Maternally Orphaned Children and Intergenerational Concerns Associated With Breast Cancer Deaths Among Women in Sub-Saharan Africa

Abstract

IMPORTANCE Low breast cancer survival in sub-Saharan Africa's young population increases the likelihood that breast cancer deaths result in maternal orphans, ie, children (<18 years) losing their mother.OBJECTIVE To estimate the number of maternal orphans and their ages for every 100 breast cancer deaths in sub-Saharan African settings during 2014-2019 and to describe family concerns about the orphaned children.DESIGN, SETTING, AND PARTICIPANTS Deaths occurring between September 1, 2014, and July 1, 2019, in the African Breast Cancer-Disparities in Outcomes (ABC-DO) were examined in a cohort of women diagnosed with breast cancer during 2014-2017 at major cancer treatment hospitals in Namibia, Nigeria, Uganda, and Zambia. The cohort was actively followed up for vital status via a trimonthly mobile phone call to each woman or her next of kin (typically a partner, husband, or child). MAIN OUTCOMES AND MEASURESThe number (Poisson counts) and ages of new orphans at the time of maternal death.RESULTS This cohort study found that a total of 795 deaths resulted in 964 new maternal orphans, with deaths occurring in women younger than 50 years accounting for 85% of the orphans. For every 100 deaths in women younger than 50 years, there were 210 new orphans (95% CI, overall, with country-specific estimates of 189 in Nigerian, 180 in Namibian, 222 in Ugandan, and 247 in Zambian Black women. For every 100 deaths of the women at any age, there were 121 maternal orphans, 17% of whom were younger than 5 years, 32% aged 5 to 9 years, and 51% aged 10 to 17 years at the time of maternal death. In follow-up interviews, families' concerns for children's education and childcare were reported to be exacerbated by the financial expenses associated with cancer treatment. CONCLUSIONS AND RELEVANCEThis study provides evidence that the number of maternal orphans due to breast cancer exceeds the number of breast cancer deaths among women in sub-Saharan Africa. The intergenerational consequences associated with cancer deaths in sub-Saharan Africa appear to be large and support the need for continued action to improve survival.

The Global, Regional, and National Burden and Trends of Breast Cancer From 1990 to 2019: Results From the Global Burden of Disease Study 2019

“…Therefore, we could speculate that the impact of breast cancer on productivity and family in low-middle and low SDI is enormous (28). A cohort in sub-Saharan Africa detects that the number of maternal orphans due to breast cancer exceeds the number of breast cancer deaths among females (29). To minimize the intergenerational effects of breast cancer deaths in sub-Saharan Africa, it is necessary to deliver adequate rehabilitation programs at crucial times in breast cancer survivors' recovery.…”

Breast cancer morbidity and mortality in rural Ethiopia: data from 788 verbal autopsies

“…This study found that the majority of breast cancer deaths occur among women in the reproductive age group. This implies that, in addition to attention on pregnancy- or childbirth-related deaths, awareness needs to be raised regarding breast cancer affecting women in this age group where they are responsible for families and children [ 16 ]. We found that breast cancer is the second leading cause of death from neoplasms in women and among the top five causes of death from NCD.…”

“…A standard four-digit VA questionnaire on signs and symptoms, duration of illness, and health service visits was used for data collection [ 16 ]. Few modifications to the survey were made with input from an expert medical panel to include detailed breast cancer symptoms.…”

Gynecological radiation oncology in sub-Saharan Africa: status, problems and considerations for the future

“…In another study of women conducted across four African countries (Namibia, Nigeria, Uganda and Zambia), it was estimated that for every 100 deaths from breast cancer (women younger than 50 years), 210 new orphans were created with the number increasing to 247 for Zambia alone. 35 The study prospectively followed Review 1541 women and had 91% of deaths reported by next of kin who were asked how the death affected the family. The impact of the woman's death included emotional, physical and financial distress.…”