Consequences of maternal mortality on infant and child survival: a 25-year longitudinal analysis in Butajira Ethiopia (1987-2011)

Abstract

BackgroundMaternal mortality remains the leading cause of death and disability for reproductive-age women in resource-poor countries. The impact of a mother’s death on child outcomes is likely severe but has not been well quantified. This analysis examines survival outcomes for children whose mothers die during or shortly after childbirth in Butajira, Ethiopia.MethodsThis study uses data from the Butajira Health and Demographic Surveillance System (HDSS) site. Child outcomes were assessed using statistical tests to compare survival trajectories and age-specific mortality rates for children who did and did not experience a maternal death. The analyses leveraged the advantages of a large, long-term longitudinal dataset with a high frequency of data collection; but used a strict date-based method to code maternal deaths (as occurring within 42 or 365 days of childbirth), which may be subject to misclassification or recall bias.ResultsBetween 1987 and 2011, there were 18189 live births to 5119 mothers; and 73 mothers of 78 children died within the first year of their child’s life, with 45% of these (n=30) classified as maternal deaths due to women dying within 42 days of childbirth. Among the maternal deaths, 81% of these infants also died. Children who experienced a maternal death within 42 days of their birth faced 46 times greater risk of dying within one month when compared to babies whose mothers survived (95% confidence interval 25.84-81.92; or adjusted ratio, 57.24 with confidence interval 25.31-129.49).ConclusionsWhen a woman in this study population experienced a maternal death, her infant was much more likely to die than to survive—and the survival trajectory of these children is far worse than those of mothers who do not die postpartum. This highlights the importance of investigating how clinical care and socio-economic support programs can better address the needs of orphans, both throughout the intra- and post-partum periods as well as over the life course.

Tracing shadows: How gendered power relations shape the impacts of maternal death on living children in sub Saharan Africa

“…Our findings are consistent with the existing literature on the linkages between gender inequalities, poverty, and MM, and the emerging evidence base regarding the enormous consequences of a maternal death, particularly in terms of creating vulnerabilities for the health and development of children (Bazile et al, 2015;Finlay et al, under review;Houle et al, 2015;Kenya MOH et al, 2014;Knight and Yamin, 2015;Moucheraud et al, 2015;.…”

“…Preliminary results from the quantitative arm of this study show dramatic effects of maternal mortality on infant and child survival in sub-Saharan Africa (Finlay et al, under review;Houle et al, 2015;Moucheraud et al, 2015). For example, in South Africa, children whose mothers died from maternal causes had 15 times the risk of dying (p < 0.001) compared to children whose mothers survived; and in Ethiopia, 30% of children whose mothers died from maternal causes died as well, compared to only 4.4% of children whose mothers died non-maternal deaths (p < 0.001) (Houle et al, 2015;Moucheraud et al, 2015). Recognizing that the four countries are very diverse, we produced country-specific qualitative papers to better understand some of the contextspecific drivers of outcomes for maternal orphans (Bazile et al, 2015;Knight and Yamin, 2015;Molla et al, 2015;.…”

“…Recognizing that the four countries are very diverse, we produced country-specific qualitative papers to better understand some of the contextspecific drivers of outcomes for maternal orphans (Bazile et al, 2015;Knight and Yamin, 2015;Molla et al, 2015;. Specific analyses of findings from each country, both qualitative and quantitative, and a detailed account of the research protocol for each country, are published or under review elsewhere (Bazile et al, 2015;Finlay et al, under review;Houle et al, 2015;Knight and Yamin, 2015;Molla et al, 2015;Moucheraud et al, 2015;.…”

Risk factors and newborn outcomes associated with maternal deaths in the UK from 2009 to 2013: a national case–control study

“…Furthermore, the health of the mother and care during pregnancy, childbirth and the postpartum period are strong determinants of fetal and neonatal wellbeing. Studies mainly from low‐ and middle‐income countries show that maternal death is associated with increased risk of stillbirth and infant death . In the UK, 3286 babies were stillborn and a total of 2966 infants died in 2013.…”

Maternity waiting homes as a cost‐effective intervention in rural Liberia

“…A final calculation of the total cost per year of life saved takes into account the decreased probability of death for the infant to whom the mother gave birth at the time of her death. Several sources in other African countries suggest the percentage point increase in the probability of an infant dying conditional on maternal death ranges from approximately 40% to 70% . Therefore, the total lives saved, inclusive of a lower bound value on the number of infants likely saved, was calculated as:…”