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

Predictors of time to death among under-five children in pastoral regions of Ethiopia: A retrospective follow-up study

BACKGROUND

In Ethiopia, the mortality rate for children under five is a public health concern. Regretfully, the problem is notably underestimated and underreported, making it impossible to fully recognize how serious the situation is in the nation's developing regions. Unfortunately, no single study has been conducted to reveal the rates and predictor factors of under-five child death in Ethiopia's pastoral regions. Therefore, the purpose of this study was to determine the critical variables that led to a shorter survival time to death for children in Ethiopia's pastoral regions under the age of five.

METHODS

Between January 18 and June 27, 2016, a retrospective follow-up study was done among under-five children in pastoral areas of Ethiopia. The statistically significant difference between categorical predictors was shown using the log-rank test, and the Kaplan-Meier survival curve was used to determine the survival time. In order to identify the time-to-death predictor factors in children under five, Cox proportional hazards (PH) model analyses of bivariable and multivariable variables were fitted.

RESULTS

A total 7,677 children were included in the study. The overall incidence rate of under-five mortality was 8.4% (95% CI 7.77%, 9.0%). In the multivariable Cox PH model analysis, children vaccinated (AHR: 0.72, 95% CI: 0.59, 0.88), mothers aged 35-40 (AHR: 1.27; 95% CI: 1.06, 1.52), and above 41 (AHR: 2.18, 95% CI: 1.59, 2.98), not initiating exclusively breastfeeding (AHR: 1.26, 95% CI: 1.02, 1.55), the agriculture sector of the mother's occupation (AHR: 2.57, 95% CI: 1.74, 3.31), the male sex of the household head (AHR: 0.67, 95% CI: 0.56, 0.81), non-anemic child (AHR: 0.67, 95% CI: 0.55, 0.83), and rural residence (AHR: 3.27, 95% CI: 1.45, 7.38) were identified as main predictors of time to death among under-five children.

CONCLUSIONS

In this study, the authors found a higher rate of under-five deaths than the national figure. A child vaccinated, exclusively breastfeeding, mother's occupation, sex of household head, anemic child, mother's age, and residence were found to be the most influential predictors for time-to-death. Therefore, to lower the high incidence of under-five mortality, the government should focus on the pastoral regional states of Ethiopia.

Factors associated with under-five mortality in Rwanda: An analysis of the Rwanda Demographic and Health Survey 2020

Despite global and Rwandan progress in reducing under-five mortality, the risk of children dying before their fifth birthday persists, necessitating intensified research on determinants. Thus, this study analyzed the birth history data to shed light on the underlying causes of under-five mortality in Rwanda. The study is a secondary analysis of data sourced from the 2020 Rwanda Demographic and Health Survey (RDHS) cross-sectional design. Using SPSS, the data was cleaned, recoded, and weighted, with descriptive and inferential statistics applied. The dependent variable was the child's living status, while independent variables included socio-demographic, media exposure status of mothers, child, and environmental factors. A total of 10267 under-five children of all interviewed mothers were included in the final analysis, of which 12.3% (1260) died. Maternal age (25-34 years: AOR = 1.514, 95% CI = 1.130-2.029, p = 0.005; 45+: AOR = 13.226, 95% CI = 9.253-18.905, p<0.001), occupational status (agricultural workers and other services), and three or more births within five years (AOR = 1.895, 95% CI = 1.433-2.508, p<0.001) significantly increase the risk of under-five mortality. Conversely, maternal education (primary: AOR = 0.821, p = 0.023; secondary: AOR = 0.533, p<0.001; higher: AOR = 0.365, p = 0.010) and higher wealth indexes (middle: AOR = 0.743, p = 0.001; rich: AOR = 0.612, p<0.001), as well as current breastfeeding (AOR = 0.524, 95% CI = 0.455-0.603, p-value <0.001), are associated with lower under-five mortality. Child sex significantly impacts under-five mortality (AOR = 0.873, 95% CI = 0.770-0.991, p = 0.035), favoring females over males. Conversely, multiple birth type children face higher under-five mortality (AOR = 3.541, 95% CI = 2.727-4.599, p<0.001) compared to singletons. Children in the northern (AOR = 1.478, 95% CI = 1.086-2.011, p = 0.013) and eastern (AOR = 1.470, 95% CI = 1.097-1.971, p = 0.010) regions are more susceptible to mortality compared to those in the central (Kigali) region. Additionally, under-five mortality is higher when using water from tanks and other sources (AOR = 2.240, 95% CI = 1.471-3.411, p<0.001) than piped water. This study identifies crucial factors linked to under-five mortality, underscoring the importance of prioritizing them in interventions to enhance Rwandan under-five survival rates.

