Abstract
In Nigeria, approximately 109 million and 66 million people lack access to sanitation facilities and water, respectively. This study aimed to determine whether children under 5 years old without access to improved water and sanitation facilities are at higher risk of death in Nigeria. Pooled 2003, 2008 and 2013 Nigeria Demographic and Health Survey data were used to examine the impact of water and sanitation on deaths of children aged 0–28 days, 1–11 months, and 12–59 months using Cox regression analysis. Survival information of 63,844 children was obtained, which included 6285 deaths of children under 5 years old; there were 2254 cases of neonatal mortality (0–28 days), 1859 cases of post-neonatal mortality (1–11 months) and 2,172 cases of child mortality (1–4 years old). Over a 10-year period, the odds of neonatal, post-neonatal and child deaths significantly reduced by 31%, 41% and 47% respectively. The risk of mortality from both unimproved water and sanitation was significantly higher by 38% (Adjusted hazard ratios (HR) = 1.38, 95% confidence interval (CI): 1.14–1.66) for post-neonatal mortality and 24% (HR = 1.24, 95% CI: 1.04–1.48) for child mortality. The risk of neonatal mortality increased by 6% (HR = 1.06, 95% CI: 0.85–1.23) but showed no significant effect. The Nigerian government needs to invest more in water and sanitation to reduce preventable child deaths.
Highlights
Access to unimproved water and sanitation among children under 5 years old is a serious public health problem in many developing countries, including Nigeria [1]
Both male and female children were nearly represented in the three study periods, while the proportion of children whose mothers were from poor households decreased from 42.3% in 2003 to 33.6% in 2013
The results show that neonates born to mothers in households with access to both unimproved water and sanitation had a higher risk of neonatal death (HR = 1.06; CI: 0.85―1.23) compared with the reference category, though it was not statistically significantly different
Summary
Access to unimproved water and sanitation among children under 5 years old is a serious public health problem in many developing countries, including Nigeria [1]. Unimproved water and sanitation are major causes of diarrhoea, which globally accounts for approximately 1.4 million child deaths each year. In the past two decades the Nigerian government has launched and implemented the National Water Supply and Sanitation Policy, Presidential Water Initiative, and National Economic Empowerment and Development Strategy [6,7]. Despite all these initiatives, a recent report on global progress on sanitation and drinking water indicates that approximately 109 million and 66 million people in Nigeria still lack access to basic sanitation facilities and improved drinking water, respectively [2]
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