Zero-inflated Poisson regression analysis of factors associated with under-five mortality in Ethiopia using 2019 Ethiopian mini demographic and health survey data

BACKGROUND: Remarkable reduction in global under-five mortality has been seen over the past two decades. However, Ethiopia is among the five countries which account for about half (49%) of all under-five mortality worldwide. This study aimed at identifying factors associated with under-five children mortality in Ethiopia using the 2019 Ethiopia mini demography and health survey data. METHODS: The most recent national representative demography and health survey data of Ethiopia, 2019 Ethiopia mini demography and health survey data, were used for this study. Count data regression models were applied to identify the factors associated with under-five children mortality. Statistical significance was declared at P-value less than 0.05. RESULTS: Zero-Inflated Poisson (ZIP) regression model was found to be the best model compared to other count regression models based on models comparison Criteria. The ZIP model revealed that decreased risk of under-five mortality was associated with mothers aged 25–34 years, unmarried mothers, mothers delivered in health facility, mothers used Pill/IUD, mothers who had larger number of children at home whereas increased risk of under-five mortality was associated with older mothers at their first births, mothers from rural areas, mothers travel for 1–30 min and >30 min to get drinking water, mothers used charcoal and wood, children with higher birth order and multiple births. CONCLUSIONS: In this study, place of residence, region, place of delivery, religion, age of mother, mother’s age at first birth, marital status, birth order, birth type, current contraceptive type used, type of cooking fuel, time to get drinking water, and number of children at home were statistically significant factors associated with under-five mortality in Ethiopia. Thus, the Ethiopian Ministry of Health and other concerned bodies are recommended to encourage mothers to deliver at health institutions, give awareness for mothers to use Pill/IUD contraceptive type, and facilitate rural areas to have electricity and drinking water near to homes so as to minimize the under-five mortality to achieve the sustainable development goal.