Spatial patterns and determinants of under-five mortality in Sub-Saharan Africa: a spatial and multilevel analysis.

backgroundSub-Saharan Africa is still the region having the highest burden of under-five mortality rate in the world. Of 4.8 million under-five deaths in 2023, more than 80 percent of under-five death reported from Sub-Saharan Africa and Southern Asia. While previous studies have examined the determinants of under-five mortality in individual countries, there is limited evidence on its spatial distribution and multilevel determinants across the region. This study aimed to examine the spatial pattern and identify significant factors of under-five mortality in Sub-Saharan African countries.

methodThis study explored the Demographic and Health Survey (DHS) data from nine Sub-Saharan African countries conducted between 2016 and 2022, and used a total of 115,335 live births for analysis. The multilevel logistic regression model was considered and several nested models were compared using the likelihood ratio test, AIC and BIC criteria. Significant predictors of under-five mortality were reported using adjusted odds ratios (AOR) with 95% Confidence Intervals (CI) and p-values < 0.05.

resultsThe spatial distribution of under-five mortality in Sub-Saharan Africa was significantly clustered, as indicated by Moran's Index of 0.552 (p < 0.001). High mortality rates were observed in Burundi (58.5 per 1,000 live births) and low rates in Kenya (33.9), with an overall rate of 48.9 per 1,000 live births. Increased risk was associated with low maternal education (AOR = 1.57, 95% CI: 1.28-1.91), large family size (AOR = 2.60, 95% CI: 2.41-2.81), and multiple births (AOR = 5.73, 95% CI: 5.01-6.36). On the other hand, a lower risk was observed among children born to employed mothers (AOR = 0.90, 95% CI: 0.84-0.97), whose mothers used contraceptives (AOR = 0.59, 95% CI: 0.55-0.63), and those delivered at health facilities (AOR = 0.83, 95% CI: 0.77-0.90).

conclusionsThe study reveals a significant spatial clustering of under-five mortality across Sub-Saharan Africa, with an overall rate that exceeds the Sustainable Development Goal (SDG) target of 25 deaths per 1,000 live births by 2030. Family planning, maternal education, and safe delivery practices would be essential in reducing under-five mortality in Sub-Saharan African countries. Empowering women through education and promoting family planning, safe delivery, and income-generating programs are vital to reduce child mortality. Regional collaboration and sharing best practices can further advance child survival across Sub-Saharan Africa.