Factors affecting infant mortality in the general population: evidence from the 2016 Ethiopian demographic and health survey (EDHS); a multilevel analysis

The risk factors of infant mortality in Somalia: evidence from the 2018/2019 Somali health & demographic survey

BACKGROUND

Globally, infant mortality is one of the major public health threats, especially in low-income countries. The infant mortality rate of Somalia stands at 73 deaths per 1000 live births, which is one of the highest infant death rates in the region as well as in the world. Therefore, the aim of this study was to ascertain the risk factors of infant mortality in Somalia using national representative data.

METHOD

In this study, data from the Somali Health and Demographic Survey (SHDS), conducted for the first time in Somalia in 2018/2019 and released in 2020, were utilized. The analysis of the data involved employing the Chi-square test as a bivariate analysis. Furthermore, a multivariate Cox proportional hazard model was applied to accommodate potential confounders that act as risk factors for infant death.

RESULTS

The study found that infant mortality was highest among male babies, multiple births, and those babies who live in rural areas, respectively, as compared to their counterparts. Those mothers who delivered babies with small birth size and belonged to a poor wealth index experienced higher infant mortality than those mothers who delivered babies with average size and belonged to a middle or rich wealth index. Survival analysis indicated that mothers who did use ANC services (HR = 0.740; 95% CI = 0.618-0.832), sex of the baby (HR = 0.661; 95% CI = 0.484-0.965), duration of pregnancy (HR = 0.770; 95% CI = 0.469-0.944), multiple births (HR = 1.369; 1.142-1.910) and place of residence (HR = 1.650; 95% CI = 1.451-2.150) were found to be statistically significantly related to infant death.

CONCLUSION

The study investigated the risk factors associated with infant mortality by analyzing data from the first Somali Health and Demographic Survey (SHDS), which included a representative sample of the country's population. Place of residence, gestational duration, infant's gender, antenatal care visits, and multiple births were identified as determinants of infant mortality. Given that infant mortality poses a significant public health concern, particularly in crisis-affected countries like Somalia, intervention programs should prioritize the provision of antenatal care services, particularly for first-time mothers. Moreover, these programs should place greater emphasis on educating women about the importance of receiving antenatal care and family planning services, in order to enhance their awareness of these vital health services and their positive impact on infant survival rates.

Effects of the COVID-19 pandemic on the rates of adverse birth outcomes and fetal mortality in Japan: an analysis of national data from 2010 to 2022

BACKGROUND

Although the coronavirus disease 2019 (COVID-19) pandemic affected trends of multiple health outcomes in Japan, there is a paucity of studies investigating the effect of the pandemic on adverse birth outcomes and fetal mortality. This study aimed to investigate the effect of the onset of the pandemic on the trends in adverse birth outcomes and fetal mortality using national data in Japan.

METHODS

We used the 2010-2022 birth and fetal mortality data from the Vital Statistics in Japan. We defined the starting time of the effect of the pandemic as April 2020, and the period from January 2010 to March 2020 and that from April 2020 to December 2022 were defined as the pre- and post- pandemic period, respectively. The rates of preterm birth, term low birth weight (TLBW), small-for-gestational-age (SGA), large-for-gestational-age (LGA), spontaneous fetal mortality, and artificial fetal mortality were used as outcomes. An interrupted time series analysis was conducted using monthly time series data of the outcomes to evaluate the effects of the pandemic. In addition, a modified Poisson regression model was used to evaluate the effects of the pandemic on these outcomes using individual-level data, and the adjusted risk ratio of the effect was calculated.

RESULTS

The adverse birth and fetal mortality outcomes showed a decreasing trend over the years, except for preterm birth and LGA birth rates, and SGA birth rates tended to reach their lowest values after the onset of the pandemic. The interrupted time series analysis revealed that the pandemic decreased preterm birth, TLBW, and SGA birth rates. In addition, the regression analysis revealed that the pandemic decreased the TLBW, SGA, and artificial fetal mortality rates.

CONCLUSIONS

Analyses performed using national data suggested that the pandemic decreased the TLBW and SGA rates in Japan.

