Determinants of under-five mortality in Sri Lanka: A multilevel analysis of 2016 Sri Lankan DHS data
Under-five mortality (U5M) is considered a major public health issue directly impacts a country’s development. This study analyzed the prognostic factors of U5M in Sri Lanka using data from the 2016 Demographic and Health Survey (DHS) of 8123 children. The study employed both a binary logistic regre...
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| description | Under-five mortality (U5M) is considered a major public health issue directly impacts a country’s development. This study analyzed the prognostic factors of U5M in Sri Lanka using data from the 2016 Demographic and Health Survey (DHS) of 8123 children. The study employed both a binary logistic regression model (BLRM) and a binary logistic random intercept multilevel model (BLRIMM) and compared the accuracy of each model’s prediction percentage. The results showed that the BLRIMM had a higher correct prediction percentage (98.67%) compared to the BLRM (98.31%). The study found that children who were not breastfed (Odds Ratio (OR) = 116.74, 95% Confidence Interval (CI) = 62.97–216.41), were part of multiple births (OR = 3.73, 95% CI = 1.21–11.51), did not have a normal delivery (OR = 1.86, 95% CI = 1.11–3.12), were born to mothers who had experienced previous miscarriages or child loss (OR = 2.27, 95% CI = 1.26–4.11), and were born to mothers with a higher Body Mass Index (BMI) (OR = 1.05, 95% CI = 1.003–1.10) had higher odds of U5M. The odds of U5M were found to be lower among Buddhists (OR = 0.06, 95% CI = 0.01–0.50), Hindus (OR = 0.05, 95% CI = 0.01–0.46), and Roman Catholics (OR = 0.032, 95% CI = 0.003–0.307) compared to the "Other Religions" category in the dataset. The estimated covariance parameter of the random intercept (0.8231, p-value = 0.0405) indicated significant unobserved cluster-level variation in U5M. The study’s results emphasize the importance of addressing religion related differences of U5M and improving maternal education regarding healthy lifestyle, proper food intake, the significance of breastfeeding, safe delivery methods, safety measures during pregnancy and childbirth in cases of multiple births, and proper child care after birth. |
| doi_str_mv | 10.1371/journal.pone.0291246 |
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This study analyzed the prognostic factors of U5M in Sri Lanka using data from the 2016 Demographic and Health Survey (DHS) of 8123 children. The study employed both a binary logistic regression model (BLRM) and a binary logistic random intercept multilevel model (BLRIMM) and compared the accuracy of each model’s prediction percentage. The results showed that the BLRIMM had a higher correct prediction percentage (98.67%) compared to the BLRM (98.31%). The study found that children who were not breastfed (Odds Ratio (OR) = 116.74, 95% Confidence Interval (CI) = 62.97–216.41), were part of multiple births (OR = 3.73, 95% CI = 1.21–11.51), did not have a normal delivery (OR = 1.86, 95% CI = 1.11–3.12), were born to mothers who had experienced previous miscarriages or child loss (OR = 2.27, 95% CI = 1.26–4.11), and were born to mothers with a higher Body Mass Index (BMI) (OR = 1.05, 95% CI = 1.003–1.10) had higher odds of U5M. The odds of U5M were found to be lower among Buddhists (OR = 0.06, 95% CI = 0.01–0.50), Hindus (OR = 0.05, 95% CI = 0.01–0.46), and Roman Catholics (OR = 0.032, 95% CI = 0.003–0.307) compared to the "Other Religions" category in the dataset. The estimated covariance parameter of the random intercept (0.8231, p-value = 0.0405) indicated significant unobserved cluster-level variation in U5M. The study’s results emphasize the importance of addressing religion related differences of U5M and improving maternal education regarding healthy lifestyle, proper food intake, the significance of breastfeeding, safe delivery methods, safety measures during pregnancy and childbirth in cases of multiple births, and proper child care after birth.