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Review
. 2018 Apr 18;5(4):51.
doi: 10.3390/children5040051.

Association of Place of Residence and Under-Five Mortality in Middle- and Low-Income Countries: A Meta-Analysis

Ian Forde  1 , Vrijesh Tripathi  2
Affiliations
Review

Association of Place of Residence and Under-Five Mortality in Middle- and Low-Income Countries: A Meta-Analysis

Ian Forde et al. Children (Basel). .

Abstract

This review evaluated the association of place of residence (urban/rural) and under-five mortality in middle- and low-income countries. Both English and Spanish language studies conducted during the Millennium Development Goal (MDG) period (1990 to 2015) were reviewed. Twenty-six cross-sectional studies, all in the English language, were selected for further review. Published data were used for this analysis. A funnel plot was produced to ascertain the presence of publication bias. The combined relative risk for under-five mortality was estimated using a random-effects model and a meta-regression was conducted on 15 of the 26 studies. The studies had a combined effect size of 1.47 (95% confidence interval, 1.27–1.67). The results of the meta-regression showed a positive association between the relative risk and the percentage of the rural population for the various regions/countries. The coefficient for the variable rural population percentage was 0.007, indicating that for every one percent increase in the rural population percentage, there was a 0.007 increase in the relative risk for under-five mortality. However, this was not significant (p-value = 0.3). Rural disadvantage persists in middle- and low-income countries. This is important to evaluate policies and programmes designed to remove the gap in under-five mortality rates between urban and rural areas.

Keywords: developing countries; meta-analysis; rural; under-five mortality (U5M); urban.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of study selection including reasons for exclusion for under-five mortality (U5M).
Figure 2
Figure 2
Funnel plot of effect sizes of the 15 selected studies (random effects model), RR: relative risk.
Figure 3
Figure 3
Normal probability plot to test for normality of the effect outcomes of the 15 studies.
Figure 4
Figure 4
Forrest plot of effect sizes, (relative risk (RR) with 95% confidence interval) for the 15 studies used in the meta-analysis.
See this image and copyright information in PMC

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