Factors associated with the survival of children within the first three months of life in Uganda

Abstract

This study investigated the factors associated with the survival of children within the first three months of life in Uganda, using secondary data from the 2016 Uganda Demographic and Health Surveys (UDHS) of 10263 children. The study used a two-stage cluster sampling design to generate a nationally representative sample of households. The analysis was conducted at three stages. First, a descriptive summary of socio-economic factors, maternal factors, and child factors was performed. Summary statistics and a life table were used to describe the survival time or probability of dying. Second, differentials in survival time by socio-economic factors, maternal factors, and child factors were assessed using the Log-rank Chi-square test. Associations were established at a 5% level of significance using the general format for the Log-rank (χ2) Chi-Square test statistics for categorical variables. Third, the influence of socio-economic factors, maternal factors and child factors on survival time was assessed using multilevel proportional hazards model. The multilevel proportional hazards model using the Weibull distribution revealed that various factors were associated with the survival of children during the first three months of life. These factors included sex, geographical region, contraceptive use, tetanus immunization, postnatal care, and birth size. Specifically, female children (HR=0.732, p=0.013), those from the eastern region (HR=0.520, p=0.002), and those whose mothers’ utilized contraceptives were more likely to survive longer. Additionally, children whose mothers received the recommended dose of tetanus injection prior to birth (HR=0.503, p=0.001) and those whose mothers participated in postnatal check-ups (HR=0.363, p=0.000) also demonstrated improved survival rates. Conversely, children with low birth size were associated with a shorter survival time or higher mortality risk (HR=2.216, p=0.000). The study recommends that the government and relevant stakeholders should enhance family planning initiatives, increase awareness about the benefits of postnatal check-ups and encourage mothers to maintain a balanced diet both before and after childbirth to improve the weight of unborn and newborn infants. Additionally, educational campaigns should be implemented to motivate families to seek medical attention at health centers before, during and after delivery.