Determinants of infant mortality in Gezira State, sudan: a survival analysis using Cox proportional hazards model

Background Infant mortality is a critical indicator of population health, with the highest rates observed in sub-Saharan Africa. This study aims to identify factors associated with infant mortality in Gezira State, Sudan. Methods A cross-sectional survey was conducted from July to December 2021, involving 332 participants selected using simple random sampling. Data was collected through a structured questionnaire, and the Cox proportional hazards regression model was used to identify significant predictors of infant mortality. Results Several factors were significantly associated with infant mortality. Infants born to mothers with illiterate or primary education had a higher risk of death (HR = 3.003, p = 0.0014), while secondary education appeared protective (HR = 0.433, p < 0.0001). Low (HR = 2.527, p = 0.0078) and average (HR = 3.109, p = 0.0001) family income were significantly associated with increased risk. Home delivery (HR = 1.684, p = 0.0006), smaller-than-normal child size at birth (HR = 12.975, p < 0.0001), and a history of stillbirth (HR = 2.508, p = 0.003) were strong predictors of infant death. Additionally, maternal age at first marriage and total number of deliveries significantly affected survival outcomes. Conclusion Efforts to reduce infant mortality in Sudan should prioritize maternal education, healthcare access, and targeted interventions for high-risk groups identified in this study.