1 | Ahinkorah,(27) | 2021 | Cross-sectional study | Multilevel logistic regression models | Multi-country analysis: 30 Sub-Saharan African (SSA) countries | To Examine the association between young maternal age at first childbirth and under-5 mortality in Sub-Saharan Africa (SSA). | Demographic and Health Surveys (n = 116,379 mothers of children under 5 years old) | Teenage childbirth (aOR = 1.11; 95% CI: 1.05–1.18). Single mothers: (aOR = 1.54; 95% CI: 1.41–1.67). Maternal obesity (aOR = 1.17; 95% CI: 1.09–1.26). Low birth weight < 2,500 g (aOR = 1.83; 95% CI: 1.64–2.03). |
2 | Kiross GT(28) | 2021 | Cross-sectional study | Multilevel logistic regression models | Ethiopia | Identify individual and community determinants of infant mortality in Ethiopia. | Demographic and Health Survey, 2016 (n = 10,641 live births) | Child's sex: Male (aOR = 1.66, 95% CI: 1.25, 2.20, p < 0.001). Multiple gestations: (aOR = 5.8, 95% CI: 3.63, 9.37, p < 0.001). Residence area: Rural (aOR = 1.44; 95% CI: 1.02–2.06; p = 0.039). Stillbirths, child deaths YES: aOR = 5.20, 95% CI: 3.40, 8.00) |
3 | Houle, Brian,(29) | 2013 | Cross-sectional study | Multilevel logistic regression models | South Africa | Investigate the relationship between the risk of child mortality and the family context. | Household censuses, 1994–2008 (n = 82,000 individuals) | Short birth interval; 0–11 months, (aOR = 2.514, 95% CI: 1.102–5.732), p = 0.028 Previous sibling death (aOR = 2.641, 95% CI: 1.688–4.132), p < 0.001 Maternal death, YES: All causes except HIV/TB; (aOR 9.828, 95% CI: 6.415–15.058), p < 0.001; Maternal death due to HIV/TB (aOR 13.167, 95% CI: 6.954–24.929) p < 0.001 |
4 | Kandala N-B (30) | 2014 | Cross-sectional study | Standard logistic regression and Bayesian spatial model. | Democratic Republic of the Congo | Examine the geographic variation at the provincial level of under-five mortality, representing individual and familial risk factors, including factors such as conflict. | Demographic and Health Survey, 2007 (n = 9000 Children) | Short birth intervals (< 2 years, (aOR = 1.14, 95% CI: 1.04–1.26), Home birth, (aOR = 1.13, 95% CI: 1.01–1.27), Marital status of the mother: Single. (aOR = 1.16, 95% CI: 1.03–1.33) |
5 | Kozuki N (31) | 2013 | Cross-sectional study | Binomial logistic regression, by country | Multi-country analysis | Examine the impact of high parity on neonatal and under-five mortality. | Demographic and Health Surveys | Under-five mortality: Multiparity (aRR 1.15, 95% CI: 1.11–1.19). Neonatal mortality: Multiparity (aRR = 1.28, 95% CI: 1.21–1.35). |
6 | Kozuki N(32) | 2013 | Cross-sectional study | Conditional logistic regression | Multi-country analysis | Examining the impact of short or long birth intervals on neonatal and under-five mortality | Demographic and Health Surveys in low- and middle-income countries | Neonatal Mortality Short birth interval: <18 months (OR = 1.79; 95% CI: 1.54 − 0.09); < 24 months (OR = 1.66; 95% CI: 1.55–1.78) Long birth interval: ≥60 months (OR = 0.81; 95% CI: 0.59–1.11); ≥ 72 months (OR = 0.75; 95% CI: 0.54–1.05) Under-five Mortality Short birth interval: <18 months (OR = 1.55; 95% CI: 1.44–1.67); < 24 months (OR = 1.40; 95% CI: 1.32–1.50) Long birth interval: ≥60 months (OR = 0.55; 95% CI: 0.47–0.65); ≥ 72 months (OR = 0.55; 95% CI: 0.45–0.68) |
