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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]

Introduction: the ravaging COVID-19 pandemic has worsened the levels of unmet need (UMN) for family planning (FP). A pulse survey showed that FP services were interrupted during the lockdown in 68% of countries. There is a need to investigate the demand gap for FP among women in the postpartum period. This study aimed to determine the prevalence and predictors of UMN of FP among women in the extended postpartum period attending immunization clinics. Methods: this was a facility-based cross-sectional study among 485 women recruited from 5 health facilities using a random sampling technique and proportional to size allocation. Data was collected using an interviewer-structured questionnaire. Analysis was done using IBM SPSS version 26. Adjusted odds ratios with 95% confidence intervals were computed. The level of significance was 5%. Results: the total unmet need was 45.4% (95% CI: 40.2--50.7) with a higher need for child spacing (60.4%) compared to limiting pregnancies (39.6%). The mean age was 30.3 ± 6.1 years. The significant predictors included age [35-39 years (aOR=5.39, 95% CI: 1.61-18.06); ≥ 40 years (aOR= 32.48, 95% CI: 6.48-162.77)], lower education status (aOR= 5.21, 95% CI: 2.09-13.01), lower income (aOR =2.21, 95% CI: 1.10-4.46), rural residence (aOR= 4.27, 95% CI: 2.15-8.47), denomination [Pentecostal (aOR= 4.09, 95% CI: 1.77-9.43); Orthodox (aOR= 5.44, 95% CI: 2.03-14.58)] and poor knowledge of postpartum FP (PPFP) (aOR= 33.93, 95% CI: 13.21-87.12). The commonest reason for FP non-use was fear of side effects. Conclusion: close to half of the women in the extended postpartum period experienced UMN for PPFP. Policymakers should consider these factors when designing FP interventions. [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]

Background: Family planning helps individuals and couples to avoid unwanted pregnancies, regulate interval between pregnancies, and determine the number of children in the family. Family planning is an effective intervention for promoting maternal health, but its acceptability and utilization are impeded by many factors. Aim: This study was conducted to assess the rural women's awareness and practice of family planning in two communities in Ogun State. Materials and Methods: This was a cross-sectional study conducted among 561 women of reproductive age. Data collection was done using interviewer administered questionnaire. Data were analyzed using IBM SPSS version 20. Frequencies were generated and Chi-square test was used to explore associations. Binary logistic regression was used to determine predictors of ever-used family planning. Results: Majority were aware of family planning (410, 73.1%). The method most commonly known was male condom (348, 84.9%), pills (276, 67.3%), and injectables (231, 56.3%). Respondents who had ever-used family planning were (265, 47.2%). The methods commonly used were injectables (104, 39.2%) and pills (85, 32.1%). Reasons for not using family planning include the desire for more children (78, 26.3%), lack of spousal support (56, 18.9%), and fear of undesirable effects (44, 14.9%). Determinants of ever-used family planning after logistic regression were age and occupation. Women between 31 and 40 years of age were two times more likely than women <20 years to have used family planning (adjusted odds ratio [AOR] 2.17, 95% confidence interval [CI] 2.17–1.23). Farmers were 53% less likely than traders to have ever-used family planning (AOR: 0.47, 95% CI: 0.29–0.78). Conclusion: Although the awareness of family planning was high in this study, it did not correspond to practice. Campaigns promoting the use of family planning for child spacing, male involvement in family planning and dispelling of fears is recommended to improve practice of family planning. [ABSTRACT FROM AUTHOR]

