|Determinants of under-five mortality in Ethiopia using the recent 2019 Ethiopian demographic and health survey data: nested shared frailty survival analysis|
||Belete Achamyelew Ayele, Sofonyas Abebaw Tiruneh, Melkalem Mamuye Azanaw, Habtamu Shimels Hailemeskel, Yonas Akalu and Asnakew Achaw Ayele
||Archives of Public Health, Volume 80, issue137; DOI:https://doi.org/10.1186/s13690-022-00896-1
Children under five
Worldwide, there is remarkable progress in child survival in the past three decades. Ethiopia is off-track on sustainable development targets in under-five mortality since 2020. Therefore, this study aimed to investigate time to death and its associated factors among under-five children in Ethiopia.
Nationally representative demographic and health survey data were used for this study. A total of 5772 under-five children were included. Data were analyzed using R software. Semi-parametric nested shared frailty survival analysis was employed to identify factors affecting under-five mortality. Adjusted hazard ratio (AHR) with 95% Confidence interval (CI) was reported and log-likelihood was used for model comparison. Statistical significance was declared at P-value?0.05.
The weighted incidence of under-five death before celebrating the first fifth year was 5.76% (95% CI: 5.17 – 6.40). Female sex and under-five children living in urban areas were high probability of survival than their counterparts. After controlling cluster and region level frailty, multiple births (AHR?=?7.03, 95% CI: 4.40—11.24), breastfed within one hour after birth (AHR?=?0.41, 95% CI: 0.28—0.61), preceding birth interval 18–23 months (AHR?=?1.62, 95% CI: 1.12 -2.36), and under-five children younger than 18 months (AHR?=?2.73, 95% CI: 1.93 -3.86), and teenage pregnancy (AHR?=?1.70, 95% CI: 1.01—2.87) were statistically significant factors for time to under-five death.
Even though Ethiopia has a significant decline under-five death, still a significant number of under-five children were dying. Early initiation of breastfeeding, preceding birth interval and teenage pregnancy were the preventable factors of under-five mortality. To curve and achieve the SDG targets regarding under-five mortality in Ethiopia, policymakers and health planners should give prior attention to preventable factors for under-five mortality.