The Impacts of Maternal Mortality and Cause of Death on Children’s Risk of Dying in Rural South Africa: Evidence From a Population Based Surveillance Study (1992–2013)

Houle et al. Reproductive Health 2015, 12 (Suppl 1): S7

9 Pages Posted: 26 Mar 2021

See all articles by Brian Houle

Brian Houle

The Australian National University

Samuel J. Clark

University College London - Department of Mechanical Engineering

Kathleen Kahn

University of Colorado at Boulder - Institute of Behavioral Sciences

Stephen Tollman

University of the Witwatersrand

Alicia Ely Yamin

Harvard University - Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics; Harvard University - Harvard Law School; Partners in Health; Chr. Michelsen Institute (CMI) - Center on Law and Social Transformation

Date Written: 2015

Abstract

Background: Maternal mortality, the HIV/AIDS pandemic, and child survival are closely linked. This study contributes evidence on the impact of maternal death on children’s risk of dying in an HIV-endemic population in rural South Africa.

Methods: We used data for children younger than 10 years from the Agincourt health and socio-demographic surveillance system (1992 – 2013). We used discrete time event history analysis to estimate children’s risk of dying when they experienced a maternal death compared to children whose mother survived (N=3,740,992 child months). We also examined variation in risk due to cause of maternal death. We defined mother’s survival status as early maternal death (during pregnancy, childbirth, or within 42 days of most recent childbirth or identified cause of death), late maternal death (within 43-365 days of most recent childbirth), any other death, and mothers who survived.

Results: Children who experienced an early maternal death were at 15 times the risk of dying (RRR 15.2; 95% CI 8.3–27.9) compared to children whose mother survived. Children under 1 month whose mother died an early (p=0.002) maternal death were at increased risk of dying compared to older children. Children whose mothers died of an HIV/AIDS or TB-related early maternal death were at 29 times the risk of dying compared to children with surviving mothers (RRR 29.2; 95% CI 11.7–73.1). The risk of these children dying was significantly higher than those children whose mother died of a HIV/AIDS or TB-related non-maternal death (p=0.017).

Conclusions: This study contributes further evidence on the impact of a mother’s death on child survival in a poor, rural setting with high HIV prevalence. The intersecting epidemics of maternal mortality and HIV/AIDS – especially in sub-Saharan Africa – have profound implications for maternal and child health and well-being. Such evidence can help guide public and primary health care practice and interventions.

Note:
Funding Statement: This project was conducted with support from The John and Katie Hansen Family Foundation. Thanks are also due to key funding partners of the MRC/Wits Rural Public Health and Health Transitions Research Unit who have enabled the ongoing Agincourt health and socio-demographic surveillance system: the Wellcome Trust grants 058893/Z/99/A, 069683/Z/02/Z, and 085477/Z/08/Z, UK; the Medical Research Council, University of the Witwatersrand, and Anglo-American Chairman’s Fund, South Africa; the Andrew W. Mellon Foundation, the William and Flora Hewlett Foundation, and the National Institutes of Health (NIH) grants K01 HD057246 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and R24 AG032112 from the National Institute on Aging (NIA), USA.

Declaration of Interests: The authors declare that they have no competing interests.

Ethic Approval Statement: The Agincourt health and socio-demographic surveillance system (HDSS) was reviewed and approved by the University of the Witwatersrand Human Research Ethics Committee (Medical) (protocol M110138 (previously M960720) and M081145). Informed consent is obtained for individuals and households at each follow-up visit.

Suggested Citation

Houle, Brian and Clark, Samuel J. and Kahn, Kathleen and Tollman, Stephen and Yamin, Alicia Ely, The Impacts of Maternal Mortality and Cause of Death on Children’s Risk of Dying in Rural South Africa: Evidence From a Population Based Surveillance Study (1992–2013) (2015). Houle et al. Reproductive Health 2015, 12 (Suppl 1): S7, Available at SSRN: https://ssrn.com/abstract=3795629

Brian Houle (Contact Author)

The Australian National University ( email )

Australia

Samuel J. Clark

University College London - Department of Mechanical Engineering

Gower Street
London, WC1E 6BT
United Kingdom

Kathleen Kahn

University of Colorado at Boulder - Institute of Behavioral Sciences ( email )

Boulder, CO 80309
United States

Stephen Tollman

University of the Witwatersrand

GA

Alicia Ely Yamin

Harvard University - Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics ( email )

23 Everett Street
Cambridge, MA 02155
United States

Harvard University - Harvard Law School ( email )

1563 Massachusetts Avenue
Cambridge, MA 02138
United States

Partners in Health ( email )

641 Huntington Ave, 1st Floor
Boston, MA 02115
United States

Chr. Michelsen Institute (CMI) - Center on Law and Social Transformation ( email )

PO Box 6033 Postterminalen
Bergen, NO-5892
Norway

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