During one year of follow-up, 306 deaths of children under the age of 5 years were included in a concurrent case-referent study that was based on a population estimated at 28,780 in 1987. A total of 612 live referents, matched for age, sex and study area, were also selected from the study population through density sampling. Data were collected by lay reporters by verbal autopsy. For the study period the estimated cumulative under-five mortality rate was 293 and the infant (0-11 months old) mortality rate was 136 per 1000. Major probable causes of death were diarrhoeal disease or acute respiratory infections (ARI). The relative importance of parental and environmental characteristics was assessed using conditional multiple logistic regression analysis. Under-five mortality was associated with paternal illiteracy, maternal ethnicity, and not being in the committee of people's organizations. Parental factors affected the infants relatively more than they did the children, especially with regard to ARI mortality. This was also noted with "absence of window", a proxy measure for evaluating the type of housing. In terms of etiological fractions a greater number of under-five deaths could be ascribed to parental than environmental conditions, with relatively more infants being affected than children.
PIP: In Butajira district, Ethiopia (130 km south of Addis Ababa), 2 trained field workers went to each household of 306 5 children who died between October 1988 and September 1989 and of 612 age, sex, and study area matched referents to interview caretakers as part of a study analyzing determinants of 5 mortality, especially parental and environmental determinants. Leading causes of infant and child deaths were acute respiratory infections (ARI) (33 and 20%, respectively) and diarrheal disease (23 and 32%, respectively). The multivariate analysis showed that Silti ethnicity of the mother (odds ration = 1.74), paternal illiteracy (OR = 1.45), and nonmembership in people's organizations (OR = 1.95) were parental risk factors. All children with all 3 parental factors were at a 4.6 times higher risk of 5 mortality than those with no parental risk factors. Infants with 3 parental risk factors were at a considerably greater mortality risk than were 1-4 year old children with 3 parental risk factors (OR, 10.7 vs. 2.5). Children with 3 parental risk factors living in the highlands faced a higher risk of death than those in the lowlands (15.5 vs. 2.8). 3 parental risk factors carried a higher risk of mortality pursuant to ARI than to diarrhea (14.8 vs. 2.4). The only environmental risk factor was no window in the house (OR = 1.54). Absence of windows was especially risky for infants (OR = 2.7) and for children with ARI (OR = 1.8 vs. 1.3 with diarrhea). Lack of windows was linked to crowding and poor housing. Public health interventions to eliminate parental or environmental factors would result in 55% or 31% fewer deaths, respectively. These findings suggest that parental factors have a greater impact on 5 mortality than environmental factors and that both parental and environmental factors and that both parental and environmental factors have a greater impact on infant than on child mortality.