Multilevel Zero Inflated and Hurdle Models for under Five‑child Mortality in Indonesia

Introduction: Overcoming under‑five mortality rate remains a great challenge for Indonesia to meet the national target despite its notable advancements and progress in reducing child mortality rate. Therefore, understanding risk factors of under‑five mortality is essential to enhance the health and well‑being of children. This research seeks to investigate associated factors of under‑five mortality in Indonesia by using the 2017 Indonesia Demographic and Health Survey data. Methods: The multilevel zero‑inflated and multilevel hurdle models are considered to handle unobserved heterogeneity that may occur at province level, and to model prevalence and risk of child death as a joint process, which are reported in terms of odds ratio (OR) and incidence ratio rate (IRR), respectively. Results: Lower number of household members (IRR = 0.803, 95% confidence interval [CI]: 0.784–0.823), older mother’s age at first birth (IRR = 1.020, 95% CI: 1.007– 1.032), higher number of children ever born (IRR = 1.491, 95% CI: 1.450–1.533), lower mother’s education (IRR = 1.224, 95% CI: 1.013–1.479), and lower father’s education (IRR = 1.232, 95% CI: 1.015–1.495) are significantly associated with higher total death numbers in children before the age of 5 years. Furthermore, the odds of no child death are significantly higher among mother who use a contraceptive method (OR = 11.088, 95% CI: 6.659–18.462) and among household in higher quantile wealth (OR = 1.133, 95% CI: 1.005–1.277). Conclusion: This evidence‑based empirical highlights priority risk factors that might provide insight for policymakers, health professional, and the community in general to design appropriate intervention to help reduce the burden of under‑five mortality in the country.