Infant Mortality Rate in Ethiopia: Causes, Trends and Influencing Factors

Nov 07, 2025 0

Under-five mortality refers to the likelihood of dying between the ages of birth and five. Under-five mortality is one of the most important components of the population, hence demographers are very interested in tracking the trend and incidence of under-five death. The global number of under-five mortality remains high, the sector has made remarkable progress in the recent few decades in reducing under-five mortality. The global under-5 mortality rate decreased by 59%, from 93 deaths per 1000 live births in 1990 to 39 in 2018. At the same time, mortality amongst children aged five to fourteen years dropped by 53%, from 15 to 7 fatalities per thousand children [2].

Despite a great reduction in child mortality since 2000, the country has not sufficient resources to meet the SDG grand ambition alone. Ethiopia has one of the fast-growing economies among the developing world and is thought to be moving forward despite its low SDG global rank.

It is critical to identify the determinant factors linked to under-five mortality to inform policymakers on how to provide relevant alternative interventions or strengthen existing interventions to bring under-five mortality down to the projected level. As a result, the goal of this study was to identify factors associated with under-five mortality in Ethiopia.

Notably, projections are based on trajectories of progress that generally predate a series of recent challenges that Ethiopia has faced - mostly notably including the COVID-19 pandemic and conflict in the Tigray region. As such, these forecasted scenarios may not fully be able to capture the realities of current obstacles to continued mortality declines.

A Level Human Geography - Factors of Infant Mortality Rates

Data and Methodology

Community-based Cross-sectional data came from Ethiopia's Mini Demographic and Health Survey 2019. The Ethiopian Public Health Institute (EPHI) worked with the Central Statistical Agency (CSA) and the Federal Ministry of Health (FMoH) to conduct the 2019 Ethiopia Mini Demographic and Health Survey (2019 EMDHS), which was coordinated by the Technical Working Group (TWG) from March 21 to June 28, 2019.

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In two stages, the 2019 EMDHS sample was stratified and selected. There were 21 sampling strata in each region, which were divided into urban and rural areas. In two steps, EA samples were picked individually in each stratum. At each of the lower administrative levels, implicit stratification and proportional allocation were achieved by sorting the sampling frame within each sampling stratum before sample selection, according to administrative units at different levels, and selecting a probability proportional to size at the first stage of sampling. 8855 women of reproductive age were interviewed using a nationally representative sample (ages 15 to 49) and 5753 children were included. Background factors, fertility determinants, marriage, and the awareness of respondents were all thoroughly examined.

For the 2019 EMDHS, five questionnaires were used: the Household Questionnaire, the Woman's Questionnaire, the Anthropometry Questionnaire, the Health Facility Questionnaire, and the Fieldworker's Questionnaire. These surveys were altered from the DHS Program's standard questionnaires to represent the Ethiopian population and health challenges. All eligible women aged 15 to 49 were asked to complete the Woman's Questionnaire. Respondents' background characteristics, reproduction, contraception, pregnancy and postnatal care, child nutrition, childhood immunisations, and health facility information were all covered in the study.

The data was analyzed using SPSS version 26 statistical software (IBM SPSS Statistics). Descriptive statistics such as frequencies and percentages were used to summarize the sample's background characteristics. Binary logistic regression was used to see if there is an association between the dependent and independent variables. All variables with a p-value of less than 0.25 in the bivariate analysis were chosen for the multivariable logistic regression to compensate for putative confounders. Significant predictors were defined as factors with a p-value of less than 0.05.

Ethical clearance for the 2019 EMDHS was provided by the Ethiopian Health and Nutrition Research Center (EHNRI) Review Board, the National Research Ethics Review Committee (NRERC) at the Ministry of Science and Technology, the Institutional Review Board of Inner City Fund (ICF) International, and the Centers for Disease Control and Prevention (CDC). The requirement for obtaining informed consent was waived by Ethiopian Health and Nutrition Research Center (EHNRI) Review Board, but the data were kept anonymous and confidential. This study was conducted by the Helsinki Declaration.

Findings from the 2019 EMDHS

The total population consisting of 8885 children's information was obtained by interviewing face to face their mothers. A total of 5753 children were included in the study with a response rate of 100%. Out of which, 5753 children have complete measurements and were considered in this study. The current study can observe that a total of 5753 children under five Mortality were 339 (5.7%) of the total under-five age were Mortal before reaching the age of five, while 5414 under-five children were still alive.

