Multilevel zero inflated and hurdle models for under five-child mortality in Indonesia

Introduction: Overcoming under-five mortality rate remains a great challenge for Indonesia to meet the national target despite its notable advancements and progress in reducing child mortality rate. Therefore, understanding risk factors of under-five mortality is essential to enhance the health and well-being of children. This research seeks to investigate associated factors of under-five mortality in Indonesia by using the 2017 Indonesia Demographic and Health Survey data. Methods: The multilevel zero-inflated and multilevel hurdle models are considered to handle unobserved heterogeneity that may occur at province level, and to model prevalence and risk of child death as a joint process, which are reported in terms of odds ratio (OR) and incidence ratio rate (IRR), respectively. Results: Lower number of household members (IRR = 0.803, 95% confidence interval [CI]: 0.784–0.823), older mother's age at first birth (IRR = 1.020, 95% CI: 1.007–1.032), higher number of children ever born (IRR = 1.491, 95% CI: 1.450–1.533), lower mother's education (IRR = 1.224, 95% CI: 1.013–1.479), and lower father's education (IRR = 1.232, 95% CI: 1.015–1.495) are significantly associated with higher total death numbers in children before the age of 5 years. Furthermore, the odds of no child death are significantly higher among mother who use a contraceptive method (OR = 11.088, 95% CI: 6.659–18.462) and among household in higher quantile wealth (OR = 1.133, 95% CI: 1.005–1.277). Conclusion: This evidence-based empirical highlights priority risk factors that might provide insight for policymakers, health professional, and the community in general to design appropriate intervention to help reduce the burden of under-five mortality in the country.