7 | Tesema(33) | 2022 | Cross-sectional study | Parametric shared frailty survival models. The shared gamma frailty model of Gompertz was the best-fitting model for the data. Bivariate analyses were considered for multivariable analysis. Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to declare significant predictors of infant mortality. | Multi-country analysis of 12 countries in East Africa: Burundi, Ethiopia, Comoros, Uganda, Rwanda, Tanzania, Mozambique, Madagascar, Zimbabwe, Kenya, Zambia, and Malawi. | Investigating the incidence of infant mortality and its predictors in East Africa. | Demographic and Health Surveys N = 138,803 children under 5 years old. | Maternal education; No education (aHR = 1.23, 95% CI: 1.13, 1.33) p < 0.05 Male sex (aHR = 1.33, 95% CI: 1.27, 1.43) p = 0.05 Cesarean delivery (aHR = 1.13, 95% CI: 1.01, 1.25) p = 0.05 Twins (aHR = 4.18, 95% CI: 3.84, 4.55) p = 0.001 Birth weight; Low: (aHR = 1.87, 95% CI: 1.75, 1.99) p = 0.05 High: (aHR = 1.08, 95% CI: 1.01, 1.15) p = 0.05 |
8 | Tesema(34) | 2021 | Cross-sectional study | Multilevel parametric survival models. Multilevel Weibull regression modeling. | Multi-country analysis of 12 East African countries: Burundi, Ethiopia, Comoros, Uganda, Rwanda, Tanzania, Mozambique, Madagascar, Zimbabwe, Kenya, Zambia, and Malawi. | Investigating the incidence and predictors of under-five mortality in East Africa. | Demographic and Health Surveys (DHS) from 12 East African countries conducted from 2008 to 2019. A total weighted sample of 138,803 live births within 5 years prior to the survey were included for analysis. | Advanced maternal age (≥ 35 years) (aHR = 1.13, 95% CI: 1.04, 1.24), Twins (aHR = 3.81, 95% CI: 3.52, 4.12), Male child: (aHR = 1.27, 95% CI: 1.21–1.33), Birth weight: Small: (aHR = 1.73, 95% CI: 1.63, 1.84), Large: (aHR = 1.11, 95% CI: 1.04, 1.11) |
9 | Abbuy(35) | 2018 | Cross-sectional study | Fixed Effects Instrumental Variables (FE-IV) estimator | Multi-country analysis | Investigate the macroeconomic determinants of mortality in UEMOA countries for the period 1980–2016. | Panel data model of UEMOA countries | GDP per capita as a proxy for income p = 0.013 Low maternal education, p = 0.001 |
10 | Edeme(36) | 2014 | Cross-sectional study | Child Survival Framework developed by W. Mosley and L.C. Chen. Regression models | Nigeria | To examine the relationship between family income and infant mortality. | Multiple Indicator Cluster Surveys (MICS) and household survey data from the general population.. | Low socioeconomic quintile: (OR = 2.14; 95% CI: 1.89–2.42) Mothers with no education: (OR = 1.72; 95% CI: 1.53–1.93) |
11 | Hirose(37) | 2020 | Retrospective cohort | Multilevel survival analysis models | Uganda | Clarify the individual and community determinants of infant mortality in rural and peri-urban areas in eastern Uganda. | Longitudinal data from the Iganga/Mayuge Demographic and Health Surveillance Site, between March 2005 and February 2015 (n = 43,043 children under 5 years old post-neonatal). | Community maternal education (RRa = 0.83; 95% CI 0.70–0.99) Low socioeconomic quintile (RRa = 1.08; 95% CI 1.00-1.18) |
12 | Kanté(38) | 2016 | Retrospective cohort | Multivariable Cox proportional hazards regression | Tanzania | Explore trends in socioeconomic disparities and under-five mortality rates in rural areas of the United Republic of Tanzania. | Longitudinal data on births, deaths, migrations, maternal education, and family characteristics from the health and demographic surveillance systems of Ifakara and Rufiji (n = 140,162). | Maternal education: None HR 1.44 (95% CI: 1.08–1.92) Low socioeconomic quintile HR 1.20 (95% CI: 0.99–1.47) in 2000–2001 HR 1.48 (95% CI: 1.15–1.89) in 2010–2011. |