Background: Fertility is high in Nigeria and contraceptive use is low. Little is known about how urban Nigerians perceive the risk of contraceptive use in relation to pregnancy and birth. This study examines and compares the risk perception of family planning methods and pregnancy related scenarios among urban Nigerians.Methods: A total of 26 focus group discussions with 243 participants were conducted in September and October 2010 in Ibadan and Kaduna. The groups were stratified by sex, age, family planning use, and city. Study participants were asked to identify the risk associated with six different family planning methods and four pregnancy related risks. The data were coded in ATLAS.ti 6 and analyzed using the thematic content analysis approach.Results: The ten family planning and pregnancy related items ranked as follows from most to least risky: sterilization, abortion, getting pregnant soon after having a baby (no birth spacing), pill, IUD, injectable, having a birth under 18 years of age (teenage motherhood), condom use, having six children, and fertility awareness methods. Risk of family planning methods was often categorized in terms of side effects and complications. Positive perceptions of teenage motherhood and having many children influenced the low ranking of these items.Conclusion: Inadequate birth spacing was rated as more risky than all contraceptive methods and pregnancy related events except for sterilization and abortion. Some of the participants' risk perceptions of contraceptives and pregnancy related scenarios does not correspond to actual risk of methods and practices. Instead, the items' perceived riskiness largely correspond with prevailing social norms. However, there was a high level of understanding of the risks of inadequate birth spacing.Trial Registration Number: This study is not a randomized control trial so the study has not been registered as such. [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: First childbirth in a woman's life is one of the most important events in her life. It marks a turnaround when she might have to drop roles of career building and education, for motherhood and parenthood. The timing of the commencement of these roles affects the child bearing behavior of women as they progress in their reproductive ages. Prevalent early first childbirth in Nigeria has been reported as the main cause of high population growth and high  fertility, mortality and morbidity among women, but little has been documented on the progression into first birth as well as factors affecting it in Nigeria. This paper modelled timing of first birth among women in Nigeria and determined socio-demographic and other factors affecting its timing.Methods: We hypothesized that background characteristics of a woman will influence her progression into having first birth. We developed and fitted a survival analysis model to understand the timing of first birth among women in Nigeria using a national representative 2013 NDHS data. Women with no children were right censored as of the date of the survey. The Kaplan Meier survival function was used to estimate the probabilities of first birth not occurring until certain ages of women while Cox proportional hazard regression was used to model the timing of first births at 5 % significance level.Results: About 75.7 % of the respondents had given birth in the Northern region of Nigerian compared with 63.8 % in the South. Half (50.1 %) of the first childbirth occurred within the 15-19 years age bracket and 38.1 % within 20-29 years. The overall median survival time to first birth was 20 years (North 19, South 22), 27 years among women with higher education and 18 years for those with no formal education. The adjusted hazard of first birth was higher in the Northern region of Nigeria than in the South (aHR = 1.24, 95 % CI: 1.20-1.27), and higher in rural areas than in urban areas (aHR = 1.15, 95 % CI: 1.12-1.19). Also, hazard of earlier first birth tripled among women with no education (aHR = 3.36, 95 % CI: 3.17-3.55) compared to women with higher education. The significant factors affecting age at first birth are education, place and zone of residence, age at first marriage, religion, ethnicity and use of contraceptives.Conclusions: This study showed that progression into early first birth is most affected by the education standing of women as well as age at first marriage. Delay of first childbirths as a strategy for fertility reduction and maternal health improvement can be achieved if women are empowered early in life with quality education. Stakeholders should therefore, give adequate attention to educating the girl child. Adverse socio-cultural norms of betrothing and marrying young girls should be abrogated, while health education and promotion of need to delay child bearing must be intensified especially among rural dwellers and also in Northern Nigeria. [ABSTRACT FROM AUTHOR]

Background: Nigeria still grapples with low family planning (FP) use and a high fertility rate. This study explores the factors associated with the unmet need for FP and the coldspots of unmet need for FP in Nigeria. Methods: The 2013 Nigerian Demographic Health Survey (NDHS) data was used to investigate the unmet need for FP in Nigeria. A geo-additive model was specified to simultaneously measure the fixed, nonlinear, spatial and random effects inherent in the data. The fixed effect of categorical covariates was modelled using the diffuse prior, the nonlinear effect of continuous variable was modelled using the P-spline with second-order random walk, the spatial effects followed Markov random field priors while the exchangeable normal priors were used for the random effect of the community. The binomial distribution was used to handle the dichotomous nature of the dependent variable. Results: North East (OR: 1.8404, CI: 1.6170, 2.0941), North West (OR: 1.1145, CI: 1.1454, 1.1789), primary education (OR: 1.0441, CI: 0.9680, 1.1286), Hausa (OR: 2.7031, CI: 2.3037, 3.1513), birth interval greater than 12 months (OR: 1.0909, CI: 1.0447, 1.1379), community (OR: 1.6733, CI: 1.5261, 1.7899) and states (OR: 6.0879, CI: 2.5995, 29.6274) significantly increased the unmet need for FP. Conclusion: The unmet need for FP in Nigeria is positively associated with the Northern region, low level of education and birth interval. [ABSTRACT FROM AUTHOR]

Background Nigeria continues to have one of the highest rates of neonatal deaths in Africa. This study aimed to identify risk factors associated with neonatal death in Nigeria using the 2008 Nigeria Demographic and Health Survey (NDHS). Methods Neonatal deaths of all singleton live-born infants between 2003 and 2008 were extracted from the 2008 NDHS. The 2008 NDHS was a multi-stage cluster sample survey of 36,298 households. Of these households, survival information of 27,147 singleton live-borns was obtained, including 996 cases of neonatal mortality. The risk of death was adjusted for confounders relating to individual, household, and community level factors using Cox regression. Results Multivariable analyses indicated that a higher birth order of newborns with a short birth interval ≤ 2 years (hazard ratio [HR] = 2.19, confidence interval [CI] : 1.68-2.84) and newborns with a higher birth order with a longer birth interval > 2 years (HR = 1.36, CI : 1.05-1.78) were significantly associated with neonatal mortality. Other significant factors that affected neonatal deaths included neonates born to mothers younger than 20 years (HR = 4.07, CI : 2.83-5.86), neonates born to mothers residing in rural areas compared with urban residents (HR = 1.26, CI : 1.03-1.55), male neonates (HR = 1.30, CI : 1.12-1.53), mothers who perceived their neonate's body size to be smaller than the average size (HR = 2.10, CI : 1.77-2.50), and mothers who delivered their neonates by caesarean section (HR = 2.80, CI : 1.84-4.25). Conclusions Our study suggests that the Nigerian government needs to invest more in the healthcare system to ensure quality care for women and newborns. Community-based intervention is also required and should focus on child spacing, childbearing at a younger age, and poverty eradication programs, particularly in rural areas, to reduce avoidable neonatal deaths in Nigeria. [ABSTRACT FROM AUTHOR]