Application of machine learning methods for predicting under-five mortality: analysis of Nigerian demographic health survey 2018 dataset

BACKGROUND

Under-five mortality remains a significant public health issue in developing countries. This study aimed to assess the effectiveness of various machine learning algorithms in predicting under-five mortality in Nigeria and identify the most relevant predictors.

METHODS

The study used nationally representative data from the 2018 Nigeria Demographic and Health Survey. The study evaluated the performance of the machine learning models such as the artificial neural network, k-nearest neighbourhood, Support Vector Machine, Naïve Bayes, Random Forest, and Logistic Regression using the true positive rate, false positive rate, accuracy, precision, F-measure, Matthew's correlation coefficient, and the Area Under the Receiver Operating Characteristics.

RESULTS

The study found that machine learning models can accurately predict under-five mortality, with the Random Forest and Artificial Neural Network algorithms emerging as the best models, both achieving an accuracy of 89.47% and an AUROC of 96%. The results show that under-five mortality rates vary significantly across different characteristics, with wealth index, maternal education, antenatal visits, place of delivery, employment status of the woman, number of children ever born, and region found to be the top determinants of under-five mortality in Nigeria.

CONCLUSIONS

The findings suggest that machine learning models can be useful in predicting U5M in Nigeria with high accuracy. The study emphasizes the importance of addressing social, economic, and demographic disparities among the population in Nigeria. The study's findings can inform policymakers and health workers about developing targeted interventions to reduce under-five mortality in Nigeria.

Spatiotemporal modeling of under-five mortality and associated risk factors in Ethiopia using 2000-2016 EDHS data

BACKGROUND

The under-five mortality rate serves as a key indicator of the performance of a country's healthcare system. Despite a minor decline, Ethiopia continues to face a persistently high under-five mortality rate across different zones. Thus, this study aimed to identify the risk factors of under-five mortality and the spatiotemporal variation in Ethiopian administrative zones.

METHOD

This study used the 2000-2016 Ethiopian Demographic and Health Survey (EDHS) data which were collected using a two-stage sampling method. A total of 43,029 (10,873 in 2000, 9,861 in 2005, 11,654 in 2011, and 10,641 in 2016) weighted sample under-five child mortality were used. The space-time dynamic model was employed to account for spatial and time effects in 65 administrative zones in Ethiopia.

RESULTS

From the result of a general nesting spatial-temporal dynamic model, there was a significant space-time interaction effect [γ = -0.1444, 95% CI(-0.6680, -0.1355)] for under-five mortality. The increase in the percentages of mothers illiteracy [β = 0.4501, 95% CI (0.2442, 0.6559)], not vaccinated[β= 0.7681, 95% CI (0.5683, 0.9678)], unimproved water[β= 0.5801, CI (0.3793, 0.7808)] were increased death rates for under five children while increased percentage of contraceptive use [β= -0.6609, 95% CI (-0.8636, -0.4582)] and antenatal care unit visit > 4 times [β= -0.1585, 95% CI(-0.1812, -0.1357)] were contributed to the decreased under-five mortality rate at the zone in Ethiopia.

CONCLUSIONS

Even though the mortality rate for children under five has decreased over time, still there is higher in different zones of Ethiopia. There exists spatial and temporal variation in under-five mortality among zones. Therefore, it is very important to consider spatial neighborhood's and temporal context when aiming to avoid under-five mortality.