13 | Keats(39) | 2018 | Cross-sectional study | Multilevel logistic regression models | Quênia | Empirically assess the drivers of change in under-five mortality, taking into account the country's complex context and underlying determinants. | Raw data from nationally representative Kenya Demographic and Health Surveys (K-DHS) from 1989 to 2014. | Fewer prenatal care visits: (RR = 0.7592; 95% CI: 0.6895–0.8355) Higher birth order: (RR = 1.1305; 95% CI: 1.0605–1.2045) Longer birth interval: (RR = 1.1405; 95% CI: 1.0705–1.2155) Small birth size: (RR = 0.8695; 95% CI: 0.8095–0.9345) Delayed breastfeeding: (RR = 0.8395; 95% CI: 0.7795–0.9045) Teenage mother: (RR = 0.8595; 95% CI: 0.7995–0.9245) Non-use of contraceptives: (RR = 1.1205; 95% CI: 1.0505–1.1955) Multiparity: (RR = 1.1505; 95% CI: 1.0805–1.2255) |
14 | Agho(40) | 2020 | Cross-sectional study | Generalized linear latent and mixed models (GLLAMM). | Rwanda and Tanzania | Examine the factors associated with mortality in children under 5 years of age in three disadvantaged districts of East Africa. | Data on live singleton births from rural districts in Rwanda (Gicumbi), Uganda (Kitgum), and Tanzania (Kilindi) N = 9,270 | Exclusive breastfeeding - No: (aOR 3.88; 95% CI: 1.58–9.52) p < 0.003 Source of drinking water - inadequate: (AOR 1.28; 95% CI: 1.06–1.53) p < 0.008 Travel time to health center (6–23 h or ≥ 24 h): (aOR 1.40; 95% CI: 1.19–1.65) p < 0.001; (AOR 1.36; 95% CI: 1.16–1.59) p < 0.001 respectively |
15 | Akinyemi(41) | 2016 | Cross-sectional study | Multivariable Cox proportional hazards regression model | Multi-country analysis: Tanzania and Rwanda (East Africa), Cameroon and Gabon (Central Africa), Nigeria and Burkina Faso (West Africa), and Namibia and Zambia (Southern Africa). | Investigate the influence of family structure on infant mortality, controlling for household and maternal characteristics in rural Sub-Saharan Africa. | Data from Demographic and Health Surveys of 8 countries in the Sub-Saharan African sub-region. The final sample sizes were 6306 (Tanzania), 7537 (Rwanda), 6722 (Cameroon), 2240 (Gabon), 20,449 (Nigeria), 11,350 (Burkina Faso), 2662 (Namibia), and 8200 (Zambia). | Female-headed households: Burkina Faso (HR = 1.64, 95% CI: 1.09–2.48) and Zambia (HR = 1.49, 95% CI: 1.02–2.17). Extended families: Burkina Faso (HR = 1.33, 95% CI: 1.04–1.69) and Zambia (HR = 1.59, 95% CI: 1.02–2.49). Household overcrowding (HR = 1.23, 95% CI: 1.09–1.39) |
16 | Asresie(42) | 2022 | Cross-sectional study | Bivariate and multivariable logistic regression analyses using STATA software version 14. | Ethiopia | Examine the individual and combined influence of high-risk fertility behavior on under-five mortality in Ethiopia. | Data from the 2016 Ethiopia Demographic and Health Surveys (DHS) were used for analysis. Information was obtained from a total of 10,773 mothers with children under five years old. | p < 0.005 Multiparity (AOR = 5.48, 95% CI: 3.45, 8.71) Short birth interval (< 24 months) (aOR = 1.52, 95% CI: 0.90, 2.58) Maternal age ≤ 18 years (aOR = 1.27, 95% CI: 0.63, 2.52) Maternal age ≥ 34 years (aOR = 1.33, 95% CI: 0.25, 7.01) Children of women exhibiting a combination of two high-risk fertility behaviors (AOR = 2.17, 95% CI: 1.52–3.08) Children of women exhibiting a combination of three high-risk fertility behaviors (AOR = 3.69, 95% CI: 1.80, 7.55) |
