Gender Disparities and Excess Risks of place of delivery for neonatal, postnatal and Child Mortality in Ethiopia: A comparative trend analysis

Abstract Males may be biologically disadvantaged compared with females starting at birth. However, literature reported in fewer countries showed gender disparities in child mortality. On average, boys are expected to have a higher probability of dying before reaching age 5 than girls. On the other hand, it was reported that a gender differential exists in the effect on child mortality with 35% excess girl child mortality. We investigated the trends of gender disparities and its excess risk effect on neonatal, postnatal and child mortality by place of delivery in Ethiopia. This study followed a time-series type of cross-sectional study. The study used the five nationally representative Ethiopian Demographic and Health Surveys data (EDHS 2000, 2005, 2011, 2016 and 2019). The Child and Birth recode data files were accessed as electronic version of STATA file format. The trends and mortality disparities of gender for neonates, post-neonates and children by place of delivery were presented with tables. The sex-age stratified mortality risk difference (RD) of place of delivery with 95% confidence level was calculated using the “csi” STATA command. In addition, we estimated the Population Attributable Risk (PAR) and the Population Attributable Fraction (PAF) of place of delivery using the regpar and punaf STATA commands, respectively. Finally, multiple variable binomial regression analysis was conducted to identify the independent excess risk effect of child sex adjusted for mothers’ educational status, ANC visit, time of breastfeeding initiation and survey year by place of delivery. Among those who got birth at health facility, male child had 0.626 [Adj.RD = 0.000626, 95%CI:-0.000791, 0.00204], male post-neonate had 2.15 [Adj.RD = 0.00215, 95%CI: 0.0000228, 0.00428] and male neonate had 68.5 [Adj.RD = 0.0685, 95%CI: 0.0576, 0.0795] excess risk of mortality per 1000LB compared to female counterparts. Of those who got birth at home, the excess risk of male child, postnatal and neonatal mortalities were 0.445 [Adj.RD = 0.000445, 95%CI: -0.00179–0.00268], 6.62 [Adj.RD = 0.00662, 95%CI: 0.00398–0.00926] and 21.3 [Adj.RD = 0.0213, 95%CI: 0.0181, 0.0245] per 1000LB compared to females, respectively.The male neonates, post-neonates and children had excess risk of mortality compared to female neonates, post-neonates and children irrespective of place of delivery. The magnitude and significance of the excess risk of mortality of males had a declining trend as the age of new-borns increased from neonate to post-neonate and to child age irrespective of place of birth. A gender based care programmatic approaches ranging from time of foetus sex determination to infancy period and investigations of sex-chromosome linked risk factors with genetics study on new-borns are recommended.