THE IMPACTS OF MATERNAL MORTALITY AND CAUSE OF DEATH ON CHILDRENS RISK OF DYING IN RURAL SOUTH AFRICA: EVIDENCE FROM A POPULATION BASED SURVEILLANCE STUDY (1992-2013)

Monday, 29th of June 2015

THE IMPACTS OF MATERNAL MORTALITY AND CAUSE OF DEATH ON CHILDRENS RISK OF DYING IN RURAL SOUTH AFRICA: EVIDENCE FROM A POPULATION BASED SURVEILLANCE STUDY (1992-2013)

Brian Houle^123*, Samuel J Clark²³⁴⁵, Kathleen Kahn²³⁵⁶, Stephen Tollman²³⁵⁶ andAlicia Ely Yamin⁷⁸

*Corresponding author: Brian Houle brian.houle@anu.edu.au

Author Affiliations

¹Australian Demographic and Social Research Institute, The Australian National University, Canberra, Australia

²Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, USA

³MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

⁴Department of Sociology, University of Washington, Seattle, Washington, USA

⁵INDEPTH Network, Accra, Ghana

⁶Centre for Global Health Research, Umeå University, Umeå, Sweden

⁷François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, MA, USA

⁸Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA

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Reproductive Health 2015, 12(Suppl 1):S7 doi:10.1186/1742-4755-12-S1-S7

The electronic version of this article is the complete one and can be found online at: http://www.reproductive-health-journal.com/content/12/S1/S7

Published:

6 May 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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 childrens 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 childrens 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 maternal 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 mothers 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.