BackgroundExisting studies indicate that about one in every six children dies before age five in Nigeria. While evidence suggests that improved access to adequate health care holds great potential for improved child survival, previous studies indicate that there are substantial barriers to accessing health care in Nigeria. There has not been a systematic attempt to examine the effects of barriers to health care on under-five mortality in Nigeria. This study is designed to address this knowledge gap.Data and methodData came from a nationally representative sample of 18,028 women (aged 15–49) who had a total of 28,647 live births within the 5 years preceding the 2008 Nigeria Demographic and Health Survey. The risk of death in children below age five was estimated using Cox proportional hazard models and results are presented as hazards ratios (HR) with 95% confidence intervals (CI).ResultsResults indicate higher under-five mortality risks for children whose mothers had cultural barriers and children whose mothers had resource-related barriers to health care (HR: 1.44, CI: 1.32–1.57, p<0.001), and those whose mothers had physical barriers (HR: 1.13, CI: 1.04–1.24, p<0.001), relative to children whose mothers reported no barriers. Barriers to health care remained an important predictor of child survival even after adjusting for the effects of possible confounders.ConclusionFindings of this study stressed the need for improved access to adequate health care in Nigeria through the elimination of barriers to access. This would enable the country to achieve a significant reduction in childhood mortality.

The Nigerian AMS scale is a standardized HRQoL scale that showed good psychometric characteristics (reliability, validity) similar to other international versions. We suggest that the results obtained with the Nigerian AMS scale should be used preliminarily as reference for 'norm values' for highest age, i.e. in absence of other data. Confirmation in future studies is needed.

• Summary: The study examined the implications of the Nigerian Child Right Acts, 2003 on checking the proliferation of street children in Nigeria, focusing on such government institutions as the police and Social Welfare Department using a combination of quantitative and qualitative methods. • Findings: It is clear that the street children are the major targets by the government agencies but these children have no cordial relationship with the police. Their vision of the police is that of ‘punishment’ rather than ‘help’. Also, the government through the Social Welfare Department provides some assistance to street children, but their programmes were not attractive enough to the children, hence, the street children’s concept of approved schools is that of a typical ‘Nigerian prison yard‘. • Applications : It is argued that the global paradigm shift from eradication of street children to providing support for street children has a very weak root in Nigeria. Therefore, there is the need for proper implementation of the Nigeria Child Rights Act promulgated in the year 2003, which could improve the standard of practice presently obtainable in Social Welfare Department and in other government agencies such as the Police Department as a possible solution to this social menace.

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