Regional inequalities in under-5 mortality in Nigeria: a population-based analysis of individual- and community-level determinants

Abstract

BackgroundRegions with geographically diverse ecology and socioeconomic circumstances may have different disease exposures and child health outcomes. This study assessed variations in the risks of death in children under age 5 across regions of Nigeria and determined characteristics at the individual and community levels that explain possible variations among regions.MethodsMultilevel Cox proportional hazards analysis was performed using a nationally representative sample of 6,029 children from 2,735 mothers aged 15-49 years and nested within 365 communities from the 2003 Nigeria Demographic and Health Survey. Hazard ratios (HR) with 95% confidence intervals (CI) were used to express measures of association among the characteristics. Variance partition coefficients and Wald statistic were used to express measures of variation.ResultsPatterns of under-5 mortality cluster within families and communities. The risks of under-5 deaths were significantly higher for children of mothers residing in the South South (Niger Delta) region (HR: 1.30; 95% CI: 1.76-2.20) and children of mothers residing in communities with a low proportion of mothers attending prenatal care by a doctor (HR: 1.36; 95% CI: 1.15-1.86). In addition, the cross-level interaction between mothers' education and community prenatal care by a doctor was associated with a more than 40% higher risk of dying (HR: 1.41; 95% CI: 1.21-1.78).ConclusionThe findings suggest the need to differentially focus on community-level interventions aimed at increasing maternal and child health care utilization and improving the socioeconomic position of mothers, especially in disadvantaged regions such as the South South (Niger Delta) region. Further studies on community-levels determinants of under-5 mortality are needed.

Neighbourhood characteristics and under-five mortality in Nigeria

“…As previously found (Antai, 2011b), this result indicates region of residence where children were born or raised as important contextual factors influencing under-five mortality in Nigeria. In particular, the results demonstrated that while characteristics of the neighbourhood contexts appear to alleviate under-five mortality risks in the South-west Nigeria, community characteristics tend to aggravate risks of under-five mortality in other regions, especially North-east, North-west and South-south.…”

“…Although, the effect of neighbourhood contexts on child survival has been recognised in a number of countries in sub-Saharan Africa (Antai, 2011b;Boco, 2010;Omariba, et al, 2007) and elsewhere (Sastry, 1997), evidence is sparse on the effects of neighbourhood contexts on under-five mortality in Nigeria.…”

Trends in the completeness of birth registration in Nigeria: 2002-2010

“…This is possibly because those who utilize these services are educated, were provided with information on the benefits of birth registration, and were subsequently linked to the registration centers after delivery. A poor pattern of maternal hospital utilization has been observed to negatively influence the chances of survival of children under five years (Antai 2011). Thus improving hospital utilization for delivery, besides having a direct effect on the health of the women concerned, can contribute toward raising birth registration completeness in Nigeria while also improving outcomes for the children born to these women.…”

Spatial Analysis of Employment Distribution in the Federal Civil Service, Nigeria

“…The issue of employment distribution is very common in developing countries, but the problem of disparity in employment among nations and among the different regions of any nation is not only restricted to Nigeria (Akpan, 2000;Antai, 2011). Regional inequality in employment has become more perturbing in Nigeria due to the imbalance in income distribution among geopolitical zones.…”