Under-Five Mortality and Associated Risk Factors in Children Hospitalized at David Bernardino Pediatric Hospital (DBPH), Angola: A Hierarchical Approach
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Type and Location
2.2. Population and Sample
2.3. Procedures and Data Collection Instrument
2.4. Definition and Categorization of Variables
- Family income: average earnings of the family over the preceding three months, categorized by minimum wages (MWs): up to 1.0 MW; 2.0–3.0 MW; 3.01–4.0 MW; >4.0 MW. This was evaluated by the respondent, considering the national minimum wage at the time of data collection, which was equivalent to EUR 35 [19]. For stratified analysis, this information was categorized as ≤1 MW; 2–3 MW; and ≥4 MW.
- Housing condition: A housing score adapted from Ludermir AB [20] was used, considering the components of the residence, to which a score was assigned. Thus, the wall was scored as 1 or 0 depending on whether it was made of brick or other materials; the roof was assigned a score of 1 and 0 (tile/slab and other materials); floor: 2—ceramic/wood, 1—cement, 0—dirt; water supply: 3—public network, 2—fountain, 1—well or spring, 0—other water supply forms; sewage system: 2—public network, 1—septic tank, 0—no sewage system. The arithmetic mean of the sum of each item was calculated, and individuals with a value below the mean were classified as having poor housing conditions; those with a value around the mean (mean ± 1 standard deviation (SD)) as medium, and those above the mean (+1 SD) as having good conditions. This was stratified in the analysis into two categories: not precarious (good and medium) and precarious.
- Household overcrowding: The overcrowding index proposed by Hill et al. [21] was used, considering three categories: 1—no overcrowding: fewer than four people per household and fewer than two people per room; 2—moderate overcrowding: fewer than four people per household and two or more people per room, or four or more people per household but fewer than two per room; 3—intense overcrowding: four or more people per household and at least two per room. For analysis, two categories were considered: no overcrowding and overcrowded (moderate/intense).
- Nutritional status: The weight-for-age anthropometric index was used, calculated at the time of inclusion in the study using the table recommended by the WHO [22]. For analysis, children with nutritional deficits were those who had two z-scores below the median value of the reference population in this index; and those without nutritional deficits were those who had two or more z-scores above the median reference value.
- Maternal education: Number of years of completed education. This was stratified into: level 1 (no formal education and/or unable to read or write, except for own name); level 2 (able to read and write and/or up to six years of schooling); level 3 (seven to 12 years of schooling); level 4 (>12 years of schooling).
- Frequent alcohol use was considered the consumption of at least one alcoholic drink, equivalent to 10 or 12 g of alcohol [23], per week during pregnancy.
- Birth spacing: the minimum interval between the birth of the child under study and the mother’s preceding or subsequent pregnancy, reclassified in accordance with WHO guidelines [24] as: 1. Less than 2 years; 2. 2 years or more.
- Breastfeeding Status: This variable pertains to whether a child is receiving maternal breast milk at the time of data collection. Operationalization divides children into two categories: “Yes” denotes those still breastfeeding at 2 years of age, while “No” signifies those who have ceased breastfeeding by this age.
- Breastfeeding Duration: This variable quantifies the total duration of breastfeeding, including both exclusive and non-exclusive breastfeeding, measured in months. It is operationalized as follows: “≤23 months” for children breastfed for 23 months or less, and “≥24 months” for those breastfed for 24 months or more.
- Number of prenatal visits: According to WHO guidelines [25], which recommend a minimum of four prenatal visits.
2.5. Data Analysis Strategy: Hierarchical Modeling
2.6. Statistical Analysis
- Initial descriptive analysis:
- 2.
- Binary logistic regression analysis, hierarchical method.
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- WHO. Child Mortality (Under 5 Years): WHO. 2022. Available online: https://www.who.int/news-room/fact-sheets/detail/levels-and-trends-in-child-under-5-mortality-in-2020 (accessed on 7 April 2024).