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0291246</identifier><identifier>PMID: 37682906</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Analysis ; Bangladesh ; Biology and Life Sciences ; Body mass ; Body mass index ; Body size ; Breast feeding ; Child mortality ; Childbirth ; Childbirth & labor ; Children ; Children & youth ; Confidence intervals ; Demographic aspects ; Drinking water ; Ethiopia ; Ethnicity ; Food intake ; Health aspects ; Households ; Immunization ; India ; Infant mortality ; Malnutrition ; Medical prognosis ; Medicine and Health Sciences ; Model accuracy ; Mortality ; Mothers ; Multiple births ; Newborn babies ; People and Places ; Pregnancy ; Public health ; Regression models ; Safety measures ; Sanitation ; Social Sciences ; South Asia ; Sri Lanka ; Statistical analysis ; Surveys ; Tetanus ; Tetanus antitoxin ; Vaccines ; Variables</subject><ispartof>PloS one, 2023-09, Vol.18 (9), p.e0291246</ispartof><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>2023 Thabrew et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright: © 2023 Thabrew et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>2023 Thabrew et al 2023 Thabrew et al</rights><rights>2023 Thabrew et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c619t-8523c9af574cd1d48f5021f506a139a7afdfeda83005b11ed029a25dcabcf12d3</cites><orcidid>0000-0002-0138-7417</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10490942/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10490942/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids></links><search><contributor>Bhatti, Sajjad Haider</contributor><creatorcontrib>Thabrew, Kaludura Anupama Seuwandi</creatorcontrib><creatorcontrib>Sooriyarachchi, Marina Roshini</creatorcontrib><creatorcontrib>Jayakody, Dushantha Nalin K</creatorcontrib><title>Determinants of under-five mortality in Sri Lanka: A multilevel analysis of 2016 Sri Lankan DHS data</title><title>PloS one</title><description>Under-five mortality (U5M) is considered a major public health issue directly impacts a country’s development. This study analyzed the prognostic factors of U5M in Sri Lanka using data from the 2016 Demographic and Health Survey (DHS) of 8123 children. The study employed both a binary logistic regression model (BLRM) and a binary logistic random intercept multilevel model (BLRIMM) and compared the accuracy of each model’s prediction percentage. The results showed that the BLRIMM had a higher correct prediction percentage (98.67%) compared to the BLRM (98.31%). The study found that children who were not breastfed (Odds Ratio (OR) = 116.74, 95% Confidence Interval (CI) = 62.97–216.41), were part of multiple births (OR = 3.73, 95% CI = 1.21–11.51), did not have a normal delivery (OR = 1.86, 95% CI = 1.11–3.12), were born to mothers who had experienced previous miscarriages or child loss (OR = 2.27, 95% CI = 1.26–4.11), and were born to mothers with a higher Body Mass Index (BMI) (OR = 1.05, 95% CI = 1.003–1.10) had higher odds of U5M. The odds of U5M were found to be lower among Buddhists (OR = 0.06, 95% CI = 0.01–0.50), Hindus (OR = 0.05, 95% CI = 0.01–0.46), and Roman Catholics (OR = 0.032, 95% CI = 0.003–0.307) compared to the "Other Religions" category in the dataset. The estimated covariance parameter of the random intercept (0.8231, p-value = 0.0405) indicated significant unobserved cluster-level variation in U5M. The study’s results emphasize the importance of addressing religion related differences of U5M and improving maternal education regarding healthy lifestyle, proper food intake, the significance of breastfeeding, safe delivery methods, safety measures during pregnancy and childbirth in cases of multiple births, and proper child care after birth.