Checking Proportional Hazards Assumption.

The risk of under-five mortality is a vital measure of healthcare system performance and directly reflects progress toward Sustainable Development Goal (SDG) 3.2, which targets the elimination of preventable deaths among newborns and children under-five, aiming to reduce mortality rates to at least 25 per 1,000 live births by 2030. While Ghana has made notable progress in lowering child mortality in recent decades, the current rates remain above this benchmark. Identifying the predictors of under-five mortality is therefore critical for shaping evidence-based policies and targeted interventions that can accelerate progress toward SDG 3 and improve child health outcomes. To explore these predictors, we employed advanced survival modeling techniques. The conventional Cox-proportional hazards (Cox-PH) model assumes constant covariate effects over time, but violations of this assumption can lead to biased results. To address this, we used the extended Cox-PH model, which accommodates time-varying effects. Data were drawn from the 2022 Ghana Demographic and Health Survey (GDHS), based on a stratified two-stage cluster sampling design. Since under-five deaths are relatively rare (