Published in PLOS One on 2026-08-12, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Wondaya Fenta Zewdia, Maru Zewdu Kassie, Melkamu A. Zeru, Asteray Assmie Ayenew
Source: PLOS One • DOI 10.1371/journal.pone.0355621
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Child mortality remains a major public health issue in Ethiopia, with under-five mortality rates among the highest in sub-Saharan Africa. Despite efforts to improve maternal and child health, many women still give birth at home without skilled assistance, which has been associated with adverse maternal and child health outcomes. Therefore, this study aimed to investigate the association and determinants of home delivery and under-five mortality (U5M) using a multilevel bivariate modeling approach.
A cross-sectional study was conducted among 5,517 women with a birth history using data from the Ethiopian Mini Demographic and Health Survey (EMDHS) 2019. Data management and analysis were performed using STATA version 17 and R version 4.2.2. The chi-square test of association was used to examine the association between predictor and outcome variables, and multilevel bivariate analysis was conducted to identify significant factors associated with the outcome variables.
Out of 5,517 women with birth history, 2,842 (51.5%) were delivered at home, and 269 (4.87%) reported experiencing at least one under-five child death. As shown in the joint and marginal probabilities of home delivery and U5M, there was a significant association (χ² = 3.83, P-value < 0.0001). The adjusted odds ratio (AOR = 2.19, 95% CI: 1.89–2.62) indicates that mothers who delivered at home had 2.19 times higher odds of experiencing at least one under-five child death than mothers who delivered in a health facility.
Overall, home delivery and U5M were significantly associated with a combination of individual, household, and community-level factors. Education, wealth, antenatal and postnatal care, and media exposure were associated with lower odds of both outcomes, while rural residence, too young or too old maternal age, and lower economic status were associated with higher odds. Regional disparities further indicate the need for targeted interventions. Expanding healthcare access in rural areas, improving female education, promoting antenatal and postnatal care, and increasing media-based health awareness campaigns may contribute to reducing the prevalence of home delivery and maternal experience of under-five child death in Ethiopia.
Introduction
Child mortality remains a major global public health issue, with four million deaths occurring in the first month of life annually [1]. Under-five mortality (U5M), the risk of death between birth and age five, is a key indicator of societal well-being [2]. The U5M rate is a critical target of the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) [3]. The SDGs aim to reduce U5M to at least 25 deaths per 1,000 live births by 2030, emphasizing the importance of maternal health facilities in achieving this goal [4]. While the MDG 4 target of reducing child mortality by two-thirds was not fully met globally, certain regions, including East Asia and the Pacific, Latin America and the Caribbean, and 62 countries, made significant progress [5,6].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Wondaya Fenta Zewdia, Maru Zewdu Kassie, Melkamu A. Zeru, Asteray Assmie Ayenew. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Level of completion of the maternal health care continuum and its determinants among rural women in East Shoa Zone, Eastern Ethiopia: A multilevel analysis
- Evidence brief: Barriers to healthcare access among women in sub-Saharan Africa: A pooled analysis of multi-country DHS data (2019–2023)
- Evidence brief: Assessment of trends and determinants of under-five mortality among children born to older women: Evidence from Ethiopian demographic and health surveys
