Background: The retention of under-5 mortality (U5M) in various ramifications has dire policy implications. The varying impacts of this inequality is very important and has been researched in many rural-urban settings. In spite of many studies that have examined rural-urban inequalities, very little has been researched with respect to low middle-income countries. In this study, we utilized an innovative statistical method to examine and explain the socio-economic determinants and rural-urban differences of mortality in some selected low- and middle-income (LMIC) countries.

Methods: Using secondary data from the Demographic Health Survey (DHS), we utilized a Fairlie decomposition analysis to enumerate the differences amongst under-5 populations across 59 low-middle income countries in four continents. Death of any child within 0 - 59 months of life was our dependent variable while some selected individual and neighborhood factors constituted the explanatory variables.

Results: Study findings revealed significant pro-rural and pro-non-rural inequities across the 59 countries. Pro-rural inequities were more commonly found in the African regions. Except for the Maldives, pro-non-rural inequities were largely associated in the remaining four continents. Some factors, unemployed status, ever married or single status, female household head, insurance cover, unimproved water sources, clean fuel were associated with a higher risk of Under-5 mortality.

Conclusion: The results from this study are pertinent to health system reforms needed to tackle the menace of under-5 mortalities in LMICs and worldwide. Consolidation of existing maternal and child health programs supported by a resolute and firm re-evaluation of political will considerably help to control the surge of U5MR in the countries studied.

Copyright: © 2025 Fagbamigbe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

背景： 5岁以下儿童死亡率（U5M）在不同方面的保留对政策有严重的后果。这种不平等的影响非常重要，并已在许多城乡环境中进行了研究。尽管有许多研究考察了城乡不平等，但针对低中等收入国家的研究却很少。在这项研究中，我们利用一种创新的统计方法来分析和解释一些选定的低收入和中等收入（LMIC）国家的社会经济决定因素以及城乡死亡率差异。

方法： 使用来自人口健康调查（DHS）的二手数据，我们采用Fairlie分解分析法来统计在四大洲中的59个低中等收入国家之间五岁以下儿童群体之间的差异。0至59个月内任何孩子死亡是我们研究的因变量，而一些选定的个体和社区因素构成了自变量。

结果： 研究表明，在这59个国家中存在显著的城市偏向和非城市偏向不平等。在非洲地区，城市偏向不平等更为常见。除了马尔代夫以外，其余四个大洲普遍存在非城市偏向不平等现象。失业状态、已婚或未婚状态、女性户主、保险覆盖范围、未经改善的水源、清洁燃料等因素与较高的5岁以下儿童死亡风险相关。

结论： 这项研究的结果对LMIC和全世界控制五岁以下儿童死亡率所需的卫生系统改革至关重要。巩固现有的孕产妇和儿童健康项目，并辅以坚定的政治意愿评估，有助于遏制这些国家中U5MR的增长。

版权：© 2025 Fagbamigbe et al. 根据知识共享署名许可协议（Creative Commons Attribution License），本文章可以在任何媒介上无限制地使用、分发和复制，但必须注明原作者及来源。