ORIGINAL RESEARCH article
Front. Public Health
Sec. Children and Health
Causes of Death Among Young Children of Female Sex Workers in Three sub-Saharan African Countries: A Cross-sectional Exploratory Investigation
Provisionally accepted
- 1Center for Social Justice and Health Equity, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
- 2Global Health Promise, Portland, United States
- 3Hospital Medicine Unit, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
ABSTRACT Introduction: 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 explores the causes of death among CFSW in Kenya, Nigeria, and Democratic Republic of the Congo (DRC), and seeks to analyze death trends within the context of leading causes of death in the general child population. Methods: 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. Results: 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 highest 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%). Conclusion: The current 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.
Keywords: Children of female sex workers, Hard-to-Reach populations, leading causes of child death, low- and middle-income countries, Marginalized children, preventable child death
Received: 01 Sep 2025; Accepted: 12 Dec 2025.
Copyright: © 2025 Macias-Konstantopoulos, Ravi and Willis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wendy L Macias-Konstantopoulos
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.