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

Abstract

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.

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

“…The Ethiopian government is working to reduce child deaths and reforms have been made in recent years. In the rural part of Ethiopia, maternal complications during childbirth, immediate exclusive breast-feeding, birth interval, maternal socioeconomic characteristics, and health service seeking actions, etc., are still major challenges 9 , 10 . In order to prepare and enforce an initiative and take steps to address the burden of newborn deaths in the rural areas of Ethiopia, identification of the enumeration area specific factors on infant mortality is therefore necessary 4 , 11 .…”

Determinant factors of under-five mortality in rural Ethiopia

“…This study found the prevalence of under-five mortality in rural Ethiopia was 6% (60/1000) of death per one thousand live children in rural Ethiopia. This result showed that under-five mortality was less than in the study conducted Previous in rural Ethiopia [ 16 ]. This indicates under-five mortality in rural Ethiopia rate is somewhat declining, and access to and utilization of health care is improving.…”

“…Using several literature reviews, region, education of mothers, wealth index of HH, marital status, sex of the child, place of delivery, types of birth, breastfeeding, and source of water and toilet facility [ 4 , 16 , 18 ].…”

“…As an illustration, in 2019 the U5MR in Ethiopia varied from 29 in Addis Abeba to 74 per 1000 live births in the Afar Region [ 15 ]. One of the most serious issues that need to be highlighted is under-five mortality in rural Ethiopia [ 16 ]. For the majority of middle- and lower-income nations, Millennium Development Goal (MDG) 4 which sought to reduce under-five mortality by two-thirds was still on the unfinished list [ 3 ].…”

Early Childhood Mortality and Associated Factors in Ethiopia: Mini Demographic and Health Survey 2019

“…Children had higher odds of childhood mortality among pit latrine-type toilet facilities as compared to ush-type toilet facilities. This nding was supported by a study in national study and Nigeria [24,25]. This could explain as a result of ush toilets being available in modern sanitation facilities, diarrhea prevalence has been reduced, reducing the infant death rate as well [26].…”