infant and child mortality rates are regarded as indicators of the prevailing health conditions in a society ; they measure the success of health programmes and policies aimed at their education . the world summit for children , held in 1990 , instituted a package of objectives for implementation by the year 2000 . among these objectives was the aim to reduce infant and under - five mortality by one third or to 50 and 70 deaths per 1000 births , respectively , whichever was less.1 this was reaffirmed at the 1994 international conference on population and development ( icpd).2 the 1992 population policy of sudan announced the intention to reduce the mortality rates of children under five years of age to 60 deaths per 1000 , from the level in 1992 by the year 2002.3 sudan is a developing country characterized by high levels of infant and child mortality . according to the 1993 fourth national population census , under - five mortality rate was 150 per 1000 live births and one out of ten infants died before reaching their first birth day . the safe mother survey ( sms ) which was conducted in 1999 showed that under - five mortality rate was 105 per 1000 live births and infant mortality rate was 69 per 1000 live births.4 the persistence of high infant and child mortality rates , call for the identification of the main causes of this phenomenon . the main objectives of this study were to determine the level of infant and child mortality rates in wad - medani and to identify the main causes . it is the second largest town in sudan and lies on the bank of the blue nile . according to the fourth national census , wad - medani has a population of 430,487 comprising 214,670 males and 215,817 females.5 its population is a mixture of different tribal groups of sudan , most of whom are government employees , traders , farmers , and casual laborers . the average health situation in wad - medani town is better than the national average and also better than any of the other towns in sudan.6 the data of this study came from a household survey conducted in september 2004 . a simple random sampling technique was used with anticipated population proportion estimated to yield 300 women who had at least one child under five years of age . a sample of 504 children under - five in 300 household were investigated using a questionnaire . this questionnaire consisted of two sets of data ; the first set asked for the child 's sex , birth weight , birth order , birth interval , immunization and child mortality , while the second set dealt with the mother 's socio - economic status and other environmental variables . after the data were collected and coded , the statistical packet for social sciences ( spss ) were used to analyze the data . was used to evaluate some associations between the dependent variable infant and child mortality and a set of independent variables . it is the second largest town in sudan and lies on the bank of the blue nile . according to the fourth national census , wad - medani has a population of 430,487 comprising 214,670 males and 215,817 females.5 its population is a mixture of different tribal groups of sudan , most of whom are government employees , traders , farmers , and casual laborers . the average health situation in wad - medani town is better than the national average and also better than any of the other towns in sudan.6 the data of this study came from a household survey conducted in september 2004 . a simple random sampling technique was used with anticipated population proportion estimated to yield 300 women who had at least one child under five years of age . a sample of 504 children under - five in 300 household were investigated using a questionnaire . this questionnaire consisted of two sets of data ; the first set asked for the child 's sex , birth weight , birth order , birth interval , immunization and child mortality , while the second set dealt with the mother 's socio - economic status and other environmental variables . after the data were collected and coded , the statistical packet for social sciences ( spss ) were used to analyze the data . was used to evaluate some associations between the dependent variable infant and child mortality and a set of independent variables . table 1 shows that 20.6% of the children were below the age of one and 79.6% of them were between 1 and 5 years . the sex percentages of infants and children under five was 43.7% males and 56.3% females . the birth weight of the children was classified into three groups : under weight , normal weight and unknown weight . those underweight were 26.2% , children with normal birth weight accounted for 62.7% and unknown birth weight were 11.1% . demographic and biomedical characteristics of the children on the immunization status of the children , 65.1% of the children had been fully vaccinated , 27.8% partially immunized , while only 7.1% had no immunizations . the distribution of children by birth order is shown in 
 table 1 . as can be seen from the table , 40.9% of the children were in the group ( six and more ) births , 32.1% in the group ( four to five ) births , 22.2% in the group ( two- three ) births and only 4.8% in the first group ( first child ) . for 33.3% of the children , the birth interval was less than one year , for 46.1% it was 1 - 2 years and it was more than two years for 20.6% . the percentage of women with 4 - 8 years of education was 11.7% , 9 - 12 years was 58.7% , 13 - 16 years was 29% and 0.6 formed the last category with more than 16 years of education . the same table shows that 91% of the women were housewives , 7% were employed,1% had other occupations . it was found that 98.6% were married , 0.7% were widowed and 0.7% were divorced . of the mothers , 96.3% used contraceptive measures , while 3.7% did not . mother 's educational , occupational and marital status table 3 shows the distribution of the sample households by the level of expenditure . it is obvious from the table that the majority of families ( 60.7% ) belonged to the middle income group , whereas the low and