Maternal complications remain the top cause of death and disability among women at the reproductive age in poor resource countries. The rate of maternal mortality in resource-poor countries is about 15 times higher than that in well-to-do nations, and within countries, the poorest women have the greatest risk of dying during pregnancy or childbirth [1] . As a result, the World Health Organization has placed a key interest in ensuring that no mother dies as a result of childbearing [2] . Improving the health status of women, and pregnant mothers has received significant attention worldwide. Maternal mortality and its effects have become very important and significant on the global debate platforms such as the Millennium Development Goals [2] and the new Sustainable Development Goals Agenda [3] .

Maternal mortality is defined as the death of a woman while pregnant or within forty-two (42) days of termination of pregnancy irrespective of the duration and site of pregnancy (whether ectopic or in the uterus), from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes [2] [4] . The direct Causes are complications arising from the pregnancy itself, such as severe bleeding (postpartum hemorrhage), infections, hypertensive disorders (eclampsia and pre-eclampsia), unsafe abortion, and complications during childbirth [5] . Indirect Causes are pre-existing conditions aggravated by the physiological changes of pregnancy, such as malaria, HIV/AIDS, cardiovascular diseases, and diabetes [6] . Limited access to quality healthcare services, including antenatal care, skilled birth attendance, emergency obstetric care, and postnatal care, significantly contributes to maternal mortality [7] . Factors such as geographic remoteness, poverty, lack of transportation, and cultural barriers may hinder women from accessing timely and appropriate care. Women from disadvantaged socioeconomic backgrounds are at higher risk of maternal mortality due to factors such as inadequate nutrition, lack of education, early marriage, and limited autonomy in decision-making regarding their health [8] . Weak healthcare infrastructure, shortages of trained healthcare providers, inadequate medical supplies and equipment, and insufficient health financing contribute to maternal mortality [9] .

Maternal mortality over the decades has rippling effects not only on the social, cultural, educational and health of women but also affects development of their children [2] . The greatest effect of maternal mortality is noted in children aged 2 - 5 months whose mothers had died [10] . Studies suggest that children whose mothers died due to maternal complications were likely to record a higher mortality in infancy compared to children of surviving mothers [11] . According to George & Wilding [12] , motherless children mostly suffer a lot due to lack of day-to-day care, isolation, lack of motivation as well as the economic cost associated with mother’s death.

Statistics from an annual performance review report of the Sagnarigu Municipal Health directorate showed that about thirty women have died from childbirth and pregnancy-related causes. It is not certain if the efforts made by previous interventions will be sufficient to improve the risk of losing more women at birth. It is also unclear how these unfortunate children are surviving. Childbearing is a natural process and therefore it is unacceptable for any pregnant woman to lose her life during pregnancy, delivery, and postpartum. When these unfortunate deaths occur, there is the likelihood that these orphans left behind will face some neglect, stigmatization, and discrimination which may lead to school dropout, streetism, and malnutrition. This study aimed to find out the lives of these children after losing their mothers during childbirth. The study findings will generate useful data for the Municipal Health Directorate (MHD) and other Non-governmental Organizations (NGOs) to help identify the reasons for high maternal mortality and to find solutions to it. It will also help the health authorities to adopt strategies to increase their health educational campaigns on the importance of antenatal, facility delivery, and post-natal services offered to Women in the Fertility Age (WIFA). Also, the study findings will contribute to the existing knowledge.

This study demonstrated significant knowledge of the effects of maternal death on children and also the determinants of maternal death. Omer et al. [8] reported that low female literacy rates, high levels of poverty, traditional practices, and socioeconomic and cultural challenges are factors that lead to maternal death. Campbell [14] also, recognized traditional practices and policies that discriminate against women as contributing factors to maternal death. This is collaborated in the findings of this study, which revealed that negligence, illiteracy, poor road access, poverty Delay in recognizing the problem, delays in making appropriate decisions, delays in attending to the patient at the health facility, delays in giving appropriate treatment, and traditional beliefs as some major determinants of maternal death. In a similar studies conducted in Ethiopia the findings of the study revealed that cultural and traditional beliefs; trust in TBAs; lack of decision making power of women, previous negative experiences with health facilities; fear of going to an unfamiliar setting; lack of privacy and perceived costs of maternal health services were the main factors causing the first delay in deciding to seek care which leads to maternal death [15] . Cultural and traditional practices mostly prevent women from seeking primary health care which results in pregnant women depending on alternative traditional health care practices or facilities such as herbal and traditional medicines for their well-being [13] . This aspect of practices accounts for the delays in pregnant women making appropriate decisions to seek proper medical care from hospitals. These traditional policies and practices have a direct effect on pregnant women and lead to maternal death.

