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An Analysis of Determinants of Under-5 Mortality across Countries: Defining Priorities to Achieve Targets in Sustainable Developmental Goals

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An Erratum to this article was published on 27 February 2017

Abstract

Objectives The end of the era of millennium development goals (MDGs) ushered in the sustainable development goals (SDGs) with a new target for the reduction of under-five mortality rates (U5MR). Although U5MR decreased globally, the reduction was insufficient to meet MDGs targets because significant socioeconomic inequities remain unaddressed across and within countries. Thus, further progress in achieving the new SDGs target will be hindered if there is no adequate prioritization of important socioeconomic, healthcare, and environmental factors. The objective of this study was to assess factors that account most for the differences in U5MR between countries around the globe. Methods We conducted an ordinary least squares (OLS) regression-based prioritization analysis of socioeconomic, healthcare, and environmental variables from 109 countries to understand which factors explain the differences in U5MR best. Results All indicators examined individually affected differences in U5MR between countries. However, the results of multivariate OLS regression showed that the most important factors that accounted for the differences were, in order: fertility rate, total health expenditure per capita, access to improved water and sanitation, and female employment rate. Conclusions To achieve the new global target for U5MR, policymakers must focus on certain priority areas, such as interventions that address access to affordable maternal healthcare services, educational programs for mothers, especially those who are adolescents, and safe drinking water and sanitation.

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Correspondence to Michael Acheampong.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s10995-017-2293-0.

Appendices

Appendix 1

See Table 7.

Table 7 Independent variables, assumptions for selection, and sources of data

Appendix 2

See Table 8.

Table 8 Total list of countries initially considered in the study

Appendix 3

Details of Statistics of Independent Variables (IVs)

The summary shows that the IVs varied significantly between countries in the study. As seen in the Table 9, the 2010 total fertility rate for all countries in the study ranged from 1.24 children per woman in Bosnia and Herzegovina to 7.58 children per woman in Niger. Adolescent fertility rate also was reported to range significantly between countries; the Republic of Korea had the lowest adolescent fertility rate in 2010, with 1.92 births per 1000 adolescent women, while Niger recorded the highest with 210.37 births. With respect to total adult literacy rate, Guinea recorded the lowest (25.31%), and the highest (100%) was reported in both France and Norway. Female adult literacy displayed a pattern similar to that of total adult literacy. The lowest was recorded in Guinea (12.19%), while the highest was recorded in both France and Norway (100%).

With respect to percent rural population, a wide range can be observed in the table, from 2.36% recorded in Belgium to 89.36% in Burundi. GNI per capita was another variable that differed significantly between countries examined in the study, ranging from $560 in the Democratic Republic of Congo to $59,400 in Norway. The table also shows that the 2010 total female employment to population ratio in all countries in the study ranged from a low of 10.2% in Syria to a high of 86.4% in Rwanda. With respect to the percentage of the population living beneath the national poverty line, the United Arab Emirates recorded the lowest (0%), while Equatorial Guinea had the highest (76.8%).

Government expenditure on health as a percent of total health expenditure ranged from 1.59% in Afghanistan to 22.35% in the United States. Per capita total expenditure on health also ranged from $11.90 in Eritrea to $8361.73 in the United States. The table also shows out-of-pocket expenditure as a percent of total health expenditure, which ranged from 5.2% in the Netherlands to 88.15% in Guinea.

The final part of the table summarizes the statistics for the two variables in the sanitary/environmental category. As shown, the percent of the population with access to improved sanitation ranged from 9.5% in Niger to 100% in four countries: Uzbekistan, Republic of Korea, Israel, and Japan. With respect to the percent of the population with access to improved drinking water sources, the range recorded was from 40 to 100%. Papua New Guinea recorded the lowest, while as many as 22 countries recorded 100%.

Table 9 Detailed dataset used in the study

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Acheampong, M., Ejiofor, C. & Salinas-Miranda, A. An Analysis of Determinants of Under-5 Mortality across Countries: Defining Priorities to Achieve Targets in Sustainable Developmental Goals. Matern Child Health J 21, 1428–1447 (2017). https://doi.org/10.1007/s10995-017-2260-9

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