Socioeconomic, bio-demographic and health/behavioral determinants of neonatal mortality in Nigeria: a multilevel analysis of 2013 demographic and health survey

Abstract

INTRODUCTIONNigeria ranks second in the world for the highest number of neonatal mortality.1 On a daily basis, an estimated seven hundred neonates die, translating to over two hundred and fifty thousand annual mortalities in neonates in the country.2 Available interventions so far have failed to yield the desirable results; hence, a recent study concluded, "there was no much improvement in neonatal survival" in Nigeria since 1990. 3 (p10) Similarly, the report on "Newborn Health" in Nigeria showed "there has been no measurable progress in reducing neonatal deaths over the past decade." 4 (p15) Compared to some developing countries such as Tanzania, Uganda, Malawi, Niger, Ethiopia, Liberia, and so on, Nigeria could not meet the targets of millennium development goal (MDG) 4 by 2015. Now that the sustainable development goals (SDGs) has commenced, the need to speed up the rate of reduction of ABSTRACT Background: Nigeria ranks as one of the countries in the world with considerable burden of neonatal mortality. This study aims to investigate the association of socioeconomic, bio-demographic and health/behavioural factors with neonatal mortality in the country using the most current available evidence. Methods:The 2013 Nigeria demographic and health survey (NDHS) dataset was analyzed. Multiple logistic regression analysis was applied to identify determinants associated with neonatal mortality. The role of breastfeeding was examined by conducting analyses with and without adjustment for "breastfeeding status". Complex sample analysis was used to control for the complex sampling design used in NDHS. Results: Neonatal mortality rate (NMR) stood at 33 deaths per 1000 live births. With or without adjustment for "breastfeeding status", bio-demographic factors -maternal marital status, rural-urban residence, birth size, gender of child, birth interval and maternal body mass index (BMI) -were predictive of neonatal mortality. Maternal age and ethnicity became additional bio-demographic predictors after adjusting for "breastfeeding status". Maternal literacy (socioeconomic factor) and mode of delivery (health/behavioral factor) were significant predictors only when breastfeeding status was not adjusted for. Conclusions: Bio-demographic factors formed the bulk of predictors of neonatal mortality in Nigeria. The effect of socioeconomic and health/behavioural factors disappeared when breastfeeding status was adjusted for. Intervention programs would need to prioritize the identified predictors for an accelerated reduction of neonatal mortality in Nigeria.

Determinants of neonatal mortality in rural and urban Nigeria: Evidence from a population‐based national survey

“…Similar to previous studies, neonates with small birth size were at a greater risk of mortality in this study, regardless of population type (rural and urban). Small birth size (a proxy for low birthweight) is closely related to preterm delivery and may be due to genetic predisposition, maternal morbidity, and so on.…”

“…As in many African countries, low access to electricity supply has been a critical challenge for decades in Nigeria . According to a recent study, only 48% of the Nigerian population had access to electricity supply . In the present study, nearly 82% of households in urban areas had electricity access compared with only 30% in rural areas (Table ).…”

“…Consistent with other studies, this study found that male neonates (in urban residence) had greater odds of mortality than their female counterparts. Biological variability between male and female newborns is a logical explanation for this result . The finding that mortality was higher among neonates with birth interval <2 years may be due to maternal depletion syndrome and competition among siblings for resources and attention, resulting in poorer care for newborns and, consequently, in increased NMR …”

“…Consistently, studies have shown only a marginal reduction in the rate of neonatal mortality was achieved in the country since 1990 . While the global NMR stands at 19 deaths per 1000 live births, Nigeria maintains a rate of 33 deaths per 1000 live births (based on analysis of the 2013 Nigeria demographic and health survey [NDHS] dataset) . Unlike countries such as Malawi, Uganda, Tanzania, Niger, Liberia, Ethiopia, and so on, Nigeria did not meet the targets of MDG 4…”

“…So far, a few studies have examined the determinants of neonatal mortality in Nigeria, but those were limited in that they were not disaggregated along rural–urban residence. Hence, much remains to be understood about the different factors contributing to the incidence of neonatal mortality in rural and urban Nigeria.…”