The Millennium Development Goal (MDG) 4 was targeted reduction of child mortality by two-thirds by 2015 and further the Sustainable Development Goals (SDGs) introduced in 2016 targeted to reduce under-5 mortality rate below 25 deaths of under-5 per 1,000 live births by 2030 [
More than 25 percent of all deaths among under-five children worldwide occur in Africa [
Reduction of child mortality is one of the prime objectives of the Ethiopian government. Ethiopia has made impressive progress in the reduction of child mortality in the past two decades [
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 [
Other determinants of child mortality may include place of residency [
According to WHO 2015 the global World health statistics 2015 estimates [
Despite the fact that a number of researches have been done on the identification of factors that are associated with under-five mortalities in Ethiopia, progress made on decreasing child mortality is still high and more effort is needed to remove barriers for under-five survivals. More researches therefore required to inform policy makers to implement appropriate health intervention programs to achieve the Sustainable Development Goals (SDGs) targeted to reduce under-5 mortality rate below 25 deaths of under-5 per 1,000 live births by 2030. To address this gap, we conducted an all-inclusive cross-sectional analysis from the recent 2016 Ethiopian Demographic Health Survey, to explore the major risk factors of under-five mortalities in Ethiopia, taking into consideration various demographic, socioeconomic, and environmental factors. Therefore, the main objective of this study is to assess the socioeconomic and demographic factors associated attributed to under-five child deaths in Ethiopia based on Ethiopian Demographic Health Survey, 2016 dataset.
This study analyzed the secondary data from the Ethiopian Demographic Health Survey (EDHS), 2016, accessed from the Measure Evaluation Demography, Health Survey 2016 Ethiopia [
Determinants of under-five mortalities in this study were selected from the available similar studies on the subject; the main predictors explored for under-five mortalities are presented in Table
Operational definition and categorization of explanatory (covariates) variables.
Variables/Covariates | Definition and categorization |
---|---|
Geographic region of residents (Region) | 1= Tigray, 2 Affar, 3= Amhara, 4= Oromiya, 5= Somali, 6= Benishangul-Gumuz, 7= SNNPR, 8 Gambela, 9= Harari, 10= Addis Ababa, 11= Dire Dawa |
Place of residence (Residence) | 1 = Rural, 2= Urban |
Mothers age at the time of first birth | 1 =11-17 years, 2= 18-24 years, 3= 25 years and higher |
Current age of mother | 1= 24 and less, 2=25-29, 3=30-34, 4=35-39, 5=40-44, 6= 45-49 years |
Mother education | 1= No education, 2= Primary, 3= Secondary, 4= Higher |
Husband or Partner education | 1= No education, 2= Primary, 3= Secondary, 4= Higher |
Religion of mother | 1= Coptic orthodox, 2= Protestant, 3= Muslim, 4= Others |
Household Wealth index | 1= Poorest, 2= Poorer, 3= Middle, 4= Richer, 5= Richest |
Sex of child | 1= Male, 2= Female |
Sex of household head | 1= Male, 2= Female |
