Increased mortality risk for motherless children aged less than 5 years: a systematic review and meta-analysis

Background - It is unclear whether the association between maternal and infant survival seen in the context of HIV applies to the general population.
Objective - To investigate the relationship between maternal survival and mortality of children <5 years outside the HIV context.
Methods - A systematic review of literature published between January 1990 and November 2016 (3079 papers identified, 156 abstracts screened, 23 full texts) reporting mother’s vital status and mortality of children less than five years of age. Eight studies were included in a qualitative analysis and four in a meta-analysis using a random effects model. Summary estimates of the odds of dying by maternal survival were obtained and statistical heterogeneity estimated. Quality of included studies was assessed using the ROBINS –I Tool and quality of the body evidence was assessed using GRADE.
Findings - Children < 5 years whose mother had died were 4.09 times (95% confidence interval, CI: 2.40, 6.98) more likely to die than those of surviving mothers (I2= 83%). Due to heterogeneity, further pooled estimates were not possible. The odds of dying ranged from 1.40 (95% CI 0.47,4.21) to 2.92 (95% CI 1.21,7.04) in two-four year olds, 6.1 (95% CI 2.27,16.77) to 33.78 (95% CI 24.21,47.14) in infants <one year and 4.39 (95% CI 3.34, 5.78 ) to 52.46 (95% CI 20.48,131.79) in infants <six months.
Conclusion - The loss of a mother was associated with increased mortality among children, especially when maternal death occurred in the first year post delivery.