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
Date Written: 2015
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.
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.
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