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

Area of Science:

• Public Health
• Demography
• Spatial Epidemiology

Background:

• Sub-Saharan Africa faces the world's highest under-five mortality rate, contributing over 80% of global deaths.
• Limited research exists on the spatial distribution and multilevel determinants of under-five mortality across the region.

Purpose of the Study:

• To examine the spatial patterns of under-five mortality in Sub-Saharan Africa.
• To identify significant multilevel determinants influencing under-five mortality in the region.

Main Methods:

• Utilized Demographic and Health Survey (DHS) data from nine Sub-Saharan African countries (2016-2022).
• Employed a multilevel logistic regression model with 115,335 live births for analysis.
• Compared nested models using likelihood ratio tests, AIC, and BIC criteria.

Main Results:

• Under-five mortality exhibited significant spatial clustering (Moran's Index = 0.552, p < 0.001).
• High mortality rates were noted in Burundi (58.5/1000) and low rates in Kenya (33.9/1000), with an overall regional rate of 48.9/1000.
• Increased risk factors included low maternal education, large family size, and multiple births; protective factors included maternal employment, contraceptive use, and health facility deliveries.

Conclusions:

• Under-five mortality rates in Sub-Saharan Africa surpass SDG targets, highlighting an urgent need for intervention.
• Maternal education, family planning, and safe delivery practices are crucial for reducing child mortality.
• Empowering women and promoting regional collaboration are vital for improving child survival rates.