Under-five Mortality In Ethiopia Research Articles

The effects of reproductive variables on child mortality in Ethiopia: evidence from demographic and health surveys from 2000 to 2016

BackgroundChild mortality is a crucial indicator reflecting a country's health and socioeconomic status. Despite significant global improvements in reducing early childhood deaths, Southern Asia and sub-Saharan Africa still bear the highest burden of newborn mortality. Ethiopia is one of five countries that account for half of new-born deaths worldwide.MethodsThis study examined the relationship between specific reproductive factors and under-five mortality in Ethiopia. A discrete-time survival model was applied to analyze data collected from four Ethiopian Demographic and Health Surveys (EDHS) conducted between 2000 and 2016. The study focused on investigating the individual and combined effects of three factors: preceding birth interval, maternal age at childbirth, and birth order, on child mortality.ResultsThe study found that lengthening the preceding birth interval to 18–23, 24–35, 36–47, or 48+ months reduced the risk of under-five deaths by 30%, 46%, 56%, and 60% respectively, compared to very short birth intervals (less than 18 months). Giving birth between the ages 20–34 and 35+ reduced the risk by 34% and 8% respectively, compared to giving birth below the age of 20. The risk of under-five death was higher for a 7th-born child by 17% compared to a 2nd or 3rd-born child. The combined effect analysis showed that higher birth order at a young maternal age increased the risk. In comparison, lower birth order in older maternal age groups was associated with higher risk. Lastly, very short birth intervals posed a greater risk for children with higher birth orders.ConclusionNot only does one reproductive health variable negatively affect child survival, but their combination has the strongest effect. It is therefore recommended that policies in Ethiopia should address short birth intervals, young age of childbearing, and order of birth through an integrated strategy.

Zero-inflated Poisson regression analysis of factors associated with under-five mortality in Ethiopia using 2019 Ethiopian mini demographic and health survey data

Background Remarkable reduction in global under-five mortality has been seen over the past two decades. However, Ethiopia is among the five countries which account for about half (49%) of all under-five mortality worldwide. This study aimed at identifying factors associated with under-five children mortality in Ethiopia using the 2019 Ethiopia mini demography and health survey data. Methods The most recent national representative demography and health survey data of Ethiopia, 2019 Ethiopia mini demography and health survey data, were used for this study. Count data regression models were applied to identify the factors associated with under-five children mortality. Statistical significance was declared at P-value less than 0.05. Results Zero-Inflated Poisson (ZIP) regression model was found to be the best model compared to other count regression models based on models comparison Criteria. The ZIP model revealed that decreased risk of under-five mortality was associated with mothers aged 25–34 years, unmarried mothers, mothers delivered in health facility, mothers used Pill/IUD, mothers who had larger number of children at home whereas increased risk of under-five mortality was associated with older mothers at their first births, mothers from rural areas, mothers travel for 1–30 min and >30 min to get drinking water, mothers used charcoal and wood, children with higher birth order and multiple births. Conclusions In this study, place of residence, region, place of delivery, religion, age of mother, mother’s age at first birth, marital status, birth order, birth type, current contraceptive type used, type of cooking fuel, time to get drinking water, and number of children at home were statistically significant factors associated with under-five mortality in Ethiopia. Thus, the Ethiopian Ministry of Health and other concerned bodies are recommended to encourage mothers to deliver at health institutions, give awareness for mothers to use Pill/IUD contraceptive type, and facilitate rural areas to have electricity and drinking water near to homes so as to minimize the under-five mortality to achieve the sustainable development goal.

Fine particulate matter air pollution and the mortality of children under five: a multilevel analysis of the Ethiopian Demographic and Health Survey of 2016.

