Global patterns and disparities in maternal and child health: a panel analysis of global health observatory and world...

This study aims to evaluate global trends in maternal and child health-related indicators in the Millennium Development Goals (MDG) and Sustainable Development Goal (SDG) eras, examine whether these associations differ across regions and income groups and assess their impact on life expectancy (LE) at birth.

We conducted a country-level panel analysis using data from 2000 to 2023 obtained from the Global Health Observatory and the World Development Indicator database. All WHO Member States with available data were included. Data on under-five mortality rate (U5MR), maternal mortality ratio (MMR), neonatal mortality rate (NMR), skilled birth attendance, ratio of nurses and midwives, total fertility rate (TFR), LE, prevalence of anaemia and hypertension in women aged 15-49 years, diphtheria tetanus toxoid and pertussis (DTP3) vaccine coverage, gross domestic product and government health expenditure as a percentage of GDP were collected, cleaned and prepared for analysis. Missing values (<10%) were imputed using linear interpolation and 5-year mean methods. Descriptive statistics and panel regression analyses were conducted to examine associations between maternal and child health indicators and LE. In addition, Joinpoint regression models were applied to assess temporal trends and estimate annual percent changes (APCs) during the MDG and SDG eras. All statistical analyses were performed using Stata MP version 17.0. Sensitivity analyses were conducted to evaluate the robustness of the findings.

Trends in LE and maternal and child health indicators and maternal and child-related factors associated with LE.

Maternal and child health improved substantially, with faster progress during the MDG era (2000-2015) compared with the SDG era (2015-2023). The MMR declined by 130.30 (100 in MDG vs 30.30 in SDG) deaths per 100 000 live births overall, from 327.60 (95% UI: 308.80-348.60) in 2000 to 197.30 (95% UI: 174.50-234.00) in 2023. Similarly, U5MR declined by 39.95 (28 in the MDG vs 11.95 in the SDG era) deaths, from 76.67 (95% UI: 75.70-77.86) to 36.72 (95% UI: 34.66-41.09) deaths per 1000 live births. The NMR decreased by 13.38 per 1000 live births, from 30.71 (95% UI: 29.91-31.58) to 17.33 (95% UI: 16.25-19.41) deaths, and LE increased by 6.6 years, from 66.77 (95% UI: 66.23-67.18) to 73.33 (95% UI: 72.73-73.93) globally. Fixed-effects regression results showed that higher U5MR (β=-0.0697, 95% CI -0.080 to -0.060, p<0.001), MMR (β=-0.0118, 95% CI -0.020 to -0.010, p<0.001), TFR (β=-0.0258, 95% CI -0.040 to -0.020, p<0.001) and prevalence of anaemia (β=-0.0223, 95% CI -0.030 to -0.010, p<0.001) were associated with reduced LE, whereas skilled birth attendance (β=0.0417, 95% CI 0.030 to 0.050, p<0.001), DPT3 coverage (β=0.0425, 95% CI 0.030 to 0.050, p<0.001) and GDP (β=0.0041, 95% CI 0.001 to 0.010, p=0.01) were associated with increased LE.

Despite progress in maternal and child health, gaps remain, particularly in low-income and lower-middle-income countries. Strengthening and retaining the health workforce, expanding access to immunisation and family planning services and improving early detection and management of hypertension and anaemia among women are critical to sustaining gains and accelerating improvements in LE.