Respondents background characteristics
In all, a total of 20,990 women were used for the analysis. In terms of migration status, as high as 90% of the women had ever migrated, while 10% had never migrated outside the study area. For duration of migration, about 19.0 percent of the women migrated and stayed for less than six months before returning to the study area. Those who moved out for 6–11 months constitute 14 percent, while those who returned after being away for at least a year were about 57 percent (Table 1). Of the total number of 20,990 women studied, 8.8 percent lost at least a child who was less than five years.
The highest proportion of 23.8 percent of the women gave birth to their children while within age 25–29 years. The smallest proportion of the study participants was in the age group 45 + years, who constituted only 3.0 percent. About 11.0 percent of the births occurred among women within the age group 15–19 years. Also, it is observed that more than half (57.1%) of the women in this analysis have never attended school. About 25.5 percent of them have education up to primary school, while 11.8 percent have junior or middle school education. Only 5.6 percent of the women have attained education at secondary school level and beyond.
In terms of household socio-economic status (SES) or characteristics, about 22.0% of the women were found in the poorest households, while those from the poorer households represented 19.0 percent of the total study participants, with 30.6 percent of them living in poor households. Only about 11.0 percent of the women were in the less poor households while the least poor (“richest”) households constituted 3,563 (17.0%) of the study population.
The distribution of women by place of birth of their children shows that 45.6 percent of the women delivered their children in a health facility, with almost 28 percent delivering at their respective homes. About 26.5 percent of them delivered at other places other than a health facility or their own homes. These other places of delivery include traditional healers' homes, traditional birth attendants (TBA) homes, marketplaces, and on the way to certain destinations.
As noted elsewhere, birth order has been found to impact the child's overall development and survival. In the analysis, 23.4 percent of the children of the women are first-order births, while second and fourth-order births constitute 37.8 percent. Children of birth order of five and higher form 38.8 percent (Table 1). Among the study population, about 2.2 percent of them had their children born as multiple births (2 or more babies from a single pregnancy). Also, about 44 percent of women had mothers-in-law (grandmothers to their children) in their respective households.
Table 1
Background characteristics of the study population
Variable | Number | Percent | | Variable | Number | Percent |
Migration status Non-migrants Migrants | 2,108 18,882 | 10.0 90.0 | | Presence of Mother-in-law No Yes | 11,725 9,265 | 55.9 44.1 |
Mothers migration Duration Non-migrants Less than 6 months Between 6–11 months At least 12 months | 2,108 3,973 2,937 11,972 | 10.0 18.9 14.0 57.1 | | Maternal Education No education Primary JHS/Middle SHS+ | 11,975 5,342 2,487 1,186 | 57.1 25.5 11.8 5.6 |
Child Survival Alive Dead | 19,136 1,854 | 91.2 8.8 | | Multiple births No Yes | 20,528 462 | 97.8 2.2 |
Household SES Poorest Poorer Poor Less poor Least poor | 4,665 3,993 6,415 2,354 3,563 | 22.2 19.0 30.6 11.2 17.0 | | Mother's Age at birth 15–19 20–24 25–29 30–34 35–39 40–44 45+ | 2,247 4,730 4,995 4,021 2,802 1,562 633 | 10.7 22.5 23.8 19.2 13.4 7.4 3.0 |
Place of birth Health facility Own Home Other | 9,575 5,850 5,565 | 45.6 27.9 26.5 | | Birth order 1 2–4 5+ | 4,902 7,936 8,152 | 23.4 37.8 38.8 |
Source: Generated from the HDSS database
There is also a statistically significant association between household SES and under-five deaths, with children of mothers in households of higher SES being associated with lower proportions of deaths compared to others with lower SES. For instance, 10.4 percent of children of women from the poorest households died before the age of five years, while women in the poorer households had about 9.4 percent of their children dying before reaching age five. Again, 8.7 percent and 8.5 percent of children of women in poor and less poor households, respectively, died before celebrating their fifth birthday while the proportion of under-five deaths (6.6%) among women in the least poor (richest) households was the lowest.
The results further indicate that maternal education is inversely associated with under-five deaths as the proportion of deaths decreases with higher education, ranging from mothers with no education (11.0%) as the highest, to others with SHS and above (4.3%) level, the lowest. Nonetheless, the proportion of deaths of children among women with primary school education (6.1%) is about the same as others with JHS/Middle school education (6.2%).