Time to death and its determinants of under-five children in rural Ethiopia by using shared frailty

Under-five (U5M) is one of the most significant and sensitive measures of the community's health. Children who live in rural areas are more likely than those who live in urban areas to die before the age of five. Therefore, the study aimed to assess the Survival status of under-five mortality and its determinants in rural Ethiopia. The 2019 Ethiopia Mini Demographic and Health Survey was used in this study as a secondary source (EMDHS). A total of 4426 weighted under-five children were included in the study. To determine survival time and identify predictors of death among children under the age of five, the Cox's gamma shared frailty model and the Kaplan Meier model, respectively, were used. An adjusted Hazard Ratio (AHR) along with a 95% Confidence Interval (CI) were used to measure the size and direction of the association. The Study showed that in rural Ethiopia, 6.03% of children died before celebrating their first birthday. The median age of under-five mortality in rural Ethiopia was estimated to be 29 Months. The hazard of death among under-five children and those who had given birth to two children in the last five years was 4.99 times less likely to be at risk of dying than those who had given birth to one Child in the previous five years (AHR 4.99, 95% CI 2.97, 8.83). The Study Concluded that under-five mortality remained high in rural Ethiopia. In the final model, the Age of Mothers, Sex of Household, Breastfeeding, Types of Birth, Sex of Child, Educational Level of Mothers, Wealth Index, Child ever born, Marital Status, and Water Source were significant predictors of under-five mortality. Twins and children who are not breastfed should receive additional attention, along with improving water resources for households and mothers income.

An artificial intelligence approach to predict infants' health status at birth

BACKGROUND

Machine learning could be used for prognosis/diagnosis of maternal and neonates' diseases by analyzing the data sets and profiles obtained from a pregnant mother.

PURPOSE

We aimed to develop a prediction model based on machine learning algorithms to determine important maternal characteristics and neonates' anthropometric profiles as the predictors of neonates' health status.

METHODS

This study was conducted among 1280 pregnant women referred to healthcare centers to receive antenatal care. We evaluated several machine learning methods, including support vector machine (SVM), Ensemble, K-Nearest Neighbor (KNN), Naïve Bayes (NB), and Decision tree classifiers, to predict newborn health state.

RESULTS

The minimum redundancy-maximum relevance (MRMR) algorithm revealed that variables, including head circumference of neonates, pregnancy intention, and drug consumption history during pregnancy, were top-scored features for classifying normal and unhealthy infants. Among the different classification methods, the SVM classifier had the best performance. The average values of accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC) in the test group were 75%, 75%, 76%, 76%, and 65%, respectively, for SVM model.

CONCLUSION

Machine learning methods can efficiently forecast the neonate's health status among pregnant women. This study proposed a new approach toward the integration of maternal data and neonate profiles to facilitate the prediction of neonates' health status.

Prevalence of preterm birth and associated factors among mothers who gave birth in public hospitals of east Gojjam zone, Ethiopia

BACKGROUNDS

Preterm birth is defined as babies born alive before 37 weeks of pregnancy or fewer than 259 days since the first day of a woman's last menstrual period. Globally, 14.84 million babies were preterm births. Preterm infants are at risk for specific diseases related to the immaturity of various organ systems. This study aimed to assess the prevalence of preterm birth and associated factors among mothers who gave birth in public hospitals of east Gojjam zone, Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted from April 1 up to June 30, 2021, in public hospitals in the east Gojjam zone. Systematic random sampling was used. Data were collected through structured questionnaires, patient interviews and patient card reviews. We used binary logistic regression analysis with 95% CI and P-value < 0.05 to identify the significant factors with preterm birth.

