ArticleBMJ open2016
Factors associated with declining under-five mortality rates from 2000 to 2013: an ecological analysis of 46 African countries.
Article in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
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Who cites it
28 citing papers in PubMed, 51 citations in OpenAlex.
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- Determinants of diarrhea and acute respiratory infection among under-five children in urban-rural Somalia: a nationally representative cross-sectional study.BMC infectious diseases · 2026Article
- Socioeconomic, demographic and environmental factors associated with under-five mortality among children in Kenya: analysis of the 2022 Kenya demographic and health survey.BMC pediatrics · 2025Article
- Population attributable fractions for modifiable risk factors of neonatal, infant, and under-five mortality in 48 low- and middle-income countries.Journal of global health · 2025Article
- What is the impact of national public expenditure and its allocation on neonatal and child mortality? A machine learning analysis.BMC public health · 2023Article
- Exploring spatiotemporal trends and impacts of health resources and services on under-5 mortality in West African countries, 2010-2019: a spatial data analysis.Frontiers in public health · 2023Article
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- Patterns, Outcomes and Predictors of Pediatric Medical Admissions at Gadarif Hospital in Eastern Sudan.Frontiers in pediatrics · 2022Article
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- Intimate partner violence, contextual factors and under-5 mortality: a multilevel analysis of cross-sectional surveys from 20 Sub-Saharan African countries.BMJ global health · 2020Article
- Geostatistical analysis and mapping: social and environmental determinants of under-five child mortality, evidence from the 2014 Ghana demographic and health survey.BMC public health · 2020Article
- Measuring socioeconomic and health financing inequality in maternal mortality in Colombia: a mixed methods approach.International journal for equity in health · 2020Article
- Measuring child survival for the Millennium Development Goals in Africa: what have we learned and what more is needed to evaluate the Sustainable Development Goals?Global health action · 2020Article
- Frequentist and Bayesian Regression Approaches for Determining Risk Factors of Child Mortality in Ghana.BioMed research international · 2020Article
- Trend in overweight and obesity among women of reproductive age in Uganda: 1995-2016.Obesity science & practice · 2019Article
- Predictive model and determinants of under-five child mortality: evidence from the 2014 Ghana demographic and health survey.BMC public health · 2019Article
- Understanding the determinants of infant and under-five mortality rates: a multivariate decomposition analysis of Demographic and Health Surveys in Ghana, 2003, 2008 and 2014.BMJ global health · 2019Article
- Lenses and levels: the why, what and how of measuring health system drivers of women's, children's and adolescents' health with a governance focus.BMJ global health · 2019Review
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Corrections and comments
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Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
Abstract
objectiveInadequate overall progress has been made towards the 4th Millennium Development Goal of reducing under-five mortality rates by two-thirds between 1990 and 2015. Progress has been variable across African countries. We examined health, economic and social factors potentially associated with reductions in under-five mortality (U5M) from 2000 to 2013.
settingEcological analysis using publicly available data from the 46 nations within the WHO African Region. OUTCOME MEASURES: We assessed the annual rate of change (ARC) of 70 different factors and their association with the annual rate of reduction (ARR) of U5M rates using robust linear regression models.
resultsMost factors improved over the study period for most countries, with the largest increases seen for economic or technological development and external financing factors. The median (IQR) U5M ARR was 3.6% (2.8 to 5.1%). Only 4 of 70 factors demonstrated a strong and significant association with U5M ARRs, adjusting for potential confounders. Higher ARRs were associated with more rapidly increasing coverage of seeking treatment for acute respiratory infection (β=0.22 (ie, a 1% increase in the ARC was associated with a 0.22% increase in ARR); 90% CI 0.09 to 0.35; p=0.01), increasing health expenditure relative to gross domestic product (β=0.26; 95% CI 0.11 to 0.41; p=0.02), increasing fertility rate (β=0.54; 95% CI 0.07 to 1.02; p=0.07) and decreasing maternal mortality ratio (β=-0.47; 95% CI -0.69 to -0.24; p<0.01). The majority of factors showed no association or raised validity concerns due to missing data from a large number of countries.
conclusionsImprovements in sociodemographic, maternal health and governance and financing factors were more likely associated with U5M ARR. These underscore the essential role of contextual factors facilitating child health interventions and services. Surveillance of these factors could help monitor which countries need additional support in reducing U5M.
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