Moucheraud Corrina, Worku Alemayehu, Molla Mitike, Finlay Jocelyn E, Leaning Jennifer, Yamin Alicia
Reprod Health. 2015 May 6;12 Suppl 1(Suppl 1):S4. doi: 10.1186/1742-4755-12-S1-S4.
Maternal mortality remains the leading cause of death and disability for reproductive-age women in resource-poor countries. The impact of a mother's death on child outcomes is likely severe but has not been well quantified. This analysis examines survival outcomes for children whose mothers die during or shortly after childbirth in Butajira, Ethiopia.
This study uses data from the Butajira Health and Demographic Surveillance System (HDSS) site. Child outcomes were assessed using statistical tests to compare survival trajectories and age-specific mortality rates for children who did and did not experience a maternal death. The analyses leveraged the advantages of a large, long-term longitudinal dataset with a high frequency of data collection; but used a strict date-based method to code maternal deaths (as occurring within 42 or 365 days of childbirth), which may be subject to misclassification or recall bias.
Between 1987 and 2011, there were 18189 live births to 5119 mothers; and 73 mothers of 78 children died within the first year of their child's life, with 45% of these (n=30) classified as maternal deaths due to women dying within 42 days of childbirth. Among the maternal deaths, 81% of these infants also died. Children who experienced a maternal death within 42 days of their birth faced 46 times greater risk of dying within one month when compared to babies whose mothers survived (95% confidence interval 25.84-81.92; or adjusted ratio, 57.24 with confidence interval 25.31-129.49).
When a woman in this study population experienced a maternal death, her infant was much more likely to die than to survive--and the survival trajectory of these children is far worse than those of mothers who do not die postpartum. This highlights the importance of investigating how clinical care and socio-economic support programs can better address the needs of orphans, both throughout the intra- and post-partum periods as well as over the life course.
在资源匮乏的国家，孕产妇死亡率仍然是育龄妇女死亡和残疾的主要原因。母亲死亡对儿童结局的影响可能很严重，但尚未得到充分量化。本分析研究了埃塞俄比亚布塔吉拉地区在分娩期间或分娩后不久母亲死亡的儿童的生存结局。
本研究使用了布塔吉拉卫生和人口监测系统（HDSS）站点的数据。通过统计检验评估儿童结局，以比较经历和未经历母亲死亡的儿童的生存轨迹和特定年龄死亡率。分析利用了一个大型、长期纵向数据集以及高频数据收集的优势；但使用了严格的基于日期的方法对孕产妇死亡进行编码（定义为在分娩后42天或365天内发生），这可能存在错误分类或回忆偏差。
1987年至2011年期间，5119名母亲生育了18189名活产婴儿；78名儿童的73名母亲在孩子出生后的第一年内死亡，其中45%（n = 30）被归类为孕产妇死亡，原因是妇女在分娩后42天内死亡。在孕产妇死亡中，这些婴儿中有81%也死亡。与母亲存活的婴儿相比，出生后42天内经历母亲死亡的儿童在一个月内死亡的风险高出46倍（95%置信区间25.84 - 81.92；或调整后的比率，57.24，置信区间25.31 - 129.49）。
在本研究人群中，当一名妇女经历孕产妇死亡时，其婴儿死亡的可能性远高于存活的可能性——而且这些儿童的生存轨迹远比产后未死亡的母亲的孩子差。这凸显了调查临床护理和社会经济支持项目如何能够在整个产时和产后期间以及生命历程中更好地满足孤儿需求的重要性。
