Trends of under-five mortality and associated risk factors in Zambia: a multi survey analysis between 2007 and 2018.

Background: Mortality at a young age is key to public health measures. This study aims to describe the burden, trend, and associated factors of under-five mortality rate (U5MR) in Zambia from 2007-to-2018. Method: A sample of 29,274 children under-five were analyzed from the Zambia demographic and health survey (ZDHS). Univariate and bivariate analysis were used to identify factors influencing U5M. Result: Pooled prevalence of U5MR in Zambia was 84.4/ 1000 live-births. Over 15 years, U5M has declined by 49% (from 118.7 to 60.5/1000 live-births). Compared to children of teenage (≤19 years) mothers the likelihood of U5M was lower by 24 to 37% among children of 20 to 34 years old mothers. The likelihood of U5M was lower by 23% (AOR, 0.77 95%CI, 0.58-1.04) for poorest, 27% (AOR, 0.73 95%CI, 0.55-0.98) for poorer, and 19% (AOR, 0.81 95%CI, 0.62-1.07) for middle as compared to the richest households. The likelihood of U5M was 21% (AOR, 0.79 95%CI, 0.67-0.93) lower among rural residents. Multiple-born children died 2.54 times (95%CI, 1.95-3.98) higher than the single-born. Male children (AOR, 1.28, 95% CI, 1.23-1.46), smaller than average birth size (AOR, 1.78; 95% CI, 1.52-2.09), and no ANC visit (AOR, 3.17, 95% CI, 2.74-3.67) were associated with U5M. The likelihoods of U5M were significantly higher in the Eastern, Luapula, and Muchinga regions than in the Central.

Conclusion: This study revealed that Zambia has made a gain on child survival. Further efforts targeting mothers, children, and provinces are needed to scale up the decline and achieve the SDG3.