Proximate, intermediate, and distal predictors of under-five mortality in Chad: analysis of the 2014\u201315 Chad demographic and health survey data

Bright Opoku Ahinkorah,Sanni Yaya,Abdul-Aziz Seidu,John Elvis Hagan,Collins Adu,Ebenezer Agbaglo,Eugene Budu,Ebenezer Kwesi Armah-Ansah

doi:10.1186/s12889-020-09869-x

Abstract

BackgroundUnder-five mortality in Chad reached a minimum value of 119 deaths per 1000 live births in 2018, compared with a maximum of 250 in 1972. Despite this decline in the mortality trend, for every six children in Chad, one dies before the age of five. This study, therefore, investigated the proximate, intermediate, and distal determinants of under-five mortality in Chad.MethodsWe used data from the 2014–15 Chad's Demographic and Health Survey. Data of 7782 children below 5 years were used for the study. Both descriptive and multivariable hierarchical logistic regression analyses were performed. Statistical significance was declared at p < 0.05.ResultsUnder-five mortality was found to be 130 deaths per 1000 live births in Chad, with variations across the various population sub-groups. For distal predictors, the likelihood of death was higher in children born in the FChari Baguirmi region (AOR = 3.83, 95% CI: 1.81–8.14). Children whose mothers belonged to the Baguirmi/Barma ethnic group (AOR = 8.04, 95% CI: 1.75–36.99) were more likely to die before the age of five. On the contrary, the likelihood of under-five mortality was low among children born in rural areas (AOR = 0.73, 95% CI: 0.55–0.97). With the intermediate predictors, the likelihood of under-five deaths was higher among children whose mothers had no formal education (AOR = 1.72, 95% CI: 1.06–2.77). Regarding the proximate predictors, the odds of under-five deaths was higher among male children (AOR = 1.03, 95% CI: 1.05–1.63) and first rank children (AOR = 1.58, 95% CI: 1.13–2.21).ConclusionThe study found that the determinants of under-five mortality in Chad are region of residence, place of residence, ethnicity, education, sex of child, and birth rank. These findings show that both socio-economic and proximate factors explain the disparities in under-five mortality in Chad. The identification of these factors can be pivotal towards the design of evidence-based interventions intended to improve child survival. Therefore, improving maternal education while refocusing and re-packaging existing strategies to target selected sub-regional populations with high under-five mortality is urgently required.

Highlights

Under-five mortality in Chad reached a minimum value of 119 deaths per 1000 live births in 2018, compared with a maximum of 250 in 1972
Children whose mothers belonged to the Baguirmi/Barma ethnic group were more likely to die before the age of five, compared to those whose mothers belonged to the Zaghawa/Bideyat ethnic group (UOR = 11.28, 95% Confidence Interval (CI): 3.02–42.07)
These findings show that both socio-economic and proximate factors explain the disparities in under-five mortality in Chad

Summary

Introduction

Under-five mortality in Chad reached a minimum value of 119 deaths per 1000 live births in 2018, compared with a maximum of 250 in 1972 Despite this decline in the mortality trend, for every six children in Chad, one dies before the age of five. With reference to Chad, under-five mortality reached its minimum value of 119 deaths per 1000 live births in 2018, compared with its maximum of 250 in 1972 [10] Despite this decline in under-five mortality, for every six children in Chad, one dies before the age of five because of diseases and malnutrition due to limited accessibility to child healthcare services such as immunisation, exclusive breastfeeding, and skilled birth attendance, antenatal care, and postnatal care [11]. In order to reduce under-five mortality in the country, it is essential to implement programmes focusing on expanded immunization, and early treatment and control of childhood diseases such as malaria and diarrhoea [7, 8, 12, 13]

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