Abraha Hiluf Ebuy, Belachew Abate Bekele, Ebrahim Mohamedawel Mohammedniguss, Tequare Mengistu Hagazi, Adhana Mache Tsadik, Assefa Natnael Etsay
College of Health Sciences, Ayder Comprehensive Specialized Hospital, Clinical Governance and Quality Improvement Unit, Mekelle University, Mek'ele, Tigray, Ethiopia.
College of Health Sciences, School of Public Health, Mekelle University, Mek'ele, Tigray, Ethiopia.
BMC Public Health. 2020 Sep 29;20(1):1465. doi: 10.1186/s12889-020-09554-z.
Globally, neonatal and child mortality remains still high. Under-five mortality accounts for four-fifth of child and young adolescent deaths. In Ethiopia, though there has been a remarkable progress over the past years, under-five mortality is still high. Evidence from population-based longitudinal studies on under-five mortality is limited. Thus, this study aims to investigate the magnitude, trend, and causes of under-five mortality in the Kilite-Awlaelo Health Demographic Surveillance System, Northern Ethiopia.
Kilite-Awlaelo health and demographic surveillance system was established in 2009 in the northern part of Ethiopia. Population-based longitudinal study design was carried out through extracting data for nine consecutive years (2009-2017). After smoothing the data revealed a visually decreasing trend. Linear, quadratic, exponential, and autoregressive time-series models were checked. Accordingly, the exponential trend model provided the best fit with the lowest standard error of estimate, lowest sum square error and highest adjusted R value. Cause-specific mortality was determined by cross tabulating cause of death with specific age death.
The overall under-five mortality rate was 35.62 per 1000 livebirths. The under-five mortality rate of rural and urban residents was 37.58 and 12.99 deaths per 1000 livebirths respectively. The exponential trend model showed the under-five mortality rate was declining exponentially. Bacterial sepsis 67(20.6%), prematurity 37(11.08%), intestinal infection disease 30(8.98%), acute lower respiratory infections 26(7.78%), and birth asphyxia 24(7.19%) were the major causes of under-five mortality.
The overall under-five mortality rate for the surveillance period was comparatively lower. A statistically significant difference in under-five mortality rate was observed between urban and rural residents. A statistically significant declining trend in the under-five mortality rate was observed. Bacterial sepsis, prematurity, intestinal infection disease, acute lower respiratory infections, and birth asphyxia were the major causes of under-five mortality. We recommend the huge discrepancy in under-five mortality rate between urban and rural dwellers could be narrowed to some level by increasing healthcare access for rural residents.
在全球范围内，新生儿和儿童死亡率仍然很高。五岁以下儿童死亡率占儿童和青少年死亡人数的五分之四。在埃塞俄比亚，尽管过去几年取得了显著进展，但五岁以下儿童死亡率仍然很高。基于人群的五岁以下儿童死亡率纵向研究的证据有限。因此，本研究旨在调查埃塞俄比亚北部基利特-阿韦洛健康人口监测系统中五岁以下儿童死亡率的规模、趋势和原因。
基利特-阿韦洛健康人口监测系统于2009年在埃塞俄比亚北部建立。通过连续九年（2009 - 2017年）提取数据进行基于人群的纵向研究设计。对数据进行平滑处理后显示出明显的下降趋势。检查了线性、二次、指数和自回归时间序列模型。相应地，指数趋势模型提供了最佳拟合，具有最低的估计标准误差、最低的平方和误差和最高的调整R值。通过将死因与特定年龄的死亡情况进行交叉列表来确定特定病因死亡率。
总体五岁以下儿童死亡率为每1000例活产35.62例。农村和城市居民的五岁以下儿童死亡率分别为每1000例活产37.58例和12.99例。指数趋势模型显示五岁以下儿童死亡率呈指数下降。细菌性败血症67例（20.6%）、早产37例（11.08%）、肠道感染疾病30例（8.98%）、急性下呼吸道感染26例（7.78%）和出生窒息24例（7.19%）是五岁以下儿童死亡的主要原因。
监测期内总体五岁以下儿童死亡率相对较低。城乡居民五岁以下儿童死亡率存在统计学上的显著差异。观察到五岁以下儿童死亡率有统计学上的显著下降趋势。细菌性败血症、早产、肠道感染疾病、急性下呼吸道感染和出生窒息是五岁以下儿童死亡的主要原因。我们建议，通过增加农村居民获得医疗保健的机会，可以在一定程度上缩小城乡居民五岁以下儿童死亡率的巨大差距。