The bivariate results also revealed a statistically significant association between under-five mortality and mothers’ age at birth of child. The expected U-shape pattern also emerged from this association as children of younger and older mothers experienced higher under-five deaths compared with children of mothers in the middle childbearing ages. For instance, 9.6 percent of children whose mothers were aged 15–19 years died, while 8.3 percent of children of mothers who were 20–24 years died before reaching age five years. The lowest proportion (6.7%) of under-five deaths was associated with children whose mothers were 25–29 years old. The proportions increased thereafter to almost 13 percent for children whose mothers were 44–49 years old at the time of birth.
The place where a woman delivers a baby is an important determinant of child survival. This was found to be significantly associated with under-five mortality. As expected, mothers who delivered their children at health facilities had 5.6 percent of their children dying before attaining the age of five years, while those who delivered their children at their own homes had 9.2 percent of their children dying before age five. Those women who delivered their children elsewhere apart from the health facility or their own homes recorded the highest proportion (14.0%) of their children dying before celebrating their fifth birthday.
By the birth order of child, first-order births were associated with 8.5 percent of deaths before age five compared to 7.1 percent for children of birth order 2–4 while children of birth order five or higher recorded the highest proportion of deaths (10.7%). These results exhibit a U-shape relationship between birth order and child deaths, which is consistent with findings from other studies (30–32).
Deaths of children associated with multiple births also showed a higher proportion of under-five deaths (11.5%) when compared with singleton births (8.8%). Also, children with grandmothers in their households had a lower proportion (6.9%) of deaths compared with 10.4% for children without grandmothers. This results conforms with the grandmother hypothesis, where children tend to benefit from the presence of older women in the household (33, 34), as shown in Table 2.
In the multivariate analysis, two models were run; the first model (Model 1) considered the gross effect of maternal migration on under-five mortality. The second model (Model 2) examined the above relationship but adjusted for the moderating effects of household and other socioeconomic variables that included household SES, place of delivery of child, mother’s education, and presence or absence of grandmother.
Table 3
Results of the Regression Analysis on the association between child survival and predictor variables
| Model 1-Unadjusted | Model 2-Adjusted for all variables. |
Variable | Hazard Ratio | [95% CI] | Hazard Ratio | [95% CI] |
Migration status Non-migrants Migrants | - 0.473** | - 0.423–0.528 | - 0.513** | - 0.451–0.585 |
Migration duration Non-migrants (RC) < 6 months 6–11 months 12 + months | - 0.489** 0.515** 0.457** | - 0.422–0.565 0.440–0.604 0.407–0.515 | - 0.572** 0.598** 0.545** | - 0.488–0.671 0.504–0.710 0.474–0.626 |
Household SES Poorest (RC) Poorer Poor Less poor Least poor | - 0.909 0.846* 0.832* 0.661** | - 0.795–1.041 0.749–0.956 0.706–0.981 0.566–0.772 | - 0.936 0.919 0.941 0.846* | - 0.818–1.072 0.813–1.038 0.798–1.110 0.721–0.992 |
Mother education No education (RC) Primary JHS/Middle SHS+ | | | - 0.605** 0.662** 0.553** | - 0.533–0.687 0.557–0.787 0.413–0.741 |
Place of birth Health facility (RC) Own Home Other | | | - 1.516** 2.129** | - 1.338–1.717 1.869–2.426 |
Mothers Age 15–19 (RC) 20–24 25–29 30–34 35–39 40–44 45+ | | | - 0.893 0.694** 0.675** 0.680** 0.624** 0.614** | - 0.747–1.068 0.564–0.855 0.536–0.850 0.530–0.872 0.477–0.818 0.447–0.843 |
Birth order 1 (RC) 2–4 5+ | | | - 0.741** 0.687** | - 0.635–0.865 0.562–0.838 |
Multiple births No (RC) Yes | | | - 1.719** | - 1.305–2.265 |
Grandmother presence No (RC) Yes | | | - 0.876* | - 0.784–0.978 |
Generated from regression output. *p-value ≤ 0.05; **p-value ≤ 0.01; RC = Reference Category |
From the results, migration status and their durations are significant predictors of under-five mortality. As shown in Table 3, children whose mothers had ever migrated, irrespective of duration, are 53 percent less likely to die before age five compared with children whose mothers have never migrated (Model 1). When the model is controlled with confounding variables, the survival benefits still prevail, where children of migrant mothers are 49 percent less likely to die before age five compared with their counterparts whose mothers have never migrated (Model 2).
