Background predictors of time to death in infancy: evidence from a survival analysis of the 2018 Nigeria DHS data

Abstract

Background Nigeria’s child health profile is quite concerning with an infant mortality rate of 67 deaths per 1000 live births and a significant slowing down in progress towards improving child health outcomes. Nigeria’s 2018 Demographic and Health Survey (DHS) suggests several bio-demographic risk factors for child death, including mother’s poor education, poverty, sex of child, age of mother, and location (rural vs urban) but studies are yet to explore the predictive power of these variables on infant survival in Nigeria. Methods The study extracted data for all births in the last 12 months preceding the 2018 Nigeria DHS and used the Cox proportional hazard model to predict infant survival in Nigeria. Failure in this analysis is death with two possible outcomes – dead/alive – while the survival time variable is age at death. We censored infants who were alive at the time of the study on the day of the interview. Covariates in the analysis were: age of mother, education of mother, wealth quintile, sex of child, location, region, place of delivery, and age of pregnancy. Results The study found that a higher education of a mother compared to no education (β = .429; p-value < 0.05); belonging to a household in the richer wealth quintile (β = .618; p-value < 0.05) or the highest quintile (β = .553; p-value < 0.05), compared to the lowest wealth quintile; and living in North West (β = 1.418; p-value < 0.05) or South East zone (β = 1.711; p-value < 0.05), significantly predict infant survival. Conclusion Addressing Nigeria’s infant survival problem requires interventions that give attention to the key drivers – education, socio-economic status, and socio-cultural contextual issues. We therefore recommend full implementation of the universal basic education policy, and child health education programs targeted at mothers as long- and short-term solutions to the problem of poor child health outcomes in Nigeria. We also argue in favor of better use of evidence in policy and program development in Nigeria.

Community and individual level determinants of infant mortality in rural Ethiopia using data from 2016 Ethiopian demographic and health survey

“…Infants born health facilities had a lower risk of death when compared to those born at home. This finding was in agreement with a study done in Ethiopia 4 rural district in Indonesia 28 and Nigeria 29 . This outcome could be explained by the fact that the place of delivery is required to promote the health of women and fetuses by lowering birth complications.…”

“…Educated mothers had lower infant mortality than uneducated mothers. This is similar to studies done in Bangladesh 15 , Ethiopia 19 , 32 , Nigeria 29 , 33 and Brazilian 34 , which found the infant death rate decreased with an increase in the level of education of the mother. Educated mothers are more likely to be conscious of nutrition, use of contraceptives to space births, and awareness of childhood diseases and care.…”

“…Infants born in the regional states of Afar, Amhara, Oromia, Somalia, SNNPR, Benishangul-gumz, Gambela, Dire Dawa, and Harari were more likely to die than those born in Tigray. It is supported by other findings in Ethiopia 24 , Bangladesh 13 and Nigeria 29 , 33 . The potential explanation for this may be the regional disparities in socioeconomic status, health-care coverage, and other amenities.…”

“…A lower risk of infant death has been associated to having a wealthy household. Previous studies in Ethiopia 20 , Bangladesh 15 , rural district in Indonesia 28 and Nigeria 29 showed that infant mortality was negatively associated with household income. Infants from high-income families would be able to meet basic needs and services including health care, quality of life, water quality, and sanitation 25 .…”

Mother's education and infant survival in Ethiopia

“…Many studies that have investigated the association between mothers' level of education and infant mortality in low‐ and middle‐income countries have found infant mortality to be negatively related to maternal education (Anele et al, 2021; Kunnuji et al, 2022; Rahman et al, 2021; Tesema et al, 2021). For example, studies by Anele et al (2021) in Brazil and Rahman et al (2021) in Bangladesh have indicated that children born to mothers with no or limited education have an increased risk of infant death compared with those of better‐educated mothers.…”