In Malawi, for example, grandparents are often understood to be primary caregivers when biological parents have died or are absent owing to "affectionate and cordial relationships" with their grandchildren (Chirwa, 2002). When grandparents do not have the material means to assume this responsibility, they retain the name and status of caregivers but the practical tasks are assumed by the orphan's siblings, aunts and uncles (ibid). In southern and east Africa the likelihood of sole or large household responsibilities increases with age, particularly for adolescent girls (Dannerbeck & Muriuki, 2007).