Women's involvement in household decision-making and strengthening social capital-crucial factors for child survival in Ethiopia.
OBJECTIVE
To assess the influence of household decision making, social capital, socio-economic factors and health service use on under-five mortality.


METHODS
Butajira Demographic Surveillance Site, Ethiopia.


METHODS
A prospective case-referent design with a total of 209 under-five year old deaths occurring in an 18-month period, together with 627 referents matched for age, sex and community of residence were included. Questionnaires were administered to mothers or caretakers. Matched case control analysis investigated the effect of risk factors on mortality and the presence of avoidable factors was assessed for each death.


RESULTS
Lack of immunization was strongly associated with mortality (adjusted OR=9.8, 95% CI 5.9, 16.1). Low decision making capacity of women (adjusted OR=3.2 95% CI 2.0, 5.0) and low social capital scores (adjusted OR=1.9 95% CI 1.1, 3.5) were also related to high under-five mortality in multivariate analyses. Potentially avoidable household and health facility factors were identified, respectively in 71% and 40% of the deaths.


CONCLUSIONS
Combined efforts to improve women's involvement in household decision making, social capital and immunization may decrease the high child mortality in this setting where the level of poverty is high and no appreciable trend in child mortality decline has been noted over the years.
Fantahun
Mesganaw
M
Department of Community Health, Addis Ababa University, PO Box 24762, Code 1000 Addis Ababa University, Addis Ababa, Ethiopia. mesganaw_f@yahoo.com
Berhane
Yemane
Y
Wall
Stig
S
Byass
Peter
P
Högberg
Ulf
U
D046688:Child Mortality; D002675:Child, Preschool; D003657:Decision Making; D005002:Ethiopia / Q000453:epidemiology; D005195:Family Relations; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007114:Immunization; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D012380:Role; D012423:Rural Health; D012959:Socioeconomic Factors; D014930:Women / Q000523:psychology*