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At the recent conference of the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) my co-authors and I were awarded the prize for the best scientific publication over the past two years for our paper “Young children’s risk of dying before and after their mother’s death, a rural Southern African population - based surveillance study” (published in PLOS Medicine). This was a collaboration with the University of Witwatrsrand ( South Africa) and the University of Washington (USA).

Young Children's Probability of Dying Before and After Their Mother's Death: A Rural South African Population-Based Surveillance Study

Samuel Clark, Kathleen Kahn, Brian Houle, Adriane Arteche, Mark Collinson, Stephen Tollman, Alan Stein.  PLOS Medicine: 2103; DOI: 10.1371/journal.pmed.1001409

Over the past few years, there has been enormous international effort to meet the target set by Millennium Development Goal 4—to reduce the under-five child mortality rate by two-thirds from the 1990 level by 2015. There has been some encouraging progress, and according to the latest figures from the World Health Organization, in 2011, just under 7 million children less than five years died, a fall of almost 3 million from a decade ago. There is strong evidence from low- and middle-income countries that children's risk of dying increases after their mother’s death.  This has highlighted the importance of interventions for orphaned children.  However, little is known about the risks to children when their mother becomes seriously ill.

Our study was conducted in a large socio-economically disadvantaged area in North East South Africa on the border with Mozambique, using data collected systematically over a 15 year period. We found that the risk of children dying began to increase 6 to 11 months before their mother’s death; the risk was much higher in the few months before her death (7 fold increase in odds of dying), the month of her death (12 months increase in odds dying) and the period one to two months following her death (7 months increase in odds of dying).  In addition the odds of dying for a child were about 1.5 times greater if the mother died of an AIDS/TB related cause than if she died from other causes. 

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 and can no longer look after her children, not just in the period following her death.  


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