Social Determinants of Childhood Mortality: Systematic Review and Meta-Analysis With Complementary Narrative Synthesis of Cultural Factors.

OBJECTIVE: To identify social determinants associated with childhood mortality and describe cultural factors. METHODS: We conducted a systematic review and meta-analysis of observational studies following MOOSE guidelines. MEDLINE, Embase, ProQuest, Wiley, OpenGrey, Google Scholar, and LILACS were searched through October 2024. Childhood mortality was defined as death before age five. Comparable social determinants were pooled quantitatively, while cultural factors were synthesized narratively. RESULTS: Thirty-two studies were included in the qualitative synthesis and 18 in the meta-analysis, mainly from Africa. Mortality was associated with poverty (OR 2.25), low birth height (OR 1.98), lack of breastfeeding (OR 8.04), poor prenatal care (OR 3.32), and previous child death in the family (OR 4.56). Several estimates showed high heterogeneity. Cultural factors included co-sleeping, women's empowerment, maternal decision-making, ethnicity, and ritual beliefs. CONCLUSIONS: Maternal and household conditions were associated with childhood mortality. Evidence on cultural determinants remains limited and heterogeneous.