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Cited by 47Global Maternal and Child HealthChild Nutrition and Water AccessMaternal and Neonatal Healthcare

Factors associated with under-five mortality in Bhutan: an analysis of the Bhutan National Health Survey 2012

Open access
Dendup, Tashi, Zhao, Yun, Dema, Deki·2018·BMC Public Health
DOI 10.1186/s12889-018-6308-6PMC PMC6296032
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Abstract

BACKGROUND: As an important marker for health equity and access, under-five mortality (UFM) is a primary measure for socioeconomic development. The importance of reducing UFM has been further emphasized in an ambitious target under Sustainable Development Goals. The factors influencing UFM are not adequately understood in Bhutan. METHODS: The most recent dataset of the Bhutan National Health Survey (BNHS) 2012 was used in this study. Multiple logistic regression analysis using a backwards elimination approach was performed to identify significant factors influencing UFM. All statistical analyses were adjusted for the complex study design due to the multistage stratified cluster sampling used in BNHS. RESULTS: Bhutan's UFM rate was 37 per 1000 live births. The weighted mean age of the children was 7.3 years (SD: 1.53; range: 3-12). Mother's age, household size, access to electricity and sanitation, residential region, and parity were the key factors associated with UFM. The UFM risk was significantly lower in children born to mothers aged 36-40 years, 41-45 years, and > 45 years when compared to that in children born to mothers aged < 26 years. The likelihood of mortality was 66% lower (95% CI: 0.21-0.55) among children born in households with > 5 members. Children born in households without electricity and safe sanitation had a significantly higher risk of death, by 81 and 49% respectively. Relative to those born in the west, children born in the central and eastern regions were 1.72 (95% CI: 1.07-2.77) and 2.09 (95% CI: 1.46-2.99) times more likely to die, respectively. Children born to mothers who gave birth to > 2 children were significantly more likely to die than their counterparts. CONCLUSION: These findings suggest that younger mother's age, the higher number of births and being born in the central and eastern regions are associated with a higher UFM risk, whereas a larger household size and access to electricity and safe sanitation are key factors associated with lower UFM risk in Bhutan. Women empowerment, health education and strategies promoting maternal and child health in rural areas need to be scaled-up. Additionally, socioeconomic development programs should seek to reduce regional disparities.

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  • Maternal demographic factors, including mother's BMI, age, education level, and lack of employment, were all found to increase the risk of disease in children.

    “Demographic factors, including the mother's BMI (Marinda et al., 2018;Prado et al., 2019), age (Dendup et al., 2018), education level (Nasr et al., 2013;Hasan and Richardson, 2017;Akachi et al., 2018;Prado et al., 2019), and lack of employment (Atalabi et al., 2016) were all found to increase the risk of disease in children.”

    From A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health (2020) · cites this paper as Dendup et al., 2018

  • Improved sanitation and handwashing reduced under-five mortality, schistosomiasis, and acquiring other soil-transmitted helminths and parasites.

    “Other aspects of WASH, including improved sanitation and handwashing, likewise reduced underfive mortality (Ahmed et al., 2016;Dendup et al., 2018), and schistosomiasis (Donohue et al., 2017), or acquiring other soiltransmitted helminths and parasites (Baker et al., 2018).”

    From A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health (2020) · cites this paper as Dendup et al., 2018

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Research works printed but not linked: 1

  1. [22]Worku Z. Factors that affect under-five mortality among south African children: analysis of the south African demographic and health survey data set. In proceedings of the world congress on engineering and computer science: 20-22. San Francisco; 2009.

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Authors
Dendup, T., Zhao, Y., & Dema, D.
Affiliations
  • University of Wollongong (AU)
  • Curtin University (AU)
  • Royal Government of Bhutan (BT)
Corresponding author
Dendup, Tashi
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2018-12
Volume
18
Issue
1
Pages
1375-1375
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-018-6308-6
PMC
PMC6296032
OpenAlex
W2904017404
Cited by
47
References
39
Citations by year
2026: 3 · 2025: 7 · 2024: 3 · 2023: 9 · 2022: 13 · 2021: 5 · 2020: 6 · 2019: 1
FWCI
3.31
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Online (University of Wollongong) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • eSpace (Curtin University) (submittedVersion, cc-by)
  • Figshare (submittedVersion)
Funders
Curtin University of Technology
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords
under-five mortality, child mortality risk factors, maternal age, parity, household size, electricity access, sanitation, regional disparities, Bhutan
MeSH terms
Adolescent, Adult, Bhutan, Child, Preschool, Female, Health Surveys, Humans, Infant, Infant Mortality, Infant, Newborn, Male, Maternal Age, Middle Aged, Mothers, Parity, Pregnancy, Residence Characteristics, Risk Factors, Child Mortality, Young Adult

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