Trend and factors associated with under-five mortality in Ethiopia further analysis of 2000-2016 Ethiopian demographic and health survey: A Multivariate decomposition analysis


 Background: The under-five mortality rate is the probability that a newborn will die before reaching the age of five years. It is usually expressed as a rate per 1000 live births. Nearly 7 million children worldwide die before their fifth birthdays, with almost all of such death occurring in developing countries Objective: To assess the trend and factors associated with under-five mortality in Ethiopia further analysis of 2000-2016 Ethiopian demographic and health survey: a decomposition analysis Methods: A secondary serial cross-sectional analysis was conducted utilizing data from four rounds of EDHS administered in 2000, 2005, 2011 and 2016. The Ethiopian health and demographic survey in 2000-2016 used a two-stage stratified sampling technique to select a nationally representative sample. In the first stage the total number of enumeration areas was 539 in 2000, 540 in 2005, 624 in 2011 and 645 EAs in 2016 were selected with probability proportional to EA size and with independent selection in each sampling stratum. In the second stage of selection, a fixed number of 28 households per cluster were selected with an equal probability systematic selection from the newly created household listing. Result: Looking at the overall trend, Ethiopia has shown a significant decrease in under-five mortality over the study period from 166 per 1000 births in 2000 to 67 per 1000 birth in 2016 with annual rate of reduction of 3.7%. The trends in under-five mortality showed a variation according to their characteristics. Among home delivery, the largest decrement was observed around 6.5% decrease from 2000 to 2016 and in health facility delivery decreased by 8.3% The decomposition analysis shows that 100.74% of the decrease in under-five mortality was accredited to the difference in the effects of characteristics. Conclusion: Under-five mortality decreased significantly over the last one and a half decades. One of the remarkable findings from the decomposition analysis is the effect of education, place of delivery and maternal age. the government of Ethiopia shall do all daughters will be educated and to build health facilities the whole place of the country Keywords: Under-five mortality decomposition analysis, trend

education, place of delivery and maternal age. the government of Ethiopia shall do all daughters will be educated and to build health facilities the whole place of the country Keywords: Under-five mortality decomposition analysis, trend

Background
The under-five mortality rate is the probability that a newborn will die before reaching the age of five years (1). It is usually expressed as a rate per 1000 live births. Nearly 7 million children worldwide die before their fifth birthdays, with almost all of such death occurring in developing countries (1).
Over the last two decades, the world made substantial progress in reducing mortality among children and young adolescents (including children under age 5, children aged 5 − 9 and young adolescents aged10-14) (2)(3)(4). Till, in 2017 alone, an estimated 6.3 million children and young adolescents died, mostly from preventable causes. Children under age 5accounted for 5.4 million of these deaths. Globally, the majority of child and young adolescent deaths occurred during the earliest ages with 85 percent of the 6.3 million deaths in 2017 occurring in the first five years of life (5). Sub-Saharan Africa continues to be the region with the highest under-five mortality rate in the world 76 deaths per 1,000 live births in 2017 (6). This translates to 1 child in 13 dying before his or her fifth birthday 14 times higher than the average ratio of 1 in 185 in high-income countries and 20 times higher than the ratio of 1 in 263 in the region of Australia and New Zealand (2,3,7,8).
Reducing under-five has long been a global public health priority particularly for developing countries. In 2011 Ethiopia demography and health survey (EDHS) the number of under-five mortality for every 1000 live birth were 88 and in 2016 EDHS the number of under-five mortality for every 1000 live birth were 67 reduced by 31.34% but. However, the rate remains at a very high level compared to the rest of the world(9-12).
Studies on determinants of under-five mortality in Ethiopia identified several proximate health behaviors and child care practice as the driver of under-five mortality (13)(14)(15). Few studies that explore socio determinants of childhood mortality also reported inverse association woman ' s level of education and childhood mortality. However, to our knowledge, there are no studies to date that examine the population composition and covariates influence under-five mortality In this study, we examine the relationship between population composition (endowment) characteristics and under-five mortality. The research adds to the body of knowledge on the pathways through endowment characteristics that may lead to the differential of under-five mortality. Estimates of the under-five mortality rate (U5MR) are used to track progress in reducing child mortality and to evaluate countries' performance related to Millennium Development Goal.
Under-five mortality is caused by easily manageable or preventable diseases such as malaria, measles, pneumonia, diarrheal diseases (or a combination of such diseases)(13). The study was conducted in Ethiopia. Ethiopia is an ancient country with a rich diversity of peoples and cultures and a unique alphabet that has existed for more than 3,000 years.