Preceding birth interval | 1=1-18, 2=19-36, 3= greater than 36 |
Child birth order | 1=1, 2=2,3 or 4, 3=5 and more |
Birth type | 1= Single birth, 2= Multiple birth |
Mothers media access to contraceptive use | 0 =No, 1=Yes |
Women Marital status | 1= Single/ formerly married, 2= Currently married |
Mother occupation | 1= Not working, 2= Professional, 3= Agricultural, 4= Skilled/manual, 5=Others |
Husband occupation | 1= Not working, 2= Professional, 3= Agricultural, 4= Skilled/manual, 5=Others |
Sources of drinking water | 1= Piped water, 2 Tube-well, 3=Others |
Toile facility | 0= No facility/bush/field, 1= with facility |
Access to Electricity | 0=No, 1=Yes |
Sources of fuel for cooking | 1= Electricity, 2= gas/kerosene, 3= Others |
Household family size | 1=1-5, 2= greater than five |
Main floor material | 1= Natural floor/dung, 2= Wood/parquet, 3= Cement |
Main roof material | 1= Natural roofing, 2= Rudimentary, 3= Finished roofing |
Main wall material | 1= Natural roofing, 2= Rudimentary, 3= Finished |
Place of delivery | 0 = health center, 1 = home |
Birth weight | 1 = Smaller, 2 = Average, 3 = Larger |
Breastfeeding status | 0 = No, 1 = Yes |
Antenatal care visit ( Antenatal service received by the mother) | 0 = No, 1 = Yes |
Postnatal check up | 0 = No and 1 = Yes |
Contraceptive methods | 1 = No method, 2 = Traditional, 3 = Modern |
Under-five death | 0 = No and 1 = Yes |
Descriptive characteristics of the subjects were presented as frequencies and percentages to summarize the distribution of selected background characteristics of mother and children aged below 5 years. To estimate the effect of socioeconomic and demographic factors on under-five deaths (odds ratios with their 95% confidence intervals), logistic regression analysis was performed using R statistical package. Bivariate analysis based on Pearson chi square test was used for testing association between the predictors and outcome variable under-five mortalities. All significant predictor variables (p < 0.05) in the bivariate analysis were included in the multivariate logistic regression analysis. Multicollinearity between covariates was checked using the variance inflation factor (VIF) and VIF values greater than 10 indicates the existence of multicollinearity. The goodness of fit for the fitted models was checked using the likelihood ratio test (LRT).
Out of the 10274 under-five children included in the dataset, 52.01% were males and 47.99% were females. About three-fourths of the children were from rural areas (73.41%) while the remaining 26.59% of the children were living in urban areas. According to Table
Background characteristics and bivariate analysis of under-five mortality (N=10274), EDHS, 2016.
Covariates/Determinants | Number (N) | Number (%) | Ever experienced an Under five death | |||
---|---|---|---|---|---|---|
Yes n (% ) | No n(% ) | P-value | ||||
Region | Tigray | 1107 | 10.77 | 266 (24) | 841(76) | <0.0001 |
Affar | 835 | 8.13 | 289(34.6) | 546(65.4) | ||
Amhara | 1160 | 11.29 | 360(31) | 800(69) | ||
Oromiya | 1366 | 13.3 | 389(28.5) | 977(71.5) | ||
Somali | 1002 | 9.75 | 326(32.5) | 676(67.5) | ||
