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While social determinants of health have been perennially linked to child survival in resource-limited countries, the precise and tested pathways to effect are not clearly understood. The objective of this study was therefore to identify the critical pathways as posited a priori in a model through which social factors (at maternal, household, and community levels) determine neonatal, infant, and under-five mortalities in Nigeria. Using a novel analytic approach (hierarchical path modelling for predicting accelerated failure time) to estimate (in)direct and total effects of social determinants of child survival, we analysed 30,960 live births (weighted data for representativeness), obtained from the 2016/2017 Nigeria Multiple Indicator Cluster Survey. There were three outcome variables: time until occurrence of neonatal, infant, and under-five mortalities. The independent variables were layered factors related to child, maternal, household and community. Geographical region, rurality of residence, infrastructural development, maternal education, contraceptive use, marital status, and maternal age at birth were found to operate more indirectly on neonatal, infant, and under-five survival. Child survival is due to direct effects of child's sex (female), gestational type (singleton), birth spacing (children whose mothers delivered at least two years apart), and maternal age at delivery (20–34 years). According to the path coefficients, the indirect effects of geographical regions are the most influential determinants of child survival, accounting for 30% (neonatal), 37.1% (infant) and 39.9% (under-five) of the total effects. This study offers comprehensive set of factors, and linked pathways, at the maternal, household, and community levels that are associated with child survival in Nigeria. To accelerate progress towards Sustainable Development Goal targets for child survival and reduce geographical inequities, stakeholders should implement more impactful policies that promote maternal education, contraceptive use and improve living conditions of women (especially in rural areas of northern Nigeria). Future research should focus on identifying the most effective interventions for addressing these social determinants of child survival in Nigeria. [ABSTRACT FROM AUTHOR]

This study aimed to assess the changes in neonatal and infant mortality rates in Nigeria over the period 1990 to 2018 using Nigerian Demographic and Health Survey (NDHS) data, and assess their socio-demographic determinants using data from the most recent survey conducted in 2018. The infant mortality rate was 87 per 1000 live births in 1990, and this increased to 100 per 1000 live births in 2003 - an increase of around 15% over 13 years. Neonatal and infant mortality rates started to decline steadily thereafter and continued to do so until 2013. After 2013, neonatal morality rose slightly by the year 2018. Information for 27,465 infants under 1 year of age from the NDHS-2018 was analysed using bivariate and multivariate analysis and the Cox proportional hazard technique. In 2018, infant deaths decreased as wealth increased, and the incidence of infant deaths was greater among those of Islam religion than among those of other religions. A negative association was found between infant deaths and the size of a child at birth. Infant mortality was higher in rural than in urban areas, and was higher among male than female children. Both neonatal and infant death rates varied by region and were found to be highest in the North West region and lowest in the South region. An increasing trend was observed in neonatal mortality in the 5-year period from 2013 to 2018. Policy interventions should be focused on the poor classes, women with a birth interval of less than 2 years and those living in the North West region of the country. [ABSTRACT FROM AUTHOR]

Infant mortality and its risk factors in Nigeria was investigated using Bayesian hierarchical modeling. The hierarchical nature of the problem was examined to detect the within and between groups (states and regions) variations in infant deaths. The effect of individual level variables on the risk of a child dying before the age of one was determined using data collected from the fifth round Multiple Indicator Survey (MICS5, 2016-2017). Infants in Northern Nigeria had a higher risk of dying than others, especially in North West, while South West had the lowest risk of infant deaths. Ten percent of the variations in infant deaths was explained by differences between states while differences between regions explained only seven percent of the variations. Also, factors such as urban place of residence, mothers with secondary and tertiary education, first birth and birth interval above 2 years were associated with a decreased risk of infant deaths. Male infants, birth interval of less than 2 years, mothers with primary and no education, teenage mothers and mothers that gave birth at age 35 years and above were associated with a higher risk of infant mortality. [ABSTRACT FROM AUTHOR]

