Published in PLOS One on 2026-07-23, 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: Tamerat Denekew Temesegen, Tariku Dejene Demissie, Solomon Abrha Damtew
Source: PLOS One • DOI 10.1371/journal.pone.0319447
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Under-five mortality has long been used as an indicator of the level of socio-economic development of a country. Global attention has been given to the issue through the Sustainable Development Goals, yet the burden continues to be disproportionately concentrated in Sub-Saharan Africa and South Asia. Ethiopia is one of six nations that together account for half of global under-five mortality, with particular burden observed among children born to older mothers. Hence, this study aimed to determine the magnitude of under-five mortality among children born from elder mothers, assess its trend over time, and identify associated factors.
Data were drawn from the nationally representative Ethiopia Demographic and Health Surveys (EDHS) conducted in 2000, 2005, 2011, and 2016. The analytic sample comprised 6,199 children born to women aged 35–49 years in the five years preceding each survey. Information on mother and child characteristics, socio-economic factors, and environmental variables was collected through face-to-face household interviews. Descriptive statistics characterized the study participants. Multilevel binary logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals for factors associated with under-five mortality.
Under five mortality declined from 128 per 1000 live births during the year 2000–56 per 1000 live births in 2016. This study identified several factors contributing for under-five mortality among children of women aged 35–49 years. Protective factors included female child sex (AOR = 0.65, 95% CI: 0.53–0.79), maternal age at first birth of 31–40 years (AOR = 0.34, 95% CI: 0.11–0.98), family size of 6–10 members (AOR = 0.18, 95% CI: 0.14–0.24), birth interval greater than 3 years (AOR = 0.35, 95% CI: 0.26–0.47), and 1–3 antenatal care visits (AOR = 0.65, 95% CI: 0.50–0.84). In contrast, the following factors increased the odds: twin birth (AOR = 6.15, 95% CI: 3.94–9.60), four births in the last five years (AOR = 2.64, 95% CI: 1.15–6.06), nine or more children ever born (AOR = 3.79, 95% CI: 2.10–6.84), and maternal age at birth of the index child of 45–49 years (AOR = 2.13, 95% CI: 1.55–2.93).
The decline in under-five mortality over the last 16 years in Ethiopia represents promising progress toward the targets set out in the Sustainable Development Goals and national health policy. However, targeted programs and interventions focusing on provision of the recommended antenatal care, adequate birth spacing, limiting the number of births within short intervals, discouraging pregnancies after age 40, and supporting smaller family sizes are essential to further reduce under-five mortality. The study findings highlight the importance of risk-pregnancy screening, well-spaced pregnancies, family health promotion, and strengthened childhood illness prevention and treatment services.
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 financing & policy 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 Tamerat Denekew Temesegen, Tariku Dejene Demissie, Solomon Abrha Damtew. 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.
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