Determinants of under-five mortality in Zimbabwe: Evidence from the 2015–2016 Zimbabwe demographic Health Survey data

Abstract

Background

Child mortality is an important measure of a population’s health status. It is included in the third sustainable development goal that aims to improve global health by reducing under-five mortality to at least as low as 25 per 1000 live births by 2030. The study determines the factors associated with under-five child mortality in Zimbabwe.

Methods

Cross-sectional secondary data from the 2015 Zimbabwe Demographic Health Survey (ZDHS) were analyzed. The sample included 5,806 women aged 15–49 years of reproductive age. The Chi-square test was used to analyze the association between child death and independent variables. We identified the individual and contextual factors associated with child deaths in Zimbabwe using the Cox proportional hazard model.

Results

The risks of under-five mortality were highest among children of first birth order (adjusted hazard ratio (aHR) ​= ​2.37, P ​= ​0.04), multiple births (aHR ​= ​2.37, P = 0.04), mothers with primary or less maternal education (aHR ​= ​1, Ref), mothers below 18 years old (aHR ​= ​1, Ref), apostolic mothers (aHR ​= ​2.90, P = 0.002), mothers who do not use contraceptives (aHR ​= ​2.20, P ​< ​0.001), formerly married women (aHR ​= ​6.42, P = 0.005), women with 5 or more children (aHR ​= ​15.84, P ​< ​0.001), women who read newspapers less than once a week (aHR ​= ​1.75, P = 0.13), and households that use high-polluting fuels (aHR ​= ​1.92, P = 0.023).

Conclusion

This study establishes that child health, maternal, socioeconomic, household, and ecological factors are important determinants of under-five mortality in Zimbabwe. Understanding these determinants is crucial for designing effective interventions and policies to reduce child mortality rates. This requires comprehensive approaches such as improving access to healthcare, education, and basic sanitation facilities; prioritizing nutrition; providing clean water; enhancing poverty reduction and immunization; and promoting breastfeeding and social empowerment, with a particular focus on vulnerable populations and marginalized communities.