Predicting under-five child mortality in Zambia: Machine learning versus parametric survival models

Background

In sub-Saharan Africa, child mortality remains a critical public health challenge, with Zambia exhibiting some of the highest rates in the region. While survival analysis has identified key risk factors, these methods often fail to capture complex non-linear interactions and the dynamic, time-varying nature of longitudinal markers like birth intervals. This study aimed to develop and compare predictive survival models to improve risk stratification for under-five mortality using the 2024 Zambia Demographic and Health Survey (ZDHS).