OBJECTIVES: Under five mortality is one of the major Public Health challenges in the Eastern Mediterranean Region (EMR). The aim of the study is to investigate associations between health care expenditure and under five mortality rates in the EMR countries and to identify confounding factors in explaining these associations.

METHODS: National-level under five mortality data for the EMR countries collected from publicly accessible WHO databases for the period 2010-2020. A number of confounding factors has been identified through literature review, and data collected from the WHO and World Bank online databases. Descriptive analysis of the dependent and independent variables is provided. Both bivariate and multivariate analyses were conducted to investigate the associations, and given the count data nature of the dependent variable, a negative binomial regression was estimated.

RESULTS: Overall, there is a decreasing trend in under five mortality in the EMR countries during 2010-2020. Crude analyses showed that per capita healthcare expenditure is negatively and out-of-pocket cost is positively associated with under five mortality. After adjusting for a number of confounding factors, current health expenditure, access to sanitation, access to safe drinking water, number of hospital beds, child immunization and access to primary care services showed statistically significant associations with under five mortality.

CONCLUSIONS: Healthcare policy makers in the EM region should take necessary steps to address a number of factors including healthcare expenditure in order to improve population health outcome such as the under-five mortality