- Yaya, S.; Bishwajit, G.; Okonofua, F.; Uthman, O.A. Under five mortality patterns and associated maternal risk factors in sub-Saharan Africa: A Multi-Country Analysis. PLoS ONE 2018, 13, e0205977. Available online: https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0205977 (accessed on 5 April 2024). [CrossRef]
- Jeffrey DSachs, G.L.; Grayson Fuller Drumm, A.E. Sustainable Development Report 2023; Dublin University Press: Paris, France, 2023; Contract No.: 10.25546/102924. [Google Scholar]
- Van Malderen, C.; Amouzou, A.; Barros, A.J.D.; Masquelier, B.; Van Oyen, H.; Speybroeck, N. Socioeconomic factors contributing to under-five mortality in sub-Saharan Africa: A decomposition analysis. BMC Public Health 2019, 19, 760. [Google Scholar] [CrossRef] [PubMed]
- Shoo, R. Reducing Child Mortality: The Challenges in Africa. UN Chron. 2007. Available online: https://www.researchgate.net/profile/Rumishael-Shoo/publication/265619672_Reducing_Child_Mortality_The_Challenges_in_Africa/links/54cb56470cf2517b7561885b/Reducing-Child-Mortality-The-Challenges-in-Africa.pdf (accessed on 5 November 2023).
- Instituto Nacional de Estatística. Inquérito de Indicadores Múltiplos e de Saúde em Angola 2015–2016. 2017. Available online: https://dhsprogram.com/pubs/pdf/fr327/fr327.pdf (accessed on 25 June 2023).
- Federation, R. Voluntary National Review on the Implementation of the 2030 Agenda for Sustainable Development; Analytical Center under the Government of the Russian Federation: Moscow, Russia, 2020; Available online: https://sustainabledevelopment.un.org/content/documents/286012021_VNR_Report_Angola.pdf (accessed on 10 November 2023).
- Rodrigues, E.C.; Alves, B.D.C.A.; Veiga, G.L.D.; Adami, F.; Carlesso, J.S.; Figueiredo, F.W.D.S.; Azzalis, L.A.; Junqueira, V.B.C.; Fonseca, A.L.A. Neonatal mortality in Luanda, Angola: What can be done to reduce it? J. Hum. Growth Dev. 2019, 29, 161. Available online: https://oa.mg/work/10.7322/jhgd.v29.9415 (accessed on 25 January 2023). [CrossRef]
- e Pinto, E.A.; Alves, J.G. The causes of death of hospitalized children in Angola. Trop. Dr. 2008, 38, 66–67. Available online: https://pubmed.ncbi.nlm.nih.gov/18302879/ (accessed on 5 November 2023). [CrossRef] [PubMed]
- Rosário, E.V.N.; Costa, D.; Timóteo, L.; Rodrigues, A.A.; Varanda, J.; Nery, S.V.; Brito, M. Main causes of death in Dande, Angola: Results from Verbal Autopsies of deaths occurring during 2009–2012. BMC Public Health 2016, 16, 719. Available online: https://pubmed.ncbi.nlm.nih.gov/27491865/ (accessed on 5 November 2023). [CrossRef] [PubMed]
- Crenshaw, K. Demarginalizing the intersection of race and sex: A black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. Droit Société 2021, 108, 465. Available online: https://heinonline.org/HOL/LandingPage?handle=hein.journals/droitsc108&div=17&id=&page= (accessed on 10 July 2024). [CrossRef]
- Marmot, M. Social determinants of health inequalities. Lancet 2005, 365, 1099–1104. Available online: https://pubmed.ncbi.nlm.nih.gov/15781105/ (accessed on 10 July 2024). [CrossRef] [PubMed]
- Krieger, N. Epidemiology and the People’s Health: Theory and Context; Oxford University Press: Oxford, UK, 2011. [Google Scholar] [CrossRef]
- Whitehead, M. The concepts and principles of equity and health. Int. J. Health Serv. Plan. Adm. Eval. 1992, 22, 429–445. Available online: https://pubmed.ncbi.nlm.nih.gov/1644507/ (accessed on 10 July 2024). [CrossRef]
- Mosley, W.H.; Chen, L.C. An analytical framework for the study of child survival in developing countries. 1984. Bull. World Health Organ. 2003, 81, 140–145. Available online: https://pubmed.ncbi.nlm.nih.gov/12756980/ (accessed on 10 November 2023).