In addressing the effects of maternal death on children, our study revealed that many of the orphans were under the care of their grandmothers, aunties, or stepmothers or given out to foster parents and unknown individuals. Some of the orphans were said to have migrated to the urban communities for greener pastures and had no option but to face situations that were not favorable. In a narrative of one of the victims of maternal mortality, he said “I have no livelihood source and I am compelled to withstand the harsh conditions of the environment if I must survive. I try to do any work just for survival amidst all the challenges of starvation, sickness and risks”. In a related study, Children of deceased mothers were cared for by the widest array of relatives, with stepmothers the most common primary caregiver whiles some of the children moved to grand maternal care after the stepmother produced a child of the new marriage [16] . The study also shows that many of the children suffered from malnutrition and lack of care. This finding is affirmed in a study conducted in Ethiopia to determine the relationship of undernutrition and psychosocial factors and developmental outcomes of children, the study revealed that malnourished children performed worse in all the developmental domains than the reference children. Among 819 extremely poor children, 325 (39.7%) were stunted, 135 (16.5%) were underweight and 27 (3.3%) were wasted [17] . The results also disclosed that stunting and underweight were negatively associated with all the developmental skills [17] . Children who lose a parent, especially a primary caregiver like a mother, can face a range of challenges that affect their physical, emotional, and cognitive development. Malnutrition, in particular, can have long-lasting effects on a child’s growth and overall health. The absence of proper care and nurturing can also lead to emotional and psychological issues. According to a rural Tanzanian study, children whose mothers died young had a 48% chance of passing away before turning one year old, while the 6% chance belonged to children whose moms lived [18] [19] . When a mother passed away, the odds of a child dying were 4.66 (95% CI: 3.15 - 6.89) times higher than for children whose mother survived. In comparison to infants whose moms survived, infants whose mothers died during delivery or shortly after had a seven-fold increased risk of dying within the first month of life [20] . Studies also reveal that following a mother's death, family fragmentation is typical and can result in strained relationships within a home as extra children are prioritized, further taxing already scarce financial resources [21] . The study concluded that for children aged 1-5 years (s), the probability of death was lower (4.4% for sons and 7.8% for daughters) because their systems would have been immune to certain environmental conditions. According to (Razzaque et al. [10] ) the greatest effect of maternal mortality is noted in children aged 2-5 months whose mothers had died. Knight & Yamin [22] reported in a study that children whose mothers died due to maternal mortality causes were likely to record a higher mortality at infancy compared to children of surviving mothers. Motherless children according to Razzaque et al. [10] usually suffer due to lack of day-to-day care, isolation, lack of motivation as well as the economic cost associated with a mother’s death. The findings and outcomes of the study confirmed the assertions made by Razzaque et al. [10] and others. These effects identified from the study were largely children adopting deviant lifestyles due to inadequate parental control and also wrong peer influence. Most of the children who were above the age of 25 years and suffered at the hands of their caregivers developed some kind of dislike for their caregivers. In some other situations, children were either timid or not assertive. They did not have self-confidence and often saw themselves as inferior to their peers. This demise of their mothers and the nature of their care often made them develop low self-esteem as postulated by Razzaque [10] .

The present study is subject to certain limitations, so it is imperative to interpret the findings within the framework of these constraints. A standardized questionnaire that forbids respondents from expressing their emotions was employed in the study. The study’s findings might not accurately represent the emotions that orphaned children truly experience. Due to the correlational nature of the investigation, conjectures and assumptions are permitted. Due to these restrictions, the results must be interpreted from a certain perspective. Due to its cross-sectional survey design, the study was unable to determine causal correlations.

The study concluded that determinants of maternal death include the following; negligence, illiteracy, poverty, and delays in recognizing the problem. Maternal death can be reduced by educating families, women of reproductive age, TBAs, health personnel, and the community members at large on the dangerous signs of pregnancies and their complications. There is also the need for TBAs to be trained to acquire the skills to recognize the appropriate problem and refer it immediately for further management. Health workers need to be more skilful and provide holistic care to pregnant women when they report to the hospital. Also, community members should help curb the situation by embracing change.

The study findings demonstrated that the effects of maternal death are diverse and cut across different areas of a child’s life including livelihood sustenance, healthcare, educational, emotional, and psychological development. These mixed effects are usually manifested in these children in the form of malnutrition, deviant behaviors, and truancy. Other children also felt neglected and became reserved as they grew into maturity. Children at the teenage who can fend for themselves engaged in menial jobs for survival.

Ethics Approval and Consent to Participate

Written informed consent was obtained from each recruited respondent after providing them with adequate explanations regarding the aims of this study.

Availability of Data and Materials

The datasets generated and/or analyzed during the current study are not publicly available due to the respondent’s confidentiality but are available from the corresponding author upon reasonable request.

Authors’ Contributions

DZK and SK conceived and designed the study. SK was responsible for the supervision and coordination of this study. DZK, ARD, and SK conducted the data collection. DZK and SK led the data analysis with inputs from ARD, DSN, and WK. SK wrote the first draft of the manuscript, and then DZK, ARD, DSN, and WK contributed to revising and reviewing the manuscript. All authors read and approved the final manuscript before submission.

We thank the Sagnarigu Municipal Chief Executive Officer (CEO) and the Sagnarigu Traditional leaders for making available all the necessary materials needed for this study.

Authors declare that they have no competing interests.

Kolbila, D.Z., Doat, A.-R., Nigarim, D.S., Kwose, W. and Kampo, S. (2024) Effects of Maternal Death on Children Living in the Sagnarigu Municipality. Open Journal of Obstetrics and Gynecology, 14, 334-347. https://doi.org/10.4236/ojog.2024.143031