Benishangul-Gumuz | 804 | 7.83 | 243(30.2) | 561(69.8) | ||
SNNPR | 1225 | 11.92 | 382(31.2) | 843(68.8) | ||
Gambela | 756 | 7.36 | 191(25.3) | 565(74.7) | ||
Harari | 605 | 5.89 | 127(20) | 478(80) | ||
Addis Ababa | 760 | 7.4 | 63(8.3) | 697(91.7) | ||
Dire Dawa | 654 | 6.37 | 166(25.4) | 488(74.6) | ||
Residence | Rural | 7542 | 73.41 | 2379(31.5) | 5163(68.5) | <0.0001 |
Urban | 2732 | 26.59 | 423(15.5) | 2309(84.5) | ||
Maternal age at first birth | 11-17 | 4094 | 39.85 | 1373(33.5) | 272(66.5) | <0.0001 |
18-24 | 5286 | 51.45 | 1271(24) | 4015(76) | ||
25 and higher | 894 | 8.7 | 158(17.7) | 736(82.3) | ||
Maternal age | 24 and less | 1933 | 18.81 | 203(10.5) | 1730(89.5) | <0.0001 |
25-29 | 2300 | 22.39 | 423(18.4) | 1877(81.6) | ||
30-34 | 2056 | 20.01 | 539(26.2) | 1517(73.8) | ||
35-39 | 1805 | 17.57 | 645(35.7) | 1160(64.3) | ||
40-44 | 1239 | 12.06 | 521(42) | 718(58) | ||
45-49 | 941 | 9.16 | 471(50) | 470(50) | ||
Mother education | No education | 6190 | 60.25 | 2161(34.9) | 4029(65.1) | <0.0001 |
Primary | 2731 | 26.58 | 504(18.5) | 2227(81.5) | ||
Secondary | 873 | 8.5 | 114(13) | 759(87) | ||
Higher | 480 | 4.67 | 23(4.7) | 457(95.3) | ||
Partner education | No education | 5674 | 55.23 | 1823(32) | 3851(68) | <0.0001 |
Primary | 2774 | 27 | 729(26.3) | 2045(73.7) | ||
Secondary | 1019 | 9.92 | 141(13.8) | 878(86.2) | ||
Higher | 807 | 7.85 | 109(13.5) | 698(86.5) | ||
Religion | Coptic orthodox | 4383 | 42.66 | 871(22.7) | 2958(77.3) | <0.0001 |
Protestant | 1871 | 18.21 | 480(25.7) | 1391(74.) | ||
Muslim | 3829 | 37.27 | 1391(31.7) | 2992(68.3) | ||
Others | 191 | 1.86 | 60(31.4) | 131(68.6) | ||
Wealth index | Poorest | 4577 | 44.55 | 1516(14.6) | 361(85.4) | |
Middle | 1400 | 13.63 | 417(30) | 983(70) | <0.0001 | |
Rich | 4297 | 41.83 | 1324(12.9) | 348(87.1) | ||
Sex of child | Male | 5344 | 52.01 | 1437(27) | 3907(73) | 0.188 |
Female | 4930 | 47.99 | 1365(27.7) | 3565(72.3) | ||
Sex of household head | Male | 7438 | 72.4 | 2086(28) | 5352(72) | 0.002 |
Female | 2836 | 27.6 | 716(25) | 2120(75) | ||
Preceding birth interval | 1-18 | 850 | 8.27 | 380(44.7) | 470(55.3) | <0.0001 |
19-36 | 5574 | 54.25 | 1361(24.4) | 4213(75.6) | ||
greater than 36 | 3850 | 37.47 | 1061(27.6) | 2789(72.4) | ||
Media access | No | 7211 | 70.19 | 2115(29.3) | 5096(70.7) | <0.0001 |
Yes | 3063 | 29.81 | 687(22.4) | 2376(77.6) | ||
Marital status | Single formerly married | 1435 | 13.97 | 356(3.4) | 113(96.6) | <0.0001 |
Currently married | 8839 | 86.03 | 2449(27.7) | 6390(72.3) | ||
Mother occupation | not working | 5255 | 51.15 | 1427(27.2) | 3828(72.8) | <0.0001 |
Professional | 1870 | 18.2 | 417(22.2) | 1453(77.8) | ||
Agricultural | 2348 | 22.85 | 759(32.3) | 1589(67.7) | ||
skilled/manual | 801 | 7.8 | 199(24.8) | 602(75.2) | ||
Husband occupation | not working | 931 | 9.06 | 263(28.2) | 668(71.8) | <0.0001 |
Agricultural | 4542 | 44.21 | 1502(33) | 3040(67) | ||
Professional | 1405 | 13.68 | 254(18) | 1151(82) | ||
skilled/unskilled manual | 1073 | 10.44 | 215(20) | 858(80) | ||
Others | 2323 | 22.61 | 568(24.5) | 1755(75.5) | ||
Birth order | 1 | 1974 | 19.21 | 94(4.8) | 1880(95.2) | <0.0001 |