- Lima, S.; Carvalho, M.L.; Vasconcelos, A.G. Proposal for a hierarchical framework applied to investigation of risk factors for neonatal mortality. Cad. Saude Publica 2008, 24, 1910–1916. Available online: https://pubmed.ncbi.nlm.nih.gov/18709231/ (accessed on 10 November 2023). [CrossRef]
- Bizzego, A.; Gabrieli, G.; Bornstein, M.H.; Deater-Deckard, K.; Lansford, J.E.; Bradley, R.H.; Costa, M.; Esposito, G. Predictors of Contemporary under-5 Child Mortality in Low- and Middle-Income Countries: A Machine Learning Approach. Int. J. Environ. Res. Public Health 2021, 18, 1315. Available online: https://pubmed.ncbi.nlm.nih.gov/33535688/ (accessed on 10 November 2023). [CrossRef] [PubMed]
- IBGE. Indicadores IBGE; Fundação Instituto Brasileiro de Geografia e Estatística: Rio de Janeiro, Brazil, 1991. [Google Scholar]
- Angola, Presidência da República. Decreto Presidencial n.º 54/22, de 17 de Fevereiro. Estabelece o Valor do Salário Mínimo Nacional Garantido Único; Diário da República: Luanda, Angola, 2022; Available online: https://www.lexlink.eu/FileGet.aspx?FileId=3030559 (accessed on 8 February 2024).
- Ludermir, A.B. Unemployment, informal work, gender and mental health. Cad. Saúde Pública 2000, 16, 647–659. Available online: https://www.scielo.br/j/csp/a/dRHjXhpRbZqMQjHRqnfXBtL/?lang=en (accessed on 24 March 2024). [CrossRef] [PubMed]
- Hill, P.C.; Jackson-Sillah, D.; Donkor, S.A.; Otu, J.; Adegbola, R.A.; Lienhardt, C. Risk factors for pulmonary tuberculosis: A clinic-based case control study in The Gambia. BMC Public Health 2006, 6, 156. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization (WHO). Physical Status: The Use and Interpretation of Anthropometry; Report of a WHO Expert Committee; World Health Organization: Geneva, Switzerland, 1995. Available online: https://www.who.int/health-topics/physical-status-the-use-and-interpretation-of-anthropometry (accessed on 21 March 2024).
- World Health Organization. Self-Help Strategies for Cutting Down or Stopping Substance Use: A Guide 2010. 2010. Available online: https://iris.who.int/handle/10665/44322 (accessed on 11 December 2023).
- World Health Organization. Report of a WHO Technical Consultation on Birth Spacing; World Health Organization: Geneva, Switzerland, 2005. Available online: https://iris.who.int/bitstream/handle/10665/69855/?sequence=1 (accessed on 19 April 2024).
- World Health Organization (WHO). WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience; World Health Organization: Geneva, Switzerland, 2016. Available online: https://iris.who.int/bitstream/handle/10665/250796/9789241549912-eng.pdf (accessed on 14 April 2024).
- Victora, C.G.; Huttly, S.R.; Fuchs, S.C.; Olinto, M.T.A. The role of conceptual frameworks in epidemiological analysis: A hierarchical approach. Int. J. Epidemiol. 1997, 26, 224–227. Available online: https://academic.oup.com/ije/article/26/1/224/668651 (accessed on 4 September 2023). [CrossRef] [PubMed]
- Fuchs, S.C.; Victora, C.G.; Fachel, J. Modelo hierarquizado: Uma proposta de modelagem aplicada à investigação de fatores de risco para diarréia grave. Rev. Saúde Pública 1996, 30, 168–178. Available online: https://www.scielo.br/j/rsp/a/hP6yDbh7HWXmLymbyvScBMw/?lang=pt&format=html (accessed on 4 September 2023). [CrossRef] [PubMed]
- Greenland, S. Modeling and variable selection in epidemiologic analysis. Am. J. Public Health 1989, 79, 340–349. Available online: https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.79.3.340 (accessed on 4 September 2023). [CrossRef] [PubMed]
- Simão, R.; Gallo, P.R. Mortes infantis em Cabinda, Angola: Desafio para as políticas públicas de saúde. Rev. Bras. Epidemiol. 2013, 16, 826–837. Available online: https://www.scielo.br/j/rbepid/a/wGTtzSgJPvqXBqJjtm5kD4c/?lang=pt (accessed on 3 September 2023). [CrossRef] [PubMed]
- Tette, E.M.; Nyarko, M.Y.; Nartey, E.T.; Neizer, M.L.; Egbefome, A.; Akosa, F.; Biritwum, R.B. Under-five mortality pattern and associated risk factors: A case-control study at the Princess Marie Louise Children’s Hospital in Accra, Ghana. BMC Pediatr. 2016, 16, 148. Available online: https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-016-0682-y (accessed on 4 September 2023). [CrossRef] [PubMed]
