Seetha Selvaraju, Victor C. W. Hoe
Background: Malaysia achieved the Sustainable Development Goal (SDG) 3.2 target of reducing under-5 mortality by 1984. However, toddler mortality (ages 1–4 years) has remained stagnant at 8–9 per 1,000 live births since 2000. This plateau signals an urgent need to investigate factors contributing to toddler deaths, particularly the distinction between preventable and non-preventable causes. This study aimed to (I) determine the incidence of toddler mortality in Malaysia from 2018 to 2022; (II) identify the causes of preventable and non-preventable deaths; and (III) examine the sociodemographic, parental, and environmental factors associated with these deaths.
Methods: A retrospective cohort study was conducted using secondary data from the Malaysian Ministry of Health’s Stillbirth and Under-5 Mortality Death Form [2018–2022]. Logistic regression was used to identify factors associated with preventable deaths.
Results: A total of 3,002 toddler deaths were reported, of which 56.6% were preventable. Injuries and external causes made up 18.6% of deaths—primarily drowning, asphyxia (40.7%), head trauma (29.9%), and motor vehicle accidents (17.2%). Females had higher odds of preventable death [odds ratio (OR) =1.236, 95% confidence interval (CI): 1.069–1.430]. Toddlers from Indigenous West Malaysia (OR =0.274, 95% CI: 0.159–0.472) and Indigenous Sabah (OR =0.566, 95% CI: 0.443–0.724) had lower odds than Malays. Higher maternal age (25–34 years: OR =1.578, 95% CI: 1.248–1.994; >34 years: OR =1.786, 95% CI: 1.396–2.286) and tertiary education (OR =4.663, 95% CI: 3.454–6.296) were linked to increased odds. Similarly, paternal age >34 years (OR =1.728, 95% CI: 1.171–2.550) and tertiary education (OR =5.851, 95% CI: 4.156–8.236) showed higher risk. Families receiving social welfare support (OR =4.067, 95% CI: 1.472–11.235) also had greater odds of preventable death.
Conclusions: This study highlights key risk factors and causes of toddler mortality in Malaysia, offering evidence to inform targeted prevention strategies. Enhancing child safety, addressing social vulnerabilities, and improving intersectoral coordination are essential to reducing preventable toddler deaths.
