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Background: Under-five mortality in Chad reached a minimum value of 119 deaths per 1000 live births in 2018, compared with a maximum of 250 in 1972. Despite this decline in the  mortality trend, for every six children in Chad, one dies before the age of five. This study, therefore, investigated the proximate, intermediate, and distal determinants of under-five mortality in Chad.Methods: We used data from the 2014-15 Chad's Demographic and Health Survey. Data of 7782 children below 5 years were used for the study. Both descriptive and multivariable hierarchical logistic regression analyses were performed. Statistical significance was declared at p < 0.05.Results: Under-five mortality was found to be 130 deaths per 1000 live births in Chad, with variations across the various population sub-groups. For distal predictors, the likelihood of death was higher in children born in the FChari Baguirmi region (AOR = 3.83, 95% CI: 1.81-8.14). Children whose mothers belonged to the Baguirmi/Barma ethnic group (AOR = 8.04, 95% CI: 1.75-36.99) were more likely to die before the age of five. On the contrary, the likelihood of under-five mortality was low among children born in rural areas (AOR = 0.73, 95% CI: 0.55-0.97). With the intermediate predictors, the likelihood of under-five deaths was higher among children whose mothers had no formal education (AOR = 1.72, 95% CI: 1.06-2.77). Regarding the proximate predictors, the odds of under-five deaths was higher among male children (AOR = 1.03, 95% CI: 1.05-1.63) and first rank children (AOR = 1.58, 95% CI: 1.13-2.21).Conclusion: The study found that the determinants of under-five mortality in Chad are region of residence, place of residence, ethnicity, education, sex of child, and birth rank. These findings show that both socio-economic and proximate factors explain the disparities in under-five mortality in Chad. The identification of these factors can be pivotal towards the design of evidence-based interventions intended to improve child survival. Therefore, improving maternal education while refocusing and re-packaging existing strategies to target selected sub-regional populations with high under-five mortality is urgently required. [ABSTRACT FROM AUTHOR]

Background: Under-five mortality (U5M) rates are among the health indicators of utmost importance globally. It is the goal 3 target 2.1 of the Sustainable Development Goals that is expected to be reduced to at least 25 per 1000 livebirths by 2030. Despite a considerable reduction in U5M observed globally, several countries especially those in sub-Saharan Africa (SSA) like Ghana are struggling to meet this target. Evidence-based targeting and utilization of the available limited public health resources are critical for effective design of intervention strategies that will enhance under-five child survival. We aimed to estimate and map U5M risk, with the ultimate goal of identifying communities at high risk where interventions and further research can be targeted.Methods: The 2014 Ghana Demographic and Health Survey data was used in this study. Geostatistical analyses were conducted on 5884 children residing in 423 geographical clusters. The outcome variable is child survival status (alive or dead). We employed a geostatistical generalised linear mixed model to investigate both measured and unmeasured child specific and spatial risk factors for child survival. We then visualise child mortality by mapping the predictive probability of survival.Results: Of the total sampled under 5 children, 289 (4.91%) experienced the outcome of interest. Children born as multiple births were at increased risk of mortality with an adjusted odds ratio (aOR) (aOR: 8.2532, 95% CI: [5.2608-12.9477]) compared to singletons. Maternal age increased risk of mortality (aOR: 1.0325, 95% CI: [1.0128-1.0527]). Child's age (aOR: 0.2277, 95% CI: [0.1870-0.2771]) and number of children under 5 within each household (aOR: 0.3166, 95% CI: [0.2614-0.3835]) were shown to have a protective effect. Additionally, mothers with secondary education level (aOR: 0.6258, 95% CI: [0.4298-0.9114]) decreased the risk of U5M. The predicted U5M risk in 2014 was at 5.98%. Substantial residual spatial variations were observed in U5M.Conclusion: The analysis found that multiple births is highly associated with increased U5M in Ghana. The high-resolution maps show areas and communities where interventions and further research for U5M can be prioritised to have health impact. [ABSTRACT FROM AUTHOR]