RESULTS

Out of 615 mothers, 13.2% gave a preterm birth. Antenatal care (AOR = 2.87; 95% CI = (1.67, 5.09)), educational status of mother (AOR = 2.79; 95% CI = (1.27, 6.67)), husband educational status(AOR = 2.11; 95% CI = (1.10, 4.18)), Average monthly family income(AOR = 1.95; 95% CI = (1.05, 3.75)),family size(AOR = 0.15; 95% CI = (0.03, 0.67)), multifetal gestation (AOR = 3.30; 95% CI = (1.29, 8.69), having Premature Rupture Of Membrane (AOR = 6.46; 95% CI= (2.52, 18.24)), history of chronic illness (AOR = 3.94; 95% CI = (1.67, 9.45)), being HIV positive(AOR = 6.99; 95% CI= (1.13, 44.65)), Ante-Partum Hemorrhage (AOR = 3.62; 95% CI= (1.12, 12.59)), pregnancy Induced Hypertension (AOR = 3.61; 95% CI= (1.19, 11.84)), mode of delivery (AOR = 7.16; 95% CI = (2.09, 29.29)), and onset of labor (AOR = 0.10; 95% CI = (0.03, 0.29)) were found to be significantly associated with preterm birth.

CONCLUSIONS

antenatal care, educational status of the mother, husband's educational status, family income, family size, multifetal gestation, Premature Rupture of the membrane, history of chronic illness, being HIV positive, Ante-Partum Hemorrhage, pregnancy Induced Hypertension, mode of delivery, and the onset of labor were found to be significantly associated with preterm birth. To minimize the proportion of preterm birth focusing on this important variables, timely identification of obstetric complications, strengthening early screening of HIV and high-risk pregnancies like multiple gestations, PIH and APH were important.

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.

Bioethical Implications of Vulnerability and Politics for Healthcare in Ethiopia and The Ways Forward

Vulnerability and politics are among the relevant and key topics of discussion in the Ethiopian healthcare context. Attempts by the formal bioethics structure in Ethiopia to deliberate on ethical issues relating to vulnerability and politics in healthcare have been limited, even though the informal analysis of bioethical issues has been present in traditional Ethiopian communities. This is reflected in religion, social values, and local moral underpinnings. Thus, the aim of this paper is to discuss the bioethical implications of vulnerability and politics for healthcare in Ethiopia and to suggest possible ways forward. First, we will briefly introduce what has been done to develop bioethics as a field in Ethiopia and what gaps remain concerning its implementation in healthcare practice. This will give a context for our second and main task - analyzing the healthcare challenges in relation to vulnerability and politics and discussing their bioethical implications. In doing so, and since these two concepts are intrinsically broad, we demarcate their scope by focusing on specific issues such as poverty, gender, health governance, and armed conflicts. Lastly, we provide suggestions for the ways forward.

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

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Risk factors of mortality among children under age five in Awi Zone, northwest Ethiopia

BACKGROUND

Globally, under-five mortality rates have dropped, but in Ethiopia, the under-five mortality rate is still high. In Amhara region, the death of children under the age of five is still a public health problem. This study assessed the risk factors of mortality among children under age five in Awi Zone.

METHOD

A community-based cross-sectional study was conducted from December 1, 2020, up to April 30, 2021. Data entry and analysis were conducted using SPSS version 26 and Stata version 16, respectively. A zero-inflated Poisson regression model was fitted to identify the risk factors of under-five mortality.

RESULT

Out of the 1,340 mothers in the Awi zone, 11.9% of women lost at least one child. Single births (IRR = 0.598, 95% CI: 0.395, 0.906), fathers whose level of education is secondary or above(IRR = 0.223, 95% CI: 0.064, 0.782), mothers who completed their secondary and above education level(IRR = 0.116, 95% CI: 0.014, 0.971), mothers who have birth interval greater than 24 months (IRR = 0.619,95% CI: 0.417, 0.917), 8 and above family size the households (IRR = 0.543, 95% CI: 0.302, 0.976), 31 and above mother age groups (IRR = 0.296, 95% CI: 0.093, 0.943), medium households of mothers (IRR = 0.540, 95% CI: 0.316, 0.920), working mothers (IRR = 1.691, 95% CI: 1.040, 2.748) and mothers who had not antenatal visits during pregnancy (IRR = 2.060, 95% CI: 1.259, 3.371) were significant factors of under-five mortality.

