title: The Effects of Maternal Mortality on Infant and Child Survival in Rural Tanzania: A Cohort Study.
abstract: OBJECTIVE
  The full impact of a maternal death includes consequences faced by orphaned children. This analysis adds evidence to a literature on the magnitude of the association between a woman's death during or shortly after childbirth, and survival outcomes for her children.
  
  
  METHODS
  The Ifakara and Rufiji Health and Demographic Surveillance Sites in rural Tanzania conduct longitudinal, frequent data collection of key demographic events at the household level. Using a subset of the data from these sites (1996-2012), this survival analysis compared outcomes for children who experienced a maternal death (42 and 365 days definitions) during or near birth to those children whose mothers survived.
  
  
  RESULTS
  There were 111 maternal deaths (or 229 late maternal deaths) during the study period, and 46.28 % of the index children also subsequently died (40.73 % of children in the late maternal death group) before their tenth birthday-a much higher prevalence of child mortality than in the population of children whose mothers survived (7.88 %, p value <0.001). Children orphaned by early maternal deaths had a 51.54 % chance of surviving to their first birthday, compared to a 94.42 % probability for children of surviving mothers. A significant, but lesser, child survival effect was also found for paternal deaths in this study period.
  
  
  CONCLUSIONS
  The death of a mother compromises the survival of index children. Reducing maternal mortality through improved health care-especially provision of high-quality skilled birth attendance, emergency obstetric services and neonatal care-will also help save children's lives.
authors.affiliation: Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA. jfinlay@hsph.harvard.edu.
authors.forename: Jocelyn E
authors.initials: JE
authors.lastname: Finlay
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Corrina
authors.initials: C
authors.lastname: Moucheraud
authors.affiliation: Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA.
authors.forename: Simo
authors.initials: S
authors.lastname: Goshev
authors.affiliation: Ifakara Health Institute, Ifakara, Tanzania.
authors.forename: Francis
authors.initials: F
authors.lastname: Levira
authors.affiliation: Ifakara Health Institute, Ifakara, Tanzania.
authors.forename: Sigilbert
authors.initials: S
authors.lastname: Mrema
authors.affiliation: Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA.|Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Canning
authors.affiliation: Ifakara Health Institute, Ifakara, Tanzania.
authors.forename: Honorati
authors.initials: H
authors.lastname: Masanja
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Alicia Ely
authors.initials: AE
authors.lastname: Yamin
mesh_terms: D000328:Adult; D002648:Child; D046688:Child Mortality; D054540:Child, Orphaned; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008423:Maternal Age; D063130:Maternal Death / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D016019:Survival Analysis; D013636:Tanzania / Q000453:epidemiology
keywords: Cohort study; Infant mortality; Maternal mortality; Orphanhood; Survival analysis; Tanzania