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Under-five mortality according to maternal survival: a systematic review and meta-analysis

Tuesday, 16th of May 2017 Print

Bull World Health Organ. 2017 Apr 1;95(4):281-287. doi: 10.2471/BLT.15.157149. Epub 2017 Feb 2.

Under-five mortality according to maternal survival: a systematic review and meta-analysis

Chikhungu LC1Newell ML2Rollins N3.

Author information

1 School of Languages and Area Studies, University of Portsmouth, Park Building, King Henry 1 Street, Portsmouth, PO1 2DZ, England.

2 Academic Unit of Health and Development, University of Southampton, Southampton, England.

3 Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.

Abstract below; full text is at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407247/



To investigate, within so-called general populations, the relationship between maternal survival and mortality of children younger than five years.


We conducted a systematic review of literature published between January 1990 and November 2016 that reported maternal vital status and the corresponding mortality of children younger than five years. Seven studies were included in a qualitative analysis and four in a random-effects meta-analysis. Summary estimates of the odds of dying by maternal survival were obtained and statistical heterogeneity estimated. Quality of the included studies and evidence was assessed using a Cochrane tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation criteria, respectively.


Among children younger than five years, those whose mother had died were found to be 4.09 times (95% confidence interval, CI: 2.40-6.98) more likely to die than those with surviving mothers. Due to heterogeneity (I2: 83%), further pooled estimates were not possible. For children that were motherless as a result of maternal mortality, the increased odds of dying ranged from 1.40 (95% CI: 0.47-4.21) to 2.92 (95% CI: 1.21-7.04) among those aged between two and four years, 6.1 (95% CI: 2.27-16.77) to 33.78 (95% CI: 24.21-47.14) for those younger than one year and 4.39 (95% CI: 3.34-5.78) to 51.68 (95% CI: 20.26-131.80) for those younger than six months.


The loss of a mother was associated with increased mortality among children, especially when maternal death occurred in the first year of the childs life.

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