Title: Under-Five Mortality and Associated Risk Factors in Rural Settings of Ethiopia: Evidences from 2016 Ethiopian Demographic and Health Survey
Abstract: Background . Evidence shows that in Ethiopia, a gradual decrease of under-five mortality is observed, but it is still high in the rural settings of the country. We are motivated to investigate the socioeconomic, demographic, maternal and paternal, and child-related associated risk factors of under-five mortality given birth from rural resident mothers. Methods . Demographic and Health Survey data from Ethiopia (2016) were used for analysis. The chi-square test of association and logistic regression were used to determine the associated risk factors of under-five children mortality. Study Settings . Rural Ethiopia. Results . Secondary school and above completed fathers (AOR = 0.77; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 0.63–0.94) and primary school completed mothers (AOR = 0.82; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 0.72–0.93); multiple twin child (AOR = 4.50; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 3.38–5.98); public sector delivery (AOR = 0.65; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 0.55–0.76); had working of mother (AOR = 1.28; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 1.16–1.42) and of father (AOR = 1.45; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 1.25–1.69); mothers aged above 16 at first birth (AOR = 0.41; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M7"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 0.37–0.45); breastfeeding (AOR = 0.60; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M8"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 0.55–0.66); birth order of 2-3 (AOR = 1.18; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M9"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 1.02–1.37); religious belief of Muslim (AOR = 1.20; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M10"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 1.02–1.41); users of contraceptive method (AOR = 0.80; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M11"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 0.71–0.90); vaccinated child (AOR = 0.52; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M12"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 0.46–0.60); family size of 4–6 (AOR = 0.74; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M13"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 0.63–0.86) and of seven and above (AOR = 0.44; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M14"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 0.36–0.52); mother’s age group: aged 20–29 (AOR = 3.88; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M15"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 3.08–4.90), aged 30–39 (AOR = 16.29; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M16"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 12.66–20.96), and aged 40 and above (AOR = 55.97; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M17"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 42.27–74.13); number of antenatal visits: 1–3 visits (AOR = 0.50; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M18"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 0.43–0.58), and four and above visits (AOR = 0.46; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M19"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 0.39–0.54); and preceding birth interval of 25–36 months (AOR = 0.55; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M20"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 0.48–0.62) and above 36 months (AOR = 0.30; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M21"><mml:mn>95</mml:mn><mml:mo>%</mml:mo><mml:mo> </mml:mo><mml:mtext>CI</mml:mtext></mml:math>: 0.26–0.34) are significant determinant factors of under-five mortality in rural settings. Conclusions . Differences in regions, educated parents, born in singleton, public sector delivery, nonavailability of occupation of parents, mothers older than 16 at first birth, breastfeeding, use of a contraceptive method, child vaccination, higher number of family size, repeated antenatal visits, and preceding birth interval play a significant role regarding the survival of under-five children. These, among other differences, should be addressed decisively as part of any upcoming strategic interventions to improve the survival of children in line with the target of 2030 Sustainable Development Goals (SDGs).