Governance matters: an ecological association between governance and child mortality

Background: Governance of a country may have widespread effects on the health of its population, yet little is known about the effect of governance on child mortality in a country that is undergoing urbanization, economic development, and disease control. Methods:We obtained indicators of six dimensions of governance (perceptions of voice and accountability, pol-itical stability and absence of violence, government effectiveness, regulatory quality, rule of law, and control of corruption) and national under-5 mortality rates for 149 countries between 1996 and 2010. We applied a semi-parametric generalized additive mixed model to examine associations after controlling for the effects of devel-opment factors (urbanization level and economy), disease control factors (hygienic conditions and vaccination rates), health expenditures, air quality, and time. Results: Governance, development, and disease control showed clear inverse relations with the under-5 mortal-ity rate (p,0.001). Per unit increases in governance, development, and disease control factors, the childmortality rate had a 0.901-, 0.823-, and 0.922-fold decrease, respectively, at fixed levels of the other two factors. Conclusions: In the effort to reduce the global under-5mortality rate, addressing a country’s need for better gov