Patterns and predictors of mortality among children under-five years in Nigeria

Abstract

Early childhood mortality remains a major public health problem in developing countries. Under-five mortality rate of 157 per 1000 live birth currently observed in Nigeria is one of the highest worldwide. Against the backdrop of limited childhood mortality research in Nigeria, this study identified predictors of child mortality. The study was a population based cross-sectional design where information was obtained from the Nigeria Demographic and Health Survey (NDHS) 2008 on childhood survival status from 28,647 mothers of reproductive age. It was a nationally representative sample. Chi Square and Cox proportional hazard regression, using forward likelihood ratio method were used in the analysis (α=0.05). Mean age of the women was 29.28yrs with standard deviation 7.078 and 11.2% had experienced childhood deaths in the last 5 years prior the survey. Among the identified predictors of under-five mortality were; age, religion, wealth index, cooking fuel type, preceding birth interval, type of toilet facility, household size. The hazard of under-five mortality was higher for children of mothers residing in the; South South (HR=2.03; C.I=1.27–3.24 , p<0.05), South West (HR=2.58; C.I=1.57–4.24, p<0.05), North East (HR = 2.90; C.I=1.88–4.48, p<0.05), South East (HR=4.54; C.I=3.03–6.79, p<0.05) and North West(HR=10.05; 95% C.I=6.67–15.16, p<0.05) than those in the North Central region. The risk of dying before the fifth birthday was higher for children whose mothers are Muslims (HR=2.34; C.I=1.41–3.90, p<0.05) than children whose mothers are Christians. Children from the mothers belonging to “Rich” wealth index had higher chances of surviving (HR=0.785; C.I=0.62–0.99, p<0.05) and those from the middle wealth class had twice the chance of surviving till their fifth birthday (HR=0.44; C.I=0.34–0.56, p<0.05) compared with children from relatively poor mothers. Children whose mothers attended postnatal clinic had better chances of surviving to their fifth birthday (HR = 0.76; C.I=0.62–0.92, p<0.05) compared with children whose mothers did not attend. Childhood mortality experienced by mothers in Nigeria is high and the predictors included both sociodemographic and health related factors. There is need to consider the identified predictors of childhood mortality when designing childhood mortality reduction strategies in Nigeria.

Keywords: Child Mortality; Survival Analysis; Under-five Mortality