The Effects of Maternal Mortality on Infant and Child Survival in Rural Tanzania: A Cohort Study

Abstract

Objectives The full impact of a maternal death includes consequences faced by orphaned children. This analysis adds evidence to a literature on the magnitude of the association between a woman's death during or shortly after childbirth, and survival outcomes for her children. Methods The Ifakara and Rufiji Health and Demographic Surveillance Sites in rural Tanzania conduct longitudinal, frequent data collection of key demographic events at the household level. Using a subset of the data from these sites (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012), this survival analysis compared outcomes for children who experienced a maternal death (42 and 365 days definitions) during or near birth to those children whose mothers survived. Results There were 111 maternal deaths (or 229 late maternal deaths) during the study period, and 46.28 % of the index children also subsequently died (40.73 % of children in the late maternal death group) before their tenth birthday-a much higher prevalence of child mortality than in the population of children whose mothers survived (7.88 %, p value \0.001). Children orphaned by early maternal deaths had a 51.54 % chance of surviving to their first birthday, compared to a 94.42 % probability for children of surviving mothers. A significant, but lesser, child survival effect was also found for paternal deaths in this study period. Conclusions The death of a mother compromises the survival of index children. Reducing maternal mortality through improved health care-especially provision of high-quality skilled birth attendance, emergency obstetric services and neonatal care-will also help save children's lives.Keywords Maternal mortality Á Infant mortality Á Survival analysis Á Orphanhood Á Tanzania Á Cohort study SignificanceMaternal mortality remains a global challenge: approximately 289,000 maternal deaths occurred in 2013, and the maternal mortality ratio in developing countries is 14 times greater than in developed regions. The full toll of maternal mortality extends beyond such aggregate numbers, however, as the death of a mother can have detrimental effects on the survival of her children. In two rural communities in Tanzania, an infant orphaned within 42 days of birth had a probability of surviving to 1 year of only 51.5 %. If a child survived to one month following the death of its mother, their survival probability to one year increased to 67.7 %. These results suggest that child survival probability is severely diminished if the mother dies, and the infant mortality risk is concentrated in the early months.Electronic supplementary material The online version of this article

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