Every year, polluted air is costing the globe 543,000 deaths of children under five. The particulate matter below 2.5 μm diameter (PM2.5) is a part of air pollution that has adverse effects on children's health. In Ethiopia, the effect of ambient PM2.5 is least explored. This study aimed to assess the association between PM2.5 and under-five mortality in Ethiopia. The study used the data from the Ethiopian Demographic Health Surveys conducted in 2016, collected between January 18 and June 27. All children under five who had data on child mortality and location coordinates were included in the study. Exposure to ambient PM2.5 concentration was a satellite-based estimate by the Atmospheric Composition Analysis Group at Washington and Dalhousie University, in the United States and Canada, respectively. Annual mean pollution levels and mortality datasets were matched by children's geographical location and dates of birth, death, and interview. The relationship between ambient PM2.5 and under-five mortality was determined by a multilevel multivariable logistic regression on R software. The statistical analyses were two-sided at a 95% confidence interval. The study addressed 10,452 children with the proportion of under-five mortality being 5.4% (95% CI 5.0-6.8%). The estimated lifetime annual mean exposure of ambient total PM2.5 was 20.1 ± 3.3 μgm-3. A 10-unit increase in the lifetime annual mean ambient total PM2.5 was associated with 2.29 [95% CI 1.44, 3.65] times more odds of under-five mortality after adjusting for other variables. Children under five are exposed to higher levels of ambient PM2.5 concentration, exceeding the limit set by the World Health Organization. Ambient PM2.5 is significantly associated with under-five mortality, adjusting for other variables. Strong measures need to be taken to reduce air pollution.

Spatiotemporal distributions of under-five mortality in Ethiopia between 2000 and 2019.

Under-five mortality declined in the last two decades in Ethiopia, but sub-national and local progress remains unclear. This study aimed to investigate the spatiotemporal distributions and ecological level factors of under-five mortality in Ethiopia. Data on under-five mortality were obtained from five different Ethiopian Demographic and Health Surveys (EDHS), conducted in 2000, 2005, 2011, 2016, and 2019. Environmental and healthcare access data were obtained from different publicly available sources. Bayesian geostatistical models were used to predict and visualize spatial risks for under-five mortality. The national under-five mortality rate in Ethiopia declined from 121 per 1000 live births in 2000 to 59 per 1000 live births in 2019. Spatial variation in under-five mortality was observed at regional and local levels with the highest rates reported in the Western, Eastern, and Central parts of Ethiopia. Spatial clustering of under-five mortality was significantly associated with population density, access to a water body, and climatic factors such as temperature. Under-five mortality rate declined over the past two decades and varied substantially at sub-national and local levels in Ethiopia. Increasing access to water and health care may help to reduce under-five mortality in high-risk areas. Therefore, interventions targeted to reduce under-five mortality should be strengthened in the areas that had a clustering of under-five mortality in Ethiopia by increasing access to quality health care access.

Prevalence and risk factors of diarrhea among children less than five years of age in the rural suburbs of Dire Dawa, Eastern Ethiopia; Robust Poisson Regression Analysis.

Diarrhea is the second leading cause of under-five mortality in Ethiopia. Information on the prevalence and the impacting factors of diarrhea in the rural suburbs of Dire Dawa is inadequate. This study was aimed at determining risk factors of diarrhea among children less than five years of age in the rural suburbs of Dire Dawa, eastern Ethiopia. A cross-sectional study was conducted from 02 May 2018, to 31 May 2018. The required 1146 children for this study were selected from the rural suburbs of Dire Dawa using multi-stage sampling. Both bi-variable and multivariable Robust Poisson regressions were used for identifying the risk factors. Explanatory variables with a p-value < 0.05 were considered as independently associated with diarrhea. The prevalence of diarrhea among the children was 23% (95% CI: 20.7 - 25.4). The type of house floor (aPR [adjusted prevalence ratio] = 0.89, 95% CI: 0.84 - 0.95) and sharing latrine with neighbours (aPR = 1.18, 95% CI: 1.09 - 1.26) were the significant factors associated with childhood diarrhea. Earthen house floor and shared use of latrine were the risk factors associated with childhood diarrhea. Hence, improving the house floor condition and construction of private latrine together with health education are recommended.

Geographic variation and factors associated with under-five mortality in Ethiopia. A spatial and multilevel analysis of Ethiopian mini demographic and health survey 2019.

