Socio-economic, demographic, and environmental determinants of under-five mortality in Indonesia: insights from a national survey

Abstract

Abstract Despite great improvements in childhood mortality in the past several decades, many Indonesian children did not surpass their fifth birthday. This paper investigates the social and environmental determinants of under-five (U-5) mortality in Indonesia. By utilising the most recent Indonesia Demographic and Health Survey (IDHS) in 2017, we fitted survival regression models to the data. We observed that maternal smoking (aHR = 2.15, 95% CI = 1.15–4.03), maternal age (aHR = 2.48, 95% CI = 1.43–4.30), and maternal employment status (aHR = 1.68, 95% CI = 1.34–2.11) correspond to shorter lives of U-5 children. Conversely, we found that higher maternal education (aHR = 0.50, 95% CI = 0.29–0.87) corresponds to better child survival. Improved household sanitation also negatively associated with child mortality, albeit statistically insignificant at 5% (aHR = 0.78, 95% CI = 0.60–1.01). These associations hold after we take into account proximate and biological correlates. These findings corroborate extant literature that living environment (not only socio-economic and demographic factors) plays a prominent role in determining child survival. Hence, increasing access to and reducing the rural-urban gap related to improved sanitation facilities and curtailing smoking prevalence are paramount in further curbing child mortality.