Economic and healthcare determinants of under-five mortality in low-income countries.

BACKGROUND

Under-five mortality (U5MR) remains a critical development challenge, particularly in low-income countries (LICs), where children face the highest risk of preventable deaths. This study explores the influence of three key variables, per capita Gross Domestic Product (PGDP), DTP1 immunisation coverage, and Government Healthcare Expenditure (GHE), on U5MR across 19 LICs from 2000 to 2020, providing a clearer understanding of their individual and combined effects.

METHODS

A balanced panel dataset was analysed using both fixed-effects and random-effects panel regression models. Additionally, country-level insights were derived through multiple linear regression (MLR) to capture variations across different LIC contexts.

RESULTS

The analysis revealed a strong inverse relationship between PGDP and U5MR, highlighting the role of economic growth in improving child survival. DTP1 immunisation coverage showed mixed effects, positively linked to reduced mortality in most LICs, but unexpectedly associated with higher U5MR in specific contexts like Malawi and the Central African Republic, suggesting challenges in access or implementation. Similarly, GHE showed varied impacts, with some countries benefiting significantly, while others demonstrated weaker or adverse effects, likely due to inefficiencies in spending.

CONCLUSIONS

The findings highlight that reducing U5MR in LICs requires more than isolated actions. It calls for combined strategies that connect economic improvements with fair healthcare investments and better immunisation delivery. Policymakers must design context-specific solutions to ensure lasting and meaningful progress in child health outcomes.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12889-025-23370-3.