Determinants of Child Mortality in Low-Resource Settings

Child mortality in low-resource environments is driven by a complex interplay of biological, social and environmental factors. Neonatal vulnerability often reflects maternal health, nutritional status and perinatal care, while post-neonatal deaths are influenced by infectious disease exposure, immunisation coverage and household living conditions. Socioeconomic determinants such as maternal education, household wealth and access to health services shape care-seeking behaviour, nutritional practices and hygiene standards. Geographic disparities—rural versus urban residence—further modulate risks through differential infrastructure, service availability and environmental exposures. Seasonality, birth spacing and multiple births introduce additional layers of vulnerability, as do underlying factors such as gender bias and household composition. Effective reduction of under-five mortality therefore requires integrated strategies addressing maternal and child health, water and sanitation, nutrition, education and social protection at community and policy levels.

Research from Nature Portfolio

Recent studies have applied advanced survival analysis to characterise under-five mortality in rural Ethiopia, drawing on national survey data. By employing a Cox’s gamma shared frailty model alongside Kaplan–Meier estimation, researchers quantified survival times and identified key predictors. Maternal age, education level, wealth index, marital status and sex of household head emerged as significant factors, alongside child characteristics such as sex, birth type (singleton versus twin) and breastfeeding status. Water source quality and birth interval also influenced hazard rates. Findings highlighted elevated risk among twins and non-breastfed infants and underscored the need for improved household water supplies and maternal income support to bolster child survival.

Determinants of Child Mortality in Low-Resource Settings publication trend

The graph below shows the total number of articles in determinants of child mortality in low-resource settings across all publications each year (not limited to Nature Index journals).

Technical terms

Under-five mortality rate: The number of deaths of children before their fifth birthday per 1,000 live births.

Hazard ratio: A measure of relative risk over time comparing the instantaneous rate of an event between two groups.

Shared frailty model: A survival analysis technique that accounts for unobserved heterogeneity within clustered data by introducing a random effect.

Random Forest: An ensemble machine learning method that constructs multiple decision trees and aggregates their predictions to improve accuracy.

Water, sanitation and hygiene (WASH): Collective term for access to safe drinking water, improved sanitation facilities and hygienic practices essential for disease prevention.

References

1. Time to death and its determinants of under-five children in rural Ethiopia by using shared frailty. Scientific Reports (2024).
2. Application of machine learning methods for predicting under-five mortality: analysis of Nigerian demographic health survey 2018 dataset. BMC Medical Informatics and Decision Making (2024).
3. Discovering Subgroups of Children With High Mortality in Urban Guinea-Bissau: Exploratory and Validation Cohort Study. JMIR Public Health and Surveillance (2024).
4. Effects of household access to water, sanitation, and hygiene services on under-five mortality in Sub-Saharan Africa. Frontiers in Public Health (2023).