- Mutombo, A.M.; Mukuku, O.; Tshibanda, K.N.; Swana, E.K.; Mukomena, E.; Ngwej, D.T.; Luboya, O.N.; Kakoma, J.-B.; Wembonyama, S.O.; Van Geertruyden, J.-P.; et al. Severe malaria and death risk factors among children under 5 years at Jason Sendwe Hospital in Democratic Republic of Congo. Pan. Afr. Med. J. 2018, 29, 184. Available online: https://www.panafricanmedicaljournal.com/index.php/pamj/article/view/1435 (accessed on 11 May 2024). [CrossRef] [PubMed]
- Tesema, G.A.; Seifu, B.L.; Tessema, Z.T.; Worku, M.G.; Teshale, A.B. Incidence of infant mortality and its predictors in East Africa using Gompertz gamma shared frailty model. Arch. Public Health 2022, 80, 195. Available online: https://archpublichealth.biomedcentral.com/articles/10.1186/s13690-022-00955-7 (accessed on 5 September 2023). [CrossRef]
- Kiross, G.T.; Chojenta, C.; Barker, D.; Tiruye, T.Y.; Loxton, D. The effect of maternal education on infant mortality in Ethiopia: A systematic review and meta-analysis. PLoS ONE 2019, 14, e0220076. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6663004/ (accessed on 11 May 2024). [CrossRef]
- Ezeh, O.K.; Agho, K.E.; Dibley, M.J.; Hall, J.J.; Page, A.N. Risk factors for postneonatal, infant, child and under-5 mortality in Nigeria: A pooled cross-sectional analysis. BMJ Open 2015, 5, e006779. Available online: https://bmjopen.bmj.com/content/bmjopen/5/3/e006779.full.pdf (accessed on 5 September 2023). [CrossRef]
- Yaya, S.; Ahinkorah, B.O.; Ameyaw, E.K.; Seidu, A.-A.; Darteh, E.K.M.; Adjei, N.K. Proximate and socio-economic determinants of under-five mortality in Benin, 2017/2018. BMJ Glob. Health 2020, 5, e002761. Available online: https://gh.bmj.com/content/5/8/e002761.abstract (accessed on 5 September 2023). [CrossRef]
- Kuate-Defo, B.; Kuate-Defo, L.; Kuate-Defo, A.; Kuate-Defo, T. Proximate, intermediate, and distal predictors of under-five mortality in Chad: Analysis of the 2014–2015 Chad demographic and health survey data. BMC Public Health 2020, 20, 1873. Available online: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09869-x (accessed on 6 December 2023).
- Bohland, A.K.; Gonçalves, A.R. Mortalidade atribuível ao consumo de bebidas alcoólicas. SMAD Rev. Electrónica Salud Ment. Alcohol Drog. 2015, 11, 136–144. Available online: https://www.redalyc.org/pdf/803/80342807004.pdf (accessed on 6 December 2023). [CrossRef]
- Grinfeld, H. Consumo nocivo de álcool durante a gravidez. Álcool Suas Consequências Uma Abordagem Multiconceitual São Paulo Manole 2009, 8, 179–199. Available online: https://www.saudedireta.com.br/docsupload/1333063336alcoolesuasconsequencias-pt-cap9.pdf (accessed on 6 December 2023).
- Ahumada, L.A.; Anunziata, F.; Molina, J.C. Alcohol consumption during pregnancy. Arch. Argent. Pediatr. 2021, 119, 6–8. Available online: https://pubmed.ncbi.nlm.nih.gov/33458973/ (accessed on 8 September 2023).
- Pinto, E. Perfil Epidemiológico, Clínico e Fatores Associados ao Óbito em Crianças Internadas no Hospital Pediátrico de Referência de Angola: Um Estudo Transversal. Ph.D. Thesis, Instituto Materno Infantil Professor Fernando Figueira, Recife, Brazil, 2005. [Google Scholar]
- Sharaf, M.F.; Rashad, A.S. Socioeconomic inequalities in infant mortality in Egypt: Analyzing trends between 1995 and 2014. Soc. Indic. Res. 2018, 137, 1185–1199. Available online: https://link.springer.com/article/10.1007/s11205-017-1631-3 (accessed on 18 March 2023). [CrossRef]
- Molitoris, J.; Barclay, K.; Kolk, M. When and where birth spacing matters for child survival: An international comparison using the DHS. Demography 2019, 56, 1349–1370. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667399/ (accessed on 5 September 2023). [CrossRef]
- Greenberg, J.A.; Bell, S.J.; Guan, Y.; Yu, Y.-H. Folic acid supplementation and pregnancy: More than just neural tube defect prevention. Rev. Obstet. Gynecol. 2011, 4, 52. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218540/ (accessed on 6 September 2023).
