Injury- and Non-Injury-Related Factors Associated with Under Five Mortality in Iran: A Multilevel Study

Background: Unintentional and intentional injuries are the most important factors that cause disability and death among children throughout the world, especially in Iran. Objectives: This study aimed to assess injury- and non-injury-related factors associated with under five mortality (U5M) at individual and community levels in Iran. Methods: This population-based case-control study recruited a total of 2,228 mothers in Iran in 2017. Subjects were divided into three groups (428 as the case group, 664 as the control group 1, and 1,136 as the control group 2). Data were extracted from health records of mothers and interviews through a researcher-made checklist in the health center of eight provinces of Iran. The multilevel logistic regression model was used to evaluate risk factors of under-five mortality at individual and community levels. Data were analyzed using R V. 3.5.0 software. Results: Analysis showed gestational age (post-term and pre-term) (OR = 4.20, CI: 3.14 - 5.61 , P < 0.001), pregnancy interval (between 1 to 3 years) (OR = 3.05, CI: 2.15 - 4.13, P < 0.001), history of mother’s diseases (OR = 3.14, CI: 2.41 - 4.10, P < 0.001), living in urban area (OR = 1.51, CI: 1.16 - 1.97, P < 0.01) and worst life events among mothers (OR = 1.91, CI: 1.46 - 2.49, P < 0.001) were risk factors associated with under-five injury-related mortality. Moreover, women’s literacy (OR = 0.72, CI: 0.54 - 0.97, P < 0.05), mothers being housewife (OR = 0.76, CI: 0.61 - 0.93, P < 0.01) were protective factor at the community level (P < 0.05). Conclusions: This study revealed factors related to under-five mortality at individual and community levels, which most of them are preventable. Therefore, child mortality can be controlled by improving family health, mothers’ education, as well as conducting interventions at the community level.