title: Maternal determinants of child survival in a rural African community.
abstract: BACKGROUND
  The aim was to determine maternal factors related to child survival in the rural area of Bwamanda, Northern Zaire.
  
  
  METHODS
  A prospective study of 30-months mortality was carried out in a cohort of 776 children aged 0-3 months, obtained by random cluster sampling. Inclusion criteria were exclusive breastfeeding, no severe prematurity and absence of severe protein-energy malnutrition, diarrhoea or acute respiratory infection. Mortality was recorded by regular home visits and inspection of hospital and funeral registers. Maternal factors that remain stable during follow-up were studied.
  
  
  RESULTS
  Factors associated with excess mortality in bivariate and multiple logistic regression analysis were: (i) mother has parity > 5 (relative risk [RR] = 1.5-4.2); (ii) distance from the health centre > 5 km (RR = 0.9-2.9); (iii) invaliding maternal diseases (RR = 1.2-9.0). Maternal school education (conditional odds ratio [OR] = 1.0-5.0) was significant in the multiple regression. In contrast to the other risk factors, mother-child separation or problems with breastfeeding were rare and did not significantly increase mortality.
  
  
  CONCLUSIONS
  Chronic stress situations created by maternal invalidity, high parity and distance from health care facilities, increase child mortality. Acute stress in the mother-child dyad seemed to be efficiently compensated for. In subsistence economy areas, maternal school education can be a disadvantage.
authors.affiliation: Bureau of the Dutch Growth Foundation, Academisch Ziekenhuis Leiden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Van den Broeck
authors.forename: R
authors.initials: R
authors.lastname: Eeckels
authors.forename: G
authors.initials: G
authors.lastname: Massa
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008429:Maternal Welfare; D009035:Mothers; D010298:Parity; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012424:Rural Population / Q000639:trends*; D015996:Survival Rate