Worku Misganaw Gebrie, Teshale Achamyeleh Birhanu, Tesema Getayeneh Antehunegn
Department of Human Anatomy, College of Medicine and Health Science, School of Medicine, University of Gondar, Gondar, Ethiopia.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Arch Public Health. 2021 Apr 23;79(1):55. doi: 10.1186/s13690-021-00578-4.
Even though the global under-five mortality rate substantially decreased over time, Sub-Saharan African (SSA) countries including Ethiopia continue to share the huge burden of under-five mortality. Ethiopia showed a substantial reduction in under-five mortality over time but the rate of reduction has varied across regions. Therefore, this study aimed to investigate determinants of under-five mortality in the high mortality regions of Ethiopia.
A secondary data analysis was done based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 3446 live births were included for this study. For the determinants of under-five mortality, mixed-effect logistic regression was fitted. The Intra-Class Correlation Coefficient (ICC), and Median Odds Ratio (MOR) were done to assess the presence of a significant clustering effect. The standard binary logistic regression and the mixed-effect logistic regression model were fitted and deviance (-2LL) was used for model comparison as the models were nested models. Variables with a p-value less than 0.2 in the bi-variable mixed-effect binary logistic regression analysis were considered for the multivariable analysis. In the multivariable mixed-effect logistic regression analysis, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) were reported to declare the statistical significance and strength of association of under-five mortality and the determinant factors.
Overall, the under-five mortality rate in the high mortality regions of Ethiopia was 74 per 1000 live births and it was highest among twin births (262 per 1000 live births). In the multivariable mixed-effect logistic regression analysis, being having 6 and above births (AOR = 3.66, 95% CI: 1.55, 8.67), preceding birth interval of 2-3 years (AOR = 0.57, 95% CI: 0.41, 0.81) and above 3 years (AOR = 0.35, 95% CI: 0.22, 0.55), being twin (AOR = 5.12, 95% CI: 2.28, 11.46), and being having antenatal care (ANC) visit during pregnancy (AOR = 0.27, 95% CI: 0.16, 0.45) were significant determinants of under-five mortality.
In this study, under-five mortality rate was highest in high mortality regions of Ethiopia. Parity, ANC visit, preceding birth interval, and multiple births were significant predictors of under-five mortality. Therefore, public health interventions that increase maternal health service utilization such as ANC and family planning service utilization to increase birth interval are needed to reduce under-five mortality among these regions of Ethiopia.
尽管全球五岁以下儿童死亡率随时间大幅下降，但包括埃塞俄比亚在内的撒哈拉以南非洲（SSA）国家仍承担着五岁以下儿童死亡的巨大负担。埃塞俄比亚五岁以下儿童死亡率随时间有大幅下降，但各地区的下降速度有所不同。因此，本研究旨在调查埃塞俄比亚高死亡率地区五岁以下儿童死亡的决定因素。
基于2016年埃塞俄比亚人口与健康调查（EDHS）数据进行二次数据分析。本研究纳入了3446例活产的总加权样本。对于五岁以下儿童死亡的决定因素，采用混合效应逻辑回归进行拟合。计算组内相关系数（ICC）和中位数优势比（MOR）以评估显著聚类效应的存在。拟合标准二元逻辑回归和混合效应逻辑回归模型，并将偏差（-2LL）用于模型比较，因为这些模型是嵌套模型。在双变量混合效应二元逻辑回归分析中p值小于0.2的变量被纳入多变量分析。在多变量混合效应逻辑回归分析中，报告调整优势比（AOR）及其95%置信区间（CI），以说明五岁以下儿童死亡率与决定因素之间的统计显著性和关联强度。
总体而言，埃塞俄比亚高死亡率地区的五岁以下儿童死亡率为每1000例活产74例，双胞胎出生时的死亡率最高（每1000例活产262例）。在多变量混合效应逻辑回归分析中，生育6胎及以上（AOR = 3.66，95% CI：1.55，8.67）、前次生育间隔为2 - 3年（AOR = 0.57，95% CI：0.41，0.81）及3年以上（AOR = 0.35，95% CI：0.22，0.55）、双胞胎（AOR = 5.12，95% CI：2.28，11.46）以及孕期进行产前检查（ANC）（AOR = 0.27，95% CI：0.16，0.45）是五岁以下儿童死亡的显著决定因素。
在本研究中，埃塞俄比亚高死亡率地区的五岁以下儿童死亡率最高。胎次、产前检查、前次生育间隔和多胎生育是五岁以下儿童死亡的重要预测因素。因此，需要采取公共卫生干预措施，提高孕产妇对诸如产前检查和计划生育服务等卫生服务的利用率，以增加生育间隔，从而降低埃塞俄比亚这些地区的五岁以下儿童死亡率。
