Risk Factors of Child Mortality in Iran: A Systematic Review and Narrative Synthesis

Background: Child mortality remains a critical indicator of population health and development.While global under-5 mortality has declined significantly, disparities persist, particularly in lowand middle-income countries.In Iran, under-5 mortality remains a concern, with various social, maternal, and child-level factors contributing to regional and demographic disparities.Objectives: This study aimed to systematically review and synthesize evidence on risk factors associated with mortality among children aged 1 to 59 months in Iran.Methods: A systematic review was conducted using a narrative synthesis approach.Articles published between 2010 and 2023 were identified through a search of national and international databases, including IranDoc, SID, PubMed, Web of Science, and ScienceDirect.The inclusion criteria required studies to use multivariate regression, report odds ratios, and focus on children aged 1-59 months in Iran.The quality of included studies was assessed using the Newcastle-Ottawa Scale.Results: Nine studies met the inclusion criteria: 6 case-control and 3 cross-sectional.Risk factors were categorized into 3 domains: Socioeconomic, maternal/pregnancy-related, and child-related.Significant risk factors included low maternal education, low socioeconomic status, paternal addiction, consanguinity, short interpregnancy intervals, history of abortion, inadequate prenatal care, low birth weight, preterm birth, and formula feeding.No significant associations were found with paternal education, parental employment, child sex, or multiple births.Conclusions: Multiple modifiable risk factors are associated with mortality among children aged 1 to 59 months in Iran.Targeted interventions focusing on maternal education, poverty reduction, prenatal care, and newborn health can effectively reduce child mortality.Future research should address regional disparities and underexplored determinants to inform comprehensive policy responses.