CONCLUSION

Mother's age group, preceding birth interval, family size, wealth index, duration of pregnancy, antenatal visits during pregnancy, types of birth, mother's education level, husband's education level, and place of delivery were significant factors of under-five mortality in Awi zone. So, Awi zone public health institute, Awi zone children's and youth office, and other relevant bodies should work to reduce under-five mortality by focusing on child mortality issues.

Under-Five Mortality in Sierra Leone and Possible Associated Factors: Evidence from the 2019 Demographic and Health Survey

High under-five mortality rate remains one of the public health challenges, especially in sub-Saharans Africa, accounting for more than half of all global cases. Sierra Leone was and still one of the countries with the highest under-five mortality rate. Using the latest 2019 SLDHS data, we investigated factors associated with under-five mortality in Sierra Leone. A total of 9771 mothers aged 15-49 years in the country were interviewed and included in the analysis. The dependent variable is child status (dead=1; alive=0). A total of 871 (9%) children died before their fifth birthday. Maternal age of 20-24 years (AOR=0.46; CI=0.33-0.64; P<0.001) up to 40-44 years (AOR=0.43; CI=0.27-0.7; P=0.001), currently breastfeeding (AOR=0.20; CI=0.17-0.24; P<0.001), maternal media exposure and usage of reading newspapers/magazines less than once a week (AOR=0.48; CI=0.28-0.85; P=0.011) were more likely to enhance child survivability through their fifth birthday. Also, the child sex being female (AOR=0.68; CI=0.59-0.79) was more likely to survive under-five mortality compared to their male counterpart. On the other hand, mothers who listened to radio at least once a week (AOR=1.31; CI=1.08-1.59; P=0.007) watched television less than once a week (AOR=1.48; CI=1.16-1.90), had two (AOR=3.4, CI=2.78-4.16; P<0.001) or three and above birth (AOR=8.11; CI=6.07-10.83; P<0.001) in five years, had multiple birth children (AOR=1.41; CI=1.08-1.86) and very small-sized child at birth (AOR= 1.95; CI=1.41-2.70) were more likely to lose their children below the age of five years. The factors contributing to under-five mortality in Sierra Leone are critical to ensuring child survival and improving maternal health. Breastfeeding, maternal age, media exposure, child's sex, multiple birth type, very small-sized child and the total number of births in five years were significant drivers of under-five mortality. The result affirms the need for attention to be focused on enhancing the survival rate of under-five children in Sierra Leone.

Assessing Individual- and Community-Level Variability in Predictors of Neonatal, Infant, and Under-Five Child Mortality in Ethiopia Using a Multilevel Modeling Approach

Background: In low-and middle-income countries, child mortality rates are basic indicators of a country’s socio-economic situation and quality of life. The Ethiopian government is currently working to reduce child mortality to accomplish its long-term development goals. Using data from the Ethiopian Mini Demographic and Health Survey, 2019, this study analyzed the determinants of child mortality in Ethiopia. Methods: A total of 4806 children were considered in the final analyses. Multivariate analysis was used to estimate the effects of the predictors simultaneously on each child mortality outcome. Results: The findings revealed that 31.6% of children died during the neonatal stage, 39.1% during the infant stage, and 48.5% during the under-five stage. Variation in child mortality was discovered between Ethiopian community clusters, with the result of heterogeneity between clusters on newborn mortality (χ2 = 202.4, p-value < 0.0001), (χ2 = 777.35, p-value < 0.0001), and (χ2 = 112.92, p-value < 0.0001). Children’s neonatal, infant, and under-five mortality intracluster correlation coefficient (ICC) were 0.35, 0.33, and 0.36, respectively, across communities. Conclusions: In Ethiopia, under-five mortality remains a serious public health issue, with wide variations and high rates among community clusters. Intervention measures focusing on lowering rates of household poverty, increasing education opportunities, and improving access to health care could assist in reducing child mortality in Ethiopia.

