Determinants of neonatal mortality in Nigeria: evidence from the 2008 demographic and health survey.

Osita Kingsley Ezeh,John Hall,Michael John Dibley,Kingsley Emwinyore Agho,Andrew Nicholas Page

doi:10.1186/1471-2458-14-521

Abstract

BackgroundNigeria 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).MethodsNeonatal 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.ResultsMultivariable 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).ConclusionsOur 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.

Highlights

Nigeria continues to have one of the highest rates of neonatal deaths in Africa
The 39 and 40 neonatal deaths per 1000 live births reported by the United Nations (UN) and Nigeria Demographic and Health Survey (NDHS), respectively, can be interpreted as approximately one in every 25 neonates born in Nigeria died in the first month of life
A weighted total of 27,147 singleton live births of children aged younger than 5 years occurred within the 5-year period preceding the 2008 NDHS, of which the total neonatal deaths over this period was 996 (Table 2)

Summary

Introduction

Nigeria continues to have one of the highest rates of neonatal deaths in Africa. 99% of these neonatal deaths occur in low- and middle-income countries, mostly in sub-Saharan Africa, including Nigeria [3]. Neonatal mortality remains disturbingly high in Nigeria, despite the significant decline in most parts of the developing world, including some sub-Sahara African countries, such as Ghana and Uganda [6]. Evidence from the Nigeria Demographic and Health Survey (NDHS) indicated a marginal decline of 4.8% (42 deaths per 1000 live births in 1990 to 40 in 2008) [7]. The 39 and 40 neonatal deaths per 1000 live births reported by the UN and NDHS, respectively, can be interpreted as approximately one in every 25 neonates born in Nigeria died in the first month of life

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