Globally, Nigeria is the second largest contributor to under-5 mortality. [1][2][3] Currently, over 2 000 under-5s die daily in the country (about four million annually) from vaccine-preventable diseases, despite advances in universal immunisation and oral rehydration therapy (ORT) for diarrhoeal disease. [4] This places Nigeria as one of the largest contributors to the under-5 mortality rate in the world. Recent trends show that Nigeria is making progress in slowing its under-5 mortality rate, but the pace of reduction remains far too slow to achieve the 2015 Millennium Development Goal of reducing child mortality by twothirds. This assertion is made evident by a recent study [6] indicating that Nigeria is 28.6% away from the target of reducing under-5 mortality from 93/1 000 in 1990 to 31/1 000 in 2015.Though various reforms and policies have been put forward by the Nigerian government to address wide-ranging issues in the healthcare system, these are yet to yield expected results, and the majority are yet to be implemented at local government level. [2] Data from the POLICY project [9] indicate that the healthcare system in Nigeria is weak, as evidenced by a lack of coordination, a fragmentation of services, a dearth of resources including medicines and supplies, inadequate and decaying infrastructure, inequity in resource distribution, poor access to care and the deplorable quality thereof.Existing research on the predictors of under-5 mortality has paid little attention to household-level factors, while great emphasis has been placed on factors such as diarrhoea, malaria, measles, acute respiratory infections, whooping cough, tuberculosis, bronchopneumonia, dirty feeding bottles and utensils, inadequate disposal of household refuse and poor storage of drinking water. [10][11][12][13][14] A number of studies have shown that under-5 mortality rates vary according to socioeconomic and biodemographic characteristics. For instance, women with little or no education, [15][16][17][18] women in a lower wealth quintile, [19,20] women who reside in rural areas, [20] women in polygamous unions, [21] women who have poor or no access to electricity, [20] women who delay initiation of breastfeeding, [22] and women who did not complete child immunisation [20] tend to have children with a higher under-5 mortality rate. Nigerian studies have overemphasised the influence of individuallevel factors in under-5 mortality, [23][24][25][26] and several studies have been largely hospital-based. [27][28][29][30][31][32] In this study the levels and influences of contextual determinants of under-5 mortality in Nigeria were explored using a multilevelmodel approach. Specifically, the associations between householdlevel variables and under-5 mortality were explored.
MethodsData were drawn from the 2008 Demographic and Health Survey in Nigeria, [35] which represents the most comprehensive of demographic and health surveys conducted in the country. The survey was conducted from June to October 2008 by the National Population Commission...
