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We applied multilevel mixed effects logistic regression to examine the extent to which the under-5 mortality U5M risks were associated with the key sociodemographic and health service-specific predictors. Poverty and low education aggravated the mortality risks. Compulsory use of ANC and PNC cards and strict monitoring of their use may improve the quality of these health services.

Leveraging committees like the Upazila Hospital Management Committee can bring harmony to implementing policies and programmes in the sectors related to U5M. It is influenced by a complex interplay of factors, including the health care delivery systems, socioeconomic and environmental conditions, and broader macro-political and structural contexts 2 , 3 , 4 , 5.

As a result, the underperformance of any of these interrelated sectors can overtake the positive impact of the improvement in other sectors. For example, educating all women may not effectively prevent U5M from severe pneumonia unless the health facilities are efficient enough to provide the required health care on time 6. Therefore, attaining sustained progress in U5M requires a collective and synchronised endeavour concurrently encompassing improvements across these interrelated sectors.