Abstract
Introduction
Under-five mortality (U5M) is reflected the socioeconomic development and health. Globally, there are about 5.3 million U5M in 2018, in which more than half of the deaths are due to diseases that are preventable and treatable through simple, affordable interventions. In Cambodia, U5M is a significant public health problem with a rate of 35 deaths per 1,000 live births in 2014. Identification of drivers of mortality among children aged below five years is crucially important. Consequently, it could help inform health policymakers and program intervention strategists aimed at achieving the SDGs target of further reducing U5M to less than 25 per 1,000 live births by 2030. The aim of the study is to examine the prevalence of U5M across provinces and to identify the factors associated with U5M.
Methods
The existing CDHS 2014 data were used to analyze the last births aged 0-59 months on 5,880 children. The outcome variable was child survival status (alive or dead). Chi-square test, simple binary logistic, and multivariate logistic regression were performed to identify significant factors
associated with U5M. Analyses were weighted to adjust for the complex study design due to the two-stage stratified cluster sampling design used in CDHS. Adjusted Odds Ratios (AOR) with 95% confidence intervals, and p-value < 0.05 was used as a statistically significant level.
Results
U5M among all last-child births varied greatly from province to province in which Kratie, Preah Vihear/Stung Treng, and Prey Veng were among the provinces with the highest U5M. Our study found that factors associated with increased odds of U5M including children born older aged 35-49 years old (AOR=9.63, 95% CI: 1.48–32.61), low birth weight (<2.5 kg) babies (AOR=4.43, 95% CI: 2.32-7.35), and children born to mothers in rural areas (AOR=2.76, 95% CI: 1.25–6.10). However, children born from the mother’s use of contraceptives remained a protecting factor of U5M (AOR = 0.30, 95% CI: 0.18–0.52). There was no association between U5M and mothers reported attending ANC4 during their last pregnancy, mothers who smoked cigarettes, children’s sex, birth order, household wealth index, and children living in households used improved sanitation.
Conclusions
The U5M was high in most remote provinces. Older mothers’ age, low birth weight babies, and children born to mothers in rural areas had higher risks of U5M, while mothers reported using contraceptives had a positive impact on child survival in Cambodia. Therefore, Cambodia should target more specifically remote provinces and take all the main associated factors into account when designing the maternal and child health program intervention aim at reducing further the U5M.