Regional Variations in Infant and Child Mortality in Nigeria: A Multilevel Analysis

Abstract

SummaryThere are substantial regional disparities in under-five mortality in Nigeria, and evidence suggests that both individual- and community-level characteristics have an influence on health outcomes. Using 2008 Nigeria Demographic and Health Survey data, this study (1) examines the effects of individual- and community-level characteristics on infant/child mortality in Nigeria and (2) determines the extent to which characteristics at these levels influence regional variations in infant/child mortality in the country. Multilevel Cox proportional hazard analysis was performed on a nationally representative sample of 28,647 children nested within 18,028 mothers of reproductive age, who were also nested within 886 communities. The results indicate that community-level variables (such as region, place of residence, community infrastructure, community hospital delivery and community poverty level) and individual-level factors (including child's sex, birth order, birth interval, maternal education, maternal age and wealth index) are important determinants of infant/child mortality in Nigeria. For instance, the results show a lower risk of death in infancy for children of mothers residing in communities with a high proportion of hospital delivery (HR: 0.70, p<0.05) and for children whose mothers had secondary or higher education (HR: 0.84, p<0.05). Although community factors appear to influence the association between individual-level factors and death during infancy and childhood, the findings consistently indicate that community-level characteristics are more important in explaining regional variations in child mortality, while individual-level factors are more important for regional variations in infant mortality. The results of this study underscore the need to look beyond the influence of individual-level factors in addressing regional variations in infant and child mortality in Nigeria.

An Assessment of Association between Neighborhood Socioeconomic Status and Infant Mortality in High Focus States in India

“…Many studies have noted a differential in rural-urban child survival rates in developing as well as in developed countries [36] [37]. The urban mortality advantage in terms of health care facilities and infant and child mortality was observed in India [38] [39]. The finding from our analysis related to rural-urban mortality gap is in agreement with the findings of these studies.…”

Individual versus community-level measures of women decisionmaking involvement and child survival in Nigeria

“…The childhood mortality differentials according to these variables have been previously described. [16,17] The random component in the multilevel model showed significant intracommunity correlation in the risk of child death. This correlation justified the analytical method used in the present study because children in the same community are exposed to similar circumstances, cultural norms and practices, and thus they would not have been completely independent of one another as far as the underfive death rate was concerned.…”

“…[6,15,16] These studies showed that contextual variables such as residence (rural v. urban), community level of education, Background. Although decision-making authority is associated with maternal healthcare utilisation, the evidence on the relative importance of individual-level v. community-level decision-making participation for child survival in sub-Saharan Africa is limited.…”

The Relationship between Health Facility-based Delivery and Child Mortality in Nigeria: Insights from 2013 Nigeria Demographic and Health Survey

“…This finding is consistent with a similar study in Nigeria. [6] The risk of child mortality was significantly reduced for children whose mothers were married. Children who belong to households with family size of five or more people had significantly reduced risk of child mortality.…”

“…[5] Numerous studies on the determinants of child mortality have been conducted in LMICs including Nigeria. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Findings of these studies showed…”