Factors associated with under-5 mortality in three disadvantaged East African districts

BACKGROUND: The high rate of avoidable child mortality in disadvantaged communities in Africa is an important health problem. This article examines factors associated with mortality in children <5 y of age in three disadvantaged East African districts. METHODS: Pooled cross-sectional data on 9270 live singleton births from rural districts in Rwanda (Gicumbi), Uganda (Kitgum) and Tanzania (Kilindi) were analysed using logistic regression generalized linear latent and mixed models to adjust for clustering and sampling weights. Mortality outcomes were neonatal (0–30 d), post-neonatal (1–11 months), infant (0–11 months), child (1–4 y) and under-5 y (0–4 y). RESULTS: The odds of post-neonatal and infant mortality were lower among children delivered by a health professional (adjusted odds ratio [AOR] 0.62 [95% confidence interval {CI} 0.47–0.81] for post-neonatal; AOR 0.60 [95% CI 0.46–0.79] for infant), mothers who had four or more antenatal care (ANC) visits during pregnancy (AOR 0.66 [95% CI 0.51–0.85]) and mothers who initiated breastfeeding within 1 h after birth (AOR 0.60 [95% CI 0.47–0.78]). Neonates not exclusively breastfed had higher mortality (AOR 3.88 [95% CI 1.58–9.52]). Children who lived >6 h away from the nearest health centre (6–23 h: AOR 1.66 [95% CI 1.4–2.0] and ≥24 h: AOR 1.43 [95% CI 1.26–1.72]) reported higher mortality rates in children <5 y of age. CONCLUSIONS: Interventions for reducing deaths in children ≤5 y of age in disadvantaged East African communities should be strengthened to target communities >6 h away from health centres and mothers who received inadequate ANC visits during pregnancy.