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.<Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> 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 consistentlyidentified as key determinants of high child mortality rates in the region. </entry> </row> <row> <entry align="left" colname="c1"> 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. </entry> </row> </tbody> </tgroup> </Table>

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

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2025年1月24日

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Israel C. Avelino,
Joaquim Van-Dúnem,
Luís Varandas

摘要

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 consistentlyidentified 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.