Maternal cumulative prevalence measures of child mortality show heavy burden in sub-Saharan Africa

Abstract

We advance a set of population-level indicators that quantify the prevalence of mothers who have ever experienced an infant, under 5-y-old child, or any-age child die. The maternal cumulative prevalence of infant mortality (mIM), the maternal cumulative prevalence of under 5 mortality (mU5M), and the maternal cumulative prevalence of offspring mortality (mOM) bring theoretical and practical value to a variety of disciplines. Here we introduce maternal cumulative prevalence measures of mortality for multiple age groups of mothers in 20 sub-Saharan African countries with Demographic and Health Surveys data spanning more than two decades. The exercise demonstrates the persistently high prevalence of African mothers who have ever experienced a child die. In some African countries, more than one-half of 45-to 49-y-old mothers have experienced the death of a child under age 5, and nearly two-thirds have experienced the death of any child, irrespective of age. Fewer young mothers have experienced a child die, yet in many countries, up to one-third have. Our results show that the mIM and mU5M can follow distinct trajectories from the infant mortality rate (IMR) and under 5 mortality rate (U5MR), offering an experiential view of mortality decline that annualized measures conceal. These measures can be adapted to quantify the prevalence of recurrent offspring mortality (mROM) and calculated for subgroups to identify within-country inequality in the mortality burden. These indicators can be used to improve current understandings of mortality change, bereavement as a public health threat, and population dynamics.child mortality | sub-Saharan Africa | bereavement D ramatic reductions in the infant mortality rate (IMR) and under 5 mortality rate (U5MR) over the past half-century are among the global health community's most notable achievements (1). The trends are clear, and the message is positive: the world today is healthier and safer for young people than ever before.Sub-Saharan African countries have experienced some of the swiftest reductions in the IMR and U5MR (2). However, the all-time low IMRs and U5MRs conceal the pervasiveness with which contemporary populations experience children die. The IMR and U5MR provide annualized snapshots of a population's mortality regime; these measures are, by design, amnesiac to any legacy of higher mortality. Yet, African mothers today had children under higher mortality conditions, and these conditions persist in surviving mothers' lives. Moreover, because each live birth exposes mothers to the risk of a child dying, high fertility multiplicatively increases African mothers' lifetime likelihood of experiencing a child's death. The clustering of deaths among siblings in high-mortality countries is well documented (3), yet we lack population-level measures that summarize the mortality burden from the perspective of parents.We present population-level mortality measures that estimate the proportion of mothers in a population who have experienced the loss of a child. Specifically, we cal...

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