Multiple indicator cluster survey (MICS) related to early childhood health: an ecological intercontinental analysis

Child health is a fundamental measure of a population's social and sanitary conditions and enables the identification of priority challenges to promote well-being in early childhood. This study aimed to conduct a joint and comparative assessment of reported child health indicators in developing countries participating in the sixth round of the Multiple Indicator Cluster Surveys (MICS6).

This ecological cross-sectional study was conducted from April to July 2024, using UNICEF data from developing countries that implemented MICS6 and reported country-level continuous quantitative indicators, such as under-five mortality, complete vaccination coverage, adequate skilled childbirth care, prevalence of low birth weight, and access to safe drinking water services. The Human Development Index (HDI) was included as an additional indicator. Statistical analyses comprised multiple linear regression and Pearson's correlation.

Of the 72 countries and territories initially considered, 58 were included in the inferential and descriptive analyses, and 39 had complete data and were included in the visual mapping, representing the following regions: Africa (n=17), Asia (n=13), Oceania (n=5), Central America (n=2), South America (n=1) and Europe (n=1). Access to safe drinking water (β = -0.63; 95 % CI: -1.11 to -0.14; p=0.013) and HDI (β = -101.18; 95 % CI: -175.03 to -27.32; p=0.008) were significantly and inversely associated with under-five mortality risk, as were the strong inverse correlations between mortality and both HDI (r = -0.793) and access to safe drinking water (r = -0.782). All correlations among variables were statistically significant (p<0.001). Africa exhibited the poorest performance across multiple child health indicators, while Asia reported the highest prevalence of low birth weight. Serbia, the sole European country analyzed, demonstrated the most favorable outcomes overall.

These findings underscore substantial inequalities in child health, particularly in Africa, and highlight the imperative for targeted global health policies to address these disparities.