Abstract
The unique healthcare needs of 5 to 9-year-olds and adolescents (10-19 years) in low- and middle-income countries have been largely neglected. We generated estimates of 5 to 9-year-old and adolescent mortality in rural Mali, a setting with high under-five mortality, and aimed to define associated individual and household risk factors. We analysed cross-sectional baseline household survey data from the ProCCM trial (NCT02694055) conducted in Bankass District, Mali collected in December 2016 and January 2017. Deaths in the preceding five years, household information, and women's birth histories were documented. Factors associated with 5 to 9-year-old and adolescent mortality were analysed using Cox regression. Our study population comprised 23,485 children aged 5 to 9-years-old and 17,910 adolescents from 7,720 households. The 5 to 9-year-old and adolescent mortality rates were 3.10 and 1.90 deaths per 1,000 person-years, respectively. Mortality rates were similar among males and females aged 5 to 9 years, but grew increasingly divergent in adolescence (1.69 and 2.17 per 1,000 person-years, respectively). Five to 9-year-olds in households with untreated water had a higher risk of death than those in households with treated water. Adolescents living in the poorest households had a higher risk of death than those in the wealthiest, and adolescents in households in which no women received schooling had a higher risk of death than those in which women had some schooling. The risk of mortality was especially acute among female adolescents compared to their male counterparts, with low access to education for women being a strong contributing factor.