17 | Gutema(43) | 2022 | Prospective cohort study | Multilevel logistic regression models | Ethiopia | Assessing mortality in children under five with a focus on trends and associated factors. | Data from the Demographic Surveillance Site, Kersa Health, in Eastern Ethiopia between 2008–2016. 18,759 newborns, of whom 1,602 deaths occurred in children under 5 years of age. | Mothers who received prenatal care had a 39% lower chance of deaths in children under five years of age compared to mothers who did not receive prenatal care (AOR = 0.61, 95% CI = 0.49, 0.74). Mothers who had term births had an 87% lower chance of deaths in children under 5 years of age compared to mothers with preterm births (AOR = 0.13, 95% CI = 0.10, 0.16). The mortality of children under five years of age was 20% higher among households with windows (AOR = 1.19, 95% CI = 0.988, 1.421) compared to those without windows. |
18 | Edite(44) | 2016 | Cross-sectional study | Chi-square tests and logistic regression models. | Angola | Describing the main causes of death (CoD) captured from the Health and Demographic Surveillance System of Dande (SVSD) located in the Bengo Province, Angola, from 2009 to 2012, and exploring associations between demographic data or socioeconomic factors and broad mortality groups (Group I - communicable, maternal, perinatal, and nutritional conditions; Group II - Non-communicable diseases; Group III - Injuries; IND - Undetermined). | Verbal autopsies (VA) conducted after identifying death during routine visits of the SVSD. | Maternal education: None: (aOR = 1.68; 95% CI: 1.04–2.72) Medium socioeconomic quintile (aOR 2.31; 95% CI: 1.00–5.30) Residence in rural areas (aOR 3.23; 95% CI: 1.71–6.10) Children under five years were more likely to die from communicable diseases when compared to adults (AOR 8.45, 95% CI 5.33–13.41) |
19 | Ekholuenetale(45) | 2020 | Cross-sectional study | Unadjusted and adjusted Cox proportional hazards regression model. | Multi-country analysis 35 countries of the SSA. | Examining the influence of household structure on infant mortality in Sub-Saharan Africa. | Demographic and Health Surveys (n = 384,747 births between 2008 and 2017). | For infant mortality: Polygyny (HR = 1.23; 95% CI 1.16, 1.29), p < 0.001 Moderate and intense household crowding (3 − 5 and ≥ 6) (HR 1.74 95% CI 1.61, 1.90), p < 0.001; HR 2.54 95% CI 2.27, 2.83), p < 0.001 respectively. Mothers with a history of multiple unions (HR = 1.16; 95% CI 1.09, 1.24), p < 0.001 Male-headed households (HR = 0.90; 95% CI 0.84, 0.96). For under-five mortality: Polygyny (HR = 1.33; 95% CI 1.28, 1.38), p < 0.001 Moderate to intense household crowding (3–5 and ≥ 6) (HR 1.83 95% CI 1.73, 1.95), p < 0.001; HR 3.28 (95% CI 3.03, 3.55), p < 0.001 respectively. Mothers with a history of multiple unions (HR = 1.30; 95% CI 1.24, 1.36), p < 0.001 |
20 | Aheto(46) | 2020 | Cross-sectional study | Generalized linear mixed geostatistical model Logistic regression analysis | Ghana | Estimate and map the risk of deaths in children under five years old, with the ultimate goal of identifying high-risk communities where interventions and further research can be targeted. | Demographic and Health Survey of 2014 (n = 5884 children under five years old) | Advanced maternal age (aOR: 1.0327, 95% CI: 1.0131, 1.0526). Multiple births (aOR: 8.1103, 95% CI: 5.1978, 12.6549). Higher family income was associated with decreased odds of infant mortality, aOR 0.6212 (95% CI: 0.3899, 0.9899). Higher maternal education was associated with decreased odds of infant mortality. |
