Factors Associated with Early Infant Survival During the first three months of life in Uganda: A Multilevel Weibull Model Approach

Background The burden of early infant mortality is enormous. It directly contributes to under-five mortality and indirectly affects maternal and child health outcomes. Globally, over 8.2 million children under the age of 5 die each year, with more than 40% of these deaths occurring within the first 30 days of life. In sub-Saharan Africa alone, 1.2 million newborns die annually, with the highest risk of death occurring within the first three months of life. The aim of this paper is to investigate the factors associated with the survival of children within the first three months of life in Uganda. Method Self-reported data were extracted from the 2016 Uganda Demographic and Health Survey (UDHS), comprising a sub-sample of 10,263 children. The analysis employed a time-to-event approach, utilizing Kaplan-Meier survival curves and a multilevel proportional hazard. Results The multi-level Weibull distribution showed that the estimated frailty variance was 0.065, indicating heterogeneity of time to death of children within the first 3 months of life across the different enumeration areas in Uganda. The significant factors found to influence time to death of children within the first three months of life in Uganda included female gender of children (HR = 0.732, 95% CI = 0.57–0.94, p = 0.013), residing in eastern region (HR = 0.520, 95%CI = 0.35–0.79, p = 0.002), children whose mothers received the recommended dose of tetanus injection prior to birth (HR = 0.503, 95%CI = 0.34–0.74, p = 0.001), those whose mothers participated in postnatal check-ups (HR = 0.363, 95% CI = 0.24–0.55, p = 0.000) and survival rates and children with low birth size (HR = 2.216, 95%CI = 0.86–1.62, p = 0.000). Conclusions Survival within the first three months of life in Uganda is significantly influenced by child sex, geographical region, contraceptive use, tetanus vaccination, postnatal check-ups, and birth size. These findings highlight the need for targeted interventions that promote maternal health and improve infant outcomes. Strengthening family planning programs, increasing access to and awareness of postnatal care, and ensuring adequate maternal nutrition are essential strategies for improving infant survival. Additionally, health education campaigns encouraging timely medical care before, during, and after childbirth are critical for reducing early infant mortality rates.