Individual-, household- and community-level determinants of infant mortality in Ethiopia

Correlates of infant mortality in Benshangul-Gumuz regional State, Ethiopia

BACKGROUND

Infant mortality is one of the commonest health-related indicators that are used to assess the health status of the society of a nation. Despite the decline in global infant mortality rate, the rate of decline in low-and middle-income countries including Ethiopia is below the rate expected to attain Sustainable Development Goal targets. Benshangul-Gumuz regional state is among the regions in Ethiopia with high infant mortality rate. Therefore, this study aimed at determining the infant mortality rate and identifying risk factors associated with the infant mortality in Benshangul-Gumuz regional state, Ethiopia.

METHODS

This study used data drawn from 2019 Ethiopian Mini Demographic and Health Survey (2019 EMDHS). Multivariable logistic regression model was used to identify the risk factors associated with infant mortality.

RESULTS

A total of 530 live births were included in this study. The infant mortality rate in this study was 81 (95% CI: 59, 108) per 1000 live births. Females (AOR: 0.690, 95% CI: 0.342, 0.899), multiple births (AOR: 3.067, 95% CI: 2.313, 10.139), mothers with secondary and higher education (AOR: 0.460, 95% CI: 0.287, 0.885), mothers aged 34 years and older (AOR: 1.539, 95% CI: 1.183, 9.802), mothers having ANC visits (AOR: 0.597, 95% CI: 0.326, 0.709) and health institution delivery (AOR: 0.611, 95% CI: 0.0.294, 0.0.899) were significant risk factors associated with infant mortality.

CONCLUSION

Factors sex of child, type of birth, maternal educational status, age of mother, ANC visits and place of delivery were found to be correlates of infant mortality in Benshangul-Gumuz regional state, Ethiopia. Thus, enhancing mothers to have the ANC follow up during pregnancy and deliver at health institution is recommended in the region.

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.

Time to Death and Its Predictors Among Infants in Ethiopia: Multilevel Mixed-Effects Parametric Survival Analysis Using the 2019 Ethiopian Mini Demographic Health Survey

Introduction

Three years ahead of the plan, Ethiopia has met Millennium Development Goal 4 of reducing under-five mortality. Additionally, the nation is on track to achieve the Sustainable Development Goal of putting an end to preventable child mortality. Despite this, recent data from the nation showed that there were 43 infant deaths for every 1000 live births. Moreover, the country has fallen short of the 2015 Health Sector Transformation Plan goal, with an anticipated infant mortality rate of 35 deaths per 1000 live births in 2020. Thus, this study aims to identify the time to death and its predictors among Ethiopian infants.

Methods

This study used the 2019 Mini-Ethiopian Demographic and Health Survey data set to conduct a retrospective study. The analysis used survival curves and descriptive statistics. Multilevel mixed-effects parametric survival analysis was applied to identify the predictors of infant mortality.

Results

The estimated mean survival time of infants was 11.3 months (95% CI: 11.1, 11.4). Women's current pregnancy status, family size, age of women, previous birth interval, place of delivery, and mode of delivery were significant individual-level predictors of infant mortality. Infants born with less than 24 months' birth interval had a 2.29 times higher estimated risk of death (AHR = 2.29, 95% CI: 1.05, 5.02). Infants born at home were 2.48 times more likely to die than those born in a health facility (AHR = 2.48, 95% CI: 1.03, 5.98). At the community level, women's education was the only statistically significant predictor of infant death.

Conclusion

The risk of infant death was higher before the first month of life, typically shortly after birth. Healthcare programs should put a strong emphasis on efforts to space out births and make institutional delivery services more readily accessible to mothers in Ethiopia to address the infant mortality challenges.

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.

Community and individual level determinants of infant mortality in rural Ethiopia using data from 2016 Ethiopian demographic and health survey

The infant mortality rate remains unacceptably high in sub-Saharan African countries. Ethiopia has one of the highest rates of infant death. This study aimed to identify individual-and community-level factors associated with infant death in the rural part of Ethiopia. The data for the study was obtained from the 2016 Ethiopian Demographic and Health Survey. A total of 8667 newborn children were included in the analysis. The multilevel logistic regression model was considered to identify the individual and community-level factors associated with new born mortality. The random effect model found that 87.68% of the variation in infant mortality was accounted for by individual and community level variables. Multiple births (AOR = 4.35; 95%CI: 2.18, 8.69), small birth size (AOR = 1.29; 95%CI: 1.10, 1.52), unvaccinated infants (AOR = 2.03; 95%CI: 1.75, 2.37), unprotected source of water (AOR = 1.40; 95%CI: 1.09, 1.80), and non-latrine facilities (AOR = 1.62; 95%CI: 1.20) were associated with a higher risk of infant mortality. While delivery in a health facility (AOR = 0.25; 95%CI: 0.19, 0.32), maternal age 35–49 years (AOR = 0.65; 95%CI: 0.49, 0.86), mothers receiving four or more TT injections during pregnancy (AOR = 0.043, 95% CI: 0.026, 0.071), and current breast feeders (AOR = 0.33; 95% CI: 0.26, 0.42) were associated with a lower risk of infant mortality. Furthermore, Infant mortality rates were also higher in Afar, Amhara, Oromia, Somalia, and Harari than in Tigray. Infant mortality in rural Ethiopia is higher than the national average. The government and other concerned bodies should mainly focus on multiple births, unimproved breastfeeding culture, and the spacing between the orders of birth to reduce infant mortality. Furthermore, community-based outreach activities and public health interventions focused on improving the latrine facility and source of drinking water as well as the importance of health facility delivery and received TT injections during the pregnancy.

Socioeconomic Status and Adult Gliomas Mortality Risk: An Observational Study Based on SEER Data

BACKGROUND

Socioeconomic status (SES) is presented as a complex structure and has not been studied adequately among adult patients with glioma. This study aims to identify the intrinsic linkages of community-level SES multivariables and discover the effects of the various patterns of these indicators on prognosis of adult gliomas.

METHODS

Based on data from the SEER (Surveillance Epidemiology and End Results) database, 44,816 adults diagnosed with gliomas from 2007 to 2016 were enrolled for the research. We first used factor analysis and cluster analysis to process SES data. Then, univariable and multivariable Cox proportional hazards models were used to analyze the risk indicators.

RESULTS

Four integrated SES factors were identified: factor 1, economic and social disadvantage (economic and education disadvantage); factor 2, immigration-associated characteristics (foreign-born, language isolation, less household room, recent interstate residential stability); factor 3, housing instability; and factor 4, absence of intrastate mobility. Factor 1 was a risk indicator for survival, whereas factor 2 and factor 4 were protective indicators. All patients fell into 7 cluster groups. Compared with cluster 1, clusters 2, 3, 4, and 7 had a better prognosis, whereas cluster 6 had a shorter survival.

CONCLUSIONS

The combinatorial patterns of SES indicators and pattern-based groups do influence the outcomes of adult gliomas. Special attention is given to patients living in areas with specialized economic-educational disadvantages, relocation instability, and immigration-related characteristics.