Distributional dynamics of child mortality in Africa: quantile evidence from economic, environmental, and demographic transitions

Abstract

Child mortality remains one of Africa's most persistent development challenges, undermining progress toward Sustainable Development Goal (SDG) 3.2, while its economic, environmental, and demographic correlates also intersect with SDGs 1, 2, 11, and 13. Although previous studies have examined mortality trends, limited attention has been devoted to understanding how economic growth, air pollution, health expenditure, urbanization, and fertility interact asymmetrically across the mortality distribution, a gap that restricts policy from targeting vulnerability where it is most pronounced. In an attempt to fill this gap and provide actionable solutions, the present study investigates the distributional dynamics of child mortality in 53 African countries from 2000 to 2024 using the method-of-moments quantile regression framework adjusted for cross-sectional dependence and slope heterogeneity and supported by Driscoll-Kraay and system-GMM estimators for robustness. The findings show that economic growth, higher public health spending, and urbanization are strongly associated with reductions in under-five deaths, particularly in high-mortality countries, whereas air pollution and fertility significantly increase mortality, with fertility emerging as the dominant risk factor. These results underscore the heterogeneous nature of mortality drivers across levels of vulnerability, highlighting that effective intervention requires tailored and multidimensional strategies. The study provides evidence-based policy recommendations to support targeted reforms that accelerate child survival and sustainable development across Africa.