Of the total of 5753 children included in the study, There were 1328(23.1%) and 4425(76.1%) with 72 (5.42%) and 267 (6.02%) of under-five mortality was occurred in urban and rural respectively. Regarding Mother Education level, there were 3149(54.7%), 1823(31.3%), 480(8.3%) and 301(5.2%) with 191(6.07%), 122(6.69%), 17(3.54%) and 9(2.99%) of under-five mortality was occurred, uneducated, Elementary, Secondary and higher school attended women. About the wealth index of households, there were 1964(34.1%), 994(17.3%), 805(14.0), 738(12.8%) and 1252(21.8%) with 133(6.77%), 60(6.04%), 805(5.59%), 45(5.59%) and 1252(5.11%) of under-five mortality was occurred to the children from poorest, poorer, middle, richer and Richest House household respectively. Concerning multiple births of children, there were 5586(97.1%), 82(1.4%), 82(1.4%) and 3(0.1%) with 295(5.28%), 13(15.98%), 28(34.55) and 3(100%) of under-five Mortality due to single birth, first multiple births, second multiple births and third multiple births respectively. Regarding to Marital Status, there were 31(0.5%),2355(93.1%),41(0.7%),61(1.1%), 181(3.1%) and 84(1.5%) with 1(3.22%), 308(13.08%), 2(4.87%), 4(6.56%),22(12.15%) and 2(2.38%) of under-five mortality were occurred with marital Status of Never union, Married, Living with partner, widowed, Divorced and no longer living together respectively.

The resulting binary logistic regression model fits well according to the Hosmer and Lemeshow goodness of fit test (p-value = .589). Under-five mortality in the Afar region was 2.280 times more likely Compared to Children born in Tigray Region (AOR = 2.280 95% CI = 1.137-4.568). Under-five mortality in Gambella Region was 2.004 times more likely Compared to children in Tigray Region (AOR = 2.004, 95% CI = 1.089-3.687). Under-five mortality in Dire Dawa city was 3.012 times more likely as compared to children born in Tigray Region (AOR = 3.012,95% CI = 1.165-7.785). Under-five Mortality in Rural residences was 1.908 times more likely as Compared to Urban Residence (AOR = 1.908, 95% CI = 1.257-4.539). Under-five mortality in Poorer index Households was 0.343 times Less likely as compared to children born in the poorest index Household (AOR = 0.343,95% CI = 0.128-0.910). Under-five mortality those who Separated were 0.165 times less likely as Compared to never union family (AOR = 0.165, 95% CI = 0.037-0.741). Under-five mortality in the urban/rural Poorer index was 3.448 times more likely as compared to children born in the urban/rural poorest index (AOR = 0.448,95% CI = 1.418-8.386). Under-five mortality of the Female Sex was 0.750 times less likely Compared to the Male Sex (AOR = 0.750, 95% CI = 0.594-0.948). Under-five mortality in the public sector was 1.763 times less likely than among children born at Home (AOR = 1.763, 95% CI = 1.252-2.482). Under-five Mortality of second multiple births was 2.389 times more likely Compared to Single birth(AOR = 2.389,95% CI = 1.257-4.539).as well Five mortality of third multiple births was 2.046 times more likely as Compared to single birth(AOR = 2.389,95% CI = 1.029-4.065). Odds ratios of Under-five mortality living with Fathers were 3.057 times more likely as compared live with mothers(AOR = 3.057,95% CI = 1.535-6.087).

The current study showed that there were regional variation for a case of under-five mortality in Ethiopia. This study is backed up by data from four EDHS surveys done across the country, which show significant regional differences in under-five mortality: lower in Addis Ababa (urban residence) and higher in a heterogeneous population (urban and rural residence) [5,[9], [10], [11]]. The current study showed that Children in rural areas have a higher chance of dying before reaching the age of five than those in urban areas. In addition, a survival study of under-five mortality in Nigeria revealed a consistent result: site of residency played a major role in the risk of under-five mortality [13]. In many research, there is greater evidence that living in a rural location is a predictor of under-five mortality [14,15]. As indicated by the prior review, rural disadvantage persists in U5M.

This study showed that male children were at a higher risk of under-five mortality compared to female children. This finding is in line with the findings of earlier investigations [19,20]. Male child on average, are more likely than female child to die before reaching the age of five, according to research [[21], [22], [23], [24]].

This study showed that the Place of delivery is a major determinant of Under-five mortality. When compared to children born in health institutions, children born at home were more likely to die before reaching the age of five. This outcome is consistent with the prior study's findings [25,26]. This could be because children who are born at home are more vulnerable to infections.

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This study showed that multiple births were a Major Determinant of Five Mortality Compared to Single birth. This is in line with the findings of prior investigations [27]. In comparison to illiterate women, educated women have a lower risk of under-five mortality, according to this study. This is because educated mothers are more likely to have a higher income, more health knowledge, and the capacity to make better decisions about their own and their children's health. This is in line with the findings of prior investigations [28]. As parents' educational qualifications improve, so will their children's chances of surviving.

