Categorisation of African Countries: Cluster Analysis of Maternal Mortality based on Health Expenditure Trends (2000-2023)- A Machine Learning Approach to SDG 3.1 Prioritisation

Pinky Lalthapersad-Pillay ORCID iD & Peter Ohue ORCID iD 

Issue: Vol.6 No.14 Article 39 pp.3922 – 3932
DOI: https://doi.org/10.38159/ehass.202561439 | Published online 30th December, 2025
© 2025 The Author(s). This is an open access article under the CCBY license (http://creativecommons.org/licenses/by/4.0/).

Views: 38
34 Downloads

DOWNLOAD PDF

The purpose of the study was to utilize maternal mortality ratios and health expenditure (HE) to categorise African countries into four distinct clusters to inform targeted policy interventions. The study used unsupervised machine learning approaches (K-Means clustering and Hierarchical clustering) with Ward’s linkage relying on data for Maternal Mortality Ratio (MMR) trajectories and HE patterns from 2000 – 2023 to identify the clusters: (1) High MMR, Low Efficiency countries; (2) Moderate MMR, Improving countries; (3) Low MMR, High Spending systems; and (4) High MMR. The findings of the Cluster analysis showed that fragile states, which make up one cluster, for example, countries such as South Sudan, have extreme mortality levels. In countries like Rwanda, the cluster indicated an effective low-cost intervention. The cluster that contained countries such as Algeria was characterised by sustained healthcare investments. In the group of countries making up the fourth cluster, governance inefficiency was the dominant challenge for countries like Lesotho. In addition, 38% of the variation in MMR was explained by HE (p<0.0001). The contribution to the study in research knowledge rests on the categorization of African countries in terms of MMR and HE.

Keywords: Health Expenditure, Africa, Maternal Mortality Ratio (MMR), Sustainable Development Goal (SDG), Clustering.

Adegoke, Yetunde Oluranti, Gavin George, and Josue Mbonigaba. “Sustainable Thresholds, Health Outcomes, Health Expenditures and Education Nexus in Selected African Countries: Quadratic and Moderation Modelling.” Globalization and Health 18, no. 1 (October 12, 2022): 84. https://doi.org/10.1186/s12992-022-00876-8.

African Health Organization. “Maternal Mortality Fact Sheet.” Accessed June 20, 2025. https://www.aho.org/fact-sheets/maternal-mortality-fact-sheet/.

Azevedo, Mario J., Akim T. Lukwa, and Olufunke A. Alaba. “Health and Economic Development.” In African Economic Development, 257–85. Emerald Publishing Limited, 2019. https://doi.org/10.1108/978-1-78743-783-820192014.

Bloom, David, Michael Kuhn, and Klaus Prettner. Health and Economic Growth: Discussion Paper Series. IZA Institute of Labour Economics: Deutsche Post Foundation, 2018.

Bwalya Jack. “SADC and the Abuja Declaration: Honouring the Pledge.” Policy Brief 230, February 2021.

Dinga, Gildas Dohba, Gisele Mah, and Teboho Mosikari. “Government Health Expenditure and Maternal Mortality: The Moderating Role of External Debt.” Healthcare 12, no. 20 (October 12, 2024): 2030. https://doi.org/10.3390/healthcare12202030.

Ibukun, Cleopatra Oluseye. “The Role of Governance in the Health Expenditure–Health Outcomes Nexus: Insights from West Africa.” International Journal of Social Economics 48, no. 4 (March 16, 2021): 557–70. https://doi.org/10.1108/IJSE-06-2020-0404.

Kassebaum, Nicholas J, Amelia Bertozzi-Villa, Megan S Coggeshall, Katya A Shackelford, Caitlyn Steiner, Kyle R Heuton, Diego Gonzalez-Medina, et al. “Global, Regional, and National Levels and Causes of Maternal Mortality during 1990–2013: A Systematic Analysis for the Global Burden of Disease Study 2013.” The Lancet 384, no. 9947 (September 2014): 980–1004. https://doi.org/10.1016/S0140-6736(14)60696-6.

Onofrei, Mihaela, Anca-Florentina Vatamanu, Georgeta Vintilă, and Elena Cigu. “Government Health Expenditure and Public Health Outcomes: A Comparative Study among EU Developing Countries.” International Journal of Environmental Research and Public Health 18, no. 20 (October 13, 2021): 10725. https://doi.org/10.3390/ijerph182010725.

Rana, Rezwanul Hasan, Khorshed Alam, and Jeff Gow. “Health Expenditure, Child and Maternal Mortality Nexus: A Comparative Global Analysis.” BMC International Health and Human Rights 18, no. 1 (December 16, 2018): 29. https://doi.org/10.1186/s12914-018-0167-1.

Razakamanana, Marilys Victoire, Voahirana Tantely Andrianatoandro, and Tiarinisaina Olivier Ramiandrisoa. “Do Public Health Expenditures Affect Maternal and Child Health in Madagascar?” Health Economics Review 13, no. 1 (October 18, 2023): 47. https://doi.org/10.1186/s13561-023-00462-7.

The World Bank Group. Universal Health Coverage, 2025.

United Nations. The Sustainable Development Goals Report 2020. United Nations, 2020.

Wanjiku, Justus Mwaura. “Public Health Expenditure and Health Outcomes: An Empirical Study Analysis.” Masters Thesis Unpublished, UMEA University, 2023.

World Health Organization. Africa Region Health Expenditure Atlas 2023. World Health Organization, 2025.

———. “Macroeconomics and Health: Investing in Health for Economic Development,” 2001.

———. Maternal Mortality: Levels and Trends 2000 to 2017. World Health Organization, 2019.

———. The Abuja Declaration: Ten Years On. World Health Organization, 2019.

———. Trends in Maternal Mortality 2000-2020. World Health Organization, 2025.

Pinky Lalthapersad-Pillay is a Professor of Economics at the University of South Africa, South Africa. Her research focuses on development economics and gender issues.

Peter Ohue is a PhD student at the University of Ibadan. His research interest is statistics.

Lalthapersad-Pillay, Pinky, and Peter Ohue. “Categorisation of African Countries: Cluster Analysis of Maternal Mortality based on Health Expenditure Trends (2000-2023)- A Machine Learning Approach to SDG 3.1 Prioritisation33.” E-Journal of Humanities, Arts and Social Sciences 6, no. 14 (2025): 3922 -3932, https://doi.org/10.38159/ehass.202561439

© 2025 The Author(s). Published and Maintained by Noyam Journals. This is an open access article under the CCBY license (http://creativecommons.org/licenses/by/4.0/).

Articles in this Issue

About Journal