Effect of maternal death on child survival in rural West Africa: 25 years of prospective surveillance data in The Gambia
Effect of maternal death on child survival in rural West Africa: 25 years of prospective surveillance data in The Gambia
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DOI：
10.1371/journal.pone.0172286
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发表时间：
2017-02-22
期刊：
影响因子：
3.7
通讯作者：
Jasseh, Momodou
中科院分区：
文献类型：
--
作者：
Scott, Susana;Kendall, Lindsay;Jasseh, Momodou
背景母亲的死亡本身就是一场悲剧，但它也可能对她的孩子的生存产生毁灭性的影响。我们的目标是探索母亲的死亡对西非冈比亚农村地区儿童生存的影响。方法我们使用了来自Farafenni健康和人口监测系统(FHDSS)的25年前瞻性监测数据。估计了每1000名儿童至10岁的死亡率，并根据产妇的生命状况绘制了Kaplan-Meier生存曲线。结果在1989年4月1日至2014年12月31日期间，152906个儿童年的随访期间共发生2221例死亡(7.8%)。总死亡率为每千名儿童14.53人(95%可信区间：13.93-15.14)。在母亲死亡的儿童中，这一比率为25.89(95%可信区间：17.99-37.25)，而母亲未死亡的儿童每1000儿童年死亡率为14.44(95%可信区间：13.84-15.06)。如果母亲去世，儿童死亡的可能性是母亲健在儿童的4.66倍(95%可信区间：3.15-6.89)。母亲在分娩过程中或在分娩后不久死亡的婴儿在出生后第一个月内死亡的可能性是母亲存活的婴儿的7倍。母亲的生命状况与出生后2年内死亡的风险显著相关(P<0.872)，而2岁以上的儿童则不再如此(P=0.05)。与死亡风险增加相关的其他因素是居住在更多农村地区，以及出生间隔和出生年份。结论母亲的生存与孩子的生存密切相关。我们的发现强调了对母亲和孩子的连续护理的重要性，不仅是在整个怀孕和分娩期间，而且是在产后6周之后。
BackgroundThe death of a mother is a tragedy in itself but it can also have devastating effects for the survival of her children. We aim to explore the impact of a mother's death on child survival in rural Gambia, West Africa.MethodsWe used 25 years of prospective surveillance data from the Farafenni Health and Demographic surveillance system (FHDSS). Mortality rates per 1,000 child-years up to ten years of age were estimated and Kaplan-Meier survival curves plotted by maternal vital status. Cox proportional hazard models were used to examine factors associated with child survival.FindingsBetween 1 st April 1989 and 31 st December 2014, a total of 2, 221 (7.8%) deaths occurred during 152,906 child-years of follow up. Overall mortality rate was 14.53 per 1,000 childyears (95% CI: 13.93 - 15.14). Amongst those whose mother died, the rate was 25.89 (95% CI: 17.99 - 37.25) compared to 14.44 (95% CI: 13.84 - 15.06) per 1,000 child-years for those whose mother did not die. Children were 4.66 (95% CI: 3.15 - 6.89) times more likely to die if their mother died compared to those with a surviving mother. Infants whose mothers died during delivery or shortly after were up to 7 times more likely to die within the first month of life compared to those whose mothers survived. Maternal vital status was significantly associated with the risk of dying within the first 2 years of life (p-value < 0.05), while this was no longer observed for children over 2 years of age (P = 0.872). Other factors associated with an increased risk of dying were living in more rural areas, and birth spacing and year of birth.ConclusionsMother's survival is strongly associated with child survival. Our findings highlight the importance of the continuum of care for both the mother and child not only throughout pregnancy, and childbirth but beyond 6 weeks post-partum.