21 | Ayele, DG(47) | 2015 | Cross-sectional study | Structured additive regression models with spatial correlation | Ethiopia | Identify factors that affect mortality in children under five years old. | Ethiopia Demographic and Health Survey 2011 | Time to obtain water for consumption exceeding 60 minutes: (aOR = 1.096, CI: 1.013, 1.199). Use of coal/wood for cooking food (aOR = 1.021, CI: 1.001, 1.042). Respondents using flush toilet/pit latrine had a 3.1% lower chance of infant mortality compared to those using other types of toilets (aOR = 0.969, CI: 0.850, 0.998). Housing conditions - moderate to poor (aOR = 1.281, CI: 1.072, 1.392 and OR = 1.345, CI: 1.044, 1.466 respectively). Low family income: Middle-income families have a 30.9% lower chance of mortality than poor families (Adjusted OR = 0.691, CI: 0.421, 0.997). Residence in rural areas: (aOR = 1.094, CI: 1.014, 1.099). Unemployment: Children with employed parents had a 4.3% lower chance of mortality before the age of five than those with unemployed or working parents (Adjusted OR = 0.837, CI: 0.995, 1.045). Female gender: The chance of a female child reaching the age of five is lower (21.3%) than that of a male child (Adjusted OR = 0.787, CI: 0.747, 0.971). |
22 | Bickton,(48) | 2020 | Cross-sectional study | Mixed-effects logistic regression models | Multi-Country Analysis 14 SSA countries. | Evaluate the association between exposure to household air pollution (i.e., biomass fuel for cooking) and mortality in children under five. | Demographic and Health Surveys (N = 164376) | Exposure to household air pollution (aOR = 1.33; 95% CI [1.03–1.71]). Families with indoor kitchens (aOR 0.85; 95% CI 0.73–0.98). Non-breastfed children (aOR 2.11; 95% CI 1.34–3.31), p = 0.01. |
23 | Tlou, B(49) | 2018 | Population-based cohort study | Cox proportional hazards regression model | South Africa | Investigating risk factors for mortality in children under five in a hyperendemic HIV rural area in South Africa from 2000 to 2014. | Demographic Information System in South Africa from 2000–2014 | Mortality in Children Under Five: Low socioeconomic quintile (aHR = 1.49; 95% CI 1.007–2.48) Household water source (borehole) (aHR = 3.03; 95% CI 1.72–5.34) Having an HIV-positive mother (aHR 4.22; 95% CI: 2.68–6.65) Infant Mortality: Low socioeconomic quintile (aHR = 3.03; 95% CI: 1.72–5.34) Household water source (borehole) (aHR = 2.98; 95% CI: 1.62–5.49) Having an HIV-positive mother (aHR 3.26; 95% CI: 1.93–5.51) |
24 | Chikandiwa(50) | 2018 | Cross-sectional study | Multilevel logistic regression models | Kenya and Zimbabwe | Investigating the spatial distribution of contraceptive coverage, prevalence of high-risk births, and mortality in children under five. | Demographic and Health Surveys of Kenya (2014) and Zimbabwe (2011) | Higher birth order (aOR = 1.57, 95% CI: 1.15–1.62), Low parental education (aOR 1.30, 95% CI: 1.07–1.58), High levels of poverty (aOR = 1.33, 95% CI: 1.07–1.64), Single mothers (aOR = 1.30, 95% CI: 1.03–1.65). |
