Predictors of mortality among under-five children in rural Ethiopia: a cross sectional study

Abstract

Background: The under-five children mortality (UFCM) is one of the major significant and sensitive indicators of the health status of the public. Although the world has seen a remarkable and substantial decrease in UFCM since 1990, its progression rate still remains alarmingly high in Sub-Saharan African (SSA) countries, particularly in Ethiopia. Therefore, this study aimed to assess predictors of mortality among under-five children in rural Ethiopia. Methods: This study used a secondary data analysis of the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) report. A total of 4,425 under-five children were included in the final analysis. The Kaplan-Meier (K-M) and Cox proportional hazard (PH) model analyses were utilized to estimate survival time and to investigate the major predictors of mortality under-five children, respectively. An Adjusted Hazard Ratio (AHR) along with a 95% Confidence Interval (CI) was employed to measure the impact size and direction of the association. Results: The study showed that 6.2% (95% CI: (5.43, 6.86)) of children died beforehand celebrating their fifth birthday in rural Ethiopia. The multivariable Cox PH regression model analysis revealed, predictors of large spacing preceding birth interval (16–26 months) (AHR = 0.61; 95% CI: (0.402–0.920)), 27–38 months (AHR =0.72; 95% CI: (0.496–1.03)), and ≥39 months, multiple births (AHR = 3.9; 95% CI: (2.77–5.62)), being breastfeeding (AHR =0.13; 95% CI: (0.099–0.162)), and unvaccinated child (AHR =11.6; 95% CI: (1.62–83.1)) were significant predictors of under-five children mortality. Conclusions: In this study, under-five children death rate was alarmingly high in the rural areas of Ethiopia. The birth type, preceding birth interval, vaccination of child, and breastfeeding are identified as significant predictors of under-five children mortality in rural Ethiopia. Therefore, public health interventionsshould be given attention to multiple births, unvaccinated and non-breastfeeding children, as well as mothers’ better encouragement to having a large spacing preceding birth interval.