Abstract:
Background
Under-five mortality (U5M) is one of the most important and sensitive indicators of the health
status of the community. Despite there having been a substantial reduction in U5M since
1990, its rate is still high in Sub-Saharan African countries. Thus, this study aimed to assess
time to under-five mortality and its predictors in rural Ethiopia.
Methods
This study utilized a secondary analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS). A total of 9,807 weighted under-five children selected at different stages were
included in the analysis. The Kaplan-Meier and Cox’s-gamma shared frailty models were
used to estimate survival time and to identify predictors of under-five mortality, respectively.
An adjusted Hazard Ratio (AHR) along with a 95% Confidence Interval (CI) was used to
measure the effect size and direction of the association.
Results
The study indicated that 6.69% (95% CI: 6.13, 7.30) of children died before celebrating their
fifth birthday in rural Ethiopia. Of all the deaths, the median time to death was 27 months. After
controlling the effect of cluster and other confounding factors, female sex (AHR = 0.62, 95% CI:
0.52, 0.75), ever born greater than five children (AHR = 1.40, 95% CI: 1.07, 1.83), very large
size at birth (AHR = 1.33, 95% CI: 1.03 1.71), very small size at birth (AHR = 1.41, 95% CI:
1.10, 1.82), twin pregnancy (AHR = 3.5, 95% CI: 2.47, 4.88), not ever breastfeeding (AHR =
11.29, 95% CI: 9.03, 14.12), unimproved latrine (AHR = 3.44, 95% CI: 1.91, 6.17), covered by
health insurance (AHR = 0.29, 95% CI: 0.12, 0.70) were predictors of under-five mortality
Conclusions
Still under-five mortality was high in rural Ethiopia as compared to the global under-five mortality rate. In the final model, sex of a child, the total number of children ever born, children’s
size at birth, type of pregnancy, breastfeeding, type of toilet, and being covered by health
insurance were significant predictors of under-five mortality. Further emphasis should be
given to twin and not breastfeeding children, as well as households’ better encouraging
membership of community health insurance and utilization of improved latrines.
