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. 2025 Jun 21;44(1):218.
doi: 10.1186/s41043-025-00862-x.

Surviving the first five years: the economic and healthcare determinants of child mortality in Sri Lanka

Vageesha Rajapakse  1 , Ruwan Jayathilaka  2
Affiliations

Surviving the first five years: the economic and healthcare determinants of child mortality in Sri Lanka

Vageesha Rajapakse et al. J Health Popul Nutr. .

Abstract

Background: This study investigates the role of economic growth, healthcare investment, immunization coverage, and malnutrition in reducing under-five mortality rates (U5MR) in Sri Lanka. Understanding how these factors interact within socio-economic ecosystems is essential to formulating sustainable strategies to improve child survival outcomes.

Methods: This study employs multiple linear regression to analyze the statistical associations between economic growth, healthcare investment, immunization, malnutrition, and under-five mortality in Sri Lanka. Using secondary data from the World Bank and UNICEF (2000-2021), U5MR was modeled against economic growth (per capita GDP), government healthcare expenditure (GHE), immunization coverage (DTP1), and malnutrition (MLN), with significance assessed through p-values and model fit via R².

Results: The multiple linear regression model demonstrated strong explanatory power, accounting for 85% of the variation in under-five mortality (R² = 0.85). Economic growth and immunization coverage were negatively associated with U5MR and found to be statistically significant (p < 0.05 and p < 0.10 respectively), indicating their potential role in reducing child mortality. Malnutrition showed a strong positive association (p < 0.01), emphasizing its continued threat to child health. Although government healthcare expenditure had a negative association, it was not statistically significant, suggesting possible inefficiencies in resource utilization.

Conclusion: The study highlights the significant role of economic growth, healthcare expenditure, immunization coverage, and nutrition in shaping U5MR trends in Sri Lanka. The findings emphasize the need for targeted policy interventions to enhance child health outcomes and ensure sustainable progress in reducing child mortality.

Keywords: Economic growth; Healthcare investment; Malnutrition; Sustainable social ecosystems; Under-Five mortality.

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Conflict of interest statement

Declarations. Statements and declarations: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Ethical approval: This study was approved by the Sri Lanka Institute of Information Technology, Sri Lanka (PVC/RI/EC/2024/04). Consent to participate: Not applicable. Conflict of interest: The authors declare no competing interests.

References

    1. Under-five mortality [https://data.unicef.org/topic/child-%20survival/under-five-mortality/]
    1. Bank W. Assessing Public Financing for Nutrition in Sri Lanka (2014–2018). In.: World Bank; 2021.
    1. World Bank Group-Trending Data. (Sri Lanka) [https://www.worldbank.org/en/country/srilanka/overview]
    1. World-Bank. Assessing Public Financing for Nutrition in Sri Lanka (2014–2018). In.: World Bank; 2021.
    1. Jayatissa R, Perera A, De Alwis N. National nutrition and micronutrient survey in Sri Lanka: 2022. In.: Medical Research Institute; 2023.

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