Time to Death and Its Predictors Among Infants in Ethiopia: Multilevel Mixed-Effects Parametric Survival Analysis Using the 2019 Ethiopian Mini Demographic Health Survey

Abstract

Introduction

Three years ahead of the plan, Ethiopia has met Millennium Development Goal 4 of reducing under-five mortality. Additionally, the nation is on track to achieve the Sustainable Development Goal of putting an end to preventable child mortality. Despite this, recent data from the nation showed that there were 43 infant deaths for every 1000 live births. Moreover, the country has fallen short of the 2015 Health Sector Transformation Plan goal, with an anticipated infant mortality rate of 35 deaths per 1000 live births in 2020. Thus, this study aims to identify the time to death and its predictors among Ethiopian infants.

Methods

This study used the 2019 Mini-Ethiopian Demographic and Health Survey data set to conduct a retrospective study. The analysis used survival curves and descriptive statistics. Multilevel mixed-effects parametric survival analysis was applied to identify the predictors of infant mortality.

Results

The estimated mean survival time of infants was 11.3 months (95% CI: 11.1, 11.4). Women’s current pregnancy status, family size, age of women, previous birth interval, place of delivery, and mode of delivery were significant individual-level predictors of infant mortality. Infants born with less than 24 months’ birth interval had a 2.29 times higher estimated risk of death (AHR = 2.29, 95% CI: 1.05, 5.02). Infants born at home were 2.48 times more likely to die than those born in a health facility (AHR = 2.48, 95% CI: 1.03, 5.98). At the community level, women’s education was the only statistically significant predictor of infant death.

Conclusion

The risk of infant death was higher before the first month of life, typically shortly after birth. Healthcare programs should put a strong emphasis on efforts to space out births and make institutional delivery services more readily accessible to mothers in Ethiopia to address the infant mortality challenges.

Keywords:

• predictors
• infant mortality
• multilevel-mixed effects
• parametric survival analysis
• Ethiopia

Abbreviations

AHR, Adjusted Hazard Ratio; ANC, Antenatal Care; CHR, Crude Hazard Ratio; CI, Confidence Interval; DHS, Demographic and Health Survey; EAs, Enumeration Areas; EMDHS, Ethiopian Mini Demographic and Health Survey; HH, Household; ICC, Intraclass Correlation Coefficient; IMR, Infant Mortality Rate; MHR, Median Hazard Ratio; PCV, Proportional Change in Variance; SDGs, Sustainable Development Goals.

Data Sharing Statement

The data sets recorded and analyzed during this study are available in the Measure DHS program repository to all registered users (https://www.dhsprogram.com/data/dataset_admin).

Ethics Approval and Consent to Participate

Ethics review and participant consent were not required for this study because it used secondary data analysis of publicly available survey data from the Measure DHS program. A written letter of permission was secured from the IRB of Demographic and Health Survey (DHS) program data archivists to download and use the data for this study from https://www.dhsprogram.com. This study was performed in line with the principles of the Declaration of Helsinki. The DHS data were kept confidential, and any identifying information was removed. The data was only used for this particular, authorized research project, and it would not be shared with any researchers.

Acknowledgment

The authors would like to thank the MEASURE DHS Project for their free access to the original data of the 2019 Mini Demographic and Health Survey of Ethiopia.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

There was no funding for this research.