title: Effect of maternal death on child survival in rural West Africa: 25 years of prospective surveillance data in The Gambia.
abstract: BACKGROUND
  The death of a mother is a tragedy in itself but it can also have devastating effects for the survival of her children. We aim to explore the impact of a mother's death on child survival in rural Gambia, West Africa.
  
  
  METHODS
  We used 25 years of prospective surveillance data from the Farafenni Health and Demographic surveillance system (FHDSS). Mortality rates per 1,000 child-years up to ten years of age were estimated and Kaplan-Meier survival curves plotted by maternal vital status. Cox proportional hazard models were used to examine factors associated with child survival.
  
  
  RESULTS
  Between 1st April 1989 and 31st December 2014, a total of 2, 221 (7.8%) deaths occurred during 152,906 child-years of follow up. Overall mortality rate was 14.53 per 1,000 child-years (95% CI: 13.93-15.14). Amongst those whose mother died, the rate was 25.89 (95% CI: 17.99-37.25) compared to 14.44 (95% CI: 13.84-15.06) per 1,000 child-years for those whose mother did not die. Children were 4.66 (95% CI: 3.15-6.89) times more likely to die if their mother died compared to those with a surviving mother. Infants whose mothers died during delivery or shortly after were up to 7 times more likely to die within the first month of life compared to those whose mothers survived. Maternal vital status was significantly associated with the risk of dying within the first 2 years of life (p-value <0.05), while this was no longer observed for children over 2 years of age (P = 0.872). Other factors associated with an increased risk of dying were living in more rural areas, and birth spacing and year of birth.
  
  
  CONCLUSIONS
  Mother's survival is strongly associated with child survival. Our findings highlight the importance of the continuum of care for both the mother and child not only throughout pregnancy, and childbirth but beyond 6 weeks post-partum.
authors.affiliation: Medical Research Council, The Gambia Unit, Fajara, The Gambia.|London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Susana
authors.initials: S
authors.lastname: Scott
authors.affiliation: Medical Research Council, The Gambia Unit, Fajara, The Gambia.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Kendall
authors.affiliation: Medical Research Council, The Gambia Unit, Fajara, The Gambia.
authors.forename: Pierre
authors.initials: P
authors.lastname: Gomez
authors.affiliation: Medical Research Council, The Gambia Unit, Fajara, The Gambia.|Department of Paediatrics, University of Auckland, Auckland, New Zealand.|Centre for International Health, University of Otago, Dunedin, New Zealand.
authors.forename: Stephen R C
authors.initials: SR
authors.lastname: Howie
authors.affiliation: Medical Research Council, The Gambia Unit, Fajara, The Gambia.|London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Syed M A
authors.initials: SM
authors.lastname: Zaman
authors.affiliation: Ministry of Health and Social Welfare, Banjul, The Gambia.
authors.forename: Samba
authors.identifier: http://orcid.org/0000-0002-7847-5482
authors.initials: S
authors.lastname: Ceesay
authors.affiliation: Medical Research Council, The Gambia Unit, Fajara, The Gambia.|London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Umberto
authors.identifier: http://orcid.org/0000-0001-6341-5009
authors.initials: U
authors.lastname: D'Alessandro
authors.affiliation: Medical Research Council, The Gambia Unit, Fajara, The Gambia.
authors.forename: Momodou
authors.initials: M
authors.lastname: Jasseh
mesh_terms: D000328:Adult; D001721:Birth Intervals; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008428:Maternal Mortality; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012424:Rural Population; D012959:Socioeconomic Factors; D015996:Survival Rate; D055815:Young Adult