Child Mortality In Nigeria Research Articles

Assessing the Link between Maternal Transport Modes and Childhood Mortality in Nigeria

ObjectivesThe study explored the association between maternal transport modes and childhood mortalities in Nigeria.MethodUtilizing data and definitions from the 2018 Nigeria Demographic and Health Survey report, the ten-year early mortality rates of the five childhood mortalities and the percentage of live births in the 5 years before the survey, transported by eight identified means of transportation, were statistically correlated for each of Nigeria’s 36 states and the federal capital territory (FCT) in the R environment at a significance level of α < 0.05.ResultsIn the spatial distribution of the five childhood mortalities, a notable north-south dichotomy was observed, contrasting with the spatial spread of maternal transport modes. The five childhood mortalities exhibited a significant, moderately positive correlation with transportation by Private Car or Truck, while their associations with Public Transport or Bus and Walking were notably moderate but negative.Conclusion for PracticeWhile the use of private cars or trucks should be encouraged as a means of maternal transport, public transport should be better organized to provide efficient services to women who need such services for maternal and child healthcare. Additionally, steps should be taken to reduce travel distances to health facilities to manageable distances for mothers.

Evaluating the Role of Households' Food Security Status and Socioeconomic Determinants on Child Mortality in Nigeria

When addressing global development, it is imperative to recognize the relationship between food security and child mortality. Despite the targeted goals of SDGs 2 (zero hunger) and 3 (good health and well-being), Nigeria continues to grapple with relatively high rates of child malnutrition, alongside persistent challenges in child mortality and food insecurity that affect its population significantly. This study employed the Nigeria Living Standard Survey (NLSS) dataset with 11,655 households to estimate the impact of food (in)security on child mortality using the Propensity Score Matching (PSM). The study shows that food insecurity is predominant in the rural northern and urban southern part of Nigeria. Child mortality rates were found to be influenced by various factors such as maternal education, maternal age, geopolitical zones, place of residence, and access to healthcare facilities, showcasing a complex interplay of positive and negative impacts. The empirical estimates revealed that households’ food insecurity had a significant impact on child mortality in Nigeria. Hence, in order to achieve the SDG’s 2 and 3 in Nigeria, a more concerted effort should be geared towards food security and child mortality among the Nigerian rural and urban communities. The insights from this study underscore the importance of prioritizing interventions that drives food security, enhancing nutritional access, and tackling underlying social determinants to substantially reduce child mortality rates. It is imperative for policymakers, healthcare professionals, and communities to integrate complementarity approaches in developing sustainable solutions that safeguard the well-being and prospects of Nigeria's children.

Spatially Weighted Multinomial Modelling of Comorbidity of Anaemia and Malaria among Under Five Children in Nigeria

Children in sub-Saharan African countries especially Nigeria continue to suffer increased mortality owing to comorbidity of infections such as anaemia and malaria, which are known to epidemiologically overlap. In order to examine the risk factors and spatial patterns of comorbidity of anaemia and malaria using 2021 Nigeria malaria indicator survey (NMIS), multinomial logit model was extended by incorporating spatially weighted random effect. The impact of climatic variation on the childhood disease comorbidity was explored by weighting the spatial structured component based on the 2021 NMIS average cluster temperature of each state in Nigeria. A number of spatial weighted geo-additive models were fitted and compared using defiance information criterion. Inference was fully Bayesian and Intrinsic Conditional Autoregressive prior was used for structured random effects. Based on the map generated from the best- fitted model which unveiled states that are more susceptible to the risk of disease comorbidity, the average temperature used as a weighting factor however has strong relationship with the spatial pattern of disease comorbidity. States with low temperature have higher risk of comorbidity of anaemia and malaria compared to states with higher average temperature.Area of residence, level of education of the mother, economic status of the mother and owning mosquito-treated nets were identified as the significant risk factors associated with the disease comorbidity.Findings from this study will be helpful to policymakers and health authorities in their effort to combat the comorbidity of childhood anaemia and malaria thereby reducing child mortality in Nigeria.

