Estimating the impact of birth interval on under-five mortality in east african countries: a propensity score matching analysis

• Published in: Archives of public health = Archives belges de santé publique 2023-04, Vol.81 (1), p.63-63, Article 63
• Main Authors: Tesema, Getayeneh Antehunegn, Worku, Misganaw Gebrie, Alamneh, Tesfa Sewunet, Teshale, Achamyeleh Birhanu, Yeshaw, Yigizie, Alem, Adugnaw Zeleke, Ayalew, Hiwotie Getaneh, Liyew, Alemneh Mekuriaw, Tessema, Zemenu Tadesse
• Format: Article
• Language: English
• Subjects: Analysis; Bias; Birth interval; Births; Child development; Child mortality; Children & youth; Childrens health; Clinical outcomes; Confounding (Statistics); East Africa; Health aspects; Health care policy; Health disparities; Health promotion; Infant mortality; Information management; Low income groups; Maternal & child health; Mortality; Mothers; Observational studies; Pregnancy; Propensity score matching; Public health; Regression analysis; Sustainable development; Under-five mortality; Variables; Womens health
• ISSN: 0778-7367; 2049-3258; 2049-3258
• DOI: 10.1186/s13690-023-01092-5

Under-five mortality remains a global public health concern, particularly in East African countries. Short birth interval is highly associated with under-five mortality, and birth spacing has a significant effect on a child's likelihood of survival. The association between short birth intervals and under-five mortality was demonstrated by numerous observational studies. However, the effect of short birth intervals on under-five mortality has not been investigated yet. Therefore, this study aimed to investigate the impact of short birth intervals on under-five mortality in East Africa using Propensity Matched Analysis. A secondary data analysis was conducted based on the most recent Demographic and Health Survey (DHS) data of 12 East African countries. A total weighted sample of 105,662 live births was considered for this study. A PSM analysis was carried out to evaluate the effect of short birth intervals on under-five mortality. Under-five mortality was the outcome variable, while the short birth interval was considered a treatment variable. To determine the Average Treatment Effect on the population (ATE), Average Treatment Effect on the treated (ATT), and Average Treatment Effect on the untreated (ATU), we performed PSM analysis with a logit-based model using the psmatch2 ate STATA function. The quality of matching was assessed statistically and graphically. The common support assumption was checked and fulfilled. We have employed Mantel-Haenszel bounds to examine whether the result would be free from hidden bias or not. The prevalence of short birth intervals in East Africa was 44%. The under-five mortality rate among mothers who had optimal birth intervals was 39.9 (95% CI: 38.3, 41.5) per 1000 live births while it was 60.6 (95% CI: 58.5, 62.8) per 1000 live births among mothers who had a short birth intervals. Propensity score matching split births from mothers into treatment and control groups based on the preceding birth interval. In the PSM analysis, the ATT values in the treated and control groups were 6.09% and 3.97%, respectively, showed under-five mortality among births to mothers with short birth intervals was 2.17% higher than births to mothers who had an optimal birth interval. The ATU values in the intervention and control groups were 3.90% and 6.06%, respectively, indicating that for births from women who had an optimal birth interval, the chance of dying within five years would increase by 2.17% if they were born to mother with short bir