Multilevel determinants of illness since birth among infants aged 5–9 weeks in Ethiopia: Evidence from the 6-week follow-up of the PMA-ethiopia longitudinal survey (2021–2023)

BACKGROUND: Infant illness in the early weeks of life remains a major public health concern in Ethiopia, contributing to neonatal and infant morbidity and mortality. Identifying individual- and community-level determinants is critical to guide targeted interventions. OBJECTIVE: To assess multilevel determinants of illness since birth among infants aged 5-9 weeks in Ethiopia using data from the PMA-Ethiopia Longitudinal Survey (2021-2023). METHODS: We analyzed data from 1,960 infants and mothers enrolled in Cohort 2 of the PMA Ethiopia longitudinal survey, conducted across Addis Ababa, Amhara, Oromia, and SNNP regions. A multistage stratified cluster design with sampling weights ensured national representativeness. The outcome was any maternal-reported infant illness since birth. Multilevel binary logistic regression accounted for clustering within mothers and enumeration areas. Adjusted odds ratios with 95% confidence intervals were reported, and model fit was compared using AIC and BIC. RESULTS: Overall, 34.42% (95% CI: 30.23-38.87) of infants experienced illness since birth, while 65.58% (95% CI: 61.13-69.77) remained illness-free. Female infants had lower odds of illness than male infants (AOR = 0.53; 95% CI: 0.35-0.82). Infants born to mothers who experienced pregnancy complications had higher odds of illness (AOR = 1.89; 95% CI: 1.11-3.20), as did infants of mothers with postpartum complications (AOR = 2.33; 95% CI: 1.27-4.27). Infants from households owning insecticide-treated bed nets also had higher odds of illness (AOR = 1.81; 95% CI: 1.10-2.96). CONCLUSION: About one-third of Ethiopian infants experienced illness within 5-9 weeks of life. Female infants were less vulnerable, whereas maternal complications during pregnancy and postpartum markedly increased illness risk. The association with bed net ownership warrants further investigation. Strengthening maternal health services and targeted interventions may reduce early infant morbidity.