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.