Trends and Excess Risk of Place of Delivery for Under-five Mortality in Ethiopia: A Trend Analysis of the Ethiopian Demographic and Health Survey Data from 2000-2019

Abstract

<title>Abstract</title> <bold>Background</bold>The place of delivery plays a crucial role in the survival of neonates. Following the recommendation that giving birth at a health facility is safer than giving birth at home, health facility delivery increased from 26% in 2016 to 48% in 2019. However, neonatal mortality increased from 29 in 2016 to 33 per 1,000 live births in 2019 in Ethiopia. Hence, this study aimed to analyze the trends and disparities in risk differences according to place of delivery for mortality in children under five years of age in Ethiopia.<bold>Methods</bold>This study used five years of nationally representative demographic and health survey data. The Child and Birth Recode data files were accessed as electronic versions in STATA file format. A modified DHS_U5_rates shared code of chap08_CM was used to save the number of deaths and at-risk individuals for the eight age intervals. Then, we calculated the number of deaths, at-risks, and mortality rates for home- and facility-born children using the Stata command “collapse (sum)” for neonates, post-neonates, infants, children, and under-fives. The trends and disparities in mortality according to place of delivery are presented with line graphs and tables. The mortality difference (RD) at the place of delivery with a 95% uncertainty level was calculated using the “<italic>csi”</italic>STATA<italic/>command.<bold>Results</bold>The excess risk difference of 12.7 under five mortality rates [RD=12.66, 95%CI: 3.27, 22.05] in 2016, 7.24 child mortality rate (CMR) [RD=7.24, 95%CI: 1.53, 12.95] in 2019, 14 infant mortality rate (IMR) [RD=13.95, 95%CI: 8.39, 19.52] for all survey years in total, 11 post-natal mortality rate (PNMR) [RD=11.22, 95%CI:6.44, 16] in 2016, and 7 PNMR [RD=7.34, 95%CI: 1.13, 13.56] in 2019 per 1000 live births might be attributable to home birth. However, the negative risk difference of -16.02 neonatal mortality rate (NMR) [RD= -16.02, 95%CI: -29.20, -2.84] in 2011 and -8.51 NMR [RD= -8.51, 95%CI: -16.23, -0.79] in 2016 per 1000 live births might indicate neonates born at home had reduced risk of death than those born at health facility.<bold>Conclusion</bold>The difference in the risk of excess U5MR, CMR, IMR, and PNMR per 1000 live births among children born at home might be attributed to their home delivery. These excess deaths would have been prevented if children born at home had the same risk of death as children born at health facilities. However, the difference in the risk of bias associated with NMR might indicate that neonates born at home have a lower risk of death than neonates born at health facilities; this possibility requires further investigation with contextual characteristics as well as access to emergency neonatal health care services.