Abstract
BackgroundMillions of children worldwide suffer and die from conditions for which effective interventions exist. While there is ample evidence regarding these diseases, there is a dearth of information on the social factors associated with child mortality.MethodsThe 2014 Verbal and Social Autopsy Study was conducted based on a nationally representative sample of 3,254 deaths that occurred in children under the age of five and were reported on the birth history component of the 2013 Nigerian Demographic and Health Survey. We conducted a descriptive analysis of the preventive and curative care sought and obtained for the 2,057 children aged 1–59 months who died in Nigeria and performed regional (North vs. South) comparisons.ResultsA total of 1,616 children died in the northern region, while 441 children died in the South. The majority (72.5%) of deceased children in the northern region were born to mothers who had no education, married at a young age, and lived in the poorest two quintiles of households. When caregivers first noticed that their child was ill, a median of 2 days passed before they sought or attempted to seek healthcare for their children. The proportion of children who reached and departed from their first formal healthcare provider alive was greater in the North (30.6%) than in the South (17.9%) (p<0.001). A total of 548 children were moderately or severely sick at discharge from the first healthcare provider, yet only 3.9%-18.1% were referred to a second healthcare provider. Cost, lack of transportation, and distance from healthcare facilities were the most commonly reported barriers to formal care-seeking behavior.ConclusionsMaternal, household, and healthcare system factors contributed to child mortality in Nigeria. Information regarding modifiable social factors may be useful in planning intervention programs to promote child survival in Nigeria and other low-income countries in sub-Saharan Africa.
Highlights
The under-five mortality rate declined from 91 deaths per 1,000 live births in 1990 to 43 deaths per 1,000 live births in 2015 [1], but the rates of childhood mortality in sub-Saharan Africa have remained the highest in the world
A total of 1,616 children died in the northern region, while 441 children died in the South
The proportion of children who reached and departed from their first formal healthcare provider alive was greater in the North (30.6%) than in the South (17.9%) (p
Summary
The under-five mortality rate declined from 91 deaths per 1,000 live births in 1990 to 43 deaths per 1,000 live births in 2015 [1], but the rates of childhood mortality in sub-Saharan Africa have remained the highest in the world. Nigeria is the most populous country in Africa, with a total population of approximately 170 million people; an estimated 750,000 deaths occurred in children under the age of 5 in 2015 [1]. Higher rates of polygamous and early marriage, poorer utilization of modern healthcare facilities, higher proportions of rural residence, and greater poverty have been identified in the northern relative to the southern region [3]. Each of these factors has previously been shown to have strong and additive influences on childhood mortality in different countries [4]. While there is ample evidence regarding these diseases, there is a dearth of information on the social factors associated with child mortality
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