Death in young children linked to their mother's poor health

(Press-News.org) In poorer countries, young children are more likely to die in the months before their mother's death, when she is seriously ill, and also in the period after her death, according to a study by international researchers published in this week's PLOS Medicine.

These findings are important as they highlight the urgent need for proactive and coordinated community-based interventions to support families, especially vulnerable children, when a mother becomes seriously ill, not just in the period following her death.

Research was carried out in a large socio-economically disadvantaged area in northeast South Africa near the border with Mozambique. The team, led by Samuel Clark, Alan Stein and Kathleen Kahn from Washington, Oxford, and Witwatersrand Universities, reached these conclusions by studying 15 years of information (1994-2008) during which 1,244 children died (3% of the total population studied). Data came from a health and socio-demographic surveillance system run by the MRC / Wits Rural Health and Transitions Unit, a founding member of the INDEPTH Network (http://www.indepth-network.org).

The researchers found that the period in which children are more likely to die began 6 – 11 months before their mother's death, and importantly, there were three distinct periods with a much higher chance (odds) of death: the period 1 – 2 months before their mother's death (7-fold increase in odds of dying), the month of her death (12-fold increase in odds of dying) and the period 1 – 2 months following her death (7-fold increase in odds of dying).

Furthermore, during the five-month period around the time of their mother's death, children (both boys and girls) aged 0 – 6 months were about nine times more likely to die than children aged 24 – 59 months. And, children were about 1.5 times more likely to die if their mother died of an AIDS-related cause rather than some other cause of death.

The authors say: "Young children's survival is put at substantial risk when their mothers become very ill. In particular, a period of very high risk for the child occurs in the two months prior to a mother's death and extends for two months after. "

They continue: "This effect is considerably greater when a mother has HIV and AIDS but the pattern is maintained for non-HIV-related causes."

The authors add: "Proactive and coordinated community-based interventions are urgently needed to support families when a mother becomes seriously ill, as well as following her death."

### Funding: This project was supported by grants K01 HD057246 and R01 HD054511 from the National Institute of Child Health and Human Development (NICHD) of the US National Institutes of Health (NIH). Thanks are due to key funding partners of the MRC/Wits Rural Public Health and Health Transitions Research Unit who have enabled the ongoing Agincourt health and socio-demographic surveillance system: The Wellcome Trust, UK (grants 058893/Z/99/A, 069683/Z/02/Z and 085477/Z/08/Z); the Medical Research Council, University of the Witwatersrand, and Anglo-American Chairman's Fund, South Africa; the William and Flora Hewlett Foundation, the National Institute on Aging of the National Institutes of Health (grant R24 AG032112), and the Andrew W. Mellon Foundation, USA. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: The authors have declared that no competing interests exist. The content of the work presented here is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Citation: Clark SJ, Kahn K, Houle B, Arteche A, Collinson MA, et al. (2013) Young Children's Probability of Dying Before and After Their Mother's Death: A Rural South African Population-Based Surveillance Study. PLoS Med 10(3): e1001409. doi:10.1371/journal.pmed.1001409

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Contact:

Samuel Clark
Department of Sociology
University of Washington
Seattle, Washington, USA
samclark@uw.edu

Kathleen Kahn
MRC/Wits Rural Public Health and Health Transitions Research Unit
University of the Witwatersrand
Johannesburg, South Africa
kathleen.kahn@wits.ac.za