{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:02:32Z","timestamp":1791576152433,"version":"4.3.4"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u201349 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>Under five mortality declined from 128 per 1000 live births during the year 2000\u201356 per 1000 live births in 2016. This study identified several factors contributing for under-five mortality among children of women aged 35\u201349 years. Protective factors included female child sex (AOR\u2009=\u20090.65, 95% CI: 0.53\u20130.79), maternal age at first birth of 31\u201340 years (AOR\u2009=\u20090.34, 95% CI: 0.11\u20130.98), family size of 6\u201310 members (AOR\u2009=\u20090.18, 95% CI: 0.14\u20130.24), birth interval greater than 3 years (AOR\u2009=\u20090.35, 95% CI: 0.26\u20130.47), and 1\u20133 antenatal care visits (AOR\u2009=\u20090.65, 95% CI: 0.50\u20130.84). In contrast, the following factors increased the odds: twin birth (AOR\u2009=\u20096.15, 95% CI: 3.94\u20139.60), four births in the last five years (AOR\u2009=\u20092.64, 95% CI: 1.15\u20136.06), nine or more children ever born (AOR\u2009=\u20093.79, 95% CI: 2.10\u20136.84), and maternal age at birth of the index child of 45\u201349 years (AOR\u2009=\u20092.13, 95% CI: 1.55\u20132.93).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0319447","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T18:58:46Z","timestamp":1784833126000},"page":"e0319447","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Assessment of trends and determinants of under-five mortality among children born to older women: Evidence from Ethiopian demographic and health surveys"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4846-1171","authenticated-orcid":true,"given":"Tamerat Denekew","family":"Temesegen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tariku Dejene","family":"Demissie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0758-7348","authenticated-orcid":true,"given":"Solomon Abrha","family":"Damtew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"pone.0319447.ref001","unstructured":"World Health Organization. Under-five mortality rate (per 1000 live births) (SDG 3.2.1). https:\/\/www.who.int\/data\/gho\/indicator-metadata-registry\/imr-details\/7 Accessed 2026 April 8."},{"issue":"12","key":"pone.0319447.ref002","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001355","article-title":"Progress toward global reduction in under-five mortality: a bootstrap analysis of uncertainty in Millennium Development Goal 4 estimates","volume":"9","author":"L Alkema","year":"2012","journal-title":"PLoS Med"},{"key":"pone.0319447.ref003","volume-title":"RH Strategic Plan - Ethiopia 2021-2025","author":"Federal Ministry of Health (Ethiopia)","year":"2021"},{"key":"pone.0319447.ref004","volume-title":"Transforming our world: the 2030 Agenda for Sustainable Development","author":"United Nations","year":"2015"},{"key":"pone.0319447.ref005","doi-asserted-by":"crossref","DOI":"10.18356\/9789211068092","volume-title":"The Sustainable Development Goals Report 2023: Special Edition","author":"United Nations","year":"2023"},{"key":"pone.0319447.ref006","volume-title":"Ethiopia Demographic and Health Survey 2016","author":"Central Statistical Agency (Ethiopia), ICF","year":"2017"},{"key":"pone.0319447.ref007","volume-title":"Ethiopia: 2016 Demographic and Health Survey: Key Findings","author":"Central Statistical Agency (Ethiopia)","year":"2016"},{"key":"pone.0319447.ref008","volume-title":"Ethiopian demographic and health survey 2005","author":"Central Statistical Agency (Ethiopia), ICF Marco","year":"2006"},{"key":"pone.0319447.ref009","volume-title":"Ethiopia Demographic and Health Survey 2000","author":"Central Statistical Authority (Ethiopia), ORC Macro","year":"2001"},{"key":"pone.0319447.ref010","volume-title":"Ethiopia Demographic and Health Survey 2011","author":"Central Statistical Agency (Ethiopia), ICF International","year":"2012"},{"issue":"2","key":"pone.0319447.ref011","doi-asserted-by":"crossref","first-page":"424","DOI":"10.4269\/ajtmh.13-0751","article-title":"Integrated community case