Evidence map›Paper›PMID 39820022›Full record

ArticleJournal of global health2025

Population attributable fractions for modifiable risk factors of neonatal, infant, and under-five mortality in 48 low- and middle-income countries.

Kedir Y Ahmed, Subash Thapa, Getiye D Kibret, Habtamu M Bizuayehu, Jing Sun, M Mamun Huda, Abel F Dadi, Felix A Ogbo, Shakeel Mahmood, Muhammad J A Shiddiky and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Avoidable mortality in childhood in Colombia: A type of violenceBiomedica : revista del Instituto Nacional de Salud · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Kedir Y AhmedRural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia.
Subash ThapaRural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia.
Getiye D KibretFaculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia.
Habtamu M BizuayehuFirst Nations Cancer and Wellbeing (FNCW) Research Program, School of Public Health, The University of Queensland, St Lucia, Queensland, Australia.
Jing SunRural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia.
M Mamun HudaRural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia.
Abel F DadiMenzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.
Felix A OgboRiverland Academy of Clinical Excellence (RACE), Riverland Mallee Coorong Local Health Network, SA Health Government of South Australia, Berri, South Australia, Australia.
Shakeel MahmoodRural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia.
Muhammad J A ShiddikyRural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia.
Fentaw T BerheDepartment of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Setognal B AychiluhmRural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia.
Anayochukwu E AnyasodorRural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia.
Allen G RossRural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Identifying the modifiable risk factors for childhood mortality using population-attributable fractions (PAFs) estimates can inform public health planning and resource allocation in low- and middle-income countries (LMICs). We estimated PAFs for key population-level modifiable risk factors of neonatal, infant, and under-five mortality in LMICs. Methods: We used the most recent Demographic and Health Survey data sets (2010-22) from 48 LMICs, encompassing 35 sub-Saharan African countries and 13 countries from South and Southeast Asia (n = 506 989). We used generalised linear latent mixed models to compute odds ratios (ORs), and we calculated the PAFs adjusted for commonality using ORs and prevalence estimates for key modifiable risk factors. Results: The highest PAFs of neonatal mortality were attributed to delayed initiation of breastfeeding (>1 hour of birth) (PAF = 23.9; 95% confidence interval (CI) = 23.1, 24.8), uncleaned cooking fuel (PAF = 6.2; 95% CI = 6.4, 7.8), infrequent antenatal care (ANC) visits (PAF = 4.3; 95% CI = 3.3, 5.9), maternal lack of formal education (PAF = 3.9; 95% CI = 2.7, 5.3), and mother's lacking two doses of tetanus injections (PAF = 3.0; 95% CI = 1.9, 3.9). These five modifiable risk factors contributed to 41.4% (95% CI = 35.6, 47.0) of neonatal deaths in the 48 LMICs. Similarly, a combination of these five risk factors contributed to 40.5% of infant deaths. Further, delayed initiation of breastfeeding (PAF = 15.8; 95% CI = 15.2, 16.2), unclean cooking fuel (PAF = 9.6; 95% CI = 8.4, 10.7), mothers lacking formal education (PAF = 7.9; 95% CI = 7.0, 8.9), infrequent ANC visits (PAF = 4.0; 95% CI = 3.3, 4.7), and poor toilet facilities (PAF = 3.4; 95% CI = 2.6, 4.3) were attributed to 40.8% (95% CI = 36.4, 45.2) of under-five deaths. Conclusions: Given the current global economic climate, policymakers should prioritise these modifiable risk factors. Key recommendations include ensuring that women enter pregnancy in optimal health, prioritising the presence of skilled newborn attendants for timely and proper breastfeeding initiation, and enhancing home-based care during the postnatal period and beyond.

Indexed as

Child MortalityDeveloping CountriesInfant MortalityAdultAfrica South of the SaharaBreast FeedingChild, PreschoolFemaleHealth SurveysHumansInfantInfant, NewbornMaleRisk Factors

Identifiers

PMID39820022
PMCPMC11739818

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.