The distribution of under-five mortality (U5M) worldwide is uneven and the burden is higher in Sub-Saharan African countries, which account for more than 53% of the global under-five mortality. In Ethiopia, though U5M decreased substantially between 1990 and 2019, it remains excessively high and unevenly distributed. Therefore, this study aimed to assess geographic variation and factors associated with under-five mortality (U5M) in Ethiopia. We sourced data from the most recent nationally representative 2019 Ethiopian Mini-Demographic and Health Survey for this study. A sample size of 5,695 total births was considered. Descriptive, analytical analysis and spatial analysis were conducted using STATA version 16. Both multilevel and spatial analyses were employed to ascertain the factors associated with U5M in Ethiopia. The U5M was 5.9% with a 95% CI 5.4% to 6.6%. Based on the multivariable multilevel logistic regression model results, the following characteristics were associated with under-five mortality: family size (AOR = 0.92, 95% CI: 0.84,0.99), number of under-five children in the family (AOR = 0.17, 95% CI: 0.14, 0.21), multiple birth (AOR = 14.4, 95% CI: 8.5, 24.3), children who were breastfed for less than 6 months (AOR = 5.04, 95% CI: 3.81, 6.67), people whose main roof is palm (AOR = 0.57, 95% CI: 0.34, 0.96), under-five children who are the sixth or more child to be born (AOR = 2.46, 95% CI: 1.49, 4.06), institutional delivery (AOR = 0.57, 95% CI: 0.41, 0.81), resident of Somali and Afar region (AOR = 3.46, 95% CI: 1.58, 7.55) and (AOR = 2.54, 95% CI: 1.10, 5.85), respectively. Spatial analysis revealed that hot spot areas of under-five mortality were located in the Dire Dawa and Somali regions. Under-five mortality in Ethiopia is high and unacceptable when compared to the 2030 sustainable development target, which aims for 25 per 1000 live births. Breastfeeding for less than 6 months, twin births, institutional delivery and high-risk areas of under-five mortality (Somali and Dire Dawa) are modifiable risk factors. Therefore, maternal and community education on the advantages of breastfeeding and institutional delivery is highly recommended. Women who deliver twins should be given special attention. An effective strategy should be designed for intervention in under-five mortality hot spot areas such as Somali and Dire Dawa.

Evaluation of the community-based outpatient therapeutic feeding program implementation for managing children with severe acute malnutrition in Northwest Ethiopia: A mixed-method evaluation protocol.

Community-based outpatient therapeutic feeding program (C-OTP) in Ethiopia has been launched to manage uncomplicated severe acute malnutrition (SAM) by trained Health Extension Workers (HEWs). This program is believed to be the most effective strategy for reaching a large group of children suffering from SAM in rural and disadvantaged communities. Nonetheless, poor treatment outcomes, notably mortality and prolonged recovery time, become pressing public health problems, which could be a result of suboptimal implementation and poor service quality. To evaluate the implementation of C-OTP for managing uncomplicated severe acute malnutrition in the Central Gondar Zone. Multiple studies involving both qualitative and quantitative will be conducted. Availability of essential drugs and equipment, acceptability of the program by mothers/caregivers, health extension workers' compliance to the treatment protocol, and treatment outcome will be assessed employing different methods. Likewise, knowledge of health extension workers about SAM diagnosis and management and their skills to diagnose and manage uncomplicated malnutrition will be determined. Health extension workers, mothers/caregivers, supervisors, and healthcare administrators will be enrolled in the study. Besides, children's medical records registered between 2017 and 2020 will be reviewed to determine the treatment outcome. The data will be collected using pretested self-administered and face-to-face interviewer-administered questionnaires. Similarly, focus group discussions (FGDs), in-depth interviews, and observation checklists will be applied. Binary logistic regression analysis will be conducted, while the qualitative data will be analyzed using thematic content analysis. Severe acute malnutrition is a public health problem that remains the underlying cause for over half of under-five mortality in Ethiopia. As a result, community-based therapeutic care has been launched in the country to address these problems and maximize population-level impact by improving treatment coverage, access, and cost-effectiveness. Despite its achievement, the program has been threatened with unfavourable treatment outcomes and a shortfall of resources. Hence, this implementation evaluation study will also identify gaps between healthcare systems and service users. The output will help programmers pass evidence-based and sound decisions to tackle the key barriers.

Risk factors of under-five mortality in Ethiopia using count data regression models, 2021.

