Surviving the First Day in Nigeria: Risk Factors and Protectors

Abstract

Background: Deaths occurring within the first twenty-four hours of life constitutes a large proportion of child mortality; about 36% of all neonatal deaths took place within the first twenty-fours of delivery globally. Nigeria contributes around 9% of the global first-day mortality. Objectives: To determine the levels and determinants of first-day mortality using the 2013 Nigeria DHS data. Methods: This study utilized the 2013 Nigeria DHS which is a cross-sectional involving a nationally representative sample of 38, 948 women aged 15-49 years. First-day mortality rates were estimated for all births within the past five year prior to the survey and disaggregated by background characteristics and Cox proportional hazard models were generated to assess the relationship between some background characteristics and first-day mortality. Analysis was conducted using Stata v13. Results: The first-day mortality rate was found to be 19 per 1000 live births which was found to be higher among younger aged women, overweight women, babies in Southern part of Nigeria, rural residents, male babies and those babies delivered in health facilities among others. Factors that significantly predict first-day mortality are maternal age of more than 35 years (HR=1.12, 95%CI: 1.01-1.24), residing in Northern Nigeria (HR=1.18, 95%CI: 1.10-1.26), living in rural areas (HR=1.30, 95%CI: 1.22-1.40) and increasing maternal education (HR=1.20, 95%CI: 1.10-1.32). Utilization of at least four ANC visits (HR=0.87, 95%CI: 0.80-0.93) and having postnatal care within 24hours (HR=094, 95%CI: 0.89-0.99) are all associated with decreased hazard of first-day mortality. Conclusion: First-day mortality rate in Nigeria is high; provision and expansion of both antenatal and postnatal care services particularly in rural areas and northern part of Nigeria will potential contribute in the reduction of first-day mortality.