management of childhood illness in Ethiopia: implementation strength and quality of care","volume":"91","author":"NP Miller","year":"2014","journal-title":"Am J Trop Med Hyg"},{"key":"pone.0319447.ref012","volume-title":"Community Based Newborn Care Implementation Plan","author":"Federal Ministry of Health (Ethiopia)","year":"2012"},{"key":"pone.0319447.ref013","volume-title":"Handbook IMCI: integrated management of childhood illness","author":"World Health Organization, UNICEF","year":"2005"},{"key":"pone.0319447.ref014","volume-title":"Ethiopia National Reproductive Health Strategy 2016-2020","author":"Federal Ministry of Health (Ethiopia)","year":"2016"},{"key":"pone.0319447.ref015","unstructured":"Federal Ministry of Health (Ethiopia), USAID, JSI. Ethiopia\u2019s primary health care reform: practice, lessons, and recommendations. Addis Ababa: FMoH."},{"key":"pone.0319447.ref016","doi-asserted-by":"crossref","first-page":"1242314","DOI":"10.3389\/fpubh.2023.1242314","article-title":"Costs and resource needs for primary health care in Ethiopia: evidence to inform planning and budgeting for universal health coverage","volume":"11","author":"A Alebachew","year":"2023","journal-title":"Front Public Health"},{"key":"pone.0319447.ref017","volume-title":"Social health insurance proclamation","author":"Federal Negarit Gazeta of the Federal Democratic Republic of Ethiopia","year":"2010"},{"issue":"1","key":"pone.0319447.ref018","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13561-022-00389-5","article-title":"Health insurance coverage in Ethiopia: financial protection in the Era of sustainable cevelopment goals (SDGs)","volume":"12","author":"BT Merga","year":"2022","journal-title":"Health Econ Rev"},{"key":"pone.0319447.ref019","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.vhri.2014.06.005","article-title":"Health Care Financing in Ethiopia: Implications on Access to Essential Medicines","volume":"4","author":"EE Ali","year":"2014","journal-title":"Value Health Reg Issues"},{"issue":"1","key":"pone.0319447.ref020","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/s13690-022-00896-1","article-title":"Determinants of under-five mortality in Ethiopia using the recent 2019 Ethiopian demographic and health survey data: nested shared frailty survival analysis","volume":"80","author":"BA Ayele","year":"2022","journal-title":"Arch Public Health"},{"issue":"3","key":"pone.0319447.ref021","first-page":"148","article-title":"Risk factors for under-five mortality in Ethiopia: evidence from the 2016 Ethiopian Demographic and Health Survey","volume":"13","author":"Y Berelie","year":"2019","journal-title":"South Afr J Child Health"},{"key":"pone.0319447.ref022","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2016\/1602761","article-title":"Determinants of under-five mortality in high mortality regions of Ethiopia: an analysis of the 2011 Ethiopia Demographic and Health Survey data","volume":"2016","author":"S Gebretsadik","year":"2016","journal-title":"Int J Popul Res"},{"issue":"1","key":"pone.0319447.ref023","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1186\/s12887-023-04026-w","article-title":"Socio-demographic and environmental determinants of under-five child mortality in Ethiopia: using Ethiopian demographic and Health 2019 survey","volume":"23","author":"M Girma","year":"2023","journal-title":"BMC Pediatr"},{"key":"pone.0319447.ref024","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/1471-2288-9-49","article-title":"Fitting multilevel models in complex survey data with design weights: Recommendations","volume":"9","author":"AC Carle","year":"2009","journal-title":"BMC Med Res Methodol"},{"issue":"11","key":"pone.0319447.ref025","doi-asserted-by":"crossref","first-page":"2214","DOI":"10.2105\/AJPH.2015.302842","article-title":"Weighted Multilevel Models: A Case Study","volume":"105","author":"BT West","year":"2015","journal-title":"Am J Public Health"},{"key":"pone.0319447.ref026","volume-title":"Multilevel analysis: techniques and applications","author":"J Hox","year":"2018","edition":"3"},{"key":"pone.0319447.ref027","doi-asserted-by":"crossref","first-page":"04010","DOI":"10.7189\/jogh.12.04010","article-title":"Uncertainties