BackgroundDespite the global reduction in under-five mortality, still many children die before their fifth birthday in Ethiopia. The main aim of this study was to identify determinants of under-five mortality using count data regression models based on 2019 Ethiopia mini demography and health survey data.MethodsThe data source for this study was the 2019 Ethiopia mini demography and health survey data. Various count data regression models were applied to identify the determinants of under-five mortality.ResultsA total of 5,535 mothers with children aged 0–59 months were included in the study. Of the total, 1,277 (23.07%) women had lost at least one child by death before celebrating fifth birthday. Zero-Inflated Poisson model was found to be the best model, and it revealed that mother's age, marital status, mother's age at 1st birth, place of delivery, current contraceptive type used, type of cooking fuel, residence, region, religion, time to get drinking water, number of children at home, birth order, and birth type were significant factors that determine U5 mortality in Ethiopia.Mothers aged 15–24 years (IRR = 1.24, p = 0.007) and above 24 years (IRR = 1.66, p = 0.000) at their 1st births, mothers from rural area (IRR = 1.27, p = 0.000), mothers traveled for 1–30 min (IRR = 1.62, p = 0.000) and >30 min (IRR = 1.82, p = 0.000) to get drinking water, mothers used charcoal (IRR = 1.86, p = 0.009) and wood (IRR = 1.64, p = 0.033), children with birth order of 2nd-3rd (IRR = 3.91, p = 0.000), 4th -5th (IRR = 13.14, p = 0.000), 5th and above (IRR = 38.17, p = 0.000), and multiple born children (IRR = 1.5, p = 0.000) had higher risk of under-five mortality while mothers aged 25–34 years (IRR = 0.73, p = 0.000), unmarried mothers (IRR = 0.68, p = 0.004), mothers delivered in public health sectors (IRR = 0.59, p = 0.000), mothers used Pill/IUD (IRR = 0.64, p = 0.018), mothers who had 3 to 5 (IRR = 0.51, p = 0.000) and more than 5 (IRR = 0.27, p = 0.000) children at home had lower risk of under-five mortality.ConclusionsMothers should be encouraged to deliver at health institutions. Mothers also should be given awareness to use Pill/IUD contraceptive type. Moreover, facilitating rural areas to get electricity and drinking water near to homes helps to reduce the burden of U5M and to be in line with sustainable development goal.

The factors associated with under-five mortality in Ethiopia

BackgroundUnder-five mortality refers to the likelihood of dying between the ages of birth and five. The number of children under the age of five who die each year continues to climb worldwide. Over the previous few decades, the industry has made great progress in reducing mortality among children under the age of five. The study aims to identify the factors associated with under-five mortality in Ethiopia. Subject and methodCommunity-based Cross-sectional data came from Ethiopia's Mini Demographic and Health Survey 2019. In two stages, the 2019 EMDHS sample was stratified and selected. 8855 women of reproductive age were interviewed using a nationally representative Woman (ages 15 to 49) and 5753 children were included. Ethiopia's under-five mortality served as the study's dependent (response) or outcome variable. Binary logistic regression was used to see if there is an association between the dependent and independent variables. All variables with a p-value of less than 0.25 in the bivariate analysis were chosen for the multivariable logistic regression to compensate for putative confounders. Significant predictors were defined as factors with a p-value of less than 0.05. ResultsA total of 5753 under-5 mortality were enrolled in this study. 339 (5.9%) of under-five Mortality have been declared lifeless before reaching the age of five. There were 1328(23.1%) and 4425(76.1%) with 72 (5.42%) and 267 (6.02%) of under-five mortality occurring in urban and rural respectively. Under-five mortality in the Afar region was 2.280 times more likely Compared to Children born in Tigray Region (AOR = 2.280 95% CI = 1.137–4.568, P = .020). Under-five Mortality in Rural residences was 1.908 times more likely as Compared to Urban Residence (AOR = 1.908, 95% CI = 1.257–4.539, P = .035). Under-five mortality in Poorer index Households was 0.343 times Less likely as compared to children born in the poorest index Household (AOR = 0.343,95% CI = 0.128–0.910, P = ). Under-five mortality in the public sector was 1.763 times less likely than among children born at Home (AOR = 1.763, 95% CI = 1.252–2.482, P = .033). Under-five Mortality of second multiple births was 2.389 times more likely Compared to Single birth (AOR = 2.389, 95% CI = 1.257–4.539, P = .008). ConclusionThis study found that the prevalence of under-five mortality, is 5.9% (59/1000) or 59 death per one thousand live children in Ethiopia. The under-five mortality rate is rapidly declining, and access to and utilization of health care is improving. Region, residence, level of education, wealth index, Place of Delivery and multiple births have all been statistically significant factors of under-five mortality in Ethiopia. The government and all stockholders should be given attention to maternal and infant health care to reduce under-five mortality.

