Predictors of mortality among under-five children in rural Ethiopia: a cross sectional study

Abstract Background The under-five children mortality (UFCM) is one of the major significant and sensitive indicators of the health status of the public. Although the world has seen a remarkable and substantial decrease in UFCM since 1990, its progression rate still remains alarmingly high in Sub-Saharan African (SSA) countries, particularly in Ethiopia. Therefore, this study aimed to assess predictors of mortality among under-five children in rural Ethiopia. Methods This study used a secondary data analysis of the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) report. A total of 4,425 under-five children selected at different stages were included in the final analysis. The Kaplan-Meier (K-M) and Cox proportional hazard (PH) model analyses were utilized to estimate survival time and to investigate the major predictors of mortality under-five children, respectively. An Adjusted Hazard Ratio (AHR) along with a 95% Confidence Interval (CI) was employed to measure the impact size and direction of the association. Results The study showed that 6.2% (95% CI: (5.43, 6.86)) of children died beforehand celebrating their fifth birthday in rural Ethiopia. The multivariable Cox PH regression model analysis revealed, predictors of large spacing preceding birth interval (16–26 months) (AHR = 0.61; 95% CI: (0.402–0.920)), 27–38 months (AHR = 0.72; 95% CI: (0.496–1.03)), and ≥ 39 months, multiple births (AHR = 3.9; 95% CI: (2.77–5.62)), being breastfeeding (AHR = 0.13; 95% CI: (0.099–0.162)), and unvaccinated child (AHR = 11.6; 95% CI: (1.62–83.1)) were significant predictors of under-five children mortality. Conclusions Still now, under-five children mortality remains alarmingly high in rural Ethiopia as compared to the global under-five children mortality rate. In the final multivariable Cox PH regression model analysis, birth type, preceding birth interval, vaccination of child, and breastfeeding were significant predictors of under-five children mortality. Additionally, attention should be given to multiple births, unvaccinated and non-breastfeeding children, as well as households’ better encouragement to having a large spacing preceding birth interval.