With respect to duration of migration, children of mothers with the longest migration duration of 12 months or more were about 54 percent less likely to die before age five compared with children whose mothers never migrated. However, when other variables are introduced into the model, children of these migrants (12 + months) are 45 percent less likely to die before age five, compared with children of non-migrant mothers. On the other hand, after controlling for other confounding variables, children of women with a migration duration of between six and 11 months were about 40 percent less likely to die before age five compared with children of non-migrant mothers. Similarly, children of mothers with a migration duration of less than six months were about 43 percent less likely to die before age five compared with children of non-migrant mothers, as shown in Model 2.
In terms of household SES, the results show that household SES is associated with under-five mortality, as established at the bivariate stage. However, after adjusting for the effects of confounding variables, only children form the least poor (“Richest”) households have a statistically significant higher chance of survival compared to children from the poorest households. For instance, after model adjustment, children from least poor households were 15 percent less likely to die compared with those from the poorest households.
Maternal education has been found to have a significant effect on child survival. For instance, the results of the multivariate analysis show that children whose mothers had education up to primary level were about 39 percent less likely to die compared with children whose mothers had no education. Similarly, children whose mothers had education up to the junior high (JHS) or middle school level were about 34 percent less likely to die before age five compared with children whose mothers had no education. As expected, the highest survival advantage was associated with children whose mothers had education up to secondary school and beyond, where those children were about 45 percent less likely to die before celebrating their fifth birthday compared with their counterparts whose mothers had no education.
The relationship between under-five mortality and maternal age at birth of a child has been found by several studies to exhibit a U-shape characteristic, with the risk of child death being highest at both ends of the reproductive age spectrum of females (Doctor, 2011; Kayode et al., 2012; Mathews, 2013; Tesema et al, 2021). However, the results of this study exhibit more or less linear relationship, where child survival gets better with increases in mothers’ age. For example, as shown in Model 2 (Table 3), where the model has been controlled for the effects of some confounders, children whose mothers were 25–29 years old, were about 31 percent less likely to die compared with children whose mothers were age 15–19. Children whose mothers were in the age group 30–34 years and 35–39 years, each were 32 percent less likely to die compared with children whose mothers were 15–19 years. Concerning children whose mothers were 40–44 years old, they were 38 percent less likely to die compared with children whose mothers were in the youngest age group. Children whose mothers were in the oldest age group were 39 percent less likely to die compared with children whose mothers were in the age group 15–19 years. This result is in contrast with that observed at the bivariate level, where the pattern exhibited a U-shape.
In terms of place delivery, the results showed that children who were delivered outside a health facility have a higher risk of under-five mortality compared with those born in health facilities (Table 3). For instance, children who were delivered at their respective homes were about 52 percent more likely to die compared with those who were born at a health facility. On the other hand, those who were born elsewhere, other than their own homes were about 2.1 times more likely to die compared with those children who were born at a health facility.
Studies have revealed some association between birth order of a child and under-five mortality. As shown in Model 2 of Table 3, the results of this study have shown that children of birth order 2–4 were about 26 percent less likely to die compared with children of first-order births. On the other hand, children of birth order five and higher were about 31 percent less likely to die compared with children of first-order births. This is based on the intra-household Resource Dilution Hypothesis, where more household members lead to little resources to take care older children (38). On the other hand, some studies have found that children of first order have a higher mortality compared with children of higher order births.
Multiple births have also been found to have high risks of deaths as studies attest to this fact (Hong & Hor, 2013; Yahya et al, 2018; Tesema et al, 2021). The results of this study confirm this assertion, where multiple birth children have about 72 percent higher probability of dying compared with children born singleton. This finding is consistent with the results of the bivariate analysis.
As noted earlier, grandmothers are important kin members whose experience in childcare has been found to contribute positively to child wellbeing and survival. In this study, the effect of the presence of a paternal grandmother in the household on under-five mortality was examined. The results revealed that children with a grandmother present in the household were 12 percent less likely to die compared with children whose households were without a grandmother. This finding is consistent with results from some studies (33, 34, 39), and the pathway through which a grandmother’s presence impacts positively on child survival has been explored.