Zahangir Mohammad Salim, Lisa Fariha Khanam, Neyma Mahmuda Al, Hossain Md Rasel, Tabassum Sawasan, Rakin Tanvir Faisal, Faruk Mohmmad Omar, Hossain Kabir
Department of Statistics, Noakhali Science and Technology University, Noakhali, 3814, Bangladesh.
Department of Oceanography, Noakhali Science and Technology University, Noakhali, 3814, Bangladesh.
BMC Public Health. 2025 Aug 18;25(1):2819. doi: 10.1186/s12889-025-22191-8.
Child mortality, defined as the likelihood of an infant dying before the age of five, is still a significant concern in developing countries with limited healthcare facilities. Sierra Leone, with a child mortality rate of 68.418 deaths per 1,000 live births in 2024-one of the highest globally-necessitates urgent public health interventions to mitigate this critical issue. This study examined the cultural, socioeconomic, and demographic factors associated with under-five mortality in Sierra Leone.
This investigation used data from the Sierra Leone Demographic and Health Survey 2019, comprised of 4540 mothers aged 15-49 years who had at least one child who died under the age of five. The significance of explanatory variables was evaluated using a variety of bivariate statistical analyses, including the Mann-Whitney U (MWU) test, Kruskal-Wallis H (KWH) test, and Kendall's tau_b and Spearman's rho correlation. Additionally, several multivariate regression models were used to investigate the factors that influence child mortality.
The results showed that increasing maternal age (IRR: 0.95, 95% CI: 0.932-0.968), living in the North-Western region (IRR: 0.110, 95% CI: 0.016-0.770), higher maternal education (IRR: 0.563, 95% CI: 0.189-1.676), higher father education (IRR: 0.816, 95% CI: 0.678-0.981), fewer children under five in the family (IRR: 0.853, 95% CI: 0.796-0.913), and being a working mother (IRR: 0.831, 95% CI: 0.705-0.980) reduced the risk of under-five mortality. However, the risk of under-five mortality increased with the total number of children ever born (IRR: 1.411, 95% CI: 1.263-1.577), younger maternal age at first birth (IRR: 1.032, 95% CI: 1.014-1.064), shorter preceding birth intervals (IRR: 1.006, 95% CI: 1.004-1.009), and having twin children (IRR: 9.792, 95% CI: 1.789-53.59).
The study highlights the urgent need to strengthen maternal and child healthcare services, particularly for younger mothers, promote family planning programs to ensure optimal birth spacing, and increase healthcare facilities in regions with high child mortality.
儿童死亡率定义为婴儿在五岁前死亡的可能性，在医疗设施有限的发展中国家仍然是一个重大问题。2024年，塞拉利昂的儿童死亡率为每1000例活产中有68.418例死亡，是全球最高之一，因此迫切需要公共卫生干预措施来缓解这一关键问题。本研究调查了与塞拉利昂五岁以下儿童死亡率相关的文化、社会经济和人口因素。
本调查使用了2019年塞拉利昂人口与健康调查的数据，该调查包括4540名年龄在15至49岁之间、至少有一个五岁以下子女死亡的母亲。使用多种双变量统计分析评估解释变量的显著性，包括曼-惠特尼U检验（MWU）、克鲁斯卡尔-沃利斯H检验（KWH）以及肯德尔tau_b和斯皮尔曼rho相关性分析。此外，还使用了几个多元回归模型来研究影响儿童死亡率的因素。
结果表明，母亲年龄增加（风险比：0.95，95%置信区间：0.932 - 0.968）、居住在西北地区（风险比：0.110，95%置信区间：0.016 - 0.770）、母亲教育程度较高（风险比：0.563，95%置信区间：0.189 - 1.676）、父亲教育程度较高（风险比：0.816，95%置信区间：0.678 - 0.981）、家庭中五岁以下儿童数量较少（风险比：0.853，95%置信区间：0.796 - 0.913）以及母亲为职业女性（风险比：0.831，95%置信区间：0.705 - 0.980）可降低五岁以下儿童死亡风险。然而，五岁以下儿童死亡风险会随着生育子女总数的增加（风险比：1.411，95%置信区间：1.263 - 1.577）、首次生育时母亲年龄较小（风险比：1.032，95%置信区间：1.014 - 1.064）、前次生育间隔较短（风险比：1.006，95%置信区间：1.004 - 1.009）以及生育双胞胎（风险比：9.792，95%置信区间：1.789 - 53.59）而增加。
该研究强调迫切需要加强母婴保健服务，特别是针对年轻母亲，推广计划生育项目以确保最佳生育间隔，并增加儿童死亡率高的地区的医疗设施。