in the path to 2030: Increasing trends of under-five mortality in the aftermath of Millennium Development Goal in Eastern Ethiopia","volume":"12","author":"M Dheresa","year":"2022","journal-title":"J Glob Health"},{"issue":"4","key":"pone.0319447.ref028","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD005215.pub2","article-title":"Interventions for preventing unintended pregnancies among adolescents","author":"C Oringanje","year":"2009","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0319447.ref029","volume-title":"Health Sector Transformation Plan II (HSTP-II) 2020\/21\u20132024\/25","author":"Federal Ministry of Health (Ethiopia)","year":"2021"},{"key":"pone.0319447.ref030","unstructured":"Demissie DB. Paradigm shifting in postgraduate nursing education in Ethiopia: a move from classroom-based lecture to hospital-based evidence-based learning by doing at St. Paul\u2019s Hospital Millennium Medical College. 2023."},{"key":"pone.0319447.ref031","volume-title":"Ethiopian health care quality bulletin: continuous health care quality improvement through knowledge management","author":"Federal Ministry of Health (Ethiopia)","year":"2019"},{"issue":"6","key":"pone.0319447.ref032","doi-asserted-by":"crossref","DOI":"10.1097\/NMC.0b013e31829f2c94","article-title":"Call for neonatal nursing specialization in developing countries","volume":"38","author":"SS Premji","year":"2013","journal-title":"MCN Am J Matern Child Nurs"},{"key":"pone.0319447.ref033","doi-asserted-by":"crossref","first-page":"7471545","DOI":"10.1155\/2020\/7471545","article-title":"Determinants of under-five child mortality in Ethiopia: analysis using Ethiopian Demographic Health Survey, 2016","volume":"2020","author":"AT Zewudie","year":"2020","journal-title":"Int J Pediatr"},{"key":"pone.0319447.ref034","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2019\/1073782","article-title":"Socioeconomic, Demographic, and Environmental Determinants of Under-5 Mortality in Ethiopia: Evidence from Ethiopian Demographic and Health Survey, 2016","volume":"2019","author":"BT Woldeamanuel","year":"2019","journal-title":"Child Development Research"},{"issue":"1","key":"pone.0319447.ref035","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s12889-019-6390-4","article-title":"Predictive model and determinants of under-five child mortality: evidence from the 2014 Ghana demographic and health survey","volume":"19","author":"JMK Aheto","year":"2019","journal-title":"BMC Public Health"},{"key":"pone.0319447.ref036","article-title":"Trends and Associated Factors of Under-five Mortality Based on 2008-2016 Data in Kersa Health and Demographic Surveillance Site, Eastern Ethiopia","volume":"59","author":"GD Gutema","year":"2022","journal-title":"Inquiry"},{"issue":"1","key":"pone.0319447.ref037","doi-asserted-by":"crossref","DOI":"10.1186\/s41118-020-00106-2","article-title":"Machine learning approach for predicting under-five mortality determinants in Ethiopia: evidence from the 2016 Ethiopian Demographic and Health Survey","volume":"76","author":"FH Bitew","year":"2020","journal-title":"Genus"},{"key":"pone.0319447.ref038","first-page":"104063","article-title":"The factors associated with under-five mortality in Ethiopia","volume":"79","author":"GD Yemane","year":"2022","journal-title":"Ann Med Surg (Lond)"},{"key":"pone.0319447.ref039","doi-asserted-by":"crossref","DOI":"10.1177\/20503121221100608","article-title":"Trend and correlates of under-5 mortality in Ethiopia: A multilevel model comparison of 2000-2016 EDHS data","volume":"10","author":"KS Wolde","year":"2022","journal-title":"SAGE Open Med"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0319447","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T18:58:53Z","timestamp":1784833133000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0319447"}},"subtitle":[],"editor":[{"given":"Syeda Humaida","family":"Hasan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":39,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0319447","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]}}}