Survival status and predictors of time-to-death among live-birth children during war time in Tigray: A retrospective cohort study

The first eighteen months of children’s life is among the critical periods for their long survival. However; evidence on survival status during this critical period in conflict affected setting is limited. Thus, this study aimed to determine survival status and time-to-death among live-birth children using survival analysis in the war-torn Tigray region of Ethiopia. Using retrospective cohort study, data from large community-based survey of child mortality was utilized and 30,935 live-births were included from 121 Tabiyas of 31 districts, in the Tigray region of Ethiopia. Using the Kaplan-Meier curve and the Log-rank test, survival time and statistical differences between groups of the independent variables were calculated respectively. The predictors for time-to-death were identified using Cox-proportional hazard model. Adjusted Hazard Ratio (AHR) with its 95% confidence interval (CI) and p < 0.05 were used to determine the degree of association and declare statistical significance respectively using SPSS software. In this study, 1430 (4.6%; 95%CI: 4.4–4.9) children died before turning their one and half years old, with three-fourths of those deaths occurred in the neonatal period. The mean survival time was 524.69 (95%CI:523.41, 525.97) days. District’s extremely very high (AHR = 1.33, 95%CI: 1.04, 1.70) level of maternal mortality transition (MMT), having baby at internally displaced people (IDP) camp/on the way to health facility (AHR = 4.27,95%CI: 3.08, 5.92) or in bush (AHR = 1.74, 95%CI: 1.36, 2.23), living in rural areas (AHR = 1.37, 95%CI: 1.16, 1.62), multiple pregnancies (AHR = 4.91, 95%CI: 4.02, 6.00), short birth interval (AHR = 6.96, 95%CI: 5.89, 8.24), and residents out of Mekelle (the capital city of the region) were found risk factors for death among the live-births. Furthermore, live-births of male sex and those to smaller family sizes were associated with greater mortality rates. One from every twenty live-births died before turning one and half years old and the mean survival time among the live-births was short during the Tigray war. Being born outside of health facility, district’s extremely very high level of MTT, rural residence, short birth intervals, multiple pregnancies, being from out of the regional capital, male gender and being born from smaller families were predictors of mortality among live-births children during the Tigray war. Immediate priorities should include expanding community-based delivery services, strengthening referral systems, and promoting safe facility-based births through maternity waiting homes and transport support. Furthermore, conflict-sensitive health planning should be institutionalized with equity-driven resource allocation prioritizing rural and conflict-affected districts. Integrating culturally appropriate family planning and establishing robust surveillance systems are essential to safeguard the live-birth children’s survival. Not applicable.