Under five causes of death in Ethiopia between 1990 and 2016: Systematic review with meta-analysis
Background: Under-five, infant and neonatal mortality rates for Ethiopia were 67, 48 and 29 per 1,000 live births, respectively, based on the 2016 Ethiopia Demographic and Health Survey. Although under-five mortality is substantially improving in Ethiopia, about 190,000 deaths still occur every year. Although various studies have been conducted on the causes of neonatal and under-five deaths in different parts of the country, none of them document pooled analytic results for the causes of death.
Objective: To identify neonatal, post-neonatal, infant and under-five causes of death in Ethiopia.
Methods: A Cochrane systematic review and meta-analysis was carried out on published and grey literature relating to the causes of death for different categories of children under the age of five in Ethiopia between 1990 and 2016. Abstracts were initially reviewed using databases such as MEDLINE/PubMed, Embase, Google Scholar, Google and HINARI, as well as university databases, and conference compendiums of the Federal Ministry of Health and Ethiopian Public Health Association. A total of 220 online and grey literature documents were collected on the basis of their titles and abstracts. However, only 13 were found to be suitable for systematic review. Furthermore, meta-analysis was carried out on 12 of them using an inverse variance heterogeneity effect model. The effect sizes and 95% confidence intervals (CI) are presented in forest plot diagrams, alongside heterogeneity. Publication bias was also examined.
Results: The major causes of neonatal deaths in Ethiopia were bacterial sepsis 28.3% (95% CI: 18.3, 38.8), birth asphyxia 26.7% (95% CI: 14.5, 39.8), prematurity 17.6% (95% CI: 11.6, 24.1), congenital malformation 5% (95% CI: 0.7, 11.3), acute lower respiratory infection 4.4% (95% CI: 0.0, 16.0), and diarrheal diseases 3.6% (95% CI: 1.6, 5.7). The leading causes of death for post-neonates and infants were acute lower respiratory infection 28% (95% CI: 17.8, 39.0), intestinal infections with diarrhea 21% (95% CI: 13.7, 28.9), severe acute malnutrition 9.4% (95% CI: 5.7, 13.8), malaria 10.7% (95% CI: 11.0, 58.9), and bacterial sepsis 6.7% (95% CI: 0.0, 18.6). The leading causes of child (1-4 years) and under-five deaths were sepsis 14.1% (95% CI: 12.0, 16.3), prematurity 13.1% (95% CI: 6.4, 20.6), acute lower respiratory infection, including pneumonia 12.5% (95% CI: 6.2, 19.5), birth asphyxia 11.3% (95% CI: 5.2, 18.2), severe acute malnutrition 9.4% (95% CI: 5.0, 14.0), diarrheal diseases 2.6% (95% CI: 0.0, 7.1), meningitis 2.2% (95% CI: 0.0, 10.8), measles 1.4% (95% CI: 0.0, 23.4), and malaria 1.4% (95% CI: 0.0, 19.9).
Conclusions and recommendations: The major causes of death for under-five children in Ethiopia are easily preventable and treatable. Almost all of the causes could be addressed through high-quality primary health care services by strengthening the health extension program. Cause-targeted obstetric and child health care interventions will remarkably reduce mortality, which requires improving primary health care units in Ethiopia. [Ethiop. J. Health Dev. 2020; 34(2):141-160]
Key words: Under five mortality, Causes of death, systematic review and meta-analysis, Ethiopia