Under-five mortality in Sierra Leone and possible associated factors: evidence from the 2019 Demographic and Health Survey

Abstract

High under-five mortality rate remains one of the public health challenges, especially in Sub-Saharan Africa, accounting for more than half of all global cases. Sierra Leone was and is still one of the countries with the highest under-five mortality rate. Using the latest 2019 Sierra Leone Demographic and Health Survey data, we investigated factors associated with under-five mortality in Sierra Leone. A total of 9771 mothers aged 15-49 years in the country were interviewed and included in the analysis. The dependent variable is child status (dead = 1; alive = 0). A total of 871 (9%) children died before their fifth birthday. The maternal age of 20-24 years [adjusted odds ratios (AOR) = 0.46; 95% confidence interval (CI) = 0.33-0.64; P < 0.001] up to 40-44 years (AOR = 0.43; CI = 0.27-0.7; P = 0.001), currently breastfeeding (AOR = 0.20; CI = 0.17-0.24; P < 0.001), maternal media exposure and usage of reading newspapers/magazines less than once a week (AOR = 0.48; CI = 0.28-0.85; P = 0.011) were more likely to enhance child survivability through their fifth birthday. Also, the child sex being female (AOR = 0.68; CI = 0.59-0.79) was more likely to survive under-five mortality compared to their male counterpart. On the other hand, mothers who listened to radio at least once a week (AOR = 1.31; CI = 1.08-1.59; P = 0.007) watched television less than once a week (AOR = 1.48; CI = 1.16-1.90), had two (AOR = 3.4, CI = 2.78-4.16; P < 0.001) or three and above birth (AOR = 8.11; CI = 6.07-10.83; P < 0.001) in five years, had multiple birth children (AOR = 1.41; CI = 1.08-1.86) and very small-sized child at birth (AOR= 1.95; CI = 1.41-2.70) were more likely to lose their children below the age of 5 years. The factors contributing to under-five mortality in Sierra Leone are critical to ensuring child survival and improving maternal health. Breastfeeding, maternal age, media exposure, child's sex, multiple birth type, very small-sized child and the total number of births in 5 years were significant drivers of under-five mortality. The result affirms the need for attention to be focused on enhancing the survival rate of under-five children in Sierra Leone.

Keywords: Sierra Leone; Sub-Saharan Africa; Under-five mortality; breastfeeding; infant mortality; maternal health.