Perinatal and childhood outcomes of children born to female cancer survivors in South Korea

Despite the increasing number of female cancer survivors, uncertainty remains regarding potential adverse health outcomes for their offspring. Comprehensive population-based studies would be invaluable for female cancer survivors in making decisions about their future. This study uses the National Health Information Database to investigate perinatal and long-term outcomes of offspring born to mothers with a history of cancer. In a South Korean cohort of 95,264 women aged 15-40 diagnosed with cancer between 2007 and 2010, we evaluated the outcomes of 15,221 children born to 11,092, cancer survivors. We selected 147,727 women without a history of cancer and 201,444 children as a control group. Our study found that children of female cancer survivors have a significantly higher odds ratio of primary outcomes including preterm birth, low birth weight, neonatal intensive care unit admission, and death. While there was no difference in the rate of death within 1 year of birth between the two groups, the total death rate during the follow-up period was significantly higher in children born to mothers with cancer. After adjusting for gestational age and birth weight, there was no statistically significant increased hazard ratio of secondary outcomes including cancer, chromosomal abnormalities, cerebral palsy, delayed development, epilepsy, language disorder, or hearing impairment.

Factors associated with infant mortality in Nigeria: A scoping review

BACKGROUND

Infant mortality persists as a global public health concern, particularly in lower-middle-income countries (LIMCs) such as Nigeria. The risk of an infant dying before one year of age is estimated to be six times higher in Africa than in Europe. Nigeria recorded an infant mortality rate of 72.2 deaths per 1,000 live births in 2020, in contrast to the global estimate of 27.4 per 1,000 live births. Several studies have been undertaken to determine the factors influencing infant mortality.

OBJECTIVE

This scoping review sought to identify and summarise the breadth of evidence available on factors associated with infant mortality in Nigeria.

METHODS

This review followed the five-stage principles of Arksey and O'Malley's framework. Four electronic databases were searched with no limit to publication date or study type: Ovid MEDLINE, PubMed, CINAHL Complete, and Web of Science. Selected studies were imported into Endnote software and then exported to Rayyan software where duplicates were removed. Included articles were thematically analysed and synthesised using the socioecological model.

RESULTS

A total of 8,139 references were compiled and screened. Forty-eight articles were included in the final review. At the individual level, maternal- and child-related factors were revealed to influence infant mortality; socioeconomic and sociocultural factors at the interpersonal level; provision and utilisation of health services, health workforce, hospital resources and access to health services at the organisational level; housing/neighbourhood and environmental factors at the community level; and lastly, governmental factors were found to affect infant mortality at the public policy level.

CONCLUSION

Factors related to the individual, interpersonal, organisational, community and public policy levels were associated with infant mortality in Nigeria.

Spatial multilevel analysis of age at death of under-5 children and associated determinants: EDHS 2000-2016

OBJECTIVE

This study examines trends, spatial distribution and determinants of age at death of under-5 children in Ethiopia.

DESIGN

This study used secondary data from the 2000, 2005, 2011 and 2016 Ethiopian Demographic and Health Surveys. A multilevel partial ordinal logistic regression model was used to assess the effects of variables on the age at death of children under 5 years.

SETTING

Ethiopia.

PARTICIPANTS

The final analysis included a sample of 3997 deaths of newborns, infants and toddlers.

RESULTS

A total of 1508, 1054, 830 and 605 deaths of under-5 children were recorded in the 2000, 2005, 2011 and 2016 survey years, respectively. The death of newborns, infants and toddlers showed a significant decrease from 2000 to 2016, with reductions of 33.3% to 17.4%, 42.4% to 12.6% and 45.2% to 11.6%, respectively. The analysis using Global Moran's Index revealed significant spatial autocorrelation in mortality for each survey year (p<0.05). The intraclass correlation of age at death of under-5 children within regions was substantial. Furthermore, the odds of newborn deaths among under-5 children (OR: 0.638, 95% CI: 0.535, 0.759) were lower for those delivered in health institutions compared with those delivered at home.

CONCLUSIONS

Throughout the survey years from 2000 to 2016, newborn children had higher mortality rates compared with infants and toddlers, and significant spatial variations were observed across different zones in Ethiopia. Factors such as child's sex, age of mother, religion, birth size, sex of household head, place of delivery, birth type, antenatal care, wealth index, spatial autocovariate, Demographic and Health Survey year, place of residence and region were found to be significant in influencing the death of under-5 children in Ethiopia. Overall, there has been a decreasing trend in the proportion of under-5 child mortality over the four survey years in Ethiopia.

Geographical disparities and determinants of infant mortality in Ethiopia: mapping and spatial analysis using EDHS data

BACKGROUND

Infant mortality remains a public health challenge in Ethiopia. Exploring infant mortality will aid in tracking the progress toward achieving sustainable development goals.