The retrospective nature of the EMDHS records is a concern with national dataset. The records are enormous and so can included large Scop... in 2015 to succeed Millennium Development Goals.

Narrowing existing equity gaps in key indicators - including family planning, antenatal care coverage, in-facility delivery, cesarean section (C-section), and postnatal care - will be crucial in continuing Ethiopia’s rapid progression through the transition framework and achieving SDG targets. Considering Ethiopia’s widely diverse demographics across regions - especially with regards to pastoralist and agrarian settings - identifying subnational trends is particularly important in the country.

Trends in Infant Mortality in Ethiopia

Infant mortality remains a serious global public health problem. The global infant mortality rate has decreased significantly over time, but the rate of decline in most African countries, including Ethiopia, is far below the rate expected to meet the SDG targets. Therefore, this study aimed to investigate the trends of infant mortality and its determinants in Ethiopia based on the four consecutive Ethiopian Demographic and Health Surveys (EDHSs).

Infant mortality rate has decreased from 96.9 per 1000 births in 2000 to 48 per 1000 births in 2016, with an annual rate of reduction of 4.2%. According to the logit-based multivariate decomposition analysis, about 18.1% of the overall decrease in infant mortality was due to the difference in composition of the respondents with respect to residence, maternal age, type of birth, and parity across the surveys, while the remaining 81.9% was due to the difference in the effect of residence, parity, type of birth and parity across the surveys. In the mixed-effect binary logistic regression analysis; preceding interval < 24 months (AOR = 1.79, 95% CI; 1.46, 2.19), small size at birth (AOR = 1.55, 95% CI; 1.25, 1.92), large size at birth (AOR = 1.26, 95% CI; 1.01, 1.57), BMI < 18.5 kg/m2 (AOR = 1.22, 95% CI; 1.05, 1.50), and twins (AOR = 4.25, 95% CI; 3.01, 6.01), parity> 6 (1.51, 95% CI; 1.01, 2.26), maternal age and male sex (AOR = 1.50, 95% CI: 1.25, 1.79) were significantly associated with increased odds of infant mortality.

This study found that the infant mortality rate has declined over time in Ethiopia since 2000. Preceding birth interval, child-size at birth, BMI, type of birth, parity, maternal age, and sex of child were significant predictors of infant mortality. Public health programs aimed at rural communities, and multiparous mothers through enhancing health facility delivery would help maintain Ethiopia’s declining infant mortality rate.

The Ethiopian government strongly motivated to improve maternal-child and maternal health for the last two decades [11] but infant mortality remains a significant health care problem in the country [12]. It has reduced from 123 per 1000 births in 1990 to 48 per 1000 births in 2015 but it is far below the national target [13, 14]. According to the Ethiopian Demographic and Health Surveys (EDHSs), the infant mortality rate has declined from 97 per 1000 live births in 2000 [15] to 48 per 1000 live births in 2016 [6] with a huge disparity across regions and within countries [12].

Maternal age [16, 17], maternal education status [18, 19], household wealth status [20], Antenatal Care (ANC) visit during pregnancy [21, 22], parity [23], birth order [24], place of delivery [25, 26], child nutritional status (stunting, wasting and underweight) [26], vaccination status [27], and residence [28] were reported by previous researchers as significant predictors of infant mortality.

Though infant mortality rates have decreased over time in Ethiopia, previous studies were focused on the prevalence and associated factors of infant mortality only [21, 29, 30] and failed to capture the trends and determinants of infant mortality in Ethiopia over time using a Logit based Multivariate Decomposition analysis for Non-linear Response Model (MVDCMP) and Generalized Linear Mixed Model (GLLM). Therefore, this study aimed to investigate the trend and determinants of infant mortality in Ethiopia over time.

All the Demographic and Health Surveys (DHSs) (EDHS 2000, 2005, 2011, and 2016) conducted in Ethiopia were used. The EDHS was employed in every five-year interval to generate updated health and health-related indicators. The majority of the country’s population lives in the regional states of Amhara, Oromia, and Southern Nations Nationalities and People’s Regions (SNNPR) [25]. Ethiopia is the 13th in the world and 2nd most populous country in Africa [26]. In 2016, there were an estimated 102 million people.

