ArticleJournal of paediatrics and child health2026
Maternal Mortality, Adolescent Fertility, and Immunization as Drivers of Under-Five Mortality: A 187-Country Panel, 1992-2023.
Article in Journal of paediatrics and child health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimTo quantify the long-term associations between adolescent fertility (AFR), maternal mortality (MMR), immunization coverage, and under-five mortality (U5MR) across countries and regions.
methodsA strongly balanced panel of 187 countries (1992-2023) was constructed using World Bank and WHO data. The primary outcome was U5MR (deaths before age five per 1000 live births). Exposures included AFR (births per 1000 women aged 15-19), MMR (per 100 000 live births), full immunization (%), and measles (MCV1) coverage (%). Two-way panel regression models with country and year effects were estimated under fixed and random effects, guided by the Hausman test. Inference used Driscoll-Kraay or cluster-robust standard errors. Robustness checks incorporated lagged covariates, correlated random effects, common-correlated-effects models, and a vaccination composite.
resultsGlobally, higher AFR and MMR were consistently linked to increased U5MR, while full immunization was protective. Each 10-per-1000 increase in AFR corresponded to about 4.6 additional under-five deaths per 1000, each 10-percentage-point increase in full immunization to 4.9 fewer, and each 100-per-100 000 increase in MMR to 8.8 more. Measles coverage showed additional protective effects in Asia and the Americas. AFR was the strongest predictor in Africa, while MMR was a near-universal predictor across regions.
conclusionU5MR remains strongly tied to adolescent fertility, maternal survival, and immunization. Region-specific, equity-focused interventions-expanding adolescent reproductive health services, high-quality maternal care, and comprehensive immunization (including at least 95% two-dose measles coverage)-are essential to accelerate progress towards Sustainable Development Goal 3.2.
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