Maternal determinants of child survival in a rural African community

Int J Epidemiol. 1996 Oct;25(5):998-1004. doi: 10.1093/ije/25.5.998.


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.

PIP: During August 1989-April 1992 in northern Zaire, random cluster sampling was taken of 16 villages in the health zone of Bwamanda. Health workers visited 766 exclusively breastfed infants, 0-3 months old, every 3 months for a total of 6 visits. This prospective study aimed to identify maternal determinants of child survival. The mortality rate was about 7.5%. More than 3% of the mothers suffered from chronic illness. 28.2% had at least 2 children. 86.1% were illiterate. 55% had already experienced at least 1 child death. Four variables were interrelated and, together, increased the risk of mortality: parity, number of surviving children, maternal age, and number of dead children. The multiple logistic regression analysis found the risk factors for mortality to include parity greater than 5 (conditional odds ratio [COR] = 4.9; p 0.01), more than 5 km distance from the health center (COR = 1.9; p = 0.06), at least 2 signs or symptoms of maternal chronic disease (COR = 4.8; p = 0.03), and any education for mothers (COR = 2.2; p = 0.05). Contrary to findings of other studies, mother-child separation and problems with breast feeding, rare in this area of northern Zaire, did not contribute significantly to mortality, but higher levels of maternal education were associated with increased levels of child mortality. These findings show that, in this rural area of subsistence farming, high parity, and illiteracy, chronic maternal stress situations (e.g., previous child deaths, maternal invalidity, high parity, great distance from health care facilities, and high child mortality) hamper child survival.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cohort Studies
  • Democratic Republic of the Congo / epidemiology
  • Female
  • Health Services Accessibility
  • Humans
  • Infant
  • Infant Mortality / trends*
  • Infant, Newborn
  • Maternal Welfare
  • Mothers*
  • Parity
  • Prospective Studies
  • Regression Analysis
  • Risk Factors
  • Rural Population / trends*
  • Survival Rate