2, 3 or 4 | 4387 | 42.7 | 792(18) | 3595(8) | ||
5 and more | 3913 | 38.09 | 1916(49) | 1997(51) | ||
Birth type | Single birth | 10114 | 98.44 | 2716(26.9) | 7398(73.1) | <0.0001 |
Multiple birth | 160 | 1.56 | 86(53.8) | 74(46.2) | ||
Sources of water | piped water | 3768 | 36.68 | 760(20) | 3008(80) | <0.0001 |
tube-well | 2740 | 26.67 | 871(31.7) | 1869(68.2) | ||
Others | 3766 | 36.66 | 1171(31) | 2595(69) | ||
Toile facility | No facility/bush/field | 4007 | 39 | 1258(31.4) | 279(68.6) | <0.0001 |
with facility | 6267 | 61 | 1544(24.6) | 4723(75.4) | ||
Electricity | No | 7086 | 68.97 | 2253(31.8) | 4833(68.2) | <0.0001 |
Ye | 3188 | 31.03 | 549(17.2) | 2639(82.8) | ||
Fuel source | Electricity | 759 | 7.39 | 83(10.9) | 676(89.1) | <0.0001 |
gas/kerosene | 108 | 1.05 | 20(18.5) | 88(81.5) | ||
Others | 9407 | 91.56 | 2699(28.7) | 6708(71.3) | ||
Family size | At most 4 | 3767 | 36.67 | 822(21.8) | 2945(78.2) | <0.0001 |
5-7 | 4648 | 45.24 | 1408(30.3) | 3240(69.7) | ||
8+ | 1859 | 18.09 | 572(30.8) | 1287(69.2) | ||
Floor material | natural floor/dung | 7760 | 75.53 | 2406(31) | 5354(69) | <0.0001 |
wood/parquet | 979 | 9.53 | 151(15.4) | 828(84.6) | ||
Cement | 1535 | 14.94 | 245(16) | 1290(84) | ||
Roof material | natural roofing | 3426 | 33.35 | 1065(31) | 2361(69) | <0.0001 |
Rudimentary | 1074 | 10.45 | 364(33.9) | 710(76.1) | ||
finished roofing | 5774 | 56.2 | 1373(23.8) | 4401(76.2) | ||
Wall material | natural wall | 141 | 1.37 | 487(33) | 984(67) | |
Rudimentary | 7654 | 74.5 | 2124(27.8) | 5530(72.2) | <0.0001 | |
finished wall | 1149 | 11.18 | 191(16.6) | 958(83.4) | ||
Place of delivery | Home | 8984 | 87.4 | 2484 (27.6) | 6500 (72.4) | 0.013 |
Heath facility | 1290 | 12.6 | 318 (24.7) | 972 (74.3) | ||
Size of child at birth | Smaller | 1714 | 28.6 | 112 (6.5) | 1602 (93.5) | <0.0001 |
Average | 2333 | 38.9 | 86 (3.7) | 2247 (96.3) | ||
Larger | 1945 | 32.5 | 61 (3.1) | 1884 (96.9) | ||
Antenatal care visit | No | 3521 | 58.7 | 154 (4.8) | 3367 (95.2) | 0.434 |
Yes | 2471 | 41.3 | 105 (4.3) | 2366 (95.7) | ||
Postnatal check up | No | 3236 | 54 | 152 (4.7) | 3074 (95.3) | 0.066 |
Yes | 2714 | 46 | 104 (3.8) | 2610 (96.2) | ||
Breastfeeding status | No | 3229 | 31.4 | 284 (8.9) | 2945 (91.1) | <0.0001 |
Yes | 7039 | 68.6 | 227 (3.2) | 6812 (96.8) |
The majority of the respondents had not attained education (60.25%), about one-fourth of respondents had primary education, 8.5% had secondary education, and only 4.67% of respondents had attained higher education. Similarly, more than half (55.23%) of their partners had no formal education at all, 27% had primary education, and only 17.77% of husbands had secondary and higher education. About 40% were given their first birth before age of 17 years old, nearly half (51.45%) of the respondent had age of first birth between 18 and 24, and only 8.7% of respondents were observed to give first birth at age of at least 25 years old. As the current age of mothers is concerned, the highest percentage was observed in the age group 24-29 and the minimum percentage and only 9% was among mothers in older age groups (45-49).
