© 1996 Oxford University Press
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Maternal Determinants of Child Survival in a Rural African Community
*Bureau of the Dutch Growth Foundation and Department of Paediatrics, Academisch Ziekenhuis Leiden 10 Rijnsburgerweg, PO Box 9600, Leiden 2300 RC, The Netherlands.
**Department of Paediatrics, University of Leuven Belgium.
Bureau of the Dutch Growth Foundation and Department of Paediatrics Academisch Ziekenhuis Leiden, The Netherlands.
Van den Broeck J (Bureau of the Dutch Growth Foundation and Department of Paediatrics, Academisch Ziekenhuis Leiden, 10 Rijnsburgerweg, PO Box 9600, Leiden 2300 RC, The Netherlands), Eeckels R and Massa G. Maternal determinants of child survival in a rural African community. International Journal of Epidemiology 1996; 25: 998–1004.
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: actors 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); (lii) 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.
Keywords child mortality, parity, material diseases, material school education, health care availability, Zaire
Revised 1 February 1996
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