Abstract
This review evaluated the association of place of residence (urban/rural) and under-five mortality in middle- and low-income countries. Both English and Spanish language studies conducted during the Millennium Development Goal (MDG) period (1990 to 2015) were reviewed. Twenty-six cross-sectional studies, all in the English language, were selected for further review. Published data were used for this analysis. A funnel plot was produced to ascertain the presence of publication bias. The combined relative risk for under-five mortality was estimated using a random-effects model and a meta-regression was conducted on 15 of the 26 studies. The studies had a combined effect size of 1.47 (95% confidence interval, 1.27–1.67). The results of the meta-regression showed a positive association between the relative risk and the percentage of the rural population for the various regions/countries. The coefficient for the variable rural population percentage was 0.007, indicating that for every one percent increase in the rural population percentage, there was a 0.007 increase in the relative risk for under-five mortality. However, this was not significant (p-value = 0.3). Rural disadvantage persists in middle- and low-income countries. This is important to evaluate policies and programmes designed to remove the gap in under-five mortality rates between urban and rural areas.
Highlights
Under-five mortality (U5M) is defined as a child dying between birth and their fifth birthday.In 2015, 16,000 children under the age of five died every day, approximating 5.9 million child deaths for the year [1]
When the results from 15 studies were combined, the findings were broadly similar for U5M being higher for rural areas than urban areas
Many studies indicated that inequalities decreased between urban and rural place of residence [20,25,27,28,38], but some indicated a widening of the gap [24,26]
Summary
Under-five mortality (U5M) is defined as a child dying between birth and their fifth birthday.In 2015, 16,000 children under the age of five died every day, approximating 5.9 million child deaths for the year [1]. The global U5M at the beginning of the Millennium Development Goals (MDGs) era was 91 per 1000 live births in 1990. This reduced by 53% to 43 per 1000 live births in 2015 [2]. Despite this decrease, many countries did not achieve MDG4, which had set the target of reducing U5M by two-thirds between 1990 and 2015. Of particular interest to the present study, are SDGs 3 and 10, which aim to reduce inequalities within and among countries, ensure healthy lives and promote well-being for all ages [3]. Since the 1950s, Children 2018, 5, 51; doi:10.3390/children5040051 www.mdpi.com/journal/children
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