J. Vandenbroeck et al., MATERNAL DETERMINANTS OF CHILD SURVIVAL IN A RURAL AFRICAN COMMUNITY, International journal of epidemiology, 25(5), 1996, pp. 998-1004
Background. The aim was to determine maternal factors related to child
survival in the rural area of Bwamanda, Northern Zaire. Methods. A pr
ospective study of 30-months mortality was carried out in a cohort of
776 children aged 0-3 months, obtained by random cluster sampling. Inc
lusion criteria were exclusive breastfeeding, no severe prematurity an
d absence of severe protein-energy malnutrition, diarrhoea or acute re
spiratory infection. Mortality was recorded by regular home visits and
inspection of hospital and funeral registers. Maternal factors that r
emain stable during follow-up were studied, Results. Factors associate
d 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) inv
aliding maternal diseases (RR = 1.2-9.0). Maternal school education (c
onditional odds ratio [OR] = 1.0-5.0) was significant in the multiple
regression. In contrast to the other risk factors, mother-child separa
tion or problems with breastfeeding were rare and did not significantl
y increase mortality. Conclusions. Chronic stress situations created b
y maternal invalidity, high parity and distance from health care facil
ities, increase child mortality. Acute stress in the mother-child dyad
seemed to be efficiently compensated for. In subsistence economy area
s, maternal school education can be a disadvantage.