ArticleWorld journal of pediatrics : WJP2025
Changes in the contributions of risk factors to under-five mortality in low- and lower-middle-income countries (1997-2022): an analysis of Demographic and Health Survey data.
Article in World journal of pediatrics : WJP, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- A phase 1 evaluation of inhaled oxytocin: Physiologically-based pharmacokinetic model informed dosing of a novel heat-stable oxytocin delivery system.British journal of clinical pharmacology · 2026Trial
- All-cause health-adjusted life expectancy in Jiangxi Province, China, 2000-2030: systematic estimation and analysis.Preventive medicine reports · 2026Article
- Spatial distribution of full immunization and associated factors among children aged 12-23 months in Madagascar: a spatial and multilevel analysis.Scientific reports · 2026Article
- Breastfeeding Practices and Associated Factors Among Mothers of Infants Aged 12 Months or Younger Attending Selected Tertiary Hospital in Dhaka, Bangladesh.Food science & nutrition · 2025Article
- Predictors of Survival in Under-Five Children with Low Birth Weight: A Population-Based Study in Indonesia.Nursing reports (Pavia, Italy) · 2025Article
- Determinants of Under-five Mortality in Vietnam: Evidence From a Nationwide Survey.Sage open pediatricsArticle
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5 authors.
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Abstract
backgroundUnder-five mortality (U5M) is a critical public health challenge in low- and lower-middle-income countries (LLMICs), where over 90% of global deaths occur. Despite progress, the changing contributions of risk factors to U5M in LLMICs remain unexplored.
methodsWe analysed Demographic and Health Survey (DHS) data from 24 LLMICs across two periods: 1997-2005 and 2016-2022. We included 139,890 live births in 1997-2005 and 319,034 in 2016-2022. A mixed-effects robust Poisson regression model with a log link function was employed to identify risk factors of U5M in each period. Population-attributable fractions (PAFs) were calculated and compared to investigate changes in the contributions of risk factors over time.
resultsU5M attributable to never having been breastfed increased by 15.5 percentage points (95% CI 8.6, 22.9), early maternal age at birth (< 20 years) by 5.4 percentage points (95% CI 3.1, 5.7), and plural births by 1.2 percentage points (95% CI 0.4, 1.8). U5M reductions attributable to maternal secondary education were increased by 5.5 percentage points (95% CI 0.4, 11.0) and tertiary education increased by 2.6 percentage points (95% CI 1.6, 4.2). However, U5M reductions associated with 1-3 antenatal care (ANC) visits decreased by 7.2 percentage points (95% CI 2.4, 11.7).
conclusionsThe main contributors of U5M in LLMICs were never breastfeeding, short birth intervals (<33 months), ANC uptake, higher maternal education (secondary and tertiary), advanced maternal age at birth (≥35 years), early maternal age at birth (<20 years), very small infants at birth, male sex, plurality, and single motherhood. The contributions of risk factors to U5M have changed over time. Interventions need to prioritise promoting breastfeeding, enhancing maternal education and increasing ANC uptake, and addressing other significant contributors to U5M.
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