die are etched in their memories which inhibits their sound mental health. Also, the findings, having found that mental health concerns are widespread, recommends the need for active and urgent involvement of practitioners (social workers, therapists etc.) with expertise in Trauma-Focused Cognitive-Behavior Therapies (TF-CBT) specializing in children (Cohen et al., 2004;Mbamba et al., 2022). TF-CBT as a comprehensive effective treatment approach is relevant because it includes aspects on exposure, cognitive-behavioral, affective, humanistic, attachment, family, and empowerment therapies.
Even though the release from the white house in October stated that American Rescue Plan pandemic relief package will provide a substantial amount of money to incorporate behavioral health services in pediatric primary care settings and expand community behavioral treatment for children affected by COVID-19, there is the need to expedite and put in place an emergency fund from the relief package because every single day that passes, children"s crisis compound (The White House, 2021).

CONCLUSION
Consistent with findings of previous studies on pandemics, the current study found that children in the United States who become orphans due to COVID-19 experience compounded forms of adverse social consequences. The prevalence of such social evils including the loss of primary social support system and the increased risks of mental health complications like depression, isolation, PTSD which could lead to suicide, brings the need for urgent intervention mechanisms from federal, state, and non-profits.
The researcher recognizes that, the narrative analysis of news reports confines the ability to make profound analytic conclusions. For example, the researcher is unable to tell the situations or circumstances under which the narrations were experienced and reported. This limits information detail that could be acquired during face-to-face interviews. However, the current findings reveal insights which could be relevant for studies with a large-scale quantitative design to generate results which will be representative for practice implications.