Author Identifier (ORCID)
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.
Mrthods: 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).
Keywords
Antenatal care, Breastfeeding, Changes, Contributions, Low- and lower-middle-income countries, Risk factors, Under-five mortality
Document Type
Journal Article
Date of Publication
5-1-2025
Volume
21
Issue
5
PubMed ID
40347427
Publication Title
World Journal of Pediatrics Wjp
Publisher
Springer
School
School of Nursing and Midwifery / Nutrition and Health Innovation Research Institute / School of Medical and Health Sciences
Funding Information
GP was supported with funding from the National Health and Medical Research Council Project and Investigator Grants #1099655 and #1173991. GAT was supported with funding from the National Health and Medical Research Council Investigator Grant #1195716. ATG was supported with funding by the Western Australian Future Health Research and Innovation Fund through Emerging Leaders Fellowship (Grant ID: WANMA/EL2023-24/7) and WANMA Ideas Grant (Grant ID: WANMA/Ideas2023-24/10) and the Edith Cowan University Vice-Chancellor Research Fellowship.
Funding received from the National Health and Medical Research Council (NHMRC)
1099655, 1173991, 1195716
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
First Page
502
Last Page
514
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. World Journal of Pediatrics, 21, 502-514. https://doi.org/10.1007/s12519-025-00912-8
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