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ORIGINAL RESEARCH article

Front. Public Health
Sec. Children and Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1408680

Spatiotemporal Models with Confounding Effects: Application on Under-Five Mortality across four sub-Saharan African Countries

Provisionally accepted
Haile Mekonnen Fenta Haile Mekonnen Fenta 1,2*Ding-Geng Chen Ding-Geng Chen 2,3Temesgen T Zewotir Temesgen T Zewotir 4Najmeh Nakhaei Rad Najmeh Nakhaei Rad 2
  • 1 Bahir Dar University, Bahir Dar, Ethiopia
  • 2 University of Pretoria, Pretoria, South Africa
  • 3 University of Arizona, Tucson, Arizona, United States
  • 4 University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa

The final, formatted version of the article will be published soon.

    Background: Different strategies have been developed to minimize under-five mortality (U5M) in sub-Saharan African (sSA) countries, but it is still a major child health concern in the region. Spatiotemporal modeling is important for areal data collected over time. However, when the number of time points and spatial areas is large, and the areas are disconnected, fitting the model becomes computationally complex due to the high number of required parameters to be estimated. Therefore, the main aim of this study is to adopt the spatiotemporal dynamic model which includes the confounding effects between time, space, and their interactions with fixed covariates, with special emphasis on U5M across disconnected sSA countries.Method: we used the nationally publicly representative Demographic and Health Survey (DHS) data for the period from 2000 to 2020. Bayesian spatiotemporal hierarchical modeling with an integrated nested Laplace approximation (INLA) program was used to model the spatiotemporal distribution of U5M among children across 37 districts located in four disconnected sSA regions, consisting of Ethiopia, Nigerian, Zimbabwe, and Ghana.Results: A total of 170,356 under-five children from 37 districts were considered and 15,467 died before the age of five. The relative risk of U5M in the first DHS was 2.02 and it sharply decreased to 0.5 in the recent phase. The proportion of improved access to water, sanitation, clean fuel use, urbanization, and access to health facilities in the district had a significant negative association with U5M: the higher the proportion of these covariates, the lower the prevalence of childhood mortality.Conclusions: This study revealed the evidence of strong spatial, temporal, and interaction effects influencing the under-five mortality risk across the districts. Improving the women's literacy index, access to improved water, the use of clean fuel, and the wealth index are associated with the improvement of risk of mortality among under-five children across the districts. Districts found in Nigeria and Ethiopia has the highest risk of U5M rate and hence districts in those countries need spetial attention.

    Keywords: Spatial random effects, Confounding, Spatiotemporal models, Space-time interactions, variance partitioning

    Received: 28 Mar 2024; Accepted: 03 Jan 2025.

    Copyright: © 2025 Fenta, Chen, Zewotir and Rad. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Haile Mekonnen Fenta, Bahir Dar University, Bahir Dar, Ethiopia

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.