As high as 86.03% were observed to be currently married, while 32.97% were never married/former married women. In regard to religious affiliation, 42.66% belong to Coptic Orthodox, 18.21% belong to Protestants, and 37.27% and 1.86% were Muslims and other religions followers, respectively. Concerning occupation, about half (51.15%) of respondents were not working, 22.85% were engaged in the agricultural sector, 18.2% were professional employed, and only 7.8% were engaged in manual or skilled work. The percentage of distribution also varies by partner’s education level. The majority of partners (44.21%) were working in the farming sector, and only 9% had no work at all.
Results show that about 19.21% of the children were first children, 42.7% were second, third, or fourth child, and 38% were children with birth order at least a fifth. According to the household wealth index, 44.55% were poor, 13.63% were within the middle class, and 41.834% were within the rich economic level. In terms of access to the media about contraceptive use, 70% of respondents reported having no media access. 36.68% of the children belonged to a household with piped water and 26.67% belonged to the household with a tube well source of drinking water while 39 of them belonged to households without toilet facilities or bush or fields.
The proportions of children belonging to the male household head are 72.4%. The majority of the children belonged to single birth type 98% and only 2% were having multiple births. Only 8.270% of them belonged to 1-18 months of preceding birth interval, about 54% of the children belonged to preceding birth interval of 19-36 months and 37.47% of them had at least three years (more than 36 months) preceding birth interval. Majority 68.97% of the children belonged to women with no electricity access while 91.56% of them belonged to a household who uses wood or animal dung or charcoal and agricultural crop as cooking fuel. 45% of the children were from women with 5-7 family sizes. About 75% of the children belonged to women who using a natural floor/dung for floor material. 56% of the children belonged to women who were using finished main roofing material, while 75% of them belonged to household’s rudimentary walling materials.
The percentage of under-five mortalities is higher among home deliveries, which is about 27%. A child born with small birth weight has the highest chance of dying at an age less than five years. Concerning healthcare service utilization children whose mother had not attended antenatal care during pregnancy and no baby postnatal care have encountered the highest percentage of under-five mortalities. Similarly, children who were not currently breastfed had a relatively higher under five mortality percentages (8.9%) (Table
The trends of under-five mortalities are displayed in Figure
Table
Also, high percentages of under-five deaths were reported among households with poor economic level, unlike minimum percent reported by rich households (P value < 0.001). Marital status was also highly associated with under-five deaths in bivariate analysis with mothers who were not currently married/formerly married at the time of the survey reported higher percent (32.9%) of the deaths of their children than mothers who were currently married (P value < 0.0001). Regarding the correlation between mother’s occupation and under-five deaths, the result shows those mothers who were engaged in agricultural occupation reported a higher percentage of deaths of their children (32.3%); similarly looking at husband occupation high under-five mortalities are related to partner working in the agricultural sector (P value < 0.0001).
Also, preceding birth interval, child birth order, media exposure to contraceptive use, birth type, sources of drinking water, access to toilet facilities, and family size household were all significant in the bivariate analysis (P value < 0.001). Those children with short birth intervals, whose mothers’ have no access to media, fifth and higher birth order, large family size, and multiple births, whose family has no access to toilet had a higher chance of experiencing under-five deaths. As access to electricity and types of cooking materials used were concerned, the respondents without access to electricity and used wood or animal dung as cooking material had experienced the highest proportion of under-five deaths.
Binary logistic regression analysis was used to examine the effect of each covariate on the under five deaths. All covariates which were found to be significant in the bivariate analysis at 5% were included in the multiple logistic regression models. The result is presented in Table
We start first by checking the overall goodness of fit using the likelihood ratio tests (LRT) goodness of fit test. We then proceed to test the significance of each covariate included in the model. Accordingly, the result summarized in Table
Overall model goodness of fit checking using likelihood ratio test.
-2 Log likelihood | Likelihood Ratio Test | Df | P-value | |
---|---|---|---|---|
Null model | 12050.755 | 1872.922 | 59 | < 0.001 |
Full model | 10177.833 |
Determinants of under-five mortality (EDHS, 2016).
