Fenta Haile Mekonnen, Chen Ding-Geng, Zewotir Temesgen T, Rad Najmeh Nakhaei, Belay Deneke Bitew, Yilema Seyifemickael Amare
Department of Statistics, University of Pretoria, Pretoria, South Africa.
Department of Statistics, Bahir Dar University, Bahir Dar, Ethiopia.
BMC Public Health. 2025 Aug 22;25(1):2884. doi: 10.1186/s12889-025-24186-x.
The under-five child mortality in sub-Saharan African (sSA) countries is a persistent problem with limited effort being made to explore the determinants of disparities across countries and their lower administrative districts. A child's survival may depend on several known and unknown covariates and vary across the study areas. The main objective of this study is to assess the time to death of under-five children and its associated risk factors by comparing the performance of semiparametric and parametric frailty models across sSA regions.
We used a dataset from the Demographic and Health Survey (DHS) across 33 sSA countries. The semiparametric and parametric models with different frailty distributions were used to model the under-five survival time of children across the administrative districts of 33 sSA countries.
A total of 330,373 under-five children were included in the study, of whom 19,893 (6.02%) died before reaching their 5th birthday. Unobserved country-level variance [Formula: see text] and district-level variance (0.183) effects considerably impacted the survival time of under-five children in sSA countries. Under-five children born to mothers aged 25-29 and 30-49 were 16% and 20% less likely to die compared to children born to mothers younger than 24 years. Moreover, children born in rural areas were 8.3% more likely to die than those who were born in urban areas. Children who were born from mothers with better access to improved water sources and clean fuel were 9% and 11% less likely to die than their counterparts, respectively.
The exponential shared frailty hazard model with lognormal frailty distribution demonstrated better performance compared to the Cox semiparametric model for identifying risk factors for under-five children across sSA countries. Place of residence, wealth index, media exposure, birth order, birth interval, access to improved water, and use of clean fuels for cooking were the significant risk factors on time to death of under-five children in sSA.
撒哈拉以南非洲（SSA）国家五岁以下儿童死亡率一直是个问题，在探索各国及其较低行政区之间差异的决定因素方面所做的努力有限。儿童的生存可能取决于几个已知和未知的协变量，并且在研究区域之间有所不同。本研究的主要目的是通过比较SSA各区域半参数和参数脆弱模型的性能，评估五岁以下儿童的死亡时间及其相关风险因素。
我们使用了来自33个SSA国家的人口与健康调查（DHS）数据集。采用具有不同脆弱分布的半参数和参数模型，对33个SSA国家各行政区五岁以下儿童的生存时间进行建模。
本研究共纳入330373名五岁以下儿童，其中19893名（6.02%）在五岁生日前死亡。未观察到的国家层面方差[公式：见正文]和地区层面方差（0.183）对SSA国家五岁以下儿童的生存时间有相当大的影响。与24岁以下母亲所生的孩子相比，25 - 29岁和30 - 49岁母亲所生的五岁以下儿童死亡可能性分别低16%和20%。此外，农村地区出生的儿童死亡可能性比城市地区出生的儿童高8.3%。母亲更容易获得改善水源和清洁燃料的儿童死亡可能性分别比同龄人低9%和11%。
与Cox半参数模型相比，具有对数正态脆弱分布的指数共享脆弱风险模型在识别SSA国家五岁以下儿童风险因素方面表现更好。居住地、财富指数、媒体曝光、出生顺序、生育间隔、获得改善水源的情况以及使用清洁燃料做饭是SSA五岁以下儿童死亡时间的重要风险因素。
