A recent study by Liyew et al. (2025) titled “Parametric modeling of under-5 children survival among 30 African countries: Lognormal accelerated failure time gamma shared frailty model,” published in PloS One, reveals that under-5 mortality varies across 30 African countries, influenced by maternal, health, child, and community factors, with regional and socioeconomic disparities evident.
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Under-five mortality in 30 African countries is driven by maternal, health, socioeconomic, and regional disparities, requiring targeted interventions.– Liyew et al. 2025
This study examines the survival rates of children under five across 30 African countries and explores key factors influencing mortality. Analyzing data from 226,862 live births between 2014 and 2022, it employs a parametric survival regression model to identify significant predictors of child mortality. Findings reveal an overall under-five mortality rate of 37.55 per 1,000 live births, with the highest rates observed in Western Africa and the lowest in Northern Africa. Key determinants include maternal age, education, healthcare autonomy, antenatal care visits, mode of delivery, and child’s birth size. The study underscores the urgent need for targeted interventions addressing these factors to reduce child mortality and advance sustainable development goals in Africa.
How the Study was Conducted
The study utilized data from the Demographic and Health Surveys (DHS) conducted between 2014 and 2022 across 30 African countries to analyze child mortality. The target population comprised children under five years old, with data drawn from the Kids Record (KR) file, which contains detailed live birth records. A multistage cluster sampling technique was implemented to ensure a representative sample, using enumeration areas (EAs) and households as the primary and secondary units of analysis.
The study focused on survival time as the dependent variable, while independent variables encompassed socio-economic, demographic, and maternal health factors such as maternal education, autonomy in healthcare decisions, and antenatal care visits. Descriptive statistics were applied to summarize the data, followed by survival analysis models to assess time-to-event outcomes. Specifically, a lognormal accelerated failure time (AFT) gamma shared frailty parametric survival regression was conducted to account for clustering effects and identify key predictors of child mortality.
What the Authors Found
The study on under-five mortality across 30 African countries found an overall mortality rate of 37.55 per 1,000 live births, with significant regional variations—highest in Western Africa and lowest in Northern Africa. Key predictors included maternal age, education, healthcare access, birth conditions, and community factors such as poverty and low education levels. Children from wealthier, urban households had better survival rates, while those born to younger, less-educated mothers with limited healthcare access faced higher risks.
Why is this important?
Addressing Public Health Priorities: Under-five child mortality is a critical indicator of a country’s overall health and development. By understanding its predictors, the study provides crucial insights for designing effective public health strategies to reduce child mortality.
Informing Policy and Intervention: Identifying factors like maternal education, antenatal care, and community poverty equips policymakers and healthcare professionals with actionable data to develop targeted interventions that improve child survival rates.
Sustainable Development Goals (SDGs): The study contributes to the global agenda of reducing under-five mortality to less than 25 per 1,000 live births by 2030 (SDG 3.2). It highlights areas where progress is lagging and where additional efforts are needed.
Highlighting Inequalities: By uncovering disparities in child mortality rates across regions, socio-economic groups, and access to healthcare, the study emphasizes the need to address inequalities that undermine child health in many communities.
Guidance for Resource Allocation: The findings can guide governments and organizations in allocating resources more effectively to the most vulnerable populations, ensuring that support reaches those who need it most.
What the Authors Recommended
- The authors recommend that policymakers should improve access to antenatal care services, ensuring at least four visits during pregnancy, and promote skilled attendance at childbirth and deliveries in healthcare facilities.
- Enhance women’s autonomy in healthcare decision-making by promoting gender equality and empowering women through education and economic opportunities.
- The study emphasizes that policymakers should focus on maternal education as a key factor in improving child survival rates. Programs that increase women’s access to education can have a profound impact.
- Develop interventions that address the needs of high-risk groups, such as teenage mothers, low-income households, and rural communities.
- Strengthen community-level healthcare initiatives, including education about child health, nutrition, and sanitation, as well as improve access to clean water and hygienic facilities to reduce disease transmission.
- Policymakers should prioritize funding for maternal and child health programs and allocate resources to areas with the highest mortality rates, such as Western and Eastern Africa.
- In addition, the study emphasizes establishing robust systems for tracking child health outcomes and evaluating the effectiveness of interventions.
Reducing under-five mortality remains a critical public health challenge across Africa, with significant regional and socioeconomic disparities influencing child survival rates. This study highlights the urgent need for targeted interventions focusing on maternal education, healthcare access, and community development to improve child health outcomes. By addressing key determinants such as antenatal care, skilled birth attendance, and poverty alleviation, policymakers can take meaningful steps toward achieving the Sustainable Development Goal of reducing under-five mortality to less than 25 per 1,000 live births by 2030. Strengthening healthcare systems, empowering women, and prioritizing high-risk populations will be essential in ensuring that every child has a fair chance at life.
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