Determinants of under-five mortality in Ethiopia using the recent 2019 Ethiopian demographic and health survey data: nested shared frailty survival analysis

BackgroundWorldwide, there is remarkable progress in child survival in the past three decades. Ethiopia is off-track on sustainable development targets in under-five mortality since 2020. Therefore, this study aimed to investigate time to death and its associated factors among under-five children in Ethiopia.MethodsNationally representative demographic and health survey data were used for this study. A total of 5772 under-five children were included. Data were analyzed using R software. Semi-parametric nested shared frailty survival analysis was employed to identify factors affecting under-five mortality. Adjusted hazard ratio (AHR) with 95% Confidence interval (CI) was reported and log-likelihood was used for model comparison. Statistical significance was declared at P-value < 0.05.ResultsThe weighted incidence of under-five death before celebrating the first fifth year was 5.76% (95% CI: 5.17 – 6.40). Female sex and under-five children living in urban areas were high probability of survival than their counterparts. After controlling cluster and region level frailty, multiple births (AHR = 7.03, 95% CI: 4.40—11.24), breastfed within one hour after birth (AHR = 0.41, 95% CI: 0.28—0.61), preceding birth interval 18–23 months (AHR = 1.62, 95% CI: 1.12 -2.36), and under-five children younger than 18 months (AHR = 2.73, 95% CI: 1.93 -3.86), and teenage pregnancy (AHR = 1.70, 95% CI: 1.01—2.87) were statistically significant factors for time to under-five death.ConclusionEven though Ethiopia has a significant decline under-five death, still a significant number of under-five children were dying. Early initiation of breastfeeding, preceding birth interval and teenage pregnancy were the preventable factors of under-five mortality. To curve and achieve the SDG targets regarding under-five mortality in Ethiopia, policymakers and health planners should give prior attention to preventable factors for under-five mortality.

Association of maternal high-risk fertility behavior and under-five mortality in Ethiopia: Community-based survey.

BackgroundHigh-risk fertility behavior is a major public health concern in low and middle-income countries including Ethiopia. Some studies show that the relationship between high-risk fertility behavior and child mortality has analyzed each fertility behavior individually. Yet, there are limited studies that have analyzed outcomes associated with the joint impact of high-risk fertility behaviors. Therefore, the objective of this study was to examine the individual and combined influence of high-risk fertility behavior on under-five mortalities in Ethiopia.MethodsData from the 2016 Ethiopian Demographic and Health Survey were used analyzed. A total of 10,773 mothers who gave live births were included in the final analysis. Both descriptive and bivariate and multivariate logistic regression analyses were performed using STATA V.14.ResultsOverall, 62.1%, 24.0%, and 2.3% of women experienced at least one, two, and three high-risk fertility behaviors, respectively. In the multivariable analysis, under-five mortality was significantly associated with a combination of two or more maternal high-risk fertility behaviors. The odds of under-five mortality among children of women who were engaged in a combination of two high-risk fertility behaviors (AOR = 2.17, 95%CI: 1.52–3.08) and three high-risk fertility behaviors (AOR = 3.69, 95%CI:1.80, 7.55) was higher compared to children of women who have not engaged any high-risk fertility behaviors.ConclusionThis study revealed that a single high-risk fertility behavior was not associated with under-five mortality, yet the presence of two or more maternal high-risk fertility behaviors was an important factor that increased the likelihood of under-five child death. Thus, special emphasis should be given to children of women who engage in a combination of high-risk fertility behaviors. Furthermore, more emphasis should be placed on increasing access to family planning services and raising awareness about high-risk reproductive behaviors among Ethiopian women.

Effects of short birth interval on neonatal, infant and under-five child mortality in Ethiopia: a nationally representative observational study using inverse probability of treatment weighting

ObjectiveTo assess the effect of short birth interval (SBI) on neonatal, infant, and under-five mortality in Ethiopia.DesignA nationally representative cross-sectional survey.SettingThis study used data from the Ethiopia Demographic and Health...

