School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
BMC Public Health. 2020 Dec 7;20(1):1873. doi: 10.1186/s12889-020-09869-x.
Under-five mortality in Chad reached a minimum value of 119 deaths per 1000 live births in 2018, compared with a maximum of 250 in 1972. Despite this decline in the mortality trend, for every six children in Chad, one dies before the age of five. This study, therefore, investigated the proximate, intermediate, and distal determinants of under-five mortality in Chad.
We used data from the 2014-15 Chad's Demographic and Health Survey. Data of 7782 children below 5 years were used for the study. Both descriptive and multivariable hierarchical logistic regression analyses were performed. Statistical significance was declared at p < 0.05.
Under-five mortality was found to be 130 deaths per 1000 live births in Chad, with variations across the various population sub-groups. For distal predictors, the likelihood of death was higher in children born in the FChari Baguirmi region (AOR = 3.83, 95% CI: 1.81-8.14). Children whose mothers belonged to the Baguirmi/Barma ethnic group (AOR = 8.04, 95% CI: 1.75-36.99) were more likely to die before the age of five. On the contrary, the likelihood of under-five mortality was low among children born in rural areas (AOR = 0.73, 95% CI: 0.55-0.97). With the intermediate predictors, the likelihood of under-five deaths was higher among children whose mothers had no formal education (AOR = 1.72, 95% CI: 1.06-2.77). Regarding the proximate predictors, the odds of under-five deaths was higher among male children (AOR = 1.03, 95% CI: 1.05-1.63) and first rank children (AOR = 1.58, 95% CI: 1.13-2.21).
The study found that the determinants of under-five mortality in Chad are region of residence, place of residence, ethnicity, education, sex of child, and birth rank. These findings show that both socio-economic and proximate factors explain the disparities in under-five mortality in Chad. The identification of these factors can be pivotal towards the design of evidence-based interventions intended to improve child survival. Therefore, improving maternal education while refocusing and re-packaging existing strategies to target selected sub-regional populations with high under-five mortality is urgently required.
乍得五岁以下儿童死亡率在 1972 年达到 250 人死亡/每千名活产儿的最高值，而在 2018 年达到了 119 人死亡/每千名活产儿的最低值。尽管死亡率趋势有所下降，但乍得每六个儿童中仍有一个在五岁前死亡。因此，本研究调查了乍得五岁以下儿童死亡的近因、中间原因和远因。
我们使用了 2014-15 年乍得人口与健康调查的数据。该研究使用了 7782 名五岁以下儿童的数据。进行了描述性和多变量分层逻辑回归分析。p 值<0.05 表示具有统计学意义。
乍得五岁以下儿童死亡率为每千名活产儿 130 人死亡，不同人群亚组之间存在差异。对于远因预测因素，出生在乍得-巴吉尔米大区的儿童死亡的可能性更高（AOR=3.83，95%CI：1.81-8.14）。母亲属于巴吉尔米/巴尔马族的儿童（AOR=8.04，95%CI：1.75-36.99）更有可能在五岁前死亡。相反，出生在农村地区的儿童五岁以下死亡率较低（AOR=0.73，95%CI：0.55-0.97）。对于中间预测因素，母亲未接受正规教育的儿童死亡的可能性更高（AOR=1.72，95%CI：1.06-2.77）。至于近因预测因素，男童（AOR=1.03，95%CI：1.05-1.63）和长子（AOR=1.58，95%CI：1.13-2.21）的五岁以下儿童死亡风险更高。
本研究发现，乍得五岁以下儿童死亡的决定因素是居住地的地区、居住地的位置、族裔、教育程度、儿童性别和出生顺位。这些发现表明，社会经济和近因因素都解释了乍得五岁以下儿童死亡率的差异。确定这些因素对于设计基于证据的干预措施以改善儿童生存至关重要。因此，迫切需要提高母亲的教育水平，同时重新调整和重新包装现有战略，以针对死亡率较高的特定次区域人口。
