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The Butajira project in Ethiopia: a nested case-referent study of under-five mortality and its public health
D Shamebo1, A Sandström, L Muhe
1Department of Community Health, Faculty of Medicine, Addis Ababa University, Ethiopia.
Insights
Parental factors like illiteracy significantly increase under-five mortality, especially infant deaths from acute respiratory infections (ARI). Environmental conditions also play a role, but parental characteristics are more impactful.
Area of Science:
- Child Health
- Epidemiology
- Public Health
Background:
- Child mortality remains a significant global health challenge, particularly in developing regions.
- Understanding the determinants of under-five mortality is crucial for effective intervention strategies.
Purpose of the Study:
- To investigate the association between parental and environmental factors and under-five mortality.
- To assess the relative importance of these factors in causing child deaths.
Main Methods:
- A concurrent case-referent study was conducted with 306 child deaths and 612 matched live referents.
- Data were collected via verbal autopsy by lay reporters.
- Conditional multiple logistic regression analysis was used to assess associations.
Main Results:
- Under-five mortality was linked to paternal illiteracy, maternal ethnicity, and lack of community involvement.
- Parental factors had a greater impact on infant mortality, especially from acute respiratory infections (ARI).
- Housing quality, indicated by the presence of windows, was also associated with mortality.
Conclusions:
- Parental characteristics are more significant contributors to under-five deaths than environmental factors.
- Interventions targeting parental education and socioeconomic status may reduce child mortality, particularly among infants.
Abstract:
During one year of follow-up, 306 deaths of children under the age of 5 years were included in a concurrent case-referent study that was based on a population estimated at 28,780 in 1987. A total of 612 live referents, matched for age, sex and study area, were also selected from the study population through density sampling. Data were collected by lay reporters by verbal autopsy. For the study period the estimated cumulative under-five mortality rate was 293 and the infant (0-11 months old) mortality rate was 136 per 1000. Major probable causes of death were diarrhoeal disease or acute respiratory infections (ARI). The relative importance of parental and environmental characteristics was assessed using conditional multiple logistic regression analysis. Under-five mortality was associated with paternal illiteracy, maternal ethnicity, and not being in the committee of people's organizations. Parental factors affected the infants relatively more than they did the children, especially with regard to ARI mortality. This was also noted with "absence of window", a proxy measure for evaluating the type of housing. In terms of etiological fractions a greater number of under-five deaths could be ascribed to parental than environmental conditions, with relatively more infants being affected than children.