Abstract
Objectives
The full impact of a maternal death includes consequences faced by orphaned children. This analysis adds evidence to a literature on the magnitude of the association between a woman’s death during or shortly after childbirth, and survival outcomes for her children.
Methods
The Ifakara and Rufiji Health and Demographic Surveillance Sites in rural Tanzania conduct longitudinal, frequent data collection of key demographic events at the household level. Using a subset of the data from these sites (1996–2012), this survival analysis compared outcomes for children who experienced a maternal death (42 and 365 days definitions) during or near birth to those children whose mothers survived.
Results
There were 111 maternal deaths (or 229 late maternal deaths) during the study period, and 46.28 % of the index children also subsequently died (40.73 % of children in the late maternal death group) before their tenth birthday—a much higher prevalence of child mortality than in the population of children whose mothers survived (7.88 %, p value <0.001). Children orphaned by early maternal deaths had a 51.54 % chance of surviving to their first birthday, compared to a 94.42 % probability for children of surviving mothers. A significant, but lesser, child survival effect was also found for paternal deaths in this study period.
Conclusions
The death of a mother compromises the survival of index children. Reducing maternal mortality through improved health care—especially provision of high-quality skilled birth attendance, emergency obstetric services and neonatal care—will also help save children’s lives.
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References
World Health Organization, UNICEF, UNFPA, The World Bank, United Nations. (2014). Trends in maternal mortality: 1990 to 2013.
Liu, L., Johnson, H. L., Cousens, S., Perin, J., Scott, S., Lawn, J. E., et al. (2012). Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends since 2000. The Lancet, 379(9832), 2151–2161.
Ronsmans, C., & Graham, W. J. (2006). Maternal mortality: Who, when, where, and why. The Lancet, 368(9542), 1189–1200.
Lawn, J. E., Lee, A. C. C., Kinney, M., Sibley, L., Carlo, W. A., Paul, V. K., et al. (2009). Two million intrapartum-related stillbirths and neonatal deaths: Where, why, and what can be done? International Journal of Gynecology and Obstetrics, 107(Supplement(0)), S5–S19.
Chan, G. J., Lee, A. C. C., Baqui, A. H., Tan, J., & Black, R. E. (2013). Risk of early-onset neonatal infection with maternal infection or colonization: A global systematic review and meta-analysis. PLoS Med, 10(8), e1001502.
Kusiako, T., Ronsmans, C., & Van der Paal, L. (2000). Perinatal mortality attributable to complications of childbirth in Matlab, Bangladesh. Bulletin of the World Health Organization, 78, 621–627.
Vogel, J. P., Souza, J. P., Mori, R., Morisaki, N., Lumbiganon, P., Laopaiboon, M., et al. (2014). Maternal complications and perinatal mortality: Findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG: An International Journal of Obstetrics and Gynaecology, 121, 76–88.
Lindblade, K. A., Odhiambo, F., Rosen, D. H., & DeCock, K. M. (2003). Health and nutritional status of orphans <6 years old cared for by relatives in western Kenya. Tropical Medicine & International Health, 8(1), 67–72.
Braitstein, P., Ayaya, S., Nyandiko, W. M., Kamanda, A., Koech, J., Gisore, P., et al. (2013). Nutritional status of orphaned and separated children and adolescents living in community and institutional environments in Uasin Gishu County, Kenya. PLoS ONE, 8(7), e70054.
Yamin, A. E., Boulanger, V. M., Falb, K. L., Shuma, J., & Leaning, J. (2013). Costs of inaction on maternal mortality: Qualitative evidence of the impacts of maternal deaths on living children in Tanzania. PLoS ONE, 8(8), e71674.
Whetten, R., Messer, L., Ostermann, J., Whetten, K., Pence, B., Buckner, M., et al. (2011). Child work and labour among orphaned and abandoned children in five low and middle income countries. BMC International Health and Human Rights, 11(1), 1.
Whetten, K., Ostermann, J., Whetten, R., O’Donnell, K., & Thielman, N. (2011). The positive outcomes for orphans research T. More than the loss of a parent: Potentially traumatic events among orphaned and abandoned children. Journal of Traumatic Stress, 24(2), 174–182.