OBJECTIVE

The study aimed to explore the geographical variations and associated factors of infant mortality in Ethiopia.

METHOD

A total of 11,023 infants from the 2016 Ethiopian Demographic and Health Survey (EDHS) data were extracted and included in the analysis. EDHS used a two-stage cluster sampling design with a census enumeration area as the primary sampling unit and households as the secondary sampling unit. Arc GIS software was used for spatial analysis using clusters for exploring geographical variations in infant mortality. A binary logistic regression was employed using R software to identify the significant determinants of infant mortality.

RESULTS

The study revealed that the spatial distribution of infant mortality was non-random in the country. Infants whose mothers not receiving ANC (AOR = 1.45; 95%CI: 1.17, 1.79), not breastfed status (AOR = 3.94; 95%CI: 3.19, 4.81), poor wealth index (AOR = 1.36; 95%CI: 1.04, 1.77), male infants (AOR = 1.59; 95%CI: 1.29, 1.95), birth order of six or above (AOR = 3.11; 95%CI: 2.08, 4.62), small birth size (AOR = 1.27; 95%CI: 1.26, 1.60), birth spacing [(≤ 24 months (AOR = 2.29; 95%CI: 1.79, 2.92), 25-36 months (AOR = 1.16; 95%CI: 1.12, 1.49)], multiple births (AOR = 6.82; 95%CI: 4.76, 10.81), rural residence (AOR = 1.63; 95%CI: 1.05, 2.77) and regions [Afar (AOR = 1.54; 95%CI: 1.01, 2.36), Harari (AOR = 1.56; 95%CI: 1.04, 2.56), and Somali (AOR = 1.52; 95%CI: 1.03, 2.39)] were the determinants of infant death in Ethiopia.

CONCLUSIONS

There is a great geographical disparity in infant mortality rates across regions. Afar, Harari, and Somali regions were verified as hot spot areas. ANC usage, breastfed status, wealth index, sex of the infant, birth order, birth size, birth spacing, birth type, residence, and region were the determinants of infant death in Ethiopia. Therefore, appropriate interventions need to be implemented in the hot spots to alleviate the risk factors for infant mortality.

An assessment of random forest technique using simulation study: illustration with infant mortality in Bangladesh

We aimed to assess different machine learning techniques for predicting infant mortality (<1 year) in Bangladesh. The decision tree (DT), random forest (RF), support vector machine (SVM) and logistic regression (LR) approaches were evaluated through accuracy, sensitivity, specificity, precision, F1-score, receiver operating characteristics curve and k-fold cross-validation via simulations. The Boruta algorithm and chi-square ( χ 2 ) test were used for features selection of infant mortality. Overall, the RF technique (Boruta: accuracy = 0.8890, sensitivity = 0.0480, specificity = 0.9789, precision = 0.1960, F1-score = 0.0771, AUC = 0.6590; χ 2 : accuracy = 0.8856, sensitivity = 0.0536, specificity = 0.9745, precision = 0.1837, F1-score = 0.0828, AUC = 0.6480) showed higher predictive performance for infant mortality compared to other approaches. Age at first marriage and birth, body mass index (BMI), birth interval, place of residence, religion, administrative division, parents education, occupation of mother, media-exposure, wealth index, gender of child, birth order, children ever born, toilet facility and cooking fuel were potential determinants of infant mortality in Bangladesh. Study findings may help women, stakeholders and policy-makers to take necessary steps for reducing infant mortality by creating awareness, expanding educational programs at community levels and public health interventions.

Factors associated with post-neonatal mortality in Ethiopia: Using the 2019 Ethiopia mini demographic and health survey

Background

Post-neonatal mortality is the number of deaths of infants aged 28 days through 11 months and is expressed as post-neonatal deaths per 1000 live births per year. This study aimed to identify the factors that influence post-neonatal death using the 2019 Ethiopia mini demographic and health survey (EMDHS2019).

Methods

The study included 2126 post neonates born from mothers who had been interviewed about births in the five years before the survey. The survey gathering period was carried out from March 21, 2019, to June 28, 2019. The data were first analyzed with a chi-square test of association, and then relevant factors were evaluated with binary logistic regression models and the results were interpreted using adjusted odds ratio (AOR) and confidence interval(CI) of parameters.

