Abstract
The need for more pragmatic approaches to achieve sustainable development goal on childhood mortality reduction necessitated this study. Simultaneous study of the influence of where the children live and the censoring nature of children survival data is scarce. We identified the compositional and contextual factors associated with under-five (U5M) and infant (INM) mortality in Nigeria from 5 MCMC Bayesian hierarchical Poisson regression models as approximations of the Cox survival regression model. The 2018 DHS data of 33,924 under-five children were used. Life table techniques and the Mlwin 3.05 module for the analysis of hierarchical data were implemented in Stata Version 16. The overall INM rate (INMR) was 70 per 1000 livebirths compared with U5M rate (U5MR) of 131 per 1000 livebirth. The INMR was lowest in Ogun (17 per 1000 live births) and highest in Kaduna (106), Gombe (112) and Kebbi (116) while the lowest U5MR was found in Ogun (29) and highest in Jigawa (212) and Kebbi (248). The risks of INM and U5M were highest among children with none/low maternal education, multiple births, low birthweight, short birth interval, poorer households, when spouses decide on healthcare access, having a big problem getting to a healthcare facility, high community illiteracy level, and from states with a high proportion of the rural population in the fully adjusted model. Compared with the null model, 81% vs 13% and 59% vs 35% of the total variation in INM and U5M were explained by the state- and neighbourhood-level factors respectively. Infant- and under-five mortality in Nigeria is influenced by compositional and contextual factors. The Bayesian hierarchical Poisson regression model used in estimating the factors associated with childhood deaths in Nigeria fitted the survival data.
Highlights
NPC National Population Commission PACF Partial Auto Correlation Function Sustainable Development Goals (SDG) Sustainable Development Goal U5M Under-Five Mortality U5M rate (U5MR) Under-Five Mortality Rate variance partition coefficient (VPC) Variance Partition Coefficient
The 2018 United Nations Inter-agency Group for Child Mortality Estimation report stated that 2.8 million children die before the fifth birthday in sub-Saharan Africa (SSA) and Southeast Asia which translates to 52% of all under-five mortality rate (U5MR) globally 7
This study identified variability of Infant Mortality (INM) and UM5 across states and regions in Nigeria, the highest being in the northern region based on the 2018 Nigerian Demographic Health Survey (NDHS)
Summary
NPC National Population Commission PACF Partial Auto Correlation Function SDG Sustainable Development Goal U5M Under-Five Mortality U5MR Under-Five Mortality Rate VPC Variance Partition Coefficient. Studies across the country have attributed these determinants in child mortality in Nigeria to maternal, child and socioeconomic factors[18,19,20] These factors include poverty, suboptimal uptake of immunization, poor access to basic healthcare services, maternal factors such as low or no education, young maternal age, high fertility risk disparity in region and place of r esidence[1,18,19,20]. Variations in these indices have been reported across sub-group of populations, geopolitical regions, states, and divisions across different countries[19,21,22,23,24,25]. This study aimed to identify the factors associated with infant and under-five mortalities regarding the communities and the states where the children live
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