Determinants of under-five mortality in rural Uganda.

Abstract

Under-five child mortality remains a critical public health challenge in sub-Saharan Africa, with rural Uganda bearing a disproportionate burden. Despite global progress in reducing child deaths, rural Uganda continue to experience high mortality rates driven by complex socio-demographic and healthcare-related factors. Understanding the determinants of under-five mortality in these settings is essential for informing targeted interventions. The data was obtained from the 2016 Uganda Demographic and Health Survey (UDHS). This was population based cross sectional secondary study with a rural sub sample population of 8218 children born. The analysis employed both chi-square tests and multivariate logistic regression to determine the determinants of under-five mortality. The outcome variable was under-five child mortality (child alive: yes/no). Key explanatory variables included breastfeeding status, antenatal care (ANC) visits, birth order, place of delivery, parity, wealth status, and child sex. Survey-weighted descriptive, bivariate, and multivariate logistic regression analyses were performed in Stata, accounting for the complex survey design using probability sampling weights (v005), primary sampling units (v001), and stratification (v023). Among that sample, 3.9 percent of children under five had died (weighted prevalence). The bivariate analysis revealed that maternal age group, parity, birth order, birth weight, breastfeeding status and antenatal care (ANC) attendance were associated with child survival (p<0.05), while maternal education, household wealth, region, place of delivery, distance to a health facility, marital status, and employment status were not. In the multivariate model only breastfeeding status and parity remained independent predictors. Children who were never breastfed had lower odds of surviving than those ever breastfed (AOR =0.037, 95% CI: 0.025-0.054, p<0.001). children born to mothers who had 2–3 children had more than twice the odds of survival (AOR=2.07, 95% CI: 1.37–3.12, p=0.001), than first born children and those of parity 4–5 had 55% higher odds of survival (AOR=1.55, 95% CI: 1.01–2.37, p=0.046). In conclusion, breastfeeding and parity were the main determinants of under-five survival among rural Ugandan children. Therefore, breastfeeding promotion should be strengthened through community and health facility programs. In addition, family planning and maternal health care services should be improved to reduce under-five mortality in rural Uganda.