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.