TITLE:
Social determinants of under-five mortality in Ethiopia: Event history analysis using evidence from Ethiopian Demographic and Health Survey (EDHS)
AUTHORS:
Tariku Dejene, Eshetu Girma
KEYWORDS:
Under-Five Mortality; Social Determinants; DHS; Ethiopia
JOURNAL NAME:
Health,
Vol.5 No.5,
May
27,
2013
ABSTRACT:
Background:
Under-five mortality is one of the indicators of the millennium development
goals (MDGs) for the child mortality reduction goal. Understanding the social
determinants of under-five mortality is helpful to narrow the gap between
different social classes. Therefore, this study focused on the social
determinants of under-five mortality inEthiopiausing EDHS 2011 data.
Methods: The data source for this analysis was the 2011 EDHS which was undertaken
over a five-month period from 27 December, 2010 to 3 June, 2011. The sample was
selected using a stratified, two-stage cluster design. Samples of 16,515 women
of reproductive age were interviewed. The questionnaire used to collect information
from these women whohad among other things such asbackground characteristics of women,
birth history of these women and the survival of each birth at the time of the interview.
Births that had occurred to women in the last 10 years prior to the date of theinterview were extracted for the analysis. Descriptive statistical methods were
used to describe the distribution of the characteristics of the data. Kaplan
Meier plots and incidence rates per 1000 person years were used to compare
survival across different categories of the risk factors. The effect of the
risk factors on survival was analyzed using Cox proportional hazards regression. Data management and analysis were carried out using
STATA 10. Results: A total of 23,581 under-five children were included in the
study. The under-five mortality incidence rate in Ethiopia for the last ten
years was 29.6 per 1000 person years. Maternal education beyond primary level
of education reduced the risk of under-five mortality by about half. A
significant reduction in risk of under-five mortality was observed among births
to mothers residing in richest households. The hazard ratio (HR) was higher for
under-five mortality among boys than daughters, twins than singleton, teen age
mother than higher ages and short births than optimal. Conclusions: Empowering
mothers with education and making them productive for improving their
income are important aspects for reducing under-five mortality. Emerging
regions were disadvantaged on the incidence of under-five mortality; however,
there was a positive result in narrowing the urban-rural under-five mortality
risks. Being teenage mother at birth, short birth interval and twin births were
identified risk factors for increased under-five mortality in Ethiopia. Interventions
targeted at empowering women and much effort in emerging regions are required.
Preventing teenage motherhood and promoting optimal birth spacing are also required to
reduce under-five mortality in Ethiopia.