Study design
The country has always maintained its independence (16).
Ethiopia is situated in the Horn of Africa between 3 and 15 degrees north latitude and 33 and48 degrees east longitude (17). It is a country with great geographical diversity; its topographic features range from the highest peak at RasDashen, which is 4,550 meters

Variables Of The Study
In EDHS under-five mortality was estimated within 5 years preceding surveys. In EDHS there is a question about the year of childbirth, whether the child was alive at the time of the survey and how old the child as if the child has died. Then a child who was born in the 5 years preceding the survey but unfortunately died within the five years of life was classified as under-five mortality and was coded as 0 if the child was alive and 1 if the child has died. The unit of analysis in this study is all live births in the five years preceding the survey.

Socioeconomic Characteristics
The exposure variable was maternal education status. Educational status was assessed based on the highest category of school completed (no education, primary, secondary or higher-level education) on an ordinal scale.
Wealth index, categorized in quintiles to reflect the cumulative living standard of a household in terms of relative wealth, was measured based on "easy to-collect data on a household's ownership of selected assets such as televisions and bicycles; materials used for housing construction, and types of water access and sanitation facilities". Women were categorized into five categories: poorest, poorer, middle, richer, and richest in terms of where their household falls in the distribution of the original sample, place of residence and region.

Demographic Characteristics
Child's sex, mother's age at birth, birth order and previous birth interval

Data Management And Analysis
The data analysis is done using SPSS 20 and STATA 14 statistical packages. In this study decomposition analysis is conducted to find out the determinants of under five-mortality in Ethiopia. This study engaged a descriptive and trend analysis of under-five mortality.
Decomposition of changes in under-five mortality. The trend in under-five mortality was analyzed using descriptive analysis, stratified by region, urban-rural residence, and selected socio-demographic characteristics. The trend was examined separately for the Explained part unexplained part The Explained component refers to the part of the differential due to differences in population composition or endowments. The unexplained component refers to that part of the differential attributable to differences in coefficients or effects. The explanatory part is presented using percentages, tables and a line graph for under-five mortality over the study period.

Result
Characteristics Of The Study Population    The trends in under-five mortality showed a variation according to their characteristics. A significant increment was observed in most of the variables. Among home delivery, the largest decrement was observed around 6.5% decreases from 2000 to 2016 and health facility delivery decreased by 8.3%. In terms of maternal education, among mothers with no educated decreased by 6.9%.
The regional level variation in under-five mortality in Amhara, Tigray, and Addis Ababa was 59.5%, 59% and 59.3% declination over the study period respectively. Those three regions the maximum percentage declination of under-five mortality in Ethiopia (Fig. 1).

Decomposition analysis Decomposition analysis of under-five mortality in Ethiopia
The decomposition analysis shows that the turndown in under-five mortality was due to the change in coefficient but the change due to difference in characteristics was not significant.
The decomposition analysis shows that 100. Ethical clearance was obtained from measure DHS through filling requesting form for accessing data. The data used in this study are publicly available, aggregated secondary data which hasn't any personal identifying information that can be linked to study participants. Confidentiality of data was maintained anonymously.

Consent for publication
Not applicable Availability of data and materials Data is available online and you can access it from www.measuredhs.com.

Competing Interests
Authors declare that they have no conflict of interest