- Garenne, M.; Aaby, P. Pattern of exposure and measles mortality in Senegal. J. Infect. Dis. 1990, 161, 1088–1094. Available online: https://academic.oup.com/jid/article-abstract/161/6/1088/905326?login=false (accessed on 6 September 2023). [CrossRef] [PubMed]
- Molitoris, J. Breastfeeding during pregnancy and its association with childhood malnutrition and pregnancy loss in low-and middle-income countries. Lund Pap. Econ. Demogr. 2018, 3, 1–81. Available online: https://www.ed.lu.se/media/ed/papers/working_papers/LPED%202018%203.pdf (accessed on 6 September 2023).
- dos Santos, I.X.P.; Curado, A.d.F.F.; Freire, A.R.R.S.; de Oliveira Martins, B.A.; Barros, R.M.; de Macedo Wehbe, M.A. Benefícios do Aleitamento Materno Exclusivo Durante os Primeiros Meses de vida do Recém-Nascido. 2022. Available online: https://cdn.publisher.gn1.link/residenciapediatrica.com.br/pdf/v12n4aop773.pdf (accessed on 19 April 2024).
- Lima, V.F.D. A Importância do Aleitamento Materno: Uma Revisão de Literatura; Universidade Federal da Paraíba: João Pessoa, Brazil, 2017. [Google Scholar]
- Rollins, N.C.; Lutter, C.K.; Bhandari, N.; Hajeebhoy, N.; Horton, S.; Martines, J.C.; Piwoz, E.G.; Richter, L.M.; Victora, C.G. Por que investir e o que será necessário para melhorar as práticas de amamentação. Epidemiol. Serv. Saúde 2016, 387, 25–44. Available online: https://maternidadesemneura.com.br/wp-content/uploads/2017/11/investimento.pdf (accessed on 19 April 2024).
- Victora, C.G.; Bahl, R.; Barros, A.J.D.; Franca, G.V.A.; Horton, S.; Krasevec, J.; Murch, S.; Sankar, M.J.; Walker, N.; Rollins, N.C.; et al. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet 2016, 387, 475–490. [Google Scholar] [CrossRef]
- Gibbs, C.M.; Wendt, A.; Peters, S.; Hogue, C.J. The impact of early age at first childbirth on maternal and infant health. Paediatr. Perinat. Epidemiol. 2012, 26 (Suppl. 1), 259–284. Available online: https://pubmed.ncbi.nlm.nih.gov/22742614/ (accessed on 29 January 2023). [CrossRef]
- Finlay, J.E.; Özaltin, E.; Canning, D. The association of maternal age with infant mortality, child anthropometric failure, diarrhoea and anaemia for first births: Evidence from 55 low- and middle-income countries. BMJ Open 2011, 1, e000226. Available online: https://bmjopen.bmj.com/content/1/2/e000226 (accessed on 29 January 2023). [CrossRef] [PubMed]
- Sinha, S.; Aggarwal, A.R.; Osmond, C.; Fall, C.H.; Bhargava, S.K.; Sachdev, H.S. Maternal age at childbirth and perinatal and under-five mortality in a prospective birth cohort from Delhi. Indian Pediatr. 2016, 53, 871–877. Available online: https://link.springer.com/article/10.1007/s13312-016-0950-9 (accessed on 29 January 2023). [CrossRef]
- Cavazos-Rehg, P.A.; Krauss, M.J.; Spitznagel, E.L.; Bommarito, K.; Madden, T.; Olsen, M.A.; Subramaniam, H.; Peipert, J.F.; Bierut, L.J. Maternal age and risk of labor and delivery complications. Matern. Child Health J. 2015, 19, 1202–1211. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418963/ (accessed on 29 January 2023). [CrossRef]