Exploring spatiotemporal distribution of under-five mortality in Ethiopia: further analysis of Ethiopian Demographic and Health Surveys 2000, 2005, 2011 and 2016

ObjectiveThe aim of this study was to explore spatiotemporal distribution of under-five mortality in Ethiopia using data from four (2000, 2005, 2011 and 2016) consecutive demographic and health surveys.MethodsA total...

The impact of antenatal care on under\u2010five mortality in Ethiopia: a difference\u2010in\u2010differences analysis

BackgroundSub-Saharan Africa, as opposed to other regions, has the highest under-five mortality rates yet makes the least improvement in reducing under-five mortality. Despite the decline, Ethiopia is among the top ten countries contributing the most to global under-five mortalities. This article examines the impact of the number of antenatal care and the timing of first antenatal care on child health outcomes. We specifically investigated if the utilization of antenatal care services positively affects the reduction of under-five mortality.MethodsWe employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14–49 who had antenatal care visits at different times before delivery.ResultsThe study revealed 1 481 cases of reported under-five mortality. 99.0% of that under-five mortality cases are women who had less than eight antenatal care visits, while only 1% of that is by women who had eight or more antenatal care visits. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 45.2% (CI = 19.2–71.3%, P-value < 0.001) while the timing of first antenatal care within the first trimester decreases the likelihood of under-five mortality by 10% (CI = 5.7–15.6%, P-value < 0.001).ConclusionsTo achieve a significant reduction in the under-five mortality rate, Intervention programs that encourages more antenatal care visits should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets.

Determinants and Trends of Under-Five Child Mortality in Ethiopia: A Multi-level Logistic Modeling Approach

The burden of under-five mortality remains unevenly distributed. About 80 percent of under-five deaths occur in two regions, sub-Saharan Africa and South Asia. Ethiopia is among the six countries that account for half of the global under-five deaths. The aim of this study was to identify the significant socio-economic and demographic factors influencing under-five child mortality and evaluate the variation among the regional states of Ethiopia. In this study, the 2000, 2005, 2011 and 2016 EDHS data were used to describe the trend of under-five mortality in Ethiopia. The 2016 EDHS data have been used to analyze determinants and variation of under-five mortality by background characteristics. Single-level logistic regression and multilevel logistic regression models were used to identify the major risk factors of under-five mortality and regional variations in under-five child mortality in Ethiopia using the 2016 EDHS data. The results from single-level and multilevel logistic regression analyses showed that Sex of a child, Age of a child in month, Birth type, Birth order number, Number of Household size, Breastfeeding status, Educational level of mother’s, Place of residence and type of toilet facility had significant effects on under-five child mortality and there is variation of under-five child mortality from region to region. Conversely, preceding birth interval, wealth index Household, Source of drinking water and place of delivery were found insignificant. The results revealed variation of under-five child mortality from region to region. The multilevel logistic regression analysis result showed that the effects of breastfeeding varied across regions whereas the effects of other covariates on under-five child mortality remained fixed across regions.

Count Models Analysis of Factors Associated with Under-Five Mortality in Ethiopia

Background. Under-five mortality has continued a key challenge to public health in Ethiopia, and other sub-Saharan Africa countries. The threat of under-five mortality is incessant and more studies are needed to generate new scientific evidence. This study aimed to model the number of under-five deaths a mother has experienced in her lifetime and factors associated with it in Ethiopia. Method. A retrospective cross-sectional study based on data obtained from the Ethiopian Demographic and Health Survey (DHS), 2016 was used. The response variable was the total number of under-five children died per mother in her lifetime. Variables such as maternal socioeconomic and demographic characteristics, health, and environmental factors were considered as risk factors of under-five mortality. Hurdle negative binomial (HNB) regression analysis was employed to determine the factors associated with under-five mortality. Results. The data showed that 27.2% (95%CI: 0263, 0.282) of women experienced under-five deaths. The study revealed the age of mother at first birth, the age of mother at the time of under-five mortality occurred, number of household members, household access to electricity, region, educational level of the mother, sex of household head, wealth index, mother residing with husband/partner at the time of under-five mortality occurred as factors associated with under-five mortality. Age of mother at first birth 18 to 24 (IRR = .663; 95%CI: 0.587, 0.749), 25 or higher years old (IRR = 0.424; 95%CI: 0.306, 0.588), access to electricity (IRR = 0.758; 95%CI: 0.588, 0.976), primary education level of the mother (IRR = 0.715; 95%CI: 0.584, 0.875) and the richer wealth index (IRR = 0.785; 95%CI: 0.624, 0.988) were associated with reduced incidence of under-five mortality controlling for other variables in the model. Whereas older age of mother 35 to 39 (IRR = 5.252; 95%CI: 2.992, 9.218), 40 to 44 (IRR = 7.429; 95%CI: 4.188, 13.177), 45 to 49 (IRR = 8.697; 95%CI: 4.853, 15.585), being a resident of the Benishangul-gumuz region (IRR = 1.781; 95%CI: 1.303, 2.434), female household head (IRR = 1.256; 95%CI: 1.034, 1.525) were associated with an increased incidence of under-five mortality. Conclusion. The findings suggested that early age of mothers’ at first birth and old ages of mothers’, female household head and being uneducated were found to increase the incidence of the under-five mortality, whereas access to electricity and living with husband was statistically associated with reduced incidence of under-five mortality. The implication of this study is that policymakers and stakeholders should provide health education for mothers not to give birth at an earlier age and improve living standards to achieve sustainable development goals.

