Department of Epidemiology and Biostatistics, institute of public health, college of medicine and health science, University of Gondar, Gondar, Ethiopia.
Department of Human Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
BMC Pregnancy Childbirth. 2021 May 5;21(1):362. doi: 10.1186/s12884-021-03835-0.
Infant mortality remains a serious global public health problem. The global infant mortality rate has decreased significantly over time, but the rate of decline in most African countries, including Ethiopia, is far below the rate expected to meet the SDG targets. Therefore, this study aimed to investigate the trends of infant mortality and its determinants in Ethiopia based on the four consecutive Ethiopian Demographic and Health Surveys (EDHSs).
This analysis was based on the data from four EDHSs (EDHS 2000, 2005, 2011, and 2016). A total weighted sample of 46,317 live births was included for the final analysis. The logit-based multivariate decomposition analysis was used to identify significantly contributing factors for the decrease in infant mortality in Ethiopia over the last 16 years. To identify determinants, a mixed-effect logistic regression model was fitted. The Intra-class Correlation Coefficient (ICC) and Likelihood Ratio (LR) test were used to assess the presence of a significant clustering effect. Deviance, Akaike Information Criteria (AIC), and Bayesian Information Criteria (BIC) were used for model comparison. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to identify the statistically significant determinants of infant mortality.
Infant mortality rate has decreased from 96.9 per 1000 births in 2000 to 48 per 1000 births in 2016, with an annual rate of reduction of 4.2%. According to the logit based multivariate decomposition analysis, about 18.1% of the overall decrease in infant mortality was due to the difference in composition of the respondents with respect to residence, maternal age, type of birth, and parity across the surveys, while the remaining 81.9% was due to the difference in the effect of residence, parity, type of birth and parity across the surveys. In the mixed-effect binary logistic regression analysis; preceding interval < 24 months (AOR = 1.79, 95% CI; 1.46, 2.19), small size at birth (AOR = 1.55, 95% CI; 1.25, 1.92), large size at birth (AOR = 1.26, 95% CI; 1.01, 1.57), BMI < 18.5 kg/m (AOR = 1.22, 95% CI; 1.05, 1.50), and twins (AOR = 4.25, 95% CI; 3.01, 6.01), parity> 6 (1.51, 95% CI; 1.01, 2.26), maternal age and male sex (AOR = 1.50, 95% CI: 1.25, 1.79) were significantly associated with increased odds of infant mortality.
This study found that the infant mortality rate has declined over time in Ethiopia since 2000. Preceding birth interval, child-size at birth, BMI, type of birth, parity, maternal age, and sex of child were significant predictors of infant mortality. Public health programs aimed at rural communities, and multiparous mothers through enhancing health facility delivery would help maintain Ethiopia's declining infant mortality rate. Furthermore, improving the use of ANC services and maternal nutrition is crucial to reducing infant mortality and achieving the SDG targets in Ethiopia.
婴儿死亡率仍然是一个严重的全球公共卫生问题。全球婴儿死亡率随着时间的推移显著下降，但包括埃塞俄比亚在内的大多数非洲国家的下降速度远低于实现可持续发展目标所需的速度。因此，本研究旨在根据四次连续的埃塞俄比亚人口与健康调查（EDHS），调查埃塞俄比亚婴儿死亡率的趋势及其决定因素。
本分析基于四次 EDHS（EDHS 2000、2005、2011 和 2016）的数据。最终分析纳入了总共 46317 例活产儿的加权总样本。使用基于对数的多变量分解分析来确定过去 16 年来埃塞俄比亚婴儿死亡率下降的显著促成因素。为了确定决定因素，拟合了混合效应逻辑回归模型。使用组内相关系数（ICC）和似然比（LR）检验来评估是否存在显著的聚类效应。偏差、赤池信息量准则（AIC）和贝叶斯信息量准则（BIC）用于模型比较。在双变量分析中 p 值小于 0.2 的变量被认为是多变量分析的候选变量。在多变量分析中，报告调整后的优势比（AOR）及其 95%置信区间（CI），以确定婴儿死亡率的统计学显著决定因素。
自 2000 年以来，婴儿死亡率从每 1000 例活产儿 96.9 例下降到 2016 年的每 1000 例活产儿 48 例，年下降率为 4.2%。根据基于对数的多变量分解分析，婴儿死亡率总体下降的 18.1%归因于受访者在居住、产妇年龄、分娩类型和生育间隔方面的构成差异，而其余 81.9%归因于居住、生育间隔、分娩类型和生育间隔方面的影响差异。在混合效应二元逻辑回归分析中；前置间隔 < 24 个月（AOR = 1.79，95%CI；1.46，2.19）、出生时体重较小（AOR = 1.55，95%CI；1.25，1.92）、出生时体重较大（AOR = 1.26，95%CI；1.01，1.57）、BMI < 18.5kg/m（AOR = 1.22，95%CI；1.05，1.50）和双胞胎（AOR = 4.25，95%CI；3.01，6.01）、产次> 6（1.51，95%CI；1.01，2.26）、产妇年龄和男性（AOR = 1.50，95%CI：1.25，1.79）与婴儿死亡率增加的几率显著相关。
本研究发现，自 2000 年以来，埃塞俄比亚的婴儿死亡率呈下降趋势。前置出生间隔、儿童出生时的大小、BMI、分娩类型、产次、产妇年龄和儿童性别是婴儿死亡率的显著预测因素。旨在针对农村社区和多产妇的公共卫生计划，通过加强医疗机构分娩，可以帮助维持埃塞俄比亚不断下降的婴儿死亡率。此外，改善使用 ANC 服务和孕产妇营养对于降低婴儿死亡率和实现埃塞俄比亚的可持续发展目标至关重要。