Results

The prevalence of post neonatal death was 16% (95% CI: 15.46, 17.78). The study also showed that not vaccinated post-neonates (AOR = 2.325, 95% CI: 1.784, 3.029), mothers who were not receiving any tetanus injection (AOR = 2.891, 95% CI: 2.254, 3.708), mothers age group 15-24(AOR = 1.836, 95% CI: 1.168, 2.886), Afar (AOR = 2.868, 95% CI: 1.264, 6.506), Somali(AOR = 2.273, 95% CI: 1.029, 5.020), Southern Nations, Nationalities, and People’s Region(SNNP) (AOR = 2.619, 95% CI: 1.096, 6.257), 2–4 birth orders (AOR = 1.936, 95% CI: 1.225, 3.060), not attend antenatal care(ANC) visit (AOR = 6.491, 95% CI: 3.928, 10.726), and preceding birth interval less than 24 months (AOR = 1.755, 95% CI: 1.363,2.261) statistically associated with a higher risk of post neonatal death. Although not given anything other than breast milk (AOR = 0.604, 95% CI 0.462, 0.789), urban residents (AOR = 0.545, 95% CI: 0.338, 0.877), single births (AOR = 0.150, 95% CI: 0.096, 0.234), less than 3 children in a family (AOR = 0.665, 95% CI 0.470, 0.939) and the head of the male household (AOR = 0.442, 95% CI: 0.270, 0.724) were statistically associated with a lower risk of post-neonatal mortality.

Conclusions

It is highly suggested that maternal and child health care services (including antenatal care visits, postnatal care visits, and immunization) be strengthened and monitored during the early stages of infancy. Mothers from Somali, Afar, and SNNP regions, as well as multiple births, rural residents, and those giving birth to a child with a birth gap of fewer than 24 months, demand special care.

Risk factor of neonatal mortality in Ethiopia: multilevel analysis of 2016 Demographic and Health Survey

Background

In sub-Saharan African countries, neonatal mortality rates remain unacceptably high. Ethiopia is one of the countries in Sub-Saharan Africa with the highest death rates of newborn children. Therefore, this study aimed to identify the risk factors associated with neonatal mortality in Ethiopia at the individual and community level.

Methods

The 2016 Ethiopian Demographic and Health Survey data was accessed and used for the analysis. A total of 2449 newborn children were included in the analysis. The multilevel logistic regression model was used to identify the significant factor of neonatal mortality. Adjusted odds ratio with a 95% confidence interval and p-value < 0.05 in the multilevel model was reported.

Results

A total of 2449 newborn children were included in this study. Multiple birth type (AOR = 3.18; 95% CI 2.78, 3.63), birth order of ≥ 5 (AOR = 2.15; 95% CI 1.75, 2.64), pre-term birth (AOR = 5.97; 95% CI 4.96, 7.20), no antenatal care (ANC) visit during pregnancy (AOR = 2.33; 95% CI 2.09, 2.61), not received TT injection during pregnancy (AOR = 2.28; 95% CI 1.92, 2.71), delivered at home (AOR = 1.99; 95% CI 1.48, 2.69), less than 24 months of preceding birth interval (AOR = 1.51; 95% CI 1.35,1.68), smaller birth size (AOR = 1.58; 95% CI 1.46, 1.71), never breastfeeding (AOR = 2.43; 95% CI 2.17, 2.72), poor wealth index (AOR = 1.29; 95% CI 1.17,1.41), non-educated mothers (AOR = 1.58; 95% CI 1.46, 1.71), non-educated fathers (AOR = 1.32; 95% CI 1.12, 1.54), rural residence (AOR = 2.71; 95% CI 2.23, 3.29), unprotected water source (AOR = 1.35; 95% CI 1.16, 1.58), and have no latrine facility (AOR = 1.78; 95% CI 1.50, 2.12) were associated with a higher risk of neonatal mortality. Neonates living in Amhara, Oromia, Somali, Harari, and Dire Dawa had a higher risk of neonatal mortality compared to Tigray. Moreover, the random effects result showed that about 85.57% of the variation in neonatal mortality was explained by individual- and community-level factors.

Conclusions

The findings suggest that attention be paid to education-based programs for mothers that would highlight the benefits of delivery care services, such as ANC visits, TT injections, and facility births. Meanwhile, public health initiatives should focus on expanding access to quality sanitation facilities, especially for latrines and drinking water that could improve neonatal health at the community-level as a whole.