Abstract:
Reduction of the under-five mortality rate of 25 or fewer deaths per 1000 live births by 2030 is
one of the priorities of the Sustainable Development Goals. Over 80% of all under-five deaths
occur in Africa and South-East Asia regions. About half of under-five deaths occur in only six
countries including Ethiopia. One in every 15 Ethiopian children dies before the fifth birthday.
Therefore, the aim of this study was to identify factors that affect under-five mortality based on
2016 EDHS dataset using count regression models. The survey collected information from a
total of 15,683 women aged 15-49 years out of which 14,370 women were considered in this
study. The data were found to have excess zeros (53.7%) and the variance was higher than its
mean. Thus several count models such as Poisson, NB, ZIP, ZINB, HP, and HNB models were
fitted to select the model which best fits the data. Among this model, HNB fits the data best. The
LRT test suggested that, the number of under-five death varies among regions and multilevel
count model fit better than the single level count model. For selected multilevel HNB model, the
truncated negative binomial part showed that fathers who have secondary and above education
are about 29% less likely to die children compared with no formal education. Similarly, the risk
of under-five death is 28% lower among the mothers having primary than those with no formal
education. A child of multiple births is 1.45 more likely to die as compared with single birth.
Babies delivered at private sector are 0.65 lower risk of under-five mortality compared to the
babies delivered at home. A child with birth order 2-3 and 4 and above is 46.6% and 58.6%
which are more likely to die as compared with birth order first. The study also showed that there
is a significant regional variation of under-five mortality (𝜎̂
= 0.450 𝑝 − 𝑣𝑎𝑙𝑢𝑒 = 0.0250
and 𝜎̂
𝑤0
2
𝑢0
2
= 0.668 𝑝 − 𝑣𝑎𝑙𝑢𝑒 = 0.0043) . Moreover, mother education level, the age of mother,
family size, place of delivery, vaccination of child and types of birth effects on under-five
mortalities vary among regions of Ethiopia. The variables of vaccination, family size, age of
mother, antenatal visit, birth interval, birth order, and religion, contraceptive used, father
education level, mother education level, father occupation, place of delivery, child twin and age
first birth were identified as significant factors. The Ministry of Health should work properly to
raise the awareness of parents for vaccination, family planning services and efforts should be
made to improve parental educational level.
Keywords: Under Five Mortality, Ethiopia, Hurdle Negative Binomial, Multilevel.