Peer-reviewed article

Driving down child mortality in the SAARC: the impact of GDP, healthcare, and vaccination

Adeesha Fernando, Nikini Sudangama, Damindu Adikari, Ashwathy Sundaram, Ruwan Jayathilaka et al. · 25 Sept 2025

Abstract

Abstract This study investigates the determinants of under-five mortality rate (U5MR) in South Asian Association for Regional Cooperation (SAARC) countries from 2000 to 2020, focusing on the roles of per capita gross domestic product (PGDP), Diphtheria-Tetanus-Pertussis (DTP1) immunisation coverage, and government healthcare expenditure (GHE). Despite global progress in reducing child mortality, disparities persist in SAARC countries, where economic, healthcare, and immunisation factors influence child survival. The research employs a panel regression analysis using a fixed effects model to assess the impact of these variables on U5MR across seven SAARC nations (excluding Afghanistan due to insufficient and inconsistent data), as well as multiple linear regression (MLR) for a country-specific explanation. Results reveal that both PGDP and DTP1 coverage are inversely related to U5MR, highlighting the importance of economic growth and immunisation programs in reducing child mortality. However, while the associations between PGDP, GHE, and DTP1 with U5MR were not statistically significant in the panel model, the country specific MLR analysis revealed statistically significant relationships in some cases. In fact, GHE presents mixed results, indicating that healthcare expenditure alone may be insufficient without effective allocation. The study’s findings emphasise the need for region-specific policies to address healthcare inequalities and expand immunisation programs, providing practical recommendations for SAARC policymakers to achieve sustainable improvements in child health outcomes.