Covariates/Determinants | Ever experienced an Under five death (n=10274) | ||
---|---|---|---|
Odds ration | 95% Confidence Interval | P-value (P>z) | |
Region(Addis Ababa) | |||
Tigray | 1.332 | .917, 1.935 | .132 |
Affar | 2.048 | 1.371, 3.058 | <.0001 |
Amhara | 1.864 | 1.281, 2.712 | .001 |
Oromiya | 1.447 | 1.002, 2.091 | .049 |
Somali | 1.412 | .958, 2.080 | .081 |
Benishangul-Gumuz | 1.407 | .952, 2.079 | .087 |
SNNPR | 1.916 | 1.305, 2.815 | .001 |
Gambela | 2.067 | 1.380, 3.095 | <.0001 |
Harari | 1.388 | .942, 2.047 | .098 |
Dire Dawa | 1.971 | 1.338, 2.904 | .001 |
Residence (Rural) | |||
Urban | .989 | .788, 1.240 | .920 |
Sex of household head( Female) | |||
Male | 1.100 | .958, 1.264 | .177 |
Wealth index(Richest) | .402 | ||
Poorest | 1.183 | .871, 1.606 | .282 |
Poorer | 1.290 | .971, 1.714 | .079 |
Middle | 1.160 | .886, 1.520 | .280 |
Richer | 1.208 | .939, 1.554 | .141 |
Mother education (Higher) | <.0001 | ||
No education | 2.610 | 1.598, 4.265 | <.0001 |
Primary | 2.271 | 1.398, 3.687 | .001 |
Secondary | 2.763 | 1.684, 4.534 | <.0001 |
Sex of child (Female) | |||
Male | .956 | .867, 1.054 | .365 |
Maternal age at first birth(25 and higher) | <.0001 | ||
11-17 | 1.556 | 1.243, 1.949 | <.0001 |
18-24 | 1.200 | .967, 1.489 | .098 |
Maternal age(45-49) | <.0001 | ||
24 and less | .295 | .227, .383 | <.0001 |
25-29 | .350 | .285, .429 | <.0001 |
30-34 | .405 | .337, .487 | <.0001 |
35-39 | .554 | .464, .661 | <.0001 |
40-44 | .690 | .573, .831 | <.0001 |
Husband occupation (Others) | .001 | ||
not working | .679 | .533, .864 | .002 |
Agricultural | .951 | .780, 1.159 | .618 |
Professional | .783 | .618, .991 | .042 |
skilled/unskilled manual | .955 | .747, 1.220 | .711 |
Mother occupation( skilled/manual) | .008 | ||
not working | .816 | .666, .999 | .049 |
Professional | 1.012 | .808, 1.267 | .917 |
Agricultural | .960 | .776, 1.187 | .705 |
Birth order(5 and more) | <.0001 | ||
1 | .110 | .084, .145 | <.0001 |
2, 3 or 4 | .382 | .335, .436 | <.0001 |
Preceding birth interval ( greater than 36) | <.0001 | ||
1-18 | 2.164 | 1.821, 2.570 | <.0001 |
19-36 | 1.320 | 1.181, 1.474 | <.0001 |
Fuel (Others) | .358 | ||
Electricity | 1.031 | .757, 1.404 | .848 |
gas/kerosene | 1.516 | .858, 2.678 | .152 |
Birth type (Multiple birth) | |||
Single birth | .355 | .250, .505 | <.0001 |
Religion (Others) | <.0001 | ||
Coptic orthodox | .809 | .557, 1.173 | .263 |
Protestant | .713 | .495, 1.026 | .069 |
Muslim | 1.040 | .721, 1.499 | .833 |
Place of delivery (Home) | |||
Health center | 0.494 | 0.293, 0832 | 0.008 |
Breastfeeding status (Yes) | |||
No | 2.894 | 2.418, 3.464 | <0.0001 |
Size of child at birth (larger) | |||
Smaller | 1.907 | 1.325, 2.747 | 0.001 |
Average | 1.082 | 0.751, 1.559 | 0.672 |
Sources of water | -.2296426 | -.4244 -.0349 | 0.021 |
Wealth index | -.1654054 | -.262 -.069 | 0.001 |
Wealth index | -.076356 | -.150 -.0024 | 0.043 |
Mother education | 0.199 | 0.103, 0.29 | <0.0001 |
Preceding birth interval | -0.123 | -.177 -.069 | <0.0001 |
Preceding birth interval | .7549096 | .545 .965 | <0.0001 |
Reference categories are in parenthesis.
