Under-five mortality in Sierra Leone and possible associated factors: evidence from the 2019 Demographic and Health Survey

Abstract

High under-five mortality rate remains one of the public health challenges, especially in sub-Saharans Africa, accounting for more than half of all global cases. Sierra Leone was and still one of the countries with the highest under-five mortality rate. Using the latest 2019 SLDHS data, we investigated factors associated with under-five mortality in Sierra Leone. A total of 9771 mothers aged 15-49 years in the country were interviewed and included in the analysis. The dependent variable is child status (dead=1; alive=0). A total of 871 (9%) children died before their fifth birthday. Maternal age of 20-24 years (AOR=0.46; CI=0.33-0.64; P<0.001) up to 40-44 years (AOR=0.43; CI=0.27-0.7; P=0.001), currently breastfeeding (AOR=0.20; CI=0.17-0.24; P<0.001), maternal media exposure and usage of reading newspapers/magazines less than once a week (AOR=0.48; CI=0.28-0.85; P=0.011) were more likely to enhance child survivability through their fifth birthday. Also, the child sex being female (AOR=0.68; CI=0.59-0.79) was more likely to survive under-five mortality compared to their male counterpart. On the other hand, mothers who listened to radio at least once a week (AOR=1.31; CI=1.08-1.59; P=0.007) watched television less than once a week (AOR=1.48; CI=1.16-1.90), had two (AOR=3.4, CI=2.78-4.16; P<0.001) or three and above birth (AOR=8.11; CI=6.07-10.83; P<0.001) in five years, had multiple birth children (AOR=1.41; CI=1.08-1.86) and very small-sized child at birth (AOR= 1.95; CI=1.41-2.70) were more likely to lose their children below the age of five years. The factors contributing to under-five mortality in Sierra Leone are critical to ensuring child survival and improving maternal health. Breastfeeding, maternal age, media exposure, child’s sex, multiple birth type, very small-sized child and the total number of births in five years were significant drivers of under-five mortality. The result affirms the need for attention to be focused on enhancing the survival rate of under-five children in Sierra Leone.

Factors associated with under-five mortality in Rwanda: An analysis of the Rwanda Demographic and Health Survey 2020

“…Children born as multiples had a notably higher probability of not surviving past their fifth birthday than those born singletons. This finding is consistent with earlier studies in Sierra Leone and Ethiopia [ 26 , 45 , 49 ]. Our study exhibited a stronger association (AOR = 1.41) between multiple births and under-five mortality compared to Sierra Leone (AOR = 1.41) [ 26 , 45 ].…”

“…This finding is consistent with earlier studies in Sierra Leone and Ethiopia [ 26 , 45 , 49 ]. Our study exhibited a stronger association (AOR = 1.41) between multiple births and under-five mortality compared to Sierra Leone (AOR = 1.41) [ 26 , 45 ]. However, this association was observed to be weaker in Ethiopia (AOR = 4.755) [ 26 , 45 ].…”

“…The analysis of child factors, specifically sex and birth type, were significant determinants of under-five mortality in Rwanda. These findings are similar to earlier studies conducted in Sierra Leone and Ethiopia using similar DHS [ 26 , 45 ]. In particular, females exhibited a lower likelihood of under-five mortality compared to males, consistent with studies in Sierra Leone, Ethiopia, and Indonesia [ 26 , 44 , 46 ] and highlighting gender differentials in child health outcomes.…”

“…These findings are similar to earlier studies conducted in Sierra Leone and Ethiopia using similar DHS [ 26 , 45 ]. In particular, females exhibited a lower likelihood of under-five mortality compared to males, consistent with studies in Sierra Leone, Ethiopia, and Indonesia [ 26 , 44 , 46 ] and highlighting gender differentials in child health outcomes. The lower risk of female under-five mortality (AOR = 0.87) in our study was almost similar to that in Ethiopia (AOR = 0.84) [ 26 , 45 ] but was higher than that of Sierra Leone (AOR = 0.68) [ 26 , 45 ].…”

Application of machine learning methods for predicting under-five mortality: analysis of Nigerian demographic health survey 2018 dataset

“…The results showed that the top ten important predictors are: wealth index, maternal education, antenatal visits, place of delivery, employment status of the woman, number of children ever born, region, skilled assistance during delivery, frequency of watching television, and birth size. These findings are consistent with the findings of previous studies, which have shown that these factors are all important predictors of U5M [ 43 – 45 ]. The variable importance results support the findings of the conventional logistic regression analysis in this study, which found that wealth index, maternal education, antenatal visits, place of delivery, employment status of the woman, children ever born, region, skilled assistance during delivery, frequency of watching television, and birth size all have a significant impact on U5M in Nigeria.…”