Death in young children in Africa linked to mother’s poor health

Young children in poorer countries who lose their mother are at increased risk from when she becomes seriously ill, not just in the period following her death.

An international study including Oxford University researchers found increased risk of mortality among children aged under five in the months before their mother's death, as well as in the months after her death.

The research was carried out in a disadvantaged area in northeast South Africa near the border with Mozambique, and the results are published in the journal PLOS Medicine.

'There is already good evidence that children's risk of dying increases around the time of their mother's death and especially after they die, but little is known about the period before she dies,' says Professor Alan Stein of the Department of Psychiatry at the University of Oxford, one of the lead researchers on the study.

'This study found that a child's risk of dying begins to increase 12 months before their mother dies and increases dramatically in the 2 months prior to her death and extends for 2 months after. This information is critical for policymakers, guiding interventions, and has important implications for public health.'

The researchers say the findings highlight the urgent need for support for families, and especially vulnerable children, when a mother becomes seriously ill.

'Services are usually only alerted and support is only activated following the death of a mother when the child becomes "orphaned", but for many children this is too late,' Professor Stein says. 'Proactive support and coordinated community interventions are urgently needed to help children and their families when the mother becomes very ill and after her death. In many low and middle income countries, such support is potentially feasible using community health workers and informal home-based carers.'

The team, led by researchers from Oxford University, the University of Washington in Seattle, and the University of the Witwatersrand in Johannesburg, studied 15 years of information for children aged under 5 from 1994 to 2008. During this time, 1,244 children died or 3% of all the children under 5 years old.

The researchers found that there was an increased risk of dying for children who lose their mother in the period around her death.

Professor Stein explains that one of the reasons might be that when a mother becomes very ill, it makes it very difficult for her to care for and feed her baby: 'Whether the mother is breastfeeding or providing substitute feeding, the lack of feeding leads to poor nutrition and susceptibility to infection.'

The higher risk begins in the period 6–11 months before their mother's death, with the greatest risk occurring in the 1–2 months before their mother's death, the month of her death and the 1–2 months following her death.

The risk was greater for babies under six months old, and for children whose mother dies of an AIDS-related cause rather than some other cause of death.

'While this risk profile was considerably more pronounced for children whose mothers died of AIDS compared to other causes of death, the pattern remained for causes unrelated to AIDS,' says Professor Stein.

'We do not know the precise reasons for the marked increase in risk in the context of maternal HIV/AIDS,' he adds, but suggests it is likely to arise from a number of causes. 'A major consequence of adult HIV/AIDS for families in poor and rural settings is impoverishment. Chronic illness and death consume a sizeable share of family resources and compromise a household’s ability to care for other dependent members.'