</description><subject>Analysis</subject><subject>Bangladesh</subject><subject>Biology and Life Sciences</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Breast feeding</subject><subject>Child mortality</subject><subject>Childbirth</subject><subject>Childbirth & labor</subject><subject>Children</subject><subject>Children & youth</subject><subject>Confidence intervals</subject><subject>Demographic aspects</subject><subject>Drinking water</subject><subject>Ethiopia</subject><subject>Ethnicity</subject><subject>Food intake</subject><subject>Health aspects</subject><subject>Households</subject><subject>Immunization</subject><subject>India</subject><subject>Infant mortality</subject><subject>Malnutrition</subject><subject>Medical prognosis</subject><subject>Medicine and Health Sciences</subject><subject>Model accuracy</subject><subject>Mortality</subject><subject>Mothers</subject><subject>Multiple births</subject><subject>Newborn babies</subject><subject>People and Places</subject><subject>Pregnancy</subject><subject>Public health</subject><subject>Regression models</subject><subject>Safety measures</subject><subject>Sanitation</subject><subject>Social Sciences</subject><subject>South Asia</subject><subject>Sri Lanka</subject><subject>Statistical analysis</subject><subject>Surveys</subject><subject>Tetanus</subject><subject>Tetanus 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one</jtitle><date>2023-09-08</date><risdate>2023</risdate><volume>18</volume><issue>9</issue><spage>e0291246</spage><pages>e0291246-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Under-five mortality (U5M) is considered a major public health issue directly impacts a country’s development. This study analyzed the prognostic factors of U5M in Sri Lanka using data from the 2016 Demographic and Health Survey (DHS) of 8123 children. The study employed both a binary logistic regression model (BLRM) and a binary logistic random intercept multilevel model (BLRIMM) and compared the accuracy of each model’s prediction percentage. The results showed that the BLRIMM had a higher correct prediction percentage (98.67%) compared to the BLRM (98.31%). The study found that children who were not breastfed (Odds Ratio (OR) = 116.74, 95% Confidence Interval (CI) = 62.97–216.41), were part of multiple births (OR = 3.73, 95% CI = 1.21–11.51), did not have a normal delivery (OR = 1.86, 95% CI = 1.11–3.12), were born to mothers who had experienced previous miscarriages or child loss (OR = 2.27, 95% CI = 1.26–4.11), and were born to mothers with a higher Body Mass Index (BMI) (OR = 1.05, 95% CI = 1.003–1.10) had higher odds of U5M. The odds of U5M were found to be lower among Buddhists (OR = 0.06, 95% CI = 0.01–0.50), Hindus (OR = 0.05, 95% CI = 0.01–0.46), and Roman Catholics (OR = 0.032, 95% CI = 0.003–0.307) compared to the "Other Religions" category in the dataset. The estimated covariance parameter of the random intercept (0.8231, p-value = 0.0405) indicated significant unobserved cluster-level variation in U5M. The study’s results emphasize the importance of addressing religion related differences of U5M and improving maternal education regarding healthy lifestyle, proper food intake, the significance of breastfeeding, safe delivery methods, safety measures during pregnancy and childbirth in cases of multiple births, and proper child care after birth.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>37682906</pmid><doi>10.1371/journal.pone.0291246</doi><tpages>e0291246</tpages><orcidid>https://orcid.org/0000-0002-0138-7417</orcidid><oa>free_for_read</oa></addata></record> |
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| source | DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Analysis Bangladesh Biology and Life Sciences Body mass Body mass index Body size Breast feeding Child mortality Childbirth Childbirth & labor Children Children & youth Confidence intervals Demographic aspects Drinking water Ethiopia Ethnicity Food intake Health aspects Households Immunization India Infant mortality Malnutrition Medical prognosis Medicine and Health Sciences Model accuracy Mortality Mothers Multiple births Newborn babies People and Places Pregnancy Public health Regression models Safety measures Sanitation Social Sciences South Asia Sri Lanka Statistical analysis Surveys Tetanus Tetanus antitoxin Vaccines Variables |
| title | Determinants of under-five mortality in Sri Lanka: A multilevel analysis of 2016 Sri Lankan DHS data |
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