Table
The probability of under-five deaths was 2.048 times (OR=1.24, 95% CI: 1.371, 3.058) more likely to occur among children whose mother is from Affar region (OR=1.24, 95% CI: 1.371, 3.058), about 87% more likely to occur among children whose mother is from Amhara region (OR=1.867, 95% CI: 1.281, 2.712), 40% more likely to occur among children whose mother is from Oromiya region (OR=1.477, 95% CI: 1.002, 2.091), 91.6% more likely to occur among children whose mother is from SNNP region (OR=1.916, 95% CI: 1.305, 2.815), 2.067 times more likely to occur among children whose mother is from Gambela region (OR=2.067, 95% CI: 1.380, 3.095), and 97% more likely to occur among children whose mother is from Dire Dawa city (OR=1.971, 95% CI: 1.338, 2.904) compared with those whose mothers reside in Addis Ababa. Level of education had a statistically significant effect on the experience of under-five deaths. Children born to a mother with no education at all were associated with a 2.61% time increased risk of under-five deaths compared to being born to mother with higher education (OR=2.610, 95% CI: 1.598, 4.265); children from mother with only primary education were 2.27 times more likely to at the risk of under-five mortality (OR=2.271, 95% CI: 1.398, 3.687), while children born to mother with secondary education were 2.163 times more likely to die before celebrating their fifth birthday (OR=2.163, 95% CI: 1.184, 3.534) compared to being born to mother with higher education, keeping all other covariates constant.
Results in Table
Employment status of mothers and husband were identified as significantly associated factors with under-five deaths (P value < 0.05). The odds of under-five mortalities was 18.4% (OR=0.816, 95% CI: .666, .999) lower among women who were to working at all compared to those who were skilled or manual worker. The probability of child mortality, under-five, was 32% (OR=0.679, 95% CI:.533, .864) and less likely to occur among women with an unemployed husband and 22% (OR=.783, 95% CI: .618, .991) less likely to occur among women whose husbands were professionally employed compared with those who were working as sales and others. Further Table
Place of delivery was found significantly associated with under-five mortalities; the odds of under-five deaths were about 50% times lower among children born at health center than the home deliveries (OR = 0.494; 95% CI: (0.293, 0832)). The study also reveals that availability of size of a child at birth had a negative impact of on under-five deaths. The odds of under-five mortalities were 90% times higher among babies born with small size than those with larger size (OR = 1.907; 95% CI: (1.325, 2.747)).
The significance of interaction terms was considered to examine the degree of association among the independent variables. As interaction effects are concerned the interaction between place of residence and source of drinking water, wealth index and toilet facility, wealth index and mother education, mother education and mother age, preceding birth interval and child birth order, and preceding birth interval and birth type were significantly associated with under-five mortalities. The coefficients associated with the interaction terms of the rest predictor variables were statistically insignificant (results not presented).
