Global strategies to achieve SDG 3.2 for ending preventable deaths of children under-five: A realist review

Objectives

At current trends, 59 countries are at risk of missing the sustainable development goal (SDG) target of bringing the under-five mortality rate to as low as 2.5 % per live birth by 2030. This article aims to identify effective global strategies for reducing under-five mortality and achieving SDG 3.2 targets.

Study design

A realist synthesis method was used to systematically review the literature for evidence in accordance with the “Realist and MEta-narrative Evidence Syntheses: Evolving Standards” (RAMESES) publication standards. The context-mechanism-outcome (CMO) framework was applied to identify how global strategies function across settings.

Methods

Studies were identified through systematic searches of MEDLINE, Embase, and Cochrane databases from September 2000 to September 2024, scanning reference lists, and citation searching of key papers. Studies for inclusion described global strategies that contribute to ending preventable deaths in children under-five and achieving SDG 3.2 targets by 2030. Data were extracted using standardised forms and analysed for CMO configurations to identify, analyse, and produce an evidence-based framework of global strategies that contribute to ending preventable deaths in children under-five.

Results

Global strategies identified revolved around three core themes: leadership, health sector, and non-health sector factors. Key global strategic areas included increased governance, accountability for resources and results, community-based approaches, and prioritisation of interventions.

Conclusion

Multiple global strategies to reduce under-five mortality exist. This evidence-based synthesis of successful strategies, mapped using realist principles, provides a practical guide for policymakers worldwide to prioritise and adapt interventions across diverse country settings to accelerate progress towards achieving SDG 3.2.