LAUSR

Abstract Introduction Sierra Leone includes in countries which exhibit the highest prevalence of under-five mortality in the world. A range of factors are known to have challenged the under-five survival in the country; some comprise outbreak of epidemics, socioeconomic inequalities, regional disparities, and unsuccessful implementation of healthcare initiatives. The present study aims to identify crucial predictors of under-five survival. Methods This paper used the Sierra Leone Demographic and Health Survey (SLDH, 2013). A Cox Proportional Hazards Model was applied to the sample of 24,742 children to analyze the adjusted and unadjusted hazards ratio of crucial risk factors of under-five mortality. Results The results show that birth interval and birth size are leading risk factors of under-five mortality in Sierra Leone. A birth spacing exceeding three years is associated with the lowest risk compared to 2–3 years and lesser than two years. The average or larger birth size has the lowest hazards followed by smaller than average, and the magnitude of the effect remains the same in adjusted and unadjusted models. The wealth status is a crucial predictor only in the unadjusted model. Mother's age, sex of the child, and a number of children in the household are significant covariates. Conclusion Given the research findings, this study recommends for re-orientation of reproductive healthcare strategies to target the younger mother and birth-spacing, and integration of nutrition-related interventions with the maternal healthcare initiatives to influence the child birth-size.