Effect of health extension service on under-five child mortality and determinants of under-five child mortality in Derra district, Oromia regional state, Ethiopia: A cross-sectional study

OBJECTIVES: Under-five child mortality is the highest in Ethiopia even though it decreased steadily in the last two decades. Hence, this study aimed to identify the risk factors and effects of Health Extension Service on under-five child mortality per mother in Derra district, Ethiopia. METHODS: The study used a three-stage sampling technique and a random sample of 446 mothers. Cross-sectional data were collected using a structured interview and analyzed using descriptive and inferential (propensity score and Poisson regression) analysis. RESULTS: One-fourth (23.5%) of mothers experienced at least one under-five child mortality in the last 13 years and the propensity score analysis also indicated that utilizing and model in the Health Extension program reduced under-five child mortality per mother by 29.84% and 15.71%, respectively. The Poisson regression model identified that kebeles, not utilized health extension program (incidence rate ratio 2.25, 95% confidence interval (1.33, 3.85)), not model in health extension program (incidence rate ratio 1.79, 95% confidence interval (1.07, 3.18)), primary educational level (incidence rate ratio 0.14, 95% confidence interval (0.18, 0.91)), mother aged at first birth less than 20 years (incidence rate ratio 1.82, 95% confidence interval (1.90, 3.05)), source of drinking water not pipped (incidence rate ratio 2.36, 95% confidence interval (1.20, 3.18)), and child delivered at home (incidence rate ratio 2.48, 95% confidence interval (1.26, 4.8)) significantly influence under-five child mortality per mother at 5% level of significance. CONCLUSION: Health extension service utilization reduced under-five child mortality per mother, and education level, source of drinking water, place of child delivery, and place of residence (kebele) were significant risk factors for under-five child mortality per mother. The health sectors and district health offices should work on health extension program to increase the community awareness of basic preventive and promotive health services and minimize risk factors of under-five child mortality.