National trends in neonatal and under-five mortality in Saudi Arabia (2018-2023): a descriptive ecological analysis...

Neonatal mortality rate (NMR) and under-five mortality rate (U5MR) are core child-survival indicators and are influenced by, though not a direct measure of, the quality of maternal and newborn care. Saudi Arabia has achieved substantial reductions in both indicators over recent decades; however, year-to-year dynamics during the period of Vision 2030 health reforms remain incompletely described using standardized, internationally comparable data.

To describe annual trends in NMR and U5MR in Saudi Arabia from 2018 to 2023 using WHO Global Health Observatory (WHO-GHO) national estimates, and to situate these descriptive trends within the broader regional and international literature on child mortality.

A descriptive ecological analysis was conducted using all available national annual estimates (2018-2023; n = 6 per indicator) from WHO-GHO. Descriptive statistics and annual percentage change (APC) were calculated as the primary analytical approach. An unadjusted linear regression of rate on year is reported to characterize the direction and approximate magnitude of change over the period; because six annual observations provide very limited statistical power, regression p-values are reported for completeness only and are not used to support claims of trend presence or absence.

NMR declined from 3.6 to 3.0 per 1,000 live births between 2018 and 2023 (mean 3.27; range 3.0-3.6), a change concentrated mainly in 2020. U5MR fluctuated within a narrow band, falling from 6.1 in 2018 to 5.6 in 2021, rising to 6.4 in 2022, and partially returning to 6.2 in 2023 (mean 5.98; range 5.6-6.4). The unadjusted linear slopes were -0.12/year for NMR and +0.03/year for U5MR.

Between 2018 and 2023, Saudi Arabia's NMR and U5MR remained low and comparatively stable by international standards, with a gradual decline in NMR and a transient fluctuation in U5MR centered on 2022. These are descriptive, population-level patterns; the dataset does not include measures of healthcare quality, patient safety, or COVID-19 service disruption, and any interpretation connecting the observed trends to these factors should be regarded as a hypothesis for future research rather than a finding of this study. Future work linking subnational data, cause-specific mortality, and direct quality-of-care indicators to these trends is needed.