Under five mortality patterns and associated maternal risk factors in sub-Saharan Africa: A multi-country analysis

Abstract

BackgroundUnder-5 mortality rate in the sub-Saharan region has remained unabated. Worse still, information on the regional trend and associated determinants are not readily available. Knowledge of the trend and determinants of under-5 mortality are essential for effective design of intervention programmes that will enhance their survival. We aimed to examine the mortality patterns in under-5 children and maternal factors associated with under-5 deaths.MethodsDemographic and Health Survey (DHS) data from five sub-Sahara Africa countries; Chad, Democratic Republic of Congo, Mali, Niger and Zimbabwe were used in this study. The sample size consisted of 68,085 women aged 15–49 years with at least one history of childbirth. The outcome variable was under-five mortality rate. Relevant information on maternal factors were extracted for analysis. Multivariable Cox proportional hazards regression was used to model maternal factors associated with under-five mortality.ResultsThe current under-5 mortality rate (per 1,000 live births) was; 133 in Republic of Chad, 104 in Democratic Republic of Congo, 95 in Mali, 127 in Niger, and 69 in Zimbabwe. Several maternal and child level factors were found to be significantly associated with under-five mortality. Lack of spousal support (not currently married) resulted to increase in under-five mortality (Chad- Hazard Ratio [HR] = 1.11, 95%CI = 0.97–1.25; DR Congo- HR = 1.24, 95%CI = 1.11–1.40; Mali- HR = 2.43, 95%CI = 1.63–3.64; Niger- HR = 1.59, 95%CI = 1.24–2.03; Zimbabwe- HR = 1.33, 95%CI = 1.06–1.67). Delivery by caesarean section was significantly associated with under-five mortality (Chad- HR = 1.32, 95%CI = 1.00–1.77; DR Congo- HR = 1.20, 95%CI = 1.01–1.43; Mali- HR = 1.42, 95%CI = 1.08–1.85; Niger- HR = 1.43, 95%CI = 1.06–1.92; Zimbabwe- HR = 1.49, 95%CI = 1.03–2.15).ConclusionDespite concerted effort by government and several stakeholders in health to improve childhood survival, the rate of under-5 mortality is still high. Our findings provided evidence on the contribution of maternal age, place of residence, household wealth index, level of education, employment, marital status, religious background, birth type, birth order and interval, sex and size of child, place and mode of delivery, to Under-5 mortality rate in SSA. The position of prominent risk factors for under-five mortality should be addressed through effective design of timely and efficient intervention aimed at reducing childhood mortality.

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

“…Average child size at birth ((0.68), (0.51, 0.90) prevent under-ve daughters mortality than very large daughters at birth. This agreed with a study derived from the 2016 EDHS data (5,30,34).Unplanned birth ((1.70), (1.03, 2.81) increase the likelihood of sons death than planned births. This contradict with a study that reported a preventive association (26).…”

How to close the maternal and neonatal sepsis gap in sub-Saharan Africa

“…2 Sepsis-related deaths in SSA reflect underlying political, poverty, health inequity and health system challenges across Africa. 5 These challenges affect preventative and public health efforts to prevent sepsis and limit prompt and effective recognition and treatment of sepsis to prevent mortality. The challenges include access to clean water and sanitation, vaccination and provision of primary care in addition to access to antimicrobial agents and strategies for their stewardship.…”

Socioeconomic, Demographic, and Environmental Determinants of Under-5 Mortality in Ethiopia: Evidence from Ethiopian Demographic and Health Survey, 2016

“…The determinants of child and under-5 mortalities are highly correlated with socioeconomic, demographic, and behavioral factors of households, health seeking behavior of mothers, and environmental factors. Several studies have investigated that maternal age and education be found to be strongly correlated with child morality [9,[13][14][15][16][17][18][19]. Level of education is inversely associated with child mortality children of educated mothers having better survival than children of noneducated mothers [20][21][22][23][24].…”

“…Other determinants of child mortality may include place of residency [14,19,[25][26][27], family size and parity [9,[21][22][23], birth order, birth intervals [19,24], water source [21,26], and toilet facility [16,21]. Bearing many children increases the risk of maternal mortality and the death of the newborns as well [9,11].…”

“…Children of women who did not receive healthcare during pregnancy and postnatal care had a higher risk of under five deaths as compared to those of mothers who did receive the treatment. Most studies also found that sex of the household head, sex of the child [19,24,27], and household economic status (wealth index) were found to be significant [14,19,22,25], where male children are at higher risk of under-five mortalities.…”