O’Donnell, K., Murphy, R., Ostermann, J., Masnick, M., Whetten, R., Madden, E., et al. (2012). A brief assessment of learning for orphaned and abandoned children in low and middle income countries. AIDS and Behavior, 16(2), 480–490.
Hosegood, V. (2009). The demographic impact of HIV and AIDS across the family and household life-cycle: Implications for efforts to strengthen families in sub-Saharan Africa. AIDS Care, 21(sup1), 13–21.
Wang, H., Ye, F., Wang, Y., & Huntington, D. (2013). The study group for economic impact of maternal deaths in C. Economic impact of maternal death on households in rural China: A prospective cohort study. PLoS ONE, 8(10), e76624.
Ye, F., Wang, H., Huntington, D., Zhou, H., Li, Y., You, F., et al. (2012). The immediate economic impact of maternal deaths on rural Chinese households. PLoS ONE, 7(6), e38467.
Storeng, K. T., Baggaley, R. F., Ganaba, R., Ouattara, F., Akoum, M. S., & Filippi, V. (2008). Paying the price: The cost and consequences of emergency obstetric care in Burkina Faso. Social Science and Medicine, 66(3), 545–557.
Ronsmans, C., Chowdhury, M. E., Dasgupta, S. K., Ahmed, A., & Koblinsky, M. (2010). Effect of parent’s death on child survival in rural Bangladesh: A cohort study. The Lancet, 375(9730), 2024–2031.
Filippi, V., Goufodji, S., Sismanidis, C., Kanhonou, L., Fottrell, E., Ronsmans, C., et al. (2010). Effects of severe obstetric complications on women’s health and infant mortality in Benin. Tropical Medicine & International Health, 15(6), 733–742.
Anderson, F. J., Morton, S., Naik, S., & Gebrian, B. (2007). Maternal mortality and the consequences on infant and child survival in rural Haiti. Maternal and Child Health Journal, 11(4), 395–401.
Family Care International, International Center for Research on Women, KEMRI-CDC Research and Public Health Collaboration. (2014). A price too high to bear: The costs of maternal mortality to families and communities.
Clark, S. J., Kahn, K., Houle, B., Arteche, A., Collinson, M. A., Tollman, S. M., et al. (2013). Young children’s probability of dying before and after their mother’s death: A rural South African population-based surveillance study. PLoS Med, 10(3), e1001409.
Zaba, B., Whitworth, J., Marston, M., Nakiyingi, J., Ruberantwari, A., Urassa, M., et al. (2005). HIV and mortality of mothers and children: Evidence from cohort studies in Uganda, Tanzania, and Malawi. Epidemiology, 16(3), 275–280. doi:10.1097/01.ede.0000155507.47884.43.
Filmer, D., & Pritchett, L. (2001). Estimating wealth effects without expenditure data—Or tears: An application to educational enrollments in States of India. Demography, 38(1), 115–132.
Blanc, A. K., Winfrey, W., & Ross, J. (2013). New findings for maternal mortality age patterns: Aggregated results for 38 countries. PLoS ONE, 8(4), e59864.
Campbell, O. M. R., & Graham, W. J. (2006). Strategies for reducing maternal mortality: Getting on with what works. The Lancet, 368(9543), 1284–1299.
Darmstadt, G. L., Bhutta, Z. A., Cousens, S., Adam, T., Walker, N., & de Bernis, L. (2005). Evidence-based, cost-effective interventions: How many newborn babies can we save? The Lancet, 365(9463), 977–988.
Acknowledgments
We thank our collaborators at the Ifakara Health Institute (IHI) for providing us with the data for this study. We thank Vanessa Boulanger for coordinating between IHI and Harvard. This Project has been conducted with support from The John and Katie Hansen Family Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Finlay, J.E., Moucheraud, C., Goshev, S. et al. The Effects of Maternal Mortality on Infant and Child Survival in Rural Tanzania: A Cohort Study. Matern Child Health J 19, 2393–2402 (2015). https://doi.org/10.1007/s10995-015-1758-2
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DOI: https://doi.org/10.1007/s10995-015-1758-2