Under-Five Child Mortality in Rural Areas of Ethiopia and its Determinants: A Mixed- Effects Analysis Using 2019 Mini Demographic Health Survey Data

Abstract Background Under-five-child mortality measures the number of deaths per 1,000 live births before five years of age are reached. It is an indicator of the child health status of a country and is considered one of the sovereign state development indicators. In general, rural areas are more vulnerable to under-five mortality and have a greater risk of child mortality than urban dwellers. In particular, this disparity is more observable in developing countries, including Ethiopia. Thus, the current study aimed to identify the determinants of under-five child mortality in rural Ethiopia. Methods - A quantitative cross-sectional study was conducted among 4425 mothers who were selected based on a Mini Ethiopian demographic and health survey conducted from March 21, 2019, to June 28, 2019. Two-level mixed effects logistic regression analyses were performed using R software (version 3.5.3). Two-level mixed effect bivariate and multivariate logistic regression analyses were performed. A p value of less than 0.05 and odds ratios with 95% CIs were used to assess the determinants of under-five-child mortality in the multivariate analysis. Results - A total of 4425 individuals were included in the analysis. A 2019 report from the Mini Ethiopian demographic and health survey showed that under-five mortality was 67 deaths per 1,000 live births. The mixed-effect analysis of the current study at the individual and community levels revealed that birth order (i.e., being at 5th and above) [AOR 1.45, 95% CI= (1.01, 2.10)], multiple pregnancies [AOR 7.37, 95% CI= (4.29, 12.73)], a short preceding birth interval (i.e., < 24 months) [AOR 2.93, 95% CI= (1.64, 5.25)], and being a resident of Gambella [AOR 4.2, 95% CI= (1.43, 12.40)], Benisahngul Gumuze [AOR 3.52, 95% CI= (1.22, 10.21)], and Harari [AOR 3.25, 95% CI= (1.01, 10.49)] were found to be factors associated with under-five mortality in rural settings in Ethiopia, with p values < 0.05. Conclusion The mixed-effects analysis revealed that infant birth order, multiple pregnancy, short preceding birth interval, and residence were significant predictors of under-five mortality in rural Ethiopia. Thus, to reduce under-five mortality and achieve the SDGs, specific interventional strategies that focus on determinants, particularly maternal reproductive health-related interventions, should be designed by policymakers at different levels. Nongovernmental organizations focusing on maternal and child health should also put more effort into rural settings to lessen under-five mortality.