This study utilized the Ethiopian Demographic and Health Survey 2016 dataset, exploring the effect of underlying socioeconomic, demographic, and cultural factors on under-five mortalities in Ethiopia. From multivariate logistic regression analysis, it was found in this study that the risk of under-five mortalities has significant associations with the region area of residence, educational level of the mother, current age of mother, mother’s age at first birth, occupation of mother, partner’s occupation, birth order, preceding birth interval, and birth type. It was found in this study that the risk of under-five mortalities was higher in Affar, Amhara, Oromiya, Somali, South Nations, Nationalities Peoples region, Gambela regions, and Dire Dawa than of residents in Addis Ababa. This study explicitly shows the existence of inconsistency in the distribution of under-five mortalities among the regions of Ethiopia [
The findings of the study show that being born to a mother with education, schooling was associated with decreased risk of under-five deaths compared to being born to mothers with no education. Thus, educational level of mothers is an important and significant factor of under-five mortality risks in Ethiopia. Several studies in the literature reported a negative relationship between child death and mothers’ education level [
Maternal age at first birth and current age of mothers were identified as a strong predictor of under-five mortalities in both bivariate and multivariate analysis after controlling for the effects of other covariates. Results also show that children born from mothers whose age at first birth is below 17 years have a significantly higher risk of mortality compared to those born from mothers whose age at first birth is 25 and higher. This finding was consistent with the result of [
Other significant determinants of under-five deaths are birth order, birth interval, and birth type. The results from this study showed that children who were birth order 5 or above are at risk of dying. Previous literature also revealed that the high birth order had a favorable child death than first birth [
Place of delivery and size of baby at birth were found to have significant association with under-five mortalities, such that children born at home had an increased risk of death compared to those born at health facilities. On the other hand babies born with small size were more likely to experience under-five deaths. This finding consistent with prior studies by [
Finally, a woman who had didn’t work and whose husband has no work at all was found to have a higher risk of experiencing child mortality. This finding is consistent with [
The study has examined the factors that are associated with the risk of under-five mortalities in Ethiopia based on Ethiopian DHS 2016 dataset using logistic regression analysis. This result supports that under-five mortality is still an important public health issue in Ethiopia.
According to the results of multivariate logistic regression model, it was found that living in Affar, Amhara, Oromia, SNNP, Gambela, and Dire Dawa regions, child being born from illiterate mothers, mother with primary or secondary education, mother’s age less than 17 at time of first birth, mothers having older age above 40 years of age, and having short birth interval, high birth order, multiple births, and having mothers with no work were significant determinants that increase the risk of under-five mortalities in Ethiopia. However, some socioeconomic and demographic factors of the mother and household such as wealth index, religion, sources of drinking water, sanitation services, and current marital status of mother were found to be insignificant factors of child mortality in this study.
In recent decades, Ethiopia has achieved significant declines in under-five and infant mortality rates. However, under-five mortality rates have stayed higher in some regions. Therefore, interventions that focus on birth spacing, mothers living in Affar and Gambela, and uneducated mothers are required for improving child survival in Ethiopia. Further research is required to enable an understanding of the distribution of under-five mortalities across all the different regions in Ethiopia.
The author recommended further investigation had to be conducted including variables not include in this study and to use spatial models to account spatial variation of experiencing under-five mortality since regional variations are significant.
This study uses a nationally representative survey dataset, which enhances inferences for the entire country level. The major strength was that interaction effects were examined in the study. However, this study is based on secondary data the major limitation was that some important determinant factors of under-five mortalities like mode of delivery and mothers’ HIV status were missed due to high missing values in the data. The other weakness of study was mother’s recall of events that took place for the past five years preceding the survey which is subject to recall bias.
Central Statistics Agency
Demographic and Health Survey
Ethiopia Demographic and Health Survey
Likelihood Ratio Test
United States Agency for International Development
Variance Inflation Factor
World Health Organization.
The data used to support the findings of this study are available from the corresponding author upon request.
The author’s full address is Department of Statistics, College of Natural and Computational. The author declares that the research is their original work, and all sources of materials used have been duly acknowledged.
The author declares that they have no conflicts of interest.
Berhanu Teshome Woldeamanuel planned and prepared the overall manuscript and analyzed, interpreted, and finalized the article.
The authors are grateful to ICF macro (Calverton, USA) for providing the 2016 DHS data of Ethiopia.