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Journal of Human Growth and Development

versão impressa ISSN 0104-1282

Rev. bras. crescimento desenvolv. hum. vol.21 no.3 São Paulo  2011

 

EDITORIAL

 

Family dynamics, death of parents and child health

 

 

Marcelo Marcos Piva Demarzo

Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, UNIFESP

Correspondence to

 

 

It is well known among health professionals, especially those working in Primary Health Care (PHC), the configuration  and dynamics directly influence family health conditions of each component of the nuclear family and vice versa1. Some events during the family´s  life cycle  are crucial in this regard, including: birth of a new child, unemployment, divorce, change of residence, violence and the presence of family members with chronic health conditions. One particular event is extremely important: a family member´s death, and the death of a parent seems to be one of the worst sceneries accordingly.

In this issue of RBCDH, Atrash's article2 brings scientific evidence on this issue, examined in a comprehensive and rigorous form, focused on the consequences of the fathers´ or mothers´ death to their young children´s health and survival. The article covers relevant information to public health in general and to the area of  child health in particular.

From the review of a series of papers that combine parental mortality historical data to the children´s survival2, the author reaches the conclusion that the mother´s death increases significantly the risk of the children´s death, especially if it occurs in the first months or years of a child's life. The father's death would bring less impact on the children´s survival, but would also have negative consequences. Other factors were identified as relevant for the children´s survival, especially for children up to five years of age: mothers´ socioeconomic status, education and health, environmental conditions, children´s nutritional status and use of health services2.

According to Atrash2, the most consistent  article  on the subject was published in 2010, with data from a cohort study in Bangladesh3. The study reviewed retrospectively all maternal and under 10-year children's deaths in rural Bangladesh, from 1982 until 2005, and included  the following 144,861  live births, with 14,868  deaths of children and 1,385 maternal deaths recorded.

It was concluded that children whose mothers died in the neonatal period had an eight times greater chance of dying compared to children whose mothers remained alive. The mother's death between the first and sixth months of life increased the chance of child death in 27.6 times. The positive association between maternal mortality and increased risk of the children´s death  remained in all ages, reducing the impact by increasing the child's age at maternal death3: 18 times, 8.2 times and 2.1 to 5.1 times higher if the mother dies when the child is between six and 11 months, 12 and 23 months and 24 to 119 months, respectively. The proportion of children whose mothers have died, and who also died before reaching 10 years of age, was 86%, 61%, 32%, 19% and 2% for maternal deaths occurring at birth, from zero to one months, from one to six, six to 12 and 12 to 60 months, respectively; significantly higher than the mortality of children whose mothers remained alive3. The numbers are quite impressive.

Atrash´s review2 focused predominantly  the relationship between  the parents' deaths and the children´s mortality rate, but other studies have also addressed aspects of morbidity related to the parents´ death, highlighting the importance of the topic to health in general, not just children survival. A recent article studied the prevalence of bipolar disorder in patients eligible for bariatric surgery, and identified a positive association between the loss of a parent in childhood and increased risk for bipolar disorder4. It is likely that the same phenomenon is occurring in other health conditions, which should be systematically verified in scientific studies in the health field.

In Brazil, studies are scarce on the subject of the influence of family dynamics on the health-disease process5.6, and there are no studies published up to that point specifically to verify the association between the death of one parent and children survival, similar to those analyzed by Atrash2.  A literature review  conducted by Oliveira and cols6, with articles published between 1955 and 2005 found only 415 articles produced in the period, with 401 international and 14 national, a very low number in relation to the relevance of the subject, even internationally.

Despite the lack of studies, it is likely that the association between parental death and child health is important for the Brazilian public health, given the still high mortality of young adults, for example, from complications of HIV infection and external causes7.8, a not  so severe situation, but similar to African countries reminded by Atrash in his review2. If the Brazilian numbers were similar to Bangladesh, would be  expected a death (related to maternal death) of children under 10 years for every 100 live births. Probably the Brazilian rate is lower, for the better socioeconomic conditions, but should not be negligible, with considerable impact against the population size.

On the other hand, the good coverage of the population (over 60%) by staff from the Estratégia Saúde da Família (ESF) may enhance the identification of families and  children at risk, and enhance integral  health actions on the  problem. The ESF teams´ characteristics  allow a privileged approach to family dynamics and problems, compared to a known territory9 and can be configured in an important public health strategy for the proper management of children whose families have lost one or both parents, or components which are from families with poor family dynamics. In this sense, the kind of knowledge discussed here should be part of training and continuing education for professionals from the ESF teams, coupled with the skills to deal with such situations.

Finally, the information systematized by Atrash2, coupled with other studies that examine this fundamental aspect of child health, should guide public policy and research agendas in countries around the world, especially in countries with high mortality rates of young adults as is the case in some Brazilian regions and from many African countries. Another relevant aspect that should also be pointed out2, would be the application of this knowledge to achieve the Millennium Development Goals (MDGs), especially the number 4 (reduce child mortality), whose priority actions should especially include the guarantee of good levels of mothers´ health and education (current and future).

 

REFERENCES

1. Fernandes CLC, Curra LCD. Ferramentas de Abordagem da Família. In: Programa de Atualização em Medicina de Família e Comunidade. 1 ed. Porto Alegre-RS: Artmed Panamericana Editora 2006, 1(3): 11-41.         [ Links ]

2. Atrash HK. Parent's death and its implications for child survival. Journal of Human Growth and Development 2011; 21(3): 769-770.         [ Links ]

3. Ronsmans C, Chowdhury ME, Dasgupta SK, Ahmed A, Koblinsky M. Effect of parent's death on child survival in rural Bangladesh: a cohort study. Lancet 2010; 375: 2024-31.         [ Links ]

4. Alciati A, Gesuele F, Rizzi A, Sarzi-Puttini P, Foschi D. Childhood parental loss and bipolar spectrum in obese bariatric surgery candidates. Int J Psychiatry Med. 2011; 41(2):155-71.         [ Links ]

5. Campos R, Raffaelli M, Ude W, Greco M, Ruff A, Rolf J, Antunes CM, Halsey N, Greco D. Social networks and daily activities of street youth in Belo Horizonte, Brazil. Street Youth Study Group. Child Dev. 1994 Apr;65(2 Spec No):319-30.         [ Links ]

6. Oliveira D, Siqueira AC, Dell'Aglio DD, Lopes RCS. The impact of family configurations on child and adolescent development: the review the scientific production. Interação psicol 2008; 12(1): 87-98.         [ Links ]

7. Barreto ML, Teixeira MG, Bastos FI, Ximenes RAA, Barata RB, Rodrigues LC. Successes and failures in the control of infectious diseases in Brazil: social and environmental context, policies, interventions, and research needs. Lancet 2011; 377: 1877-89.         [ Links ]

8. Reichenheim ME, de Souza ER, Moraes CL, et al. Violence and injuries in Brazil: the effect, progress made, and challenges ahead. Lancet 2011; 377: 1962-75.         [ Links ]

9. Gabardo RM, Junges JR, Selli L. Arranjos familiares e implicações à saúde na visão dos profissionais do Programa Saúde da Família. Rev. Saúde Pública 2009; 43(1): 91-97.         [ Links ]

 

 

Correspondence to:
demarzo@unifesp.br

Manuscript submitted Nov 04 2011, accepted for publication Dec 02 2011.

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