Seven-year review of paediatric mortality in the University Of Uyo Teaching Hospital, Uyo, Nigeria

Background: Childhood mortality has become one of the world’s targets for reduction as encapsulated in the Sustainable Development Goals (SDG). Although mortality among children aged younger than 5 years has declined globally in the past two decades, considerable geographical differences exist and remain disproportionately high in sub-Saharan Africa and Southeast Asia. Many hospital-based studies in Nigeria have shown the predominance of infectious diseases such as sepsis, bronchopneumonia, and HIV/AIDS as the leading causes of childhood mortality. Methods: The study was conducted at the Department of Paediatrics of the University of Uyo Teaching Hospital (UUTH), Uyo, Akwa Ibom State, Nigeria. The study was a descriptive, cross-sectional and retrospective review of all the deaths among the hospitalized children from 1st January 2015 to 31st December 2021. Results: A total of 191 deaths in the Paediatrics Department of the University of Uyo Teaching Hospital were recorded, 99 males (51.3%) and 92 females (47.7%). This study shows that 27.00% of children who died where infants, 28.30% were children 1-5 years and 44.50% were children above 5 years. The commonest cause of childhood mortality in this study was severe sepsis (30.00%), followed by HIV/AIDS (11.40%), bronchopneumonia (9.84%). Conclusion: Most of the leading causes of childhood mortality in Nigeria are infectious diseases. These are largely preventable and leave room for improvement in our practice of Infection Prevention and Control (IPC), appropriate community education on hygienic practices and prevention of HIV/AIDS.

Spatially Weighted Multinomial Modelling of Comorbidity of Anaemia and Malaria among Under-Five Children in Nigeria

Children in sub-Saharan African countries, especially Nigeria, continue to suffer increased mortality owing to comorbidity of infections such as anaemia and malaria, which are known to epidemiologically overlap. In order to examine the risk factors and spatial patterns of comorbidity of anaemia and malaria using the 2021 Nigeria Malaria Indicator Survey (NMIS), a multinomial logit model was extended by incorporating a spatially weighted random effect. The impact of climatic variation on the childhood disease comorbidity was explored by weighting the spatial structured component based on the 2021 NMIS average cluster temperature of each state in Nigeria. A number of spatially weighted geo-additive models were fitted and compared using deviance information criterion. Inference was fully Bayesian, and an Intrinsic Conditional Autoregressive prior was used for structured random effects. Based on the map generated from the best-fitted model, which unveiled states that are more susceptible to the risk of disease comorbidity, the average temperature used as a weighting factor, however, has a strong relationship with the spatial pattern of disease comorbidity. States with low temperatures have a higher risk of comorbidity of anaemia and malaria compared to states with higher average temperatures. Area of residence, level of education of the mother, economic status of the mother, and owning mosquito-treated nets were identified as the significant risk factors associated with the disease comorbidity. Findings from this study will be helpful to policymakers and health authorities in their effort to combat the comorbidity of childhood anaemia and malaria, thereby reducing child mortality in Nigeria.

Dynamics of IgG antibody response against Plasmodium antigens among Nigerian infants and young children.

Plasmodium falciparum malaria is a leading cause of child mortality in Nigeria. Neonates are born with maternal antibodies from placental transfer which may protect against malaria infection in the first months of life. The IgG dynamics of the transition from passively transferred antimalarial antibodies to actively acquired IgG from natural exposure have not been well elucidated. Blood samples collected during a 2018 Nigeria nationwide HIV/AIDS household survey were available for 9,443 children under 5 years of age, with a subset of infants under 2 months of age having maternal samples available (n=41). Samples were assayed for the P. falciparum HRP2 antigen and anti-malarial IgG antibodies. LOESS regression examined the dynamics in IgG response in the first 5 years of life. Correlation with maternal IgG levels was assessed for mother/child pairs. Consistent decreases were observed in median IgG levels against all Plasmodium spp. antigen targets for the first months of life. At a population level, P. falciparum apical membrane antigen-1 (AMA1) and merozoite surface protein-1 19kD (PfMSP1) IgG decreased during the first 12 months of life before reaching a nadir, whereas IgGs to other targets only declined for the first 4 months of life. Seropositivity showed a similar decline with the lowest seropositivity against AMA1 and PfMSP1 at 10-12 months, though remaining above 50% during the first 2 years of life in higher transmission areas. No protective association was observed between IgG positivity and P. falciparum infection in infants. Maternal antibody levels showed a strong positive correlation with infant antibody levels for all P. falciparum antigens from birth to 2 months of age, but this correlation was lost by 6 months of age. Maternally transferred anti-malarial IgG antibodies rapidly decline during the first 6 months of life, with variations among specific antigens and malaria transmission intensity. From 3-23 months of age, there was a wide range in IgG levels for the blood-stage antigens indicating high individual variation in antibody production as children are infected with malaria. Non-falciparum species-specific antigens showed similar patterns in waning immunity and correlation with paired mother's IgG levels compared to P. falciparum antigens.

Is there a link between the autonomