RESUMO
BACKGROUND: Worldwide, there is remarkable progress in child survival in the past three decades. Ethiopia is off-track on sustainable development targets in under-five mortality since 2020. Therefore, this study aimed to investigate time to death and its associated factors among under-five children in Ethiopia. METHODS: Nationally representative demographic and health survey data were used for this study. A total of 5772 under-five children were included. Data were analyzed using R software. Semi-parametric nested shared frailty survival analysis was employed to identify factors affecting under-five mortality. Adjusted hazard ratio (AHR) with 95% Confidence interval (CI) was reported and log-likelihood was used for model comparison. Statistical significance was declared at P-value < 0.05. RESULTS: The weighted incidence of under-five death before celebrating the first fifth year was 5.76% (95% CI: 5.17 - 6.40). Female sex and under-five children living in urban areas were high probability of survival than their counterparts. After controlling cluster and region level frailty, multiple births (AHR = 7.03, 95% CI: 4.40-11.24), breastfed within one hour after birth (AHR = 0.41, 95% CI: 0.28-0.61), preceding birth interval 18-23 months (AHR = 1.62, 95% CI: 1.12 -2.36), and under-five children younger than 18 months (AHR = 2.73, 95% CI: 1.93 -3.86), and teenage pregnancy (AHR = 1.70, 95% CI: 1.01-2.87) were statistically significant factors for time to under-five death. CONCLUSION: Even though Ethiopia has a significant decline under-five death, still a significant number of under-five children were dying. Early initiation of breastfeeding, preceding birth interval and teenage pregnancy were the preventable factors of under-five mortality. To curve and achieve the SDG targets regarding under-five mortality in Ethiopia, policymakers and health planners should give prior attention to preventable factors for under-five mortality.
RESUMO
INTRODUCTION: Antenatal care (ANC) is a medical care and procedure carried out for pregnant women. Data on ANC visits can help policymakers show gaps in service provision. Therefore, this study assessed the factors associated with the number of ANC visits among women in rural Ethiopia. METHODS: We included a total of 6611 women who gave birth within 5 years preceding the survey from the 2016 Ethiopian Demographic and Health Survey. A multi-level negative binomial regression analysis was employed to consider the hierarchical nature of the data. In the multivariable analysis, variables with a p-value <0.05 were considered to be significantly associated with the number of ANC visits. RESULTS: Overall, 27.3% (95% CI: 14.63, 15.76) of women had at least four ANC visits during pregnancy in rural Ethiopia. Among individual level factors, age group 25-29 years (adjusted incidence rate ratio (AIRR)=1.13,95% CI:1.02,1.26), household rich wealth status (AIRR=1.17, 95% CI:1.04,1.31), women's educational status (primary, AIRR=1.19,95% CI:1.08,1.32; secondary, AIRR= 1.30,95% CI:1.08,1.55; above secondary, AIRR=1.35, 95% CI:1.07,1.71), partner educational status (primary, AIRR=1.16, 95% CI:1.05,1.28; secondary, AIRR=1.22,95% CI:1.08,1.38), and autonomy to decision to their care (AIRR=1.25,95% CI:1.10,1.42) were positively associated factors whereas having a birth order of five or more (AIRR=0.80,95% CI: 0.69,0.94) was a negative associated with number of ANC visits. Among community-level variables, being in higher community level literacy (AIRR=1.35, 95% CI: 1.14, 1.59) and higher poverty level (AIRR=0.77, 95% CI: 0.64, 0.92) were significant factors with the number of ANC visits. CONCLUSIONS AND RECOMMENDATIONS: Women's age, wealth status, women's educational status, partner educational status, autonomy to decision making in health care, and birth order were determinants of the number of ANC visits. Furthermore, poverty and literacy are also important factors at the community level. Addressing economic and educational interventions for rural women should be prioritized.
