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. 2025 Jan 24;184(2):150.
doi: 10.1007/s00431-024-05966-w.

Under-five mortality and social determinants in africa: a systematic review

Israel C Avelino  1 , Joaquim Van-Dúnem  2 , Luís Varandas  3   4   5
Affiliations

Under-five mortality and social determinants in africa: a systematic review

Israel C Avelino et al. Eur J Pediatr. .

Abstract

Purpose: Under-five mortality is a key public health indicator, highly responsive to preventive interventions. While global efforts have made strides in reducing mortality rates in this age group, significant disparities persist, particularly in Sub-Saharan Africa. This study aimed to systematically review the factors influencing under-five mortality in Africa, focusing on sociodemographic factors and health-related determinants.

Methods: A systematic review was conducted adhering to PRISMA guidelines. Studies were identified from a range of well-established indexed academic databases. Keywords and Boolean operators facilitated relevant study retrieval. Only articles published in English, Portuguese, or Spanish between January 2013 and November 2024, in peer-reviewed journals, were included. Methodological quality assessment utilised the Joanna Briggs Institute tool.

Results: Of the 602 studies identified, 39 met the inclusion criteria. Key determinants of under-five mortality included socioeconomic factors such as poverty and maternal education, along with maternal age extremes, multiparity, inadequate prenatal care, and low birth weight.

Conclusion: Addressing social disparities, particularly through enhanced maternal education and improved access to primary healthcare, is critical in reducing under-five mortality in Africa. The findings underscore the importance of targeted interventions that address both social and healthcare-related factors to mitigate child mortality in the region.

What is known: •Under-five mortality in Sub-Saharan Africa is primarily driven by preventable infectious diseases, such as diarrhoea, pneumonia, malaria, and HIV/AIDS, compounded by malnutrition and inadequate healthcare infrastructure. •Socio-economic factors, including poverty, maternal education, and limited access to quality healthcare, are consistently identified as key determinants of high child mortality rates in the region.

What is new: •This review applies the Mosley and Chen framework to categorise the determinants of under-five mortality into distal, intermediate, and proximal factors, providing a structured understanding of their interconnections. •The findings underscore how socio-economic conditions, maternal education, and healthcare access interact to influence child survival outcomes in Sub-Saharan Africa, offering valuable insights for region-specific public health interventions.

Keywords: Africa; Economic disparity; Infant death; Risk factors; Under-five mortality.

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Conflict of interest statement

Declarations. Ethics approval: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable. Competing interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of literature search and data extraction
Fig. 2
Fig. 2
Regional distribution of the articles included in the analysis
See this image and copyright information in PMC

References

    1. Ortiz L. Agrupamento das causas evitáveis de morte dos menores de um ano segundo critério de evitabilidade das doenças. São Paulo: Fundação SEADE [Internet]. 2000 [cited 2024 10/April]. Available from: https://www.saude.mg.gov.br/images/documentos/Agrupamento%20das%20Causas....
    1. Simão R, Gallo PR. Mortes infantis em Cabinda, Angola: desafio para as políticas públicas de saúde. Revista Brasileira de Epidemiologia [Internet]. 2013 [cited 2023 03/September]; 16:[826–37 pp.]. Available from: https://www.scielo.br/j/rbepid/a/wGTtzSgJPvqXBqJjtm5kD4c/?lang=pt. - PubMed
    1. NationsChildren'sFund U, (UNICEF). THE STATEOF THE WORLD'S CHILDREN 1987. NEW YORK: 1987 13/03/2021. Report No.: 1.
    1. UNICEF, Organization WH. Levels and Trends Child Mortality-Report 2023: Estimates Developed by the United Nations Inter-agency Group for Child Mortality Estimation. 2024.
    1. Aguilera X. Under five and infant mortality in Chile (1990–2016): Trends, disparities, and causes of death. International journal of pediatrics [Internet]. 2020 [cited 2021 MAIO 25]; 15(9):[e0239974 p.]. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239974. - PMC - PubMed

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