Open AccessFactors associated with under-5 mortality in three disadvantaged East African districts
Author(s) -
Kingsley Agho,
Osita Kingsley Ezeh,
Akhi J. Ferdous,
Irene Mbugua,
Joseph K. Kamara
Publication year - 2020
Publication title -
international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.743
H-Index - 31
eISSN - 1876-3413
pISSN - 1876-3405
DOI - 10.1093/inthealth/ihz103
Subject(s) - medicine , breastfeeding , demography , odds ratio , confidence interval , infant mortality , logistic regression , tanzania , disadvantaged , pediatrics , pregnancy , prenatal care , population , obstetrics , environmental health , geography , environmental planning , sociology , biology , political science , law , genetics
Background The high rate of avoidable child mortality in disadvantaged communities in Africa is an important health problem. This article examines factors associated with mortality in children <5 y of age in three disadvantaged East African districts. Methods Pooled cross-sectional data on 9270 live singleton births from rural districts in Rwanda (Gicumbi), Uganda (Kitgum) and Tanzania (Kilindi) were analysed using logistic regression generalized linear latent and mixed models to adjust for clustering and sampling weights. Mortality outcomes were neonatal (0–30 d), post-neonatal (1–11 months), infant (0–11 months), child (1–4 y) and under-5 y (0–4 y). Results The odds of post-neonatal and infant mortality were lower among children delivered by a health professional (adjusted odds ratio [AOR] 0.62 [95% confidence interval {CI} 0.47–0.81] for post-neonatal; AOR 0.60 [95% CI 0.46–0.79] for infant), mothers who had four or more antenatal care (ANC) visits during pregnancy (AOR 0.66 [95% CI 0.51–0.85]) and mothers who initiated breastfeeding within 1 h after birth (AOR 0.60 [95% CI 0.47–0.78]). Neonates not exclusively breastfed had higher mortality (AOR 3.88 [95% CI 1.58–9.52]). Children who lived >6 h away from the nearest health centre (6–23 h: AOR 1.66 [95% CI 1.4–2.0] and ≥24 h: AOR 1.43 [95% CI 1.26–1.72]) reported higher mortality rates in children <5 y of age. Conclusions Interventions for reducing deaths in children ≤5 y of age in disadvantaged East African communities should be strengthened to target communities >6 h away from health centres and mothers who received inadequate ANC visits during pregnancy.