high income groups formed 30.0% and 9.3% respectively . family income and some selected community and environmental variables housing conditions and sanitation are known to be important determinants of the level of infant and child mortality . table 3 shows the types of houses , and number of the rooms and latrines . ninety - seven point 3 percent of the women reported that their houses were made of bricks , 36.3% reported their houses had two rooms , 31.3% three rooms , and 17.1% had four rooms while 15.3% had one room only . when asked about latrines , 63.3% of the same women said they had pit - latrines , while only 36.7% had siphon . seventy - five families kept animals , 60% of whom said the animals were kept inside the house , while 40% kept them outside . it was found that 7.7% of the women 's infants had died , while 92.3% of them are alive . for the age group 1 - 5 years , 6.7% of the children had died , while 93.3% of them were alive , yielding child mortality rate for that age group as 67 per 1000 live births . infant and child mortality in this part , cross - tabulation for the most important variables relating to infant and under - five mortality are presented . in each case , a test of independence was performed using  ( chi -square ) test of independence . the independent variables that were assumed to affect the mortality of infants and children under five significantly ( dependent variable ) were child order , child interval , child weight , child immunization , mothers education , family income , keeping of animals , latrines and the use of contraceptives . table 5 shows that child order , child weight , interval between children , child immunization , the use of contraceptives , family income , mother 's education and latrines were all significant at 1% , while only the keeping of animals was significant at 5% . this means that all these variables were strongly associated with the mortality of children under five years old and increased the risk of infant and child mortality . table 1 shows that 20.6% of the children were below the age of one and 79.6% of them were between 1 and 5 years . the sex percentages of infants and children under five was 43.7% males and 56.3% females . the birth weight of the children was classified into three groups : under weight , normal weight and unknown weight . those underweight were 26.2% , children with normal birth weight accounted for 62.7% and unknown birth weight were 11.1% . demographic and biomedical characteristics of the children on the immunization status of the children , 65.1% of the children had been fully vaccinated , 27.8% partially immunized , while only 7.1% had no immunizations . the distribution of children by birth order is shown in 
 table 1 . as can be seen from the table , 40.9% of the children were in the group ( six and more ) births , 32.1% in the group ( four to five ) births , 22.2% in the group ( two- three ) births and only 4.8% in the first group ( first child ) . for 33.3% of the children , the birth interval was less than one year , for 46.1% it was 1 - 2 years and it was more than two years for 20.6% . the percentage of women with 4 - 8 years of education was 11.7% , 9 - 12 years was 58.7% , 13 - 16 years was 29% and 0.6 formed the last category with more than 16 years of education . the same table shows that 91% of the women were housewives , 7% were employed,1% had other occupations . it was found that 98.6% were married , 0.7% were widowed and 0.7% were divorced . of the mothers , it is obvious from the table that the majority of families ( 60.7% ) belonged to the middle income group , whereas the low and high income groups formed 30.0% and 9.3% respectively . family income and some selected community and environmental variables housing conditions and sanitation are known to be important determinants of the level of infant and child mortality . table 3 shows the types of houses , and number of the rooms and latrines . ninety - seven point 3 percent of the women reported that their houses were made of bricks , 36.3% reported their houses had two rooms , 31.3% three rooms , and 17.1% had four rooms while 15.3% had one room only . when asked about latrines , 63.3% of the same women said they had pit - latrines , while only 36.7% had siphon . seventy - five families kept animals , 60% of whom said the animals were kept inside the house , while 40% kept them outside . it was found that 7.7% of the women 's infants had died , while 92.3% of them are alive . for the age group 1 - 5 years , 6.7% of the children had died , while 93.3% of them were alive , yielding child mortality rate for that age group as 67 per 1000 live births . in this part , cross - tabulation for the most important variables relating to infant and under - five mortality are presented . in each case , a test of independence was performed using  ( chi -square ) test of independence . the independent variables that were assumed to affect the mortality of infants and children under five significantly ( dependent variable ) were child order , child interval , child weight , child immunization , mothers education , family income , keeping of animals , latrines and the use of contraceptives . table 5 shows that child order , child weight , interval between children , child immunization , the use of contraceptives , family income , mother 's education and latrines were all significant at 1% , while only the keeping of animals was significant at 5% . this means that all these variables were strongly associated with the mortality of children under five years old and increased the risk of infant and child mortality . since the 1970s , the estimated annual number of deaths among children of less than 5 years has decreased by almost a third . this reduction has been very uneven and in some countries the rates of childhood mortality are increasing . in 1998 , more than 50 countries including sudan still had childhood mortality rates of over 100 per 1000 live births.7 according to rutstein ( 1984 ) , infant mortality rate ( imr ) is the number of infants