Research title on Multilevel Modelling of Time to Death for Under-Five Children: 2016 Ethiopia Demographic and Health Survey, 2019

Abstract

Background: Reducing child mortality is now a global concern. Globally, Under-five child mortality rate was decreased by 58% in 2017. In the 2016 EDHS report, under-five mortality was declined to 60% in Ethiopia in 2016. Methods: The data for the study was obtained from EDHS data conducted in 2016. In the study, we analysed the data using stratified Cox proportional hazard model and multilevel lognormal parametric survival model. Results: From the total of 10,331 under-five children, 635 (6.1%) deaths had occurred in the 2016 EDHS data. And, the overall probability of survival value was near to 0.92 with the estimated mean survival time was 55.4 months. In the study we found that covariates like birth type of the child, family size, wealth index, frequency of listening radio, place of delivery, place of residence, and geographical region were significant factors for the death of under-five children in stratified Cox proportional hazard model. In the multilevel lognormal parametric survival model, we found that the random-intercept effects of variations between region and household levels on the mean survival times of the children were 1.7 and 0.9, respectively. These values indicated that we had enough evidence for the existence of unobserved heterogeneities between regions and households. Conclusion: The covariates like birth type of the child, family size, wealth index, frequency of listening radio, place of delivery, place of residence, and geographical region covariates were significant factors for under-five children mortality using stratified Cox proportional hazard regression model. In the random-intercept effects model, the two estimated variances of the random-intercept effects for regional and household levels were 1.7 and 0.9, respectively. The values indicate that we have enough evidence that there were unobserved heterogeneities on the mean survival times of the under-five children between regions and households levels. Further studies should be conducted to identify the individual, household, and community-level factors associated with infant and child mortality in Ethiopia.

Time to death and its predictors among Ethiopian under-five children: cluster-level shared frailty survival analysis using the 2019 Ethiopian mini demographic health survey

“…29 This result is also higher than what Argawu's study in Ethiopia found, which was 55.4 months. 23 This finding suggests that under-five child survival rates have improved in Ethiopia.…”

“…According to a multilevel survival study conducted in Ethiopia, children from families with four to six members and more had a reduced probability of passing away before the age of five than those from families with one to three members. 23 A study conducted in rural Ethiopia found that having a larger family size decreased the chance of death among children under the age of five by fifty-six percent. 30 On the other hand, a study by Gebretsadik using the 2011 DHS data in Ethiopia found a direct relationship between family size and mortality among children under the age of five.…”

“…The independent variables explored in the study were taken from Mosley and Chen's (1984) determinants of childhood morbidity and mortality framework for developing countries, previous similar studies, 9,14,15,23 and available data in the data set. The independent variables in this study ranged from socio-economic factors to variables specific to the mother and the child.…”

“…Censored: a child failed to experience the event of interest, which is death. 23 Antenatal care utilization: mothers who attended at least four antenatal appointments. 24…”