Urban-rural inequalities in under-five child mortality in Pakistan: Evidence from the Pakistan Maternal Mortality Survey (PMMS)

Abstract

Under-five child mortality remains a critical public health challenge in Pakistan, with persistent disparities between urban and rural populations. This study examines the magnitude and determinants of urban–rural inequalities in child mortality using data from the Pakistan Maternal Mortality Survey 2019. A quantitative cross-sectional design was employed, analyzing 89,155 live birth records through descriptive statistics, chi-square tests, and binary logistic regression. The findings reveal that rural children experience significantly higher mortality rates compared to urban children. However, multivariate analysis shows that this disparity is largely explained by socioeconomic and environmental factors rather than residence alone. Household wealth emerges as the strongest predictor, with higher wealth significantly reducing the risk of child mortality. Access to improved sanitation also demonstrates a protective effect, while the influence of rural residence becomes statistically insignificant after controlling these variables. Additionally, substantial regional variations in mortality patterns highlight the uneven distribution of health outcomes across provinces. The study concludes that socioeconomic inequality and inadequate household infrastructure are the primary drivers of child mortality disparities in Pakistan. Addressing these structural determinants through targeted policy interventions is essential for reducing mortality rates and achieving Sustainable Development Goal targets related to child health.