Factors Affecting Under-Five Mortality in Ethiopia: A Multilevel Negative Binomial Model.

PurposeEven though remarkable declines in under-five mortality rates noticed globally, nearly 5.6 million children still die annually before celebrating their fifth birthday. The 2016 Ethiopian Demographic and Health Survey (EDHS) report revealed that 67 children per 1000 live births died before the fifth birthday. This study aimed at determining factors affecting under-five mortality in Ethiopia using EDHS, 2016.Materials and MethodsThe data were retrieved from the EDHS 2016, and a total weighted number of 11,023 under-five children were included. Descriptive statistics were reported using tables, graphs, and texts. A multilevel negative binomial regression model was fitted, and adjusted incidence rate (ARR) with a 95% confidence interval (CI) and a p-value <0.05 were reported. The deviance test was used to check the goodness of fit.ResultsMother attained higher education (ARR=0.25, 95% CI: 0.10–0.66), female-headed household (ARR=1.32, 95% CI: 1.05–1.66), age of household head (AIRR=1.07, 95% CI: 1.03,1.11), preceding birth interval ≥48 months (ARR=0.51, 95% CI: 0.42–0.61), child who had history of diarrhea (ARR=1.23, 95% CI: 1.08–1.41), multiple birth type (ARR=1.80, 95% CI: 1.34–2.42), mothers who delivered in health facility (ARR=0.86, 95% CI: 0.73,0.94), residents of Addis Ababa (ARR=0.52, 95% CI: 0.28–0.98), and Amhara region (ARR=1.43, 95% CI: 1.09, 1.88) were statistically significant with the number of under-five mortality.ConclusionIn this study, under-five mortality remains a public health problem in Ethiopia. Educational status of the mother, women delivered at health institution, preceding birth interval 24–35 and ≥48, and residents of Addis Ababa reduced the incidence of under-five mortality. On the other hand, being a female household head, age of mother at first giving birth, being employed, having multiple births, and childhood diarrhea were associated with a higher incidence of under-five mortality. This finding suggests that enhancing opportunities to female education, addressing regional disparities, and encouraging mothers to deliver at health institutions will help to reduce the burden of under-five mortality.

Determinants of Under-Five Child Mortality in Ethiopia: Analysis Using Ethiopian Demographic Health Survey, 2016.

Background Under-five mortality rate is a leading indicator of the level of child health and the overall development in countries which indicate the quality of life of a given population, as measured by life expectancy. Objectives To identify and analyze factors that may have a significant influence on under-five mortality in Ethiopia. Methods A national representative cross-sectional study and a quantitative study were conducted among 18,008 households selected based on 2016 EDHS data. The analysis was done using SPSS version 20 statistical software. Both bivariate and multivariable analyses were employed. In multivariable analysis, p value less than 0.05 was considered statistically significant and odds ratio with 95% CI (confidence interval) was used to assess the determinants of under-five child mortality. Results A total of 10,641 children were included in the study with a 99.0% response rate. The U5CM for being a rural resident (AOR = 1.802, 95% CI: 1.251, 2.595), not breastfeeding (AOR = 2.956, 95% CI: 2.490, 3.511), having multiple birth (AOR = 4.755, 95% CI: 3.440, 6.572), male gender (AOR = 1.363, 95% CI: 1.153, 1.612), having first birth order (AOR = 1.592, 95% CI: 1.275, 1.992), and having family size six and above (AOR = 2.187, 95% CI: 1.769, 2.707). The increment of family size increases the risk of U5CM.Conclusion Multivariate logistic analysis reflected that place of residence, mothers' educational level, religion, current breastfeeding status, type of birth, sex of child, birth order, and family size were found to be significant predictors of under-five child mortality. So, government policy, nongovernmental organizations, and all concerned bodies should be focused on the major determinants of under-five child mortality and put in a lot more effort to reduce under-five child mortality, and health intervention policies should be revised.