Trend and correlates of under-5 mortality in Ethiopia: A multilevel model comparison of 2000-2016 EDHS data

Objectives:

The main objectives of this article were to answer (1) what is the trend of under-5 mortality from 2000 to 2016 Ethiopian Demographic and Health Survey? (2) What are the correlates that contribute to under-5 mortality in Ethiopia?

Methods:

The data used in this study were obtained from 2000, 2005, 2011, and 2016 Ethiopian Demographic and Health Survey data. We used multivariable three-level logistic regression model to predict under-5 mortality, with sex of a child, preceding birth interval, birth order, place of delivery, weight of child at birth, and plurality as first-level variables; mother’s education level, wealth index, mother’s age at first birth, and sex of household head as second-level variables; and residence and survey time as third-level variables.

Results:

The under-5 mortality declined from 166 deaths per 1000 live birth in 2000 to 67 deaths per 1000 live births in 2016. The odds of under-5 mortality among children with rural residence were 2.81 times greater than among children with urban residence. Moreover, the odds of under-5 mortality were higher among mothers who gave birth with preceding birth intervals of less than 24 months. A child whose preceding birth interval was less than 24 months had a 0.235, 0.174, 0.143, and 0.107 predicted probability of dying in the years 2000, 2005, 2011, and 2016, respectively.

Conclusion:

Child mortality varied across time in Ethiopia. Understanding both the time-varying nature of the correlates and changes in the type of their associations can help to explain some of the decreases in child mortality rates. Direction and/or presence of a relationship between these correlates and child mortality significantly interacted with time. Therefore, to mitigate the burden of under-5 mortality, the concerned body should provide awareness to the community.

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

BACKGROUND

Worldwide, 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.

METHODS

Nationally 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.

RESULTS

The 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.

CONCLUSION

Even 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.

Time to under-five mortality and its predictors in rural Ethiopia: Cox-gamma shared frailty model

Background

Under-five mortality (U5M) is one of the most important and sensitive indicators of the health status of the community. Despite there having been a substantial reduction in U5M since 1990, its rate is still high in Sub-Saharan African countries. Thus, this study aimed to assess time to under-five mortality and its predictors in rural Ethiopia.

Methods

This study utilized a secondary analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS). A total of 9,807 weighted under-five children selected at different stages were included in the analysis. The Kaplan-Meier and Cox’s-gamma shared frailty models were used to estimate survival time and to identify predictors of under-five mortality, respectively. An adjusted Hazard Ratio (AHR) along with a 95% Confidence Interval (CI) was used to measure the effect size and direction of the association.

Results

The study indicated that 6.69% (95% CI: 6.13, 7.30) of children died before celebrating their fifth birthday in rural Ethiopia. Of all the deaths, the median time to death was 27 months. After controlling the effect of cluster and other confounding factors, female sex (AHR = 0.62, 95% CI: 0.52, 0.75), ever born greater than five children (AHR = 1.40, 95% CI: 1.07, 1.83), very large size at birth (AHR = 1.33, 95% CI: 1.03 1.71), very small size at birth (AHR = 1.41, 95% CI: 1.10, 1.82), twin pregnancy (AHR = 3.5, 95% CI: 2.47, 4.88), not ever breastfeeding (AHR = 11.29, 95% CI: 9.03, 14.12), unimproved latrine (AHR = 3.44, 95% CI: 1.91, 6.17), covered by health insurance (AHR = 0.29, 95% CI: 0.12, 0.70) were predictors of under-five mortality.

Conclusions

Still under-five mortality was high in rural Ethiopia as compared to the global under-five mortality rate. In the final model, sex of a child, the total number of children ever born, children’s size at birth, type of pregnancy, breastfeeding, type of toilet, and being covered by health insurance were significant predictors of under-five mortality. Further emphasis should be given to twin and not breastfeeding children, as well as households’ better encouraging membership of community health insurance and utilization of improved latrines.