25 | Yaya,(51) | 2018 | Cross-sectional study | Multivariable Cox Proportional Hazards Regression Model | Multi-country Analysis: Five countries in Sub-Saharan Africa; Chad, Democratic Republic of Congo, Mali, Niger, and Zimbabwe | Examine patterns of mortality in children under 5 years and associated maternal factors. | Demographic and Health Surveys | Single mothers: (Chad - [HR] = 1.11, 95% CI = 0.97–1.25; Democratic Republic of Congo - HR = 1.24, 95% CI = 1.11–1.40; Mali - HR = 2.43, 95% CI = 1.63–3.64; Niger - HR = 1.59, 95% CI = 1.24–2.03; Zimbabwe - HR = 1.33, 95% CI = 1.06–1.67). Cesarean section delivery (Chad - HR = 1.32, 95% CI = 1.00–1.77; Democratic Republic of Congo - HR = 1.20, 95% CI = 1.01–1.43; Mali - HR = 1.42, 95% CI = 1.08–1.85; Niger - HR = 1.43, 95% CI = 1.06–1.92; Zimbabwe - HR = 1.49, 95% CI = 1.03–2.15). Advanced maternal age at first childbirth (above 40 years): Chad HR 0.89, 95% CI (0.68–1.23); Mali HR 1.07, 95% CI (1.05–1.09); Zimbabwe HR 1.07, 95% CI (1.03–1.09). Place of residence (rural): (Chad - HR = 1.11, 95% CI = 1.01–1.19; Democratic Republic of Congo - HR = 1.29, 95% CI = 1.02–1.57; Mali - HR = 1.28, 95% CI = 1.01–1.64; Niger - HR = 1.14, 95% CI = 1.01–1.33; Zimbabwe - HR = 1.01, 95% CI = 0.83–1.20). |
26 | Berelie, Y(52) | 2019 | Cross-sectional study | Binary logistic regression | Ethiopia | Estimate the effects of socioeconomic and demographic factors on mortality in children under five in Ethiopia. | Demographic and Health Survey of 2016 (n = 10,641 children under five years old) | Home birth (aOR = 1.30; 95% CI: 1.04–1.63); Male gender (aOR 1.36; 95% CI: 1.15–1.60) |
27 | Daniel,(53) | 2022 | Cross-sectional study | Spatial Cox Proportional Hazards Regression Model | Kenya | Evaluate the effects of spatial variation on mortality in children under five in Kenya. | Demographic and Health Survey | Sex of the child (female): (OR = 0.8696; 95% CI: 0.7465–0.9921) Place of residence (rural): (OR) = 1.1529; 95% CI: 0.9802–1.3633) Sex of household head (female): (OR = 0.8562; 95% CI: 0.7543–0.9713) Low socioeconomic quintile: (OR = 1.0889; 95% CI: 0.9064–1.3167) |
28 | Sharaf,(54) | 2018 | Cross-sectional study | Multivariate logistic regression models | Egypt | Examine the demographic and socioeconomic correlates of infant mortality. | Demographic and Health Survey | Twin birth (OR = 7.570; 95% CI = 6.195–9.250) Birth interval at risk (OR = 3.307; 95% CI = 2.868–3.813) Place of residence (Rural) (OR = 1.239; 95% CI = 0.964–1.594) Having more than two children under five years old: (OR = 0.370; 95% CI = 0.305–0.448) |
29 | Abdesslam B(55) | 2019 | Cross-sectional study | Multivariate logistic regression models | Sudan | Show how health indicators in general, and the infant mortality rate in particular, are related to the social determinants of health in Sudan. | Demographic and Health Survey | Home births: (OR = 1.62; 95% CI = 1.53–1.71) Low family income: (OR = 1.40; 95% CI = 1.33–1.47) Low parental education: (OR = 1.56; 95% CI = 1.48–1.64) Residence in rural areas: (OR = 1.62; 95% CI = 1.54–1.71) |
30 | Sidi-Yakhlef, A.(56) | 2021 | Retrospective case-control study | Multivariate logistic regression models | Algeria | Identify determinants associated with neonatal mortality from data collected in the Multiple Indicator Cluster Survey conducted in Algeria in 2012–2013 (MICS 4). | Demographic and Health Survey | Rural residence (p < 0.01; OR = 1.3; 95% CI = 1.08–1.54), Low maternal education (p < 0.01; OR = 2.10; 95% CI = 1.35–3.29), Early maternal childbearing age (p < 0.001; OR = 4.34; 95% CI = 2.19–14.40), Multiparity (p < 0.01; OR = 1.57; 95% CI = 1.13–2.44), Low socioeconomic quintile (p < 0.001; OR = 2; 95% CI = 1.45–2.62) |