The best statistical model to estimate predictors of under-five mortality in Ethiopia

The under-five mortality rate is one of the most important indicators of the socio-economic wellbeing and public health conditions of a country. Under-five death in Ethiopia has reduced, but the rate is still higher than the sustainable development goal target of 20 deaths per 1000 live births. This study aimed to identify the best statistical model to estimate predictors of under-five mortality in Ethiopia. Ethiopian demography and health survey of 2016 data were accessed and used for the analysis. A total of 14,370 women were included. Various count models (Poisson, Negative Binomial, Zero-Inflated Poisson, Zero-Inflated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial) were considered to identify risk factors associated with the death of under-five in Ethiopia. The mean number of under-five death was 0.9 and its variance was 1. 697. The hurdle negative binomial model had the smallest AIC, Deviance, and BIC, suggesting the best goodness of fit. Besides, the predictive value and probabilities for many counts in the hurdle negative binomial model fitted the observed counts best. The result of hurdle negative binomial model showed that region, mother’s age, educational level of the father, education level of the mother, father’s occupation, family size, age of mother at first birth, vaccination of child, contraceptive use, birth order, preceding birth interval, twin children, place of delivery, antenatal visit predict under-five death in Ethiopia. The rate of Under-five death remains high. Concerned governmental organizations should work properly to reduce under-five mortality through encouraging child vaccinations and antenatal care visits. Attention should also be provided to multiple births and the spacing among order of birth. The Hurdle negative binomial model provided a better fit for the data. It is argued the Hurdle negative binomial model for count data with excess zeros of unknown sources such as the number of under-five death should be fitted.

Survival and associated factors of mortality of preterm neonates admitted to Felege Hiwot specialized hospital, Bahir Dar, Ethiopia.

Background:The complication of prematurity is the second commonest cause of under-five mortality in Ethiopia. Amhara region has the highest neonatal mortality rate in the country. There was no previous study and this study aimed to assess the survival of preterm neonates and its associated factors of preterm neonatal mortality admitted to Felege Hiwot Specialized Hospital, Bahir Dar, Ethiopia, to take necessary action to maximize survival of preterm babies in developing countries.Methods:A retrospective cross-sectional study was conducted among 686 preterm neonates admitted in Felege Hiwot Specialized Hospital from 1 August 2017 to 30 July 2018. Kaplan–Meier survival curve was used to show the survival rate of preterm neonates and the multivariate Cox proportional hazards model was used to identify covariates of survival of preterm neonates. Those variables having a p-value less than 0.05 were statistically significant for the survival of preterm neonates.Result:Out of 686 preterm neonates admitted from 1 August 2017 to 30 July 2018, 49.1% neonates were improved and discharged and 36.1% died. The survival rate was 0%, 19.4%, 46.7% and 75% for gestational age <28 weeks, 28–31 + 6 weeks, 32–33 + 6 weeks and 34–36 + 6 weeks, respectively. In the multivariate Cox regression model, respiratory distress syndrome, necrotizing enterocolitis, asphyxia, hospital-acquired infection, birth weight, gestational age and place of delivery were significantly associated with time to death of preterm neonates at 95% confidence level (p < 0.05).Conclusion:The mortality rate (36.1%) of preterm neonates is unacceptably high in Felege Hiwot hospital compared to other similar hospitals in Ethiopia. More than 50% of preterm neonatal deaths can be prevented with available resources. Neonatal units with adequate and committed manpower, using a strict aseptic technique, proper follow-up, early detection and timely management of complications, are recommended to improve the survival of preterm neonates.