Mapping under-five mortality in Malawi: towards achieving sustainable development goals

Abstract As many low- and middle-income countries continue making gains towards attaining sustainable development goals in under-five mortality, surveillance of mortality outcomes and indicators at the sub-district level will become important as national- and district-level estimates may mask areas with a high burden. Spatial statistical modelling techniques such as geostatistical prevalence mapping can play a role in identifying hotspots of relatively high under-five mortality. To achieve this objective, it is necessary to combine data from multiple sources with different spatial resolutions to produce maps that reveal these hotspot clusters. We pooled DHS, high-resolution census data, economic vulnerability, and malaria risk data to estimate under-five mortality at a sub-district level in Malawi. Using a Bayesian hierarchical modelling approach, we fitted a binomial generalized linear geostatistical model with local area effects to generate estimates of under-five mortality at a sub-district level in Malawi. Results, in general, showed low mortality rates across the country with pockets of locations mostly in northern Malawi showing elevated risk. Rural locations were associated with higher odds of under-five mortality compared to urban locations. Our study provides a better understanding of progress made after the Millennium Development Goals in 2015 and can help improve surveillance through the application of targeted interventions which can lead to the attainment of sustainable development goals by 2030. Competing Interest Statement The authors have declared no competing interest. Funding Statement RV thanks the DELTAS Africa Initiative, Sub-Saharan Africa Consortium for Advanced Biostatistics Training (SSACABT) for scholarship to pursue a MSc at the University of Malawi. The funders had no role in the design and conduct of the study, nor the decision to prepare and submit the manuscript for publication. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The DHS was approved by the National Health Sciences Research Committee I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability The data can be accessed upon request from the DHS program on https://dhsprogram.com/