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Under-five mortality estimation methods: A methodological systematic review.

Bereket Kefale¹, Jonine Jancey², Amanuel T Gebremedhin³

¹Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.

Annals of Epidemiology

|December 21, 2025

Summary

This summary is machine-generated.

This systematic review synthesizes global under-five mortality (U5M) estimation methods. Findings reveal significant variations and challenges, emphasizing the need for harmonized approaches and improved vital registration systems for accurate U5M data.

Keywords:

Censuses Child mortality Global Burden of Disease Infant mortality Methods Systematic review Vital statistics

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Area of Science:

Global child health research
Epidemiological methodology
Demographic analysis

Background:

Accurate estimation of under-five mortality (U5M) is crucial for global health initiatives and policy-making.
Existing methods for U5M estimation exhibit considerable diversity in application and underlying assumptions.
Methodological reviews are essential to understand the landscape of U5M estimation techniques.

Purpose of the Study:

To systematically identify and synthesize all existing methods for estimating under-five mortality (U5M) worldwide.
To provide a comprehensive overview of the current methodologies employed in U5M estimation.
To inform future research and policy by highlighting strengths and weaknesses of current U5M estimation approaches.

Main Methods:

A systematic literature search was conducted across seven major databases and grey literature sources.
The review included studies from inception up to September 25, 2025.
The review protocol was prospectively registered with PROSPERO (CRD42023465476).

Main Results:

Fifty-six studies met the inclusion criteria for this review.
The indirect method (16 studies) was most common, followed by the Global Burden of Disease (GBD) study method (12 studies) and the direct method (11 studies).
Spatiotemporal Gaussian process regression and Bayesian B-spline bias-reduction models were frequently applied, with notable variations in geographical scope, data sources, and statistical modeling.

Conclusions:

Significant heterogeneity exists in under-five mortality estimation methods, posing challenges in data availability, uncertainty quantification, and bias adjustment.
Harmonizing methodological approaches and refining estimation techniques are critical for improving the reliability of U5M data.
Strengthening vital registration systems is paramount for generating accurate, dependable data essential for evidence-based decision-making and achieving U5M reduction targets.