Availability and Utilization of World Health Organization Recommended Priority Life-Saving Medicines for Under Five-Year-Old Children in Gondar Town, Ethiopia: A Cross-Sectional Study

BACKGROUND

Globally, more than eight million under-five children die every year because of diseases that could be treated or prevented with drug therapy. Thus, this study aimed to evaluate the utilization and availability of the World Health Organization (WHO) suggested priority life-saving medicines for under-five-year-old children in Gondar town.

METHODS

Institutional-based cross-sectional survey was conducted from March 2020 to May 2020 in public health centers of Gondar town. Data entry and validation were performed in EpiData 3.1 and exported to SPSS version 20 for descriptive analysis like frequency, percentage, mean, standard deviation, and median.

RESULTS

The availability of zinc phosphate and oral rehydration salt for the diarrheal cases was 57.14% and 85.71%, respectively. The availabilities of amoxicillin dispersible tablet and gentamicin injection for the treatments of pneumonia cases were 71.43% and 42.85%, respectively, and the availability of paracetamol tablet was high (85.71%). The availabilities of artemether/lumefantrine tablet and artesunate rectal were ranged between fairly high (57.1%) to very low (28.5%), respectively, and the availabilities of zidovudine/lamivudine/nevirapine-based antiretroviral regimen was 100%, a utilization for this regimen was high (96.29%). Two (3.70%) of the surveyed cases were utilized lopinavir/ritonavir-based regimen. The utilization of priority medicines was low for pain management and pneumonia which was 18.5% and 48.18%, respectively.

CONCLUSION

The study concluded that medicine was not consistently available throughout public health centers in Gondar town. Thus, this finding suggests the integration of WHO-recommended life-saving priority medicines into the essential drug management systems and health unit logistics to raise their utilization and availability.

Determinants of under-five mortality in the high mortality regions of Ethiopia: mixed-effect logistic regression analysis

BACKGROUND

Even though the global under-five mortality rate substantially decreased over time, Sub-Saharan African (SSA) countries including Ethiopia continue to share the huge burden of under-five mortality. Ethiopia showed a substantial reduction in under-five mortality over time but the rate of reduction has varied across regions. Therefore, this study aimed to investigate determinants of under-five mortality in the high mortality regions of Ethiopia.

METHODS

A secondary data analysis was done based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 3446 live births were included for this study. For the determinants of under-five mortality, mixed-effect logistic regression was fitted. The Intra-Class Correlation Coefficient (ICC), and Median Odds Ratio (MOR) were done to assess the presence of a significant clustering effect. The standard binary logistic regression and the mixed-effect logistic regression model were fitted and deviance (-2LL) was used for model comparison as the models were nested models. Variables with a p-value less than 0.2 in the bi-variable mixed-effect binary logistic regression analysis were considered for the multivariable analysis. In the multivariable mixed-effect logistic regression analysis, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) were reported to declare the statistical significance and strength of association of under-five mortality and the determinant factors.

RESULTS

Overall, the under-five mortality rate in the high mortality regions of Ethiopia was 74 per 1000 live births and it was highest among twin births (262 per 1000 live births). In the multivariable mixed-effect logistic regression analysis, being having 6 and above births (AOR = 3.66, 95% CI: 1.55, 8.67), preceding birth interval of 2-3 years (AOR = 0.57, 95% CI: 0.41, 0.81) and above 3 years (AOR = 0.35, 95% CI: 0.22, 0.55), being twin (AOR = 5.12, 95% CI: 2.28, 11.46), and being having antenatal care (ANC) visit during pregnancy (AOR = 0.27, 95% CI: 0.16, 0.45) were significant determinants of under-five mortality.

CONCLUSION

In this study, under-five mortality rate was highest in high mortality regions of Ethiopia. Parity, ANC visit, preceding birth interval, and multiple births were significant predictors of under-five mortality. Therefore, public health interventions that increase maternal health service utilization such as ANC and family planning service utilization to increase birth interval are needed to reduce under-five mortality among these regions of Ethiopia.