Source: UNICEF - Child Mortality in Ethiopia

Factors Influencing Infant Mortality

Several demographic, socioeconomic, biological, and environmental factors play a role in infant mortality. These include:

Mother's current age
Mother's education level
Wealth index
Family gender
Mother's work status
Contraception
Family size
Child's gender
Birth order
Birth type
Place of residence and birth
Toilet facilities
Drinking water source

Out-of-pocket (OOP) health expenditure significantly reduces maternal health, as it leads to a decrease in the skilled birth attendance by increasing the maternal mortality ratio [29,30]. The population in low-income countries is often exposed to out-of-pocket (OOP) and related indirect costs for their illnesses for health care, and this infers that the household’s health expenditure reduces the infant and maternal mortality across low-income countries to reach a goal of ensuring healthy lives and people’s well-being [31]. Moreover, according to the study conducted by [32], higher government spending on health services can be shown to provide better overall health results for children and in turn it reduces the infant mortality rate.

The Bacillus Calmette-Guerin (BCG) vaccine is given soon after birth to infants to decrease the incidence of tuberculosis (TB) disease and TB-associated mortality in childhood [33,34]. The lack of BCG vaccination in the first week of life was highly associated with the infant mortality rate [35]. The WHO currently suggests the BCG vaccination at birth for developing countries except for preterm infants who should be vaccinated when they reach the age of 40 weeks [36]. The infant mortality rate was lower for BCG vaccinated than for unvaccinated [37].

Equity Trends in Health Indicators

Family Planning

In 2000 in Ethiopia, family planning was generally only available to the most affluent communities, as demand satisfied by modern methods was 38.7% for the wealthiest quintile, but under 10% for all others. In 2000 there was a 39.0% absolute gap between urban and rural communities, and by 2016 this had shrunk to 12.9%.

Antenatal Care (ANC)

While the CAGR for ANC4+ coverage has been higher among the poorest wealth quintile than the richest quintile, this margin has not been high enough to narrow the gap in the past two decades. In 2000, there was a 30.6% absolute gap in ANC4+ coverage between the wealthiest and poorest quintiles, but by 2019 this had expanded to a 50.3% absolute gap. Despite this trend, equity gaps narrowed between urban and rural communities.

In-Facility Delivery

In Ethiopia in 2000, facility-based delivery was almost entirely limited to the wealthiest communities. In-facility delivery rates were 22.7% among the wealthiest quintile, 3.2% for the second wealthiest quintile, and near 1% for the poorest three quintiles. In 2019, in-facility delivery coverage was 85.9% among the wealthiest quintile and 19.7% among the poorest quintile. Contrastingly, the in-facility delivery coverage gap between urban and rural populations has stayed relatively constant.

Cesarean Section (C-Section)

Disparities in in-facility delivery coverage has translated to gaps in C-section rates across many equity gradients, with this procedure being far more common among wealthier, urban communities. The gap in C-section rates between urban and rural communities expanded from 4.9% to 6.2% from 2000 to 2019.

Postnatal Care (PNC)

In line with other health service indicators, disparities in postnatal care (PNC) coverage levels have similarly improved. In 2019, 50.7% of mothers in the wealthiest quintile received PNC within four hours of birth as compared with only 11.3% of mothers in the poorest quintile.

Source: ResearchGate - Determinants of Infant Mortality in Ethiopia

Lessons from Multi-Country Comparisons

In assessing neonatal and maternal mortality progress in Ethiopia, it is valuable to contextualize this progress in comparison to peer countries and international targets. Positioning progress relative to other geographies provides insights into trajectories of mortality reduction, potential future challenges, and progressions towards global targets.

From 2000 to 2020, Ethiopia progressed from phase I to phase III in the integrated maternal, neonatal, and stillbirth mortality transition framework. Advancements beyond phase I were often linked to contraceptive use and fertility declines. Further progress through phase II and III often occurred as coverage of antenatal care, in-facility delivery, skilled birth attendance, and postnatal care improved, in part due to an expansion of physical infrastructure and human resources for health.

As Ethiopia continues to progress further through the transition, addressing equity gaps will be crucial for advancing to later phases and reducing mortality levels.

Progressing Toward the Sustainable Development Goals

Ethiopia has accomplished remarkable reductions in NMR and MMR in the past two decades. This progress has situated the country nearer to the SDG targets, although continued progress will be necessary to reach these ambitious targets.

For NMR, the SDG target is 12 neonatal deaths per 1,000 live births for all countries. Ethiopia must similarly accelerate progress to successfully reach this target by 2030. From 2000 to 2021, the country experienced an AARR of 2.89%, which will need to be accelerated to 8.31% to reach the SDG target by 2030.

The end preventable deaths of newborns and children under 5 years of age by 2030, with all countries directed to reduce the neonatal mortality to at least as low as 12 per 1000 live births and under −5 mortality to at least as low as 25 per 1000 live births (SDG 3.2). Despite that, overall actions to meet the goals is not yet advancing at the speed or scale required [10].