Aims: This study investigates the rural–urban differences in infant mortality rates (IMRs) and the associated risk factors in Nigeria. Methods: The dataset from the 2013 Nigeria demographic and health survey (NDHS), disaggregated by rural–urban residence, was analyzed using complex samples statistics. A multivariable logistic regression analysis was computed to explore the adjusted relationship and identify risk factors for infant mortality. Results: In rural and urban Nigeria, IMRs were 70 and 49 deaths per 1000 live births, respectively. Risk factors in rural residence were past maternal marital union (adjusted odds ratio (AOR): 1.625, p = 0.020), small birth size (AOR: 1.550, p < 0.001), birth interval <24 months (AOR: 2.057, p < 0.001), residence in North-East (AOR: 1.346, p = 0.038) and North-West (AOR: 1.653, p < 0.001) regions, and cesarean delivery (AOR: 2.922, p = 0.001). Risk factors in urban residence were poor wealth index (AOR: 2.292, p < 0.001), small birth size (AOR: 2.276, p < 0.001), male gender (AOR: 1.416, p = 0.022), birth interval <24 months (AOR: 1.605, p = 0.002), maternal obesity (AOR: 1.641, p = 0.008), and cesarean delivery (AOR: 1.947, p = 0.032). Conclusions: Infants in rural residence had higher rates of mortality than their urban counterparts and disparities in risk factors exist between the residences. [ABSTRACT FROM AUTHOR]

Background Significant reduction in the global burden of neonatal mortality was achieved through the millennium development goals. In Nigeria, however, only a marginal reduction was realized. This study assesses the rural-urban differences in neonatal mortality rate ( NMR) and the associated risk factors in Nigeria. Methods The dataset from the 2013 Nigeria demographic and health survey ( NDHS), disaggregated by rural-urban residence (n = 20 449 and 9935, respectively), was explored using univariate, bivariate, and multivariable analysis. Complex samples analysis was applied to adjust for the unequal selection probabilities due to the multi-stage cluster sampling method used in the 2013 NDHS. The adjusted relationship between the outcome and predictor variables was assessed on multi-level logistic regression analysis. Results NMR for rural and urban populations was 36 and 28 deaths per 1000 live births, respectively. Risk factors in urban residence were lack of electricity access (adjusted OR [ AOR], 1.555; 95% CI: 1.089-2.220), small birth size (as a proxy for low birthweight; AOR, 3.048; 95% CI: 2.047-4.537), and male gender ( AOR, 1.666; 95% CI: 1.215-2.284). Risk factors in rural residence were small birth size (a proxy for low birthweight; AOR, 2.118; 95% CI: 1.600-2.804), and birth interval <2 years ( AOR, 2.149; 95% CI: 1.760-2.624). Cesarean delivery was a risk factor both in rural ( AOR, 5.038; 95% CI: 2.617-9.700) and urban Nigeria ( AOR, 2.632; 95% CI: 1.543-4.489). Conclusions Determinants of neonatal mortality were different in rural and urban Nigeria, and rural neonates had greater risk of mortality than their urban counterparts. [ABSTRACT FROM AUTHOR]

Results are presented from an analysis of the intervals between births from Imesi, Western Nigeria. The mean interval following births of children who survived to 1 year was 35·03 months, but nearly half this value at 18·8 months following stillbirths or deaths under 1 year. Both these results confirm an early study done in the village (Martin, Morley & Woodland, 1964), and the role of post-partum sexual abstention as an explanation for these results is discussed. Attempts were made to look for effects of birth interval variation on the survival of the following child, but no strong trends emerged. Similarly, analyses of many growth variables by preceding and following birth intervals gave very little evidence of real effects. There were, however, hints of trends which were possibly caused by birth order biases; higher birth orders had been found to have correspondingly higher birth intervals. An intriguing result was that those children who had ever suffered from kwashiorkor showed a significantly higher preceding mean birth interval, and also a higher mean interval to the next birth. [ABSTRACT FROM PUBLISHER]