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DETERMINANTS OF MORTALITY RATE AMONG UNDER FIVE CHILDREN

CHAPTER ONE

INTRODUCTION

1.1           Background of the Study

The mortality rate among children under five years old is a critical indicator of a nation's health and development. Understanding the determinants of this mortality rate involves examining a complex interplay of factors, including socioeconomic, environmental, healthcare-related, and behavioral elements (UNICEF, 2020; WHO, 2021).

Socioeconomic status (SES) is a fundamental determinant of under-five mortality. Poverty significantly increases the risk of child mortality as it is often associated with poor nutrition, limited access to clean water, inadequate sanitation, and a lack of education (Liu et al., 2016). Children from low-income families are more likely to suffer from malnutrition, which compromises their immune system and increases their susceptibility to infectious diseases such as pneumonia, diarrhea, and malaria, which are leading causes of death among young children (Black et al., 2013). Additionally, maternal education has been shown to have a profound impact on child health outcomes. Educated mothers are more likely to adopt healthier practices, seek timely medical care, and ensure their children receive vaccinations (Gakidou et al., 2010).

Environmental factors also play a significant role in determining under-five mortality rates. Access to clean drinking water and adequate sanitation facilities is crucial for preventing waterborne diseases, which are a major cause of morbidity and mortality in young children (WHO/UNICEF, 2019). In many developing countries, children are exposed to unsanitary conditions that facilitate the transmission of pathogens. For instance, inadequate disposal of human waste and lack of hygiene practices can lead to outbreaks of diarrheal diseases, which are particularly deadly for malnourished children (WHO/UNICEF, 2019).

Healthcare infrastructure and accessibility are critical determinants of child mortality. The availability of healthcare services, including prenatal and postnatal care, vaccination programs, and treatment for common childhood illnesses, directly impacts survival rates (Bhutta et al., 2014). In regions where healthcare systems are underdeveloped, children are less likely to receive essential medical interventions. Vaccination is a key preventative measure; however, in many low-income countries, immunization coverage remains incomplete, leading to higher incidences of vaccine-preventable diseases like measles and tetanus (Liu et al., 2016). Moreover, the presence of skilled birth attendants during delivery and the provision of emergency obstetric care can significantly reduce neonatal and infant mortality rates (Bhutta et al., 2014).

Nutrition is another critical factor. Proper nutrition during the prenatal period and the first years of life is essential for healthy growth and development. Breastfeeding provides essential nutrients and antibodies that protect against infections. However, in many regions, practices such as exclusive breastfeeding are not widely adopted due to cultural beliefs, lack of knowledge, or inadequate support from healthcare systems (Black et al., 2013). Malnutrition, including both undernutrition and micronutrient deficiencies, remains a leading cause of death among young children globally (Black et al., 2013).

Behavioral and cultural practices also influence child mortality. Practices such as early marriage and teenage pregnancies can lead to poor health outcomes for both mothers and their children. Young mothers are at a higher risk of complications during pregnancy and childbirth, which can result in preterm births and low birth weights, further increasing the risk of infant mortality (Conde-Agudelo et al., 2005). Additionally, gender disparities in access to nutrition and healthcare can result in higher mortality rates for female children in certain cultures (United Nations, 2020).

Infectious diseases continue to be a major cause of under-five mortality. Diseases such as malaria, HIV/AIDS, and tuberculosis disproportionately affect young children, especially in sub-Saharan Africa and parts of Asia (O'Meara et al., 2010). Preventative measures, such as the use of insecticide-treated bed nets for malaria and antiretroviral therapy for

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