Abstract
Introduction
Globally, in 2021, approximately 5 million children died before reaching six years of age, and more than half of the deaths were due to diseases that are preventable with affordable interventions. In Cambodia, children under five mortality (U5M) rate declined from 124 to 16 per 1,000 live births between 1990 and 2022. However, this decline requires further public health attention to children living in rural areas where child survival interventions are under coverage. This study aimed to examine the factors associated with U5M.
Methods
We analyzed data from the Cambodia Demographic and Health Survey (CDS) 2022, which included 8,153 children aged 0-59 months recorded in the last five years preceding the survey. The outcome variable was U5M status (alive or dead). Multivariate logistic regressions were performed using STATA V14.2 to examine factors associated with U5M by taking into account the CDHS complex survey sampling design.
Results
The prevalence of U5M in 2022 was 16 deaths per 1,000 live births compared to 35 deaths in 2014. Mothers’ education was independently associated with lower odds of U5M (AOR = 0.5, 95% CI: 0.30-0.84) for those with primary education and an AOR of 0.53 (95% CI: 0.26-0.96) for those with secondary or higher education compared to those with no education. Mothers’ use of contraceptives was also associated lower odds with U5M, with an AOR of 0.45 (95% CI: 0.29-0.72), compared to mothers not using contraceptives. Conversely, children whose birth order was fourth or more had higher odds of dying before their fifth birthday (AOR?=?2.13, 95% CI: 1.12-4.06) than those whose birth order was first. Lastly, children born to mothers residing in rural areas were considered the main predictor of mortality of the children under the age of five with AOR=1.84 (95% CI: 1.03-3.30) compared to those born to mothers living in urban areas.
Conclusion
Mothers’ education and contraceptive use had a positive impact on child survival, whereas children who were fourth or older in birth order and women residing in rural areas had higher odds of U5M. Therefore, efforts of the Cambodia Maternal and Child Health Program to further reduce the U5M rate should primarily target mothers with no education, those who reside in rural areas and those with four or more pregnancies. Among the key maternal and child interventions, there is a need to promote the use of family planning services among married women and their couples.