O3235: Modelling Child Mortality in Pakistan: Demographic Projections and the Impact of Health Interventions to 2030

Background: Pakistan continues to face one of the highest under-five mortality rates globally—65.2 per 1,000 live births—despite global declines and regional progress. This persistent burden reflects a combination of rapid population growth, low health expenditure, poor infrastructure, and high prevalence of preventable diseases. This study analyses demographic trends and models the projected impact of three categories of child health interventions using Spectrum software to inform future policy directions.

Methods: Using Spectrum version 6.29, we employed two modules: DemProj (Demographic Projection) and LiST (Lives Saved Tool). DemProj was used to project long-term demographic trends from 1970–2030, while LiST modelled short-term impacts of interventions from 2024–2030. Baseline data were sourced from Pakistan’s most recent Demographic and Health Survey (2017–18). Three types of interventions were modelled:
1) Vaccine Uptake (e.g., Polio, BCG, Pentavalent);
2) Infectious Disease Prevention and Treatment (e.g., ORS for diarrhoea, antibiotics for pneumonia and sepsis);
3) WASH and Nutrition Improvements (e.g., piped water, handwashing with soap, fortified foods).
Each intervention group was compared to a baseline (no improvement) to estimate its impact on child mortality.

Results: Demographic projections revealed that while Pakistan’s population continues to grow, under-five mortality has gradually declined since 1970. However, progress has slowed in recent years and remains behind regional averages. LiST modelling demonstrated that among the three categories of interventions assessed, infectious disease management had the greatest impact on reducing under-five mortality. Specifically, scaling up interventions such as oral rehydration salts (ORS) for diarrhoea, oral antibiotics for pneumonia, and injectable antibiotics for neonatal sepsis could reduce under-five mortality from 70.4 to 66.5 per 1,000 live births, representing a 5.5% decline. Water, sanitation, hygiene (WASH), and nutrition-related interventions—including improved access to piped water, handwashing with soap, and food fortification—could reduce mortality to 67.4 per 1,000 (a 4.3% decrease). In contrast, increased vaccine uptake, while essential for long-term health security, showed a more modest short-term reduction to 69.5 per 1,000 live births (a 1.3% decrease). Among all individual interventions modelled, ORS for diarrhoea emerged as the single most effective measure for reducing child mortality.

Conclusion: This study highlights the urgent need to scale up simple, cost-effective interventions targeting infectious disease—particularly ORS and antibiotics—as the most efficient strategy for reducing child mortality in Pakistan by 2030. Additionally, investments in WASH infrastructure, maternal education, and health workforce capacity are needed to support broader health improvements. Policymakers should prioritise integrated, multisectoral approaches while ensuring that funding and governance mechanisms are in place to sustain coverage. These findings can inform Pakistan’s efforts to achieve SDG 3 and offer a replicable modelling framework for other low- and middle-income countries.