- Lima, L.C.d. Idade materna e mortalidade infantil: Efeitos nulos, biológicos ou socioeconômicos? Rev. Bras. Estud. Popul. 2010, 27, 211–226. Available online: https://pesquisa.bvsalud.org/portal/resource/pt/ens-26351 (accessed on 21 April 2024). [CrossRef]
- Chirwa, G.C.; Mazalale, J.; Likupe, G.; Nkhoma, D.; Chiwaula, L.; Chintsanya, J. An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi. PLoS ONE 2019, 14, e0225374. Available online: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225374 (accessed on 12 January 2024). [CrossRef]
- Atuyambe, L.; Mirembe, F.; Tumwesigye, N.M.; Annika, J.; Kirumira, E.K.; Faxelid, E. Adolescent and adult first time mothers’ health seeking practices during pregnancy and early motherhood in Wakiso district, central Uganda. Reprod. Health 2008, 5, 13. Available online: https://www.ajol.info/index.php/pamj/article/view/176605 (accessed on 8 September 2023). [CrossRef] [PubMed]
- Fall, C.H.D.; Sachdev, H.S.; Osmond, C.; Restrepo-Mendez, M.C.; Victora, C.; Martorell, R.; Stein, A.D.; Sinha, S.; Tandon, N.; Adair, L.; et al. Association between maternal age at childbirth and child and adult outcomes in the offspring: A prospective study in five low-income and middle-income countries (COHORTS collaboration). Lancet Glob. Health 2015, 3, e366–e377. Available online: https://pubmed.ncbi.nlm.nih.gov/25999096/ (accessed on 7 December 2023). [CrossRef] [PubMed]
ICD-10 | Diagnosis | Discharge Status | Total | ||||
---|---|---|---|---|---|---|---|
Control | Case | ||||||
No | % | No | % | No | % | ||
R10.0 | Acute abdomen | 5 | 0.7 | 5 | 1.5 | 10 | 1.0 |
D64.9 | Severe anemia | 23 | 3.4 | 21 | 6.2 | 44 | 4.3 |
Q20–Q26 | Congenital heart disease | 20 | 2.9 | 10 | 2.9 | 30 | 2.9 |
E43 | Severe unspecified protein-energy malnutrition | 137 | 20.1 | 50 | 14.7 | 187 | 18.3 |
A09 | Diarrhea and Presumed Infectious Gastroenteritis | 53 | 7.8 | 32 | 9.4 | 85 | 8.3 |
G00-G09 | Inflammatory diseases of the central nervous system | 22 | 3.2 | 26 | 7.6 | 48 | 4.7 |
J00–J99 | Acute Respiratory Infections | 215 | 31.6 | 62 | 18.2 | 277 | 27.2 |
D57 | Sickle cell disease | 20 | 2.9 | 9 | 2.6 | 29 | 2.8 |
K92.2 | Upper gastrointestinal bleeding | 2 | 0.3 | 4 | 1.2 | 6 | 0.6 |
G91 | Hydrocephalus | 19 | 2.8 | 5 | 1.5 | 24 | 2.4 |
L08.9 | Localized infection of skin and subcutaneous tissue | 13 | 1.9 | 2 | 0.6 | 15 | 1.5 |
T18 | Foreign body ingestion | 8 | 1.2 | - | - | 8 | 0.8 |
B50.8 | Unspecified malaria by Plasmodium falciparum | 104 | 15.3 | 74 | 21.8 | 178 | 17.5 |
Q44 | Congenital malformations of the gallbladder, bile ducts, and other unspecified liver diseases | 1 | 0.1 | 4 | 1.2 | 5 | 0.5 |
C80 | Malignant neoplasm, unspecified site | 3 | 0.4 | - | - | 3 | 0.3 |
P20-P29;M069;E10;A35;G81.0;B05;K40; I27 | Others: Hypoxia, Arthritis, Diabetes, Tetanus, Non-specific flaccid paralysis, AIDS, Measles, Hernia, and Pulmonary Hypertension | 15 | 2.2 | 10 | 2.9 | 25 | 2.5 |
