Trends, causes, and risk factors of mortality among children under 5 in Ethiopia, 1990–2013: findings from the Global Burden of Disease Study 2013

Abstract

BackgroundEthiopia has made remarkable progress in reducing child mortality over the last two decades. However, the under-5 mortality rate in Ethiopia is still higher than the under-5 mortality rates of several low- and middle-income countries (LMIC). On the other hand, the patterns and causes of child mortality have not been well investigated in Ethiopia. The objective of this study was to investigate the mortality trend, causes of death, and risk factors among children under 5 in Ethiopia during 1990–2013.MethodsWe used Global Burden of Disease (GBD) 2013 data. Spatiotemporal Gaussian Process Regression (GPR) was applied to generate best estimates of child mortality with 95% uncertainty intervals (UI). Causes of death by age groups, sex, and year were measured using Cause of Death Ensemble modeling (CODEm). For estimation of HIV/AIDS mortality rate, the modified UNAIDS EPP-SPECTRUM suite model was used.ResultsBetween 1990 and 2013 the under-5 mortality rate declined from 203.9 deaths/1000 live births to 74.4 deaths/1000 live births with an annual rate of change of 4.6%, yielding a total reduction of 64%. Similarly, child (1–4 years), post-neonatal, and neonatal mortality rates declined by 75%, 64%, and 52%, respectively, between 1990 and 2013. Lower respiratory tract infection (LRI), diarrheal diseases, and neonatal syndromes (preterm birth complications, neonatal encephalopathy, neonatal sepsis, and other neonatal disorders) accounted for 54% of the total under-5 deaths in 2013. Under-5 mortality rates due to measles, diarrhea, malaria, protein-energy malnutrition, and iron-deficiency anemia declined by more than two-thirds between 1990 and 2013. Among the causes of under-5 deaths, neonatal syndromes such as sepsis, preterm birth complications, and birth asphyxia ranked third to fifth in 2013.Of all risk-attributable deaths in 1990, 25% of the total under-5 deaths (112,288/435,962) and 48% (112,288/232,199) of the deaths due to diarrhea, LRI, and other common infections were attributable to childhood wasting. Similarly, 19% (43,759/229,333) of the total under-5 deaths and 45% (43,759/97,963) of the deaths due to diarrhea and LRI were attributable to wasting in 2013. Of the total diarrheal disease- and LRI-related deaths (n = 97,963) in 2013, 59% (57,923/97,963) of them were attributable to unsafe water supply, unsafe sanitation, household air pollution, and no handwashing with soap.ConclusionsLRI, diarrheal diseases, and neonatal syndromes remain the major causes of under-5 deaths in Ethiopia. These findings call for better-integrated newborn and child survival interventions focusing on the main risk factors.

Childhood Mortality: Trends and Determinants in Ethiopia from 1990 to 2015—A Systematic Review

“…A community based study done using verbal autopsy method in Gondar revealed that malnutrition is one of the causes of childhood mortality [33]. Childhood wasting, underweight, and stunting were also the main risk factors for under-5 mortality, but all improved dramatically during the MDG era [34] (Figure 7). …”

“…According to findings from the Global Burden of Disease Study in 2013, Child deaths due to diarrheal diseases that were attributable to unsafe water supply and sanitation declined by more than 60% between 1990 and 2013 [34]. The source of drinking water is another determinant that was consistently associated with child survival.…”

Health Extension Workers’ diagnostic accuracy for common childhood illnesses in four regions of Ethiopia: a cross‐sectional study

“…Despite this improvement, the under‐five mortality in Ethiopia remains high. The significant causes of death in Ethiopia are, according to national‐level statistics, lower respiratory tract infections, diarrhoeal diseases and neonatal conditions, such as preterm birth, birth complications, asphyxia and neonatal sepsis . Malnutrition is a major contributing cause to the under‐five deaths .…”

High prevalence of under-five child mortality in the pastoralist communities of Ethiopia: Evidence from the 2016 Ethiopian demographic and health survey data

“…Worldwide, nearly 15,000 children die daily from preventable and treatable diseases such as diarrhea, malaria and fever (1). However, the world has made substantial progress in reducing child mortality over the last four decades (2)(3)(4). Despite such global progress in reducing child mortality over the past decades, an estimated 5.4 million children under the age of ve years were died in 2017, and half of those deaths occurred in sub-Saharan Africa (5).…”