dying in the first year of life per 1000 live birth , whereas child mortality rate ( 1 - 5 ) is the probability of dying between the first and fifth birthday expressed per 1000.8 the analysis of infant and child mortality in wad - medani reveals that infant mortality rate is 77 per 1000 live births . this figure is consistent with the findings of the 1999 safe mother survey ( sms),7 in which the national level of infant mortality was estimated at 68 deaths per 1000 live births . also the study estimated under - five mortality as 67 deaths per 1000 live births . the multiple indicators cluster survey ( mics ) which was conducted in the gezira state in 2002 , showed an analogous level in which 59 out of 1000 children died before reaching the age of five.9 on examination of the determinants of infant and child mortality , the study found a strong association with child order . many studies suggest that infant and child mortality increase with the increase of parity after the second birth . the higher the parity , the shorter the birth interval , and the shorter the birth interval the higher risk of dying for a child . the risk of dying is considerably higher for a child who has a sibling born within the preceding two years.1011 on the other hand , other studies suggest that infant and child mortality is generally higher for first born children , especially during the first year of life.12 the study showed that there is a significant association between birth interval and infant and under - five mortality . the length of the birth interval is a very important factor for the survival status of infants and children . if the length of the birth interval is short , the probability of dying is high . the probability of dying before age five for children born less than two years after a previous birth is more than double that for children born four or more years after a previous birth.13 moreover , short birth intervals have indirect effects through such factors as mother 's depletion , premature birth and limited family resources.11 the birth weight of the child has been found to be statistically significant as a determinant of under - five mortality . in line with results found elsewhere , mortality decreased with the child 's increase in weight at birth . the rates of mortality for children who were under weight at birth were higher than those who had normal weight at birth.14 further , the study showed a significant association between mother 's education and infant and under - five mortality . maternal education has been identified as one of the most important socioeconomic determinants of infant and child mortality . many studies show that the higher the level of maternal education , the lower the infant and child mortality.15 caldwell ( 1981 ) provided three explanations for the phenomenon : better educated mothers become less fatalistic about their children 's illnesses . they are more capable of manipulating available health facilities and personnel and they greatly change the traditional balance of familial relationships with a profound effect on child care . in addition to these , they are more likely to have had antenatal care , to have given birth with some medical attention , and to have taken their children at some point to see a physician.16 . regarding the significant association between the use of contraception and child mortality , we found that 73% of the women had not used any contraceptive methods within the last twelve months because of lack or unavailability in many of the areas covered by the study . however , not all the children had been vaccinated ( full immunization 65.1% ) , because of the fear of complications from immunization . lack of latrines leads to high environmental contamination in houses and makes children more vulnerable to infectious diseases . for example , in an inter - american study , the incidence of diarrheal disease was lowest in households with pipe - borne drinking water and flush toilet facilities . current access to proper toilet facilities was found to influence infant mortality , especially beyond the post - neonatal stage.12 considering the association between the keeping of animals and child mortality , it was found that most households kept animals inside their houses , which increased the hazards of infectious diseases . the conclusion of this study is that infant and under - five mortality in gezira state was still high and socioeconomic and environmental factors had a lot of influence on the health status of children in wad medani . finally , this study recommends the expansion of immunization of children , and education for mothers in order to promote family planning and improve child health . also further detailed research is needed to provide better explanations for the determinants of the higher rates of infant and child mortality in sudan .
aim : this study aimed to determine the level of infant and under - five mortality rates and to examine the effect of socioeconomic , demographic and environmental factors on the health status of the children under five years.methods:the data for this study were collected by means of a questionnaire addressed to women in wad - medani , sudan . 
 three hundred women in the reproductive age ( 15 - 49 ) years were chosen randomly for this study . 
 the data were analyzed statistically using the statistical package for social sciences ( spss ) . 
 frequency distributions and a statistical test based on chi - square for independence was conducted.results:infant mortality rate was 77 per 100 and child mortality rate was 67 per 100 . 
 the results revealed that immunization , child order , child birth weight , birth interval and contraceptive use had a significant influence on the mortality of children under the age of five . 
 the mother 's level of education is highly significant on the mortality of children under five years old.conclusions:the ministry of health should give greater attention to improving immunization services and concentrate on health education campaigns for mothers and for the community .