254485 A young child's risk of dying increases both before and after their mother dies

Tuesday, October 30, 2012

Samuel Clark, PhD , Department of Sociology, University of Washington, Seattle, WA
Kathleen Kahn, PhD , MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt); School of Public Health, Faculty of Health Sci, University of the Witwatersrand, Johannesburg, South Africa
Brian Houle, PhD, MPH , Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO
Adriane Arteche, PhD , Department of Psychiatry, University of Oxford, Oxford, United Kingdom
Mark Collinson, PhD , MRC/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Acornhoek, South Africa
Stephen Tollman, PhD , Medical Research Council / University Unit in Rural Public Health and Health Transitions Research, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
Alan Stein, FRCPsych , Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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.

Learning Areas:
Epidemiology
Public health or related research
Social and behavioral sciences

Learning Objectives:
List the at-risk time periods for child mortality both before and after their mother dies. Explain how these at-risk time periods are moderated by child age, time period, and maternal cause of death. Discuss potential interventions to support families both when the mother becomes very ill and after her death.

Keywords: HIV/AIDS, International MCH

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the lead analyst for several child mortality analyses in South Africa. I also have a background in demography, social statistics, and public health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.