Causes of death among young children of female sex workers in three sub-Saharan African countries: a cross-sectional exploratory investigation

TL;DR

This study explores why young children of female sex workers in three African countries die, revealing high rates of neonatal issues, infections, and malnutrition.

Contribution

The study provides the first cross-sectional analysis of causes of death among children of female sex workers in sub-Saharan Africa.

Findings

Neonatal conditions were the leading cause of death among children of female sex workers.

Infectious diseases and malnutrition were major contributors to child mortality in this population.

Newborn and infant deaths accounted for over 70% of all reported child deaths.

Abstract

Children of female sex workers (CFSW) are a particularly marginalized population of children who experience similar negative health, social, and economic outcomes as their mothers. In low- and middle-income countries (LMIC), the level of vulnerability and adversity is exacerbated by stigma and structural inequities that result in abject poverty, chronic food insecurity, hazardous living conditions, and exposure to violence. The current study aimed to explore the causes of death among CFSW in Kenya, Nigeria, and the Democratic Republic of the Congo (DRC). It seeks to analyze death trends within the context of leading causes of death in the general child population.

An exploratory, interview-based cross-sectional investigation of the causes of death among CFSW. Interviews with mothers who are female sex workers (MFSW) were conducted across eight cities in the three study countries in 2022 (Kenya, Nigeria) and 2023 (DRC). Data collected included participant sociodemographic information and detailed accounts of the circumstances surrounding the death of their children. Descriptive analysis was employed to organize and present the data.

A total of 188 child deaths reported by 156 MFSW with a mean age of 26.9 years were included for analysis. The overall mean number of deceased children per mother was 1.21, and the highest was in Nigeria (1.32). Newborn and infant deaths (under-1) accounted for 71.3% of all deaths. Neonatal conditions comprised the overall leading cause of death (n = 50, 26.6%), followed by infectious diseases (n = 41, 21.8%) and malnutrition (n = 37, 19.7%). Other identified causes of death included accidents (n = 7, 3.7%), overdose (n = 7, 3.7%), and murder (n = 3, 1.6%).

The present analysis provides important insights into the causes of death among this hard-to-reach, marginalized group of children in LMIC. Regular surveillance of child death trends can inform targeted policy and programmatic interventions to mitigate risk and address the causes of death among young CFSW in LMICs.