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

Authors/Creators

Bereket Kefale
Jonine Jancey
Amanuel T. Gebremedhin, Edith Cowan UniversityFollow
Gavin Pereira
Gizachew A. Tessema

Abstract

BACKGROUND: Under-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. METHODS: We 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. RESULTS: U5M 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).

Document Type

Journal Article

Date of Publication

5-1-2025

Volume

21

Issue

5

Funding Information

National Health and Medical Research Council / Western Australian Future Health Research and Innovation Fund (WANMA/EL2023-24/7, WANMA/Ideas2023-24/10) / Edith Cowan University Vice-Chancellor Research Fellowship

PubMed ID

40347427

School

School of Nursing and Midwifery / Nutrition and Health Innovation Research Institute / School of Medical and Health Sciences

Grant Number

NHMRC Numbers : 1099655, 1173991, 1195716,

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

Publisher

Springer

Identifier

Amanuel T. Gebremedhin: https://orcid.org/0000-0003-2459-1805

Comments

Kefale, B., Jancey, J., Gebremedhin, A. T., Pereira, G., & Tessema, G. A. (2025). 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. World Journal of Pediatrics, 21, 502-514. https://doi.org/10.1007/s12519-025-00912-8

Recommended Citation

Kefale, B., Jancey, J., Gebremedhin, A. T., Pereira, G., & Tessema, G. A. (2025). 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. DOI: https://doi.org/10.1007/s12519-025-00912-8