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According to the World Health Organization, 5.3 million children under five died in 2018 globally, and the risk of a child dying before completing five years of age is highest in the African region, with 76 per 1,000 live births.
Using demographic and health surveys conducted in 20 countries in Sub-Saharan Africa including Burkina Faso, Ghana, Kenya and Zimbabwe from 1986 to 2016, researchers analysed the prevalence of infant and children under five deaths for every 1,000 mothers.
According to the study published this month in the Proceedings of the National Academy of Sciences, more than half of women aged 45 to 49 years in Sub-Saharan Africa have experienced the death of a child under the age of five.
“These results increase our recognition of bereavement as itself a public health threat — one that’s unfairly concentrated in low-income regions of the world.”
Emily Smith-Greenaway, University of Southern California
“In the shadows of very high child mortality rates that the global health community typically focuses on are all these grieving parents that never receive any attention,” says lead author Emily Smith-Greenaway, an assistant professor of sociology at the US-based University of Southern California. “These results increase our recognition of bereavement as itself a public health threat — one that’s unfairly concentrated in low-income regions of the world.”
The study adds that from the late 1980s and early 1990s through to 2010, about one-third of surviving mothers aged 20 to 44 in almost all the 20 countries had experienced the death of at least one infant.
“In Benin, Burkina Faso, Liberia, Malawi, Mali, and Niger, having had at least one infant die was a more common experience than having had all of one’s children survive infancy,” the study explains. “In no country has the [total infant deaths] fallen below 100 per 1,000 for mothers age 45 to 49, and only in Benin, Kenya, Namibia and Zimbabwe has it fallen below 200 per 1,000.”
Smith-Greenaway tells SciDev.Net that although parental bereavement research has been receiving increasing attention in North America and Western Europe, it is not so in Sub-Saharan Africa.
“Continued efforts to reduce not only infant and under-five mortality but also mortality among adolescents and young adults will reduce mothers' risk of having a child die,” she says, adding that it is important to create programmes in Sub-Saharan Africa that support bereaved mothers as they navigate life after loss.
Phelgona A. Otieno, a paediatrician and an epidemiologist at the Kenya Medical Research Institute's Centre for Clinical Research, praises the researchers for conducting a study that “takes an interesting turn and calls for countries to recognise the impact of child mortality on women and bereavement as a public health threat”.
Otieno attributes increased child death to healthcare-related and other factors.“Poor access to quality, affordable health care is one of the biggest factors especially in low-income countries. Poor nutrition is also a factor since children who suffer from malnutrition are more vulnerable to disease,” she says.
The burden of loss is especially heavy for mothers not only because of the pregnancy and childbirth experience, but because they are also the primary care givers to their children, she adds.
This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.
Emily Smith-Greenaway and Jenny Trinitapol Maternal cumulative prevalence measures of child mortality show heavy burden in sub-Saharan Africa (Proceedings of the National Academy of Sciences, 10 February, 2020)