Regional and national estimates of children affected by all-cause and COVID-19-associated orphanhood and caregiver death in Brazil, by age and family circumstance.

Children affected by orphanhood of any cause may benefit from assessment and referral to appropriate services. Timely and accurate data can guide policy. We leveraged new data sources expanding previous reports on national COVID-19-associated orphanhood to estimate national and sub-national numbers of children newly affected by death of parents and co-residing elderly caregivers due to all-causes and to COVID-19-associated causes in 2020-2021 in Brazil. We estimated that 1,300,000 (95% uncertainty interval 1,190,000, 1,430,000) children in Brazil experienced loss of one or multiple parents and/or co-residing caregivers 60+. 673,000 (652,000, 690,000) children were estimated to have lost one or both parents, of which 149,000 (144,000, 154,000) were COVID-19-associated; 635,000 (534,000, 758,000) children were estimated to have lost a co-residing grandparent or other kin, of which 135,000 (85,900, 199,000) were COVID-19-associated. Orphanhood estimates varied across states. The highest all-cause rate of parental orphanhood was in Roraima, at 17.5 (95% uncertainty interval 15.6, 20.6) per 1000 children, and the lowest was in Santa Catarina, at 9.5 (8.7, 10.4) per 1000 children. COVID-19-associated orphanhood was also unevenly distributed, with Mato Grosso experiencing the greatest rate, at 4.4 (3.9, 5.3) per 1000 children, while Para experienced the lowest rate of 1.4 (1.2, 1.8) per 1000 children. We compared our estimates with administrative data for COVID-19-associated orphanhood (from Brazils civil registry offices and manually reviewed death certificates in Campinas) and found that a similar demographic distribution of orphanhood. However, our estimates suggested that administrative sources undercount orphanhood, suggesting that approximately 32% and 56% of total orphanhood was captured in the two datasets, respectively. Our findings highlight the extent of orphanhood in Brazil and the large inequalities between states. Our comparisons with administrative data both validate our model and suggest that strengthening vital registration systems can put children at the center of public health responses globally.