Under-five mortality and its associated factors in sub-Saharan Africa: a multilevel analysis of recent demographic and health surveys data based on Bayesian approach
Abstract Background An estimated 75.8 under-five deaths per 1000 live births occurred in sub-Saharan Africa. This study aimed to investigate the prevalence and factors associated with under-five mortality in Sub-Saharan Africa. Methods This study was based on secondary data sources from 33 Sub-Sahar...
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2025-02-01
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| author | Atalay Liknaw Birhanie Zemenu Tadesse Tessema Bekalu Endalew Koku Sisay Tamirat |
| author_facet | Atalay Liknaw Birhanie Zemenu Tadesse Tessema Bekalu Endalew Koku Sisay Tamirat |
| author_sort | Atalay Liknaw Birhanie |
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| description | Abstract Background An estimated 75.8 under-five deaths per 1000 live births occurred in sub-Saharan Africa. This study aimed to investigate the prevalence and factors associated with under-five mortality in Sub-Saharan Africa. Methods This study was based on secondary data sources from 33 Sub-Saharan countries’ recent Demography and Health surveys from 2010 to 2020. A weighted sample of 360,397 under-five children was included in the study. Bayesian multilevel binary logistic regression was fitted using the brms R package. Besides, leave one out information criteria was used for model comparison. The adjusted odds ratio (AOR) and its 95% credible interval (CrI) were reported for significant factors associated with under-five mortality. Clinical trial number: not applicable. Results The prevalence of under-five mortality in sub Saharan Africa was 62 per 1000 live births (95%CI (56.29, 68.29). In sub region of SSA, it was 65 in central, 52 in eastern, 50 in southern and 73 in western region per 1000 live births. Multiple birth (AOR = 5.27; 95%CrI: 4.72, 5.87), number of under-five children 3 to 5 (AOR = 3.31; 95%CrI: 3.01, 3.60), caesarean section delivery (AOR = 1.64; 95%CrI: 1.47, 1.83), being unmarried (AOR = 1.16; 95%CrI 1.08, 1.26), using unimproved toilet (AOR = 1.08;95%CrI: 1.02, 1.16), birth order of 4th to 6th (AOR = 1.18; 95%CrI:1.1, 1.25),were risk factors of under-five mortality. Whereas, being female (AOR = 0.86; 95%CrI: 0.82, 0.91), preceding birth interval of 24–35 months (AOR = 0.61; 95%CrI: 0.57, 0.65) and above 36 months (AOR = 0.48; 95%CrI: 0.43, 0.49), ANC visit (AOR = 0.80; 95%CrI: 0.74 0.86), contraceptive use (AOR = 0.57; 95%CrI: 0.53, 0.61), were preventive factors of under-five mortality. Conclusion Under-five mortality remains the highest in sub-Saharan Africa. Most of the risk factors of under-five mortality were found to be preventable. Policymakers and other stakeholders should enhance maternal education, lengthen birth interval, ANC visit, improved toilet facilities and, giving special attention to small size child and cesarean section delivery to reduce under-five mortality. |
| format | Article |
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| institution | Kabale University |
| issn | 1471-2431 |
| language | English |
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| spelling | doaj-art-c673040419394e6082f97faf0ba72bca2025-02-09T12:54:31ZengBMCBMC Pediatrics1471-24312025-02-0125111510.1186/s12887-025-05454-6Under-five mortality and its associated factors in sub-Saharan Africa: a multilevel analysis of recent demographic and health surveys data based on Bayesian approachAtalay Liknaw Birhanie0Zemenu Tadesse Tessema1Bekalu Endalew2Koku Sisay Tamirat3Department of Public Health, College of Health Science, Debre Markos UniversityDepartment of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of GondarDepartment of Public Health, College of Health Science, Debre Markos UniversityDepartment of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of GondarAbstract Background An estimated 75.8 under-five deaths per 1000 live births occurred in sub-Saharan Africa. This study aimed to investigate the prevalence and factors associated with under-five mortality in Sub-Saharan Africa. Methods This study was based on secondary data sources from 33 Sub-Saharan countries’ recent Demography and Health surveys from 2010 to 2020. A weighted sample of 360,397 under-five children was included in the study. Bayesian multilevel binary logistic regression was fitted using the brms R package. Besides, leave one out information criteria was used for model comparison. The adjusted odds ratio (AOR) and its 95% credible interval (CrI) were reported for significant factors associated with under-five mortality. Clinical trial number: not applicable. Results The prevalence of under-five mortality in sub Saharan Africa was 62 per 1000 live births (95%CI (56.29, 68.29). In sub region of SSA, it was 65 in central, 52 in eastern, 50 in southern and 73 in western region per 1000 live births. Multiple birth (AOR = 5.27; 95%CrI: 4.72, 5.87), number of under-five children 3 to 5 (AOR = 3.31; 95%CrI: 3.01, 3.60), caesarean section delivery (AOR = 1.64; 95%CrI: 1.47, 1.83), being unmarried (AOR = 1.16; 95%CrI 1.08, 1.26), using unimproved toilet (AOR = 1.08;95%CrI: 1.02, 1.16), birth order of 4th to 6th (AOR = 1.18; 95%CrI:1.1, 1.25),were risk factors of under-five mortality. Whereas, being female (AOR = 0.86; 95%CrI: 0.82, 0.91), preceding birth interval of 24–35 months (AOR = 0.61; 95%CrI: 0.57, 0.65) and above 36 months (AOR = 0.48; 95%CrI: 0.43, 0.49), ANC visit (AOR = 0.80; 95%CrI: 0.74 0.86), contraceptive use (AOR = 0.57; 95%CrI: 0.53, 0.61), were preventive factors of under-five mortality. Conclusion Under-five mortality remains the highest in sub-Saharan Africa. Most of the risk factors of under-five mortality were found to be preventable. Policymakers and other stakeholders should enhance maternal education, lengthen birth interval, ANC visit, improved toilet facilities and, giving special attention to small size child and cesarean section delivery to reduce under-five mortality.https://doi.org/10.1186/s12887-025-05454-6Under-five mortalityAssociated factorsBayesianSub-saharan AfricaDHS |
| spellingShingle | Atalay Liknaw Birhanie Zemenu Tadesse Tessema Bekalu Endalew Koku Sisay Tamirat Under-five mortality and its associated factors in sub-Saharan Africa: a multilevel analysis of recent demographic and health surveys data based on Bayesian approach BMC Pediatrics Under-five mortality Associated factors Bayesian Sub-saharan Africa DHS |
| title | Under-five mortality and its associated factors in sub-Saharan Africa: a multilevel analysis of recent demographic and health surveys data based on Bayesian approach |
| title_full | Under-five mortality and its associated factors in sub-Saharan Africa: a multilevel analysis of recent demographic and health surveys data based on Bayesian approach |
| title_fullStr | Under-five mortality and its associated factors in sub-Saharan Africa: a multilevel analysis of recent demographic and health surveys data based on Bayesian approach |
| title_full_unstemmed | Under-five mortality and its associated factors in sub-Saharan Africa: a multilevel analysis of recent demographic and health surveys data based on Bayesian approach |
| title_short | Under-five mortality and its associated factors in sub-Saharan Africa: a multilevel analysis of recent demographic and health surveys data based on Bayesian approach |
| title_sort | under five mortality and its associated factors in sub saharan africa a multilevel analysis of recent demographic and health surveys data based on bayesian approach |
| topic | Under-five mortality Associated factors Bayesian Sub-saharan Africa DHS |
| url | https://doi.org/10.1186/s12887-025-05454-6 |
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