P07 | Prematurity | - | - | 6 | 1.8 | 6 | 0.6 |
A41.9 | Unspecified sepsis | 7 | 1.0 | 13 | 3.8 | 20 | 2.0 |
S00–S09 | Injuries to the head | 13 | 1.9 | 7 | 2.1 | 20 | 2.0 |
Total | 680 | 100.0 | 340 | 100.0 | 1020 | 100.0 |
Level 1 | Case: n (%) | Control: n (%) | OR (CI 95%) |
---|---|---|---|
Maternal education | |||
No schooling | 97 (44.7) | 120 (55.3) | 10.1 (4.5–22.8) |
≤6 years | 157 (38.2) | 254 (61.8) | 7.7 (3.5–17.1) |
7–12 years | 79 (27.5) | 208 (72.5) | 4.7 (2.1–10.6) |
>12 years | 7 (7.4) | 87 (92.6) | 1.0 |
Maternal marital status | |||
Single | 158 (37.4) | 264 (62.6) | 1.4 (1.1–1.8) |
With partner | 182 (30.4) | 416 (69.6) | 1.00 |
Housing conditions | |||
Precarious | 136 (35.5) | 247 (64.5) | 1.2 (0.9–1.5) |
Non-precarious | 204 (32.0) | 433 (68.0) | 1.00 |
Family income | |||
Unknown | 493 (66.5) | 248 (33.5) | 2.2 (1.4–3.6) |
≤1 MW | 20 (62.5) | 12 (37.5) | 1.7 (0.7–3.9) |
1.01–3 MW | 107 (66.0) | 55 (34.0) | 2.1 (1.3–3.7) |
≥3.01 MW | 60 (70.6) | 25 (29.4) | 1.00 |
Intra-household crowding | |||
Moderate to intense crowding | 701 (74.7) | 237 (25.3) | 2.1 (1.3–3.3) |
No crowding | 48 (58.5) | 34 (41.5) | 1.00 |
Caregiver’s integration into the workforce | |||
Unemployed | 137 (30.6) | 311 (69.4) | 0.8 (0.6–1.0) |
Not unemployed | 203 (35.5) | 369 (64.5) | 1.00 |
Household waste collection and treatment | |||
Inappropriate | 180 (30.3) | 415 (69.7) | 0.7 (0.6–0.9) |
Appropriate | 160 (37.6) | 265 (62.4) | 1.00 |
Source of drinking water | |||
Not appropriate | 324 (34.5) | 614 (65.5) | 2.2 (1.2–3.8) |
Appropriate | 16 (19.5) | 66 (80.5) | 1.00 |
Level 2 | Cases: n (%) | Controls: n (%) | OR (CI 95%) |
---|---|---|---|
Parity | |||
≥3 | 151 (33.1) | 305 (66.9) | 1.0 (0.8–1.3) |
≤2 | 189 (33.5) | 375 (66.5) | 1.00 |
Alcohol consumption during pregnancy | |||
Yes | 222 (48.5) | 236 (51.5) | 3.5 (2.7–4.7) |
No | 118 (21.0) | 444 (79.0) | 1.00 |
Number of prenatal visits | |||
≤3 | 219 (33.7) | 430 (66.3) | 1.1 (0.8–1.4) |
≥4 | 121 (32.6) | 250 (67.4) | 1.00 |
Type of delivery | |||
Cesarean | 13 (19.1) | 55 (80.9) | 0.5 (0.2–0.8) |
Vaginal | 327 (34.3) | 625 (65.7) | 1.00 |
Place of delivery | |||
Non-Hospital | 106 (38.0) | 173 (62.0) | 1.3 (1.0–1.8) |
Hospital | 234 (31.6) | 507 (68.4) | 1.00 |
Length of hospital stay: | |||
≤24 h | 70 (76.1) | 22 (23.9) | 7.8 (4.7–12.8) |
>24 h | 270 (29.1) | 658 (70.9) | 1.00 |
Nutritional status | |||
With nutritional deficit | 202 (39.1) | 314 (60.9) | 1.7 (1.3–2.2) |
No nutritional deficit | 138 (27.4) | 366 (72.6) | 1.00 |
Vaccination schedule | |||
Incomplete for age | 88 (39.5) | 135 (60.5) | 1.4 (1.0–1.9) |
Complete for age | 252 (31.6) | 545 (68.4) | 1.00 |
Birth Spacing * | |||
<24 months | 113 (39.9) | 170 (60.1) | 2.0 (1.4–2.8) |
≥24 months | 85 (25.2) | 252 (74.8) | 1.00 |
Breastfeeding status at 2 years of age | |||
No | 42 (37.7) | 79 (65.3) | 0.3 (0.2–0.4) |
