The Effect of Maternal Death on the Health of the Husband and Children in a Rural Area of China: A Prospective Cohort Study.
OBJECTIVE
To examine the effects of maternal death on the health of the index child, the health and educational attainment of the older children, and the mental health and quality of life of the surviving husband.


METHODS
A cohort study including 183 households that experienced a maternal death matched to 346 households that experienced childbirth but not a maternal death was conducted prospectively between June 2009 and October 2011 in rural China. Data on household sociodemographic characteristics, physical and mental health were collected using a quantitative questionnaire and medical examination at baseline and follow-up surveys. Multivariate linear regression, logistic regression models and difference-in-difference (DID) were used to compare differences of outcomes between two groups.


RESULTS
The index children who experienced the loss of a mother had a significantly higher likelihood of dying, abandonment and malnutrition compared to children whose mothers survived at the follow-up survey. The risk of not attending school on time and dropping out of school among older children in the affected group was higher than those in the control group during the follow-up. Husbands whose wife died had significantly lower EQ-5D index and EQ-VAS both at baseline and at follow-up surveys compared to those without experiencing a wife's death, suggesting an immediate and sustained poorer mental health quality of life among the surviving husbands. Also the prevalence of posttraumatic stress disorder (PTSD) was 72.6% at baseline and 56.2% at follow-up among husbands whose wife died.


CONCLUSIONS
Maternal death has multifaceted and spillover effects on the physical and mental health of family members that are sustained over time. Programmes that reduce maternal mortality will mitigate repercussions on surviving family members are critical and needed.
Division of Maternal and Child Health, School of Public Health, Peking University, No.38 Xueyuan Road Haidian District, Beijing, China.
Hong
H
Zhou
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Long
L
Zhang
Department of Preventive Health Care, China-Japan Friendship Hospital, Beijing, China No.38 Xueyuan Road Haidian District, Beijing, China.
Fang
F
Ye
Institute of Child and Adolescent Health, School of Public Health, Peking University, No.38 Xueyuan Road Haidian District, Beijing, China.
Hai-Jun
HJ
Wang
Asia Pacific Observatory on Health Systems and Policies, World Health Organization Western Pacific Regional Office, Manila, Philippines.
Dale
D
Huntington
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Yanjie
Y
Huang
Division of Maternal and Child Health, School of Public Health, Peking University, No.38 Xueyuan Road Haidian District, Beijing, China.
Anqi
A
Wang
Division of Maternal and Child Health, School of Public Health, Peking University, No.38 Xueyuan Road Haidian District, Beijing, China.
Shuiqing
S
Liu
Division of Maternal and Child Health, School of Public Health, Peking University, No.38 Xueyuan Road Haidian District, Beijing, China.
Yan
Y
Wang
D000328:Adult; D002648:Child; D002681:China; D005192:Family Health; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D063130:Maternal Death / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D011446:Prospective Studies; D011788:Quality of Life; D012424:Rural Population; D012959:Socioeconomic Factors; D018454:Spouses / Q000523:psychology*