Peer-reviewed article

Navigating a syndemic: Caregiving, dual identities, and child-headed households in rural Lesotho.

Setaka L, Nzuza NY · 19 Aug 2026

Abstract

Child-headed households (CHHs) have become a salient feature of family life in parts of Southern Africa where HIV/AIDS, poverty, labour migration, and, more recently, COVID-19 have interacted to produce a syndemic that has eroded adult caregiving capacity. These intersecting structural pressures have contributed to sustained orphanhood, household instability, and the reorganisation of caregiving responsibilities within families. This article examines how children in CHHs in rural Lesotho navigate the intersecting effects of HIV/AIDS and COVID-19, negotiate caregiving responsibilities, and construct dual identities as both students and household heads. The study was conducted in Mafeteng district, Lesotho, and draws on qualitative data generated between March and June 2023 from 28 participants aged 12-18 years, with an analytical focus on 20 children in primary caregiving roles. Data were collected through semi-structured interviews, participant diaries, non-participant observation, and participatory visual methods, and analysed using reflexive thematic analysis. The findings demonstrate that resilience and vulnerability coexist within CHHs and caution against romanticising children's coping capacities in contexts of structural neglect. By adopting a syndemic lens, the article argues that overlapping epidemics do not merely intensify vulnerability but actively reorganise family systems and reshape childhood. The study underscores the need for coordinated social protection, education, and child-welfare responses that recognise children's agency without relying on it as a substitute for institutional responsibility, while addressing the structural conditions that compel them to assume adult caregiving roles.