Yes | 375 (67.0) | 185 (33.0) | 1.00 |
Breastfeeding duration ** | |||
≤23 months | 112 (36.4) | 196 (63.6) | 1.5 (1.0–2.2) |
≥24 months | 53 (27.3) | 141 (72.7) | 1.00 |
Level 3 | Case: n (%) | Control: n (%) | OR (CI95%) |
---|---|---|---|
Gender | |||
Male | 190 (33.3) | 380 (66.7) | 1.0 (0.8–1.3) |
Female | 150 (33.7) | 300 (66.7) | 1.00 |
Child’s age | |||
≤12 months | 152 (33.3) | 305 (66.7) | 1.0 (0.8–1.3) |
>12 months | 188 (33.4) | 375 (66.6) | 1.00 |
Maternal age at delivery | |||
10–19 Years | 142 (46.0) | 167 (54.0) | 2.5 (1.9–3.4) |
20–34 Years | 152 (25.3) | 449 (74.7) | 1.00 |
≥35 Years | 46 (41.8) | 64 (58.2) | 2.1 (1.4–3.2) |
Factors | Β | S.E | Wald | Df | Sig. | OR (CI 95%) |
---|---|---|---|---|---|---|
Caregiver’s occupation (unemployed) | −0.8 | 0.3 | 10.1 | 1 | 0.001 | 0.4 (0.3–0.7) |
Marital status (without a partner) | −0.1 | 0.3 | 0.3 | 1 | 0.580 | 0.9 (0.5–1.4) |
Maternal education | ||||||
No education | 1.5 | 0.7 | 4.9 | 1 | 0.027 | 4.3 (1.2–15.7) |
≤6 Years | 1.2 | 0.7 | 3.5 | 1 | 0.060 | 3.4 (1.0–12.1) |
7–12 Years | 1.1 | 0.7 | 2.9 | 1 | 0.087 | 3.1 (0.9–11.5) |
>12 Years | 5.4 | 3 | 0.144 | |||
Frequent alcohol consumption during pregnancy (Yes) | 1.4 | 0.2 | 38.0 | 1 | 0.001 | 3.8 (2.5–5.9) |
Type of delivery (cesarean section) | −1.4 | 0.8 | 3.3 | 1 | 0.071 | 0.3 (0.1–1.1) |
Length of hospital stay (≤24 h) | 2.6 | 0.4 | 40.7 | 1 | 0.001 | 13.8 (6.2–30.8) |
Nutritional status (with deficit) | 0.8 | 0.2 | 12.3 | 1 | 0.001 | 2.1 (1.4–3.2) |
Birth Spacing (<24 months) | 0.5 | 0.2 | 6.1 | 1 | 0.014 | 1.7 (1.1–2.5) |
Breastfeeding duration (<2 years) | 0.42 | 0.20 | 4.00 | 1 | 0.045 | 1.5 (1.1–2.1) |
Maternal age at the time of delivery | ||||||
≤19 Years | 1.7 | 0.3 | 27.4 | 1 | 0.001 | 5.6 (3.0–10.8) |
20 to 34 Years | 30.5 | 2 | 0.001 | |||
≥35 Years | 0.8 | 0.3 | 7.4 | 1 | 0.006 | 2.1 (1.2–3.7) |
Constant | −3.5 | 0.7 | 28.4 | 1 | 0.001 | 0.03 |
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Avelino, I.C.; Van-Dúnem, J.; Varandas, L. Under-Five Mortality and Associated Risk Factors in Children Hospitalized at David Bernardino Pediatric Hospital (DBPH), Angola: A Hierarchical Approach. Int. J. Environ. Res. Public Health 2024, 21, 1062. https://doi.org/10.3390/ijerph21081062
Avelino IC, Van-Dúnem J, Varandas L. Under-Five Mortality and Associated Risk Factors in Children Hospitalized at David Bernardino Pediatric Hospital (DBPH), Angola: A Hierarchical Approach. International Journal of Environmental Research and Public Health. 2024; 21(8):1062. https://doi.org/10.3390/ijerph21081062
Chicago/Turabian StyleAvelino, Israel C., Joaquim Van-Dúnem, and Luís Varandas. 2024. "Under-Five Mortality and Associated Risk Factors in Children Hospitalized at David Bernardino Pediatric Hospital (DBPH), Angola: A Hierarchical Approach" International Journal of Environmental Research and Public Health 21, no. 8: 1062. https://doi.org/10.3390/ijerph21081062