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The Effect of Maternal Death on the Health of the Husband and Children in a Rural Area of China: A Prospective Cohort Study.

ABSTRACT: 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. FINDINGS: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.

SUBMITTER: Zhou H

PROVIDER: S-EPMC4900542 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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The Effect of Maternal Death on the Health of the Husband and Children in a Rural Area of China: A Prospective Cohort Study.

Zhou Hong H Zhang Long L Ye Fang F Wang Hai-Jun HJ Huntington Dale D Huang Yanjie Y Wang Anqi A Liu Shuiqing S Wang Yan Y

PloS one 20160609 6

<h4>Objective</h4>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.<h4>Methods</h4>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 sociodemograp ...[more]

PMID: 27280717

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Project description:ObjectiveTo assess the economic impact of maternal death on rural Chinese households during the year after maternal death.MethodsA prospective cohort study matched 183 households who had suffered a maternal death to 346 households that experienced childbirth without maternal death in rural areas of three provinces in China. Surveys were conducted at baseline (1-3 months after maternal death or childbirth) and one year after baseline using the quantitative questionnaire. We investigated household income, expenditure, accumulated debts, and self-reported household economic status. Difference-in-Difference (DID), linear regression, and logistic regression analyses were used to compare the economic status between households with and without maternal death.FindingsThe households with maternal death had a higher risk of self-reported "household economy became worse" during the follow-up period (adjusted OR = 6.04, p<0.001). During the follow-up period, at the household level, DID estimator of income and expenditure showed that households with maternal death had a significant relative reduction of US$ 869 and US$ 650, compared to those households that experienced childbirth with no adverse event (p<0.001). Converted to proportions of change, an average of 32.0% reduction of annual income and 24.9% reduction of annual expenditure were observed in households with a maternal death. The mean increase of accumulated debts in households with a maternal death was 3.2 times as high as that in households without maternal death (p = 0.024). Expenditure pattern of households with maternal death changed, with lower consumption on food (p = 0.037), clothes and commodity (p = 0.003), traffic and communication (p = 0.022) and higher consumption on cigarette or alcohol (p = 0.014).ConclusionCompared with childbirth, maternal death had adverse impact on household economy, including higher risk of self-reported "household economy became worse", decreased income and expenditure, increased debts and changed expenditure pattern.

Project description:In Pakistan, incidence of antenatal depression ranges from 18 to 80 %, which goes undiagnosed, resulting in maternal and neonatal implications. The current study aimed to examine the association of antenatal depression with maternal dietary intake and neonatal outcome.A hospital-based, prospective cohort study was conducted on 94 middle class antenatal attendees coming to a tertiary care hospital in Lahore, Pakistan at the beginning of second trimester. Participants fulfilling eligibility were enrolled consecutively after taking written informed consent. Exposure group was identified by Edinburgh Postnatal Depression Scale (EPDS) and cohort members were followed till after delivery. Maternal dietary intake was assessed by 24-h Recall and Food Frequency Checklist, while neonatal outcome was identified through patient files before discharge. Data on potential confounders was collected. Loss to follow up was 13 % (82/94). Data was collected from April-September 2013. Results for 82 participants were analyzed using SPSS version 21.EPDS screened 35/82 (43 %) eligible antenatal attendees as depressed, out of which 16/35 (20 %) were severely depressed and 19/35 (23 %) were moderately depressed. Incidence of poor maternal dietary intake was more in females with antenatal depression. Antenatal depression increased the risk of poor Healthy Eating Index (RR = 2.58, C.I 1.60-5.23, AR = 62 %), carbohydrate <175 gm (RR = 1.188, CI 0.836-1.688, AR = 15 %), protein <71 gm (RR = 1.343, CI 1.059-1.703, AR = 26 %) and fat <55 gm (RR = 2.954, CI 1.612-5.416, AR = 67 %) Incidence of neonatal outcomes included, Fetal Growth Retardation (RR = 2.70, C.I 0.69-3.70, AR = 60 %), preterm birth (RR = 1.60, C.I 0.72-2.45, AR = 54 %), low Apgar score (RR = 2.70, C.I 0.69-3.70, AR = 60 %) and Low Birth Weight (RR = 0.56, C.I 0.93-1.39, AR = -44 %).Antenatal women with depression developed poor dietary intake and had increased incidence of Fetal Growth Retardation, preterm birth and low Apgar score, but not of Low Birth Weight.

Dataset Information

The Effect of Maternal Death on the Health of the Husband and Children in a Rural Area of China: A Prospective Cohort Study.

Publications

The Effect of Maternal Death on the Health of the Husband and Children in a Rural Area of China: A Prospective Cohort Study.

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