A young child's risk of dying increases both before and after their mother dies

There is increasing evidence that children are at high risk of dying following their mother's death. Little is known about the risks for the child when the mother becomes very ill, prior to her death. Understanding of these risks and their timing in relation to maternal death is critical to guide interventions. Data from a health and socio-demographic surveillance system in rural South Africa were collected from children 0 – 5 years from 1994 – 2008. Discrete time event history analysis was used to estimate children's probability of dying before and after the mother's death, accounting for moderators. 1,244 children (3% of sample) died from 1994 – 2008. Child mortality risk began to rise six months prior to maternal death, increased markedly during the two months immediately before maternal death (OR 7.053 (3.923 – 12.680)), at maternal death (OR 12.554 (6.219 – 25.344)) and during the two months following death (OR 7.009 (3.157 – 15.560)). This risk profile was more pronounced for children whose mother died of HIV/AIDS compared to other deaths (OR 6.605 (3.423 – 12.748)). Infants who were 0 – 6 months at the time of their mother's death were nine times more likely to die than older children 2 – 5 years. Young children are at high risk not only after the mother's death but in the months prior when she is seriously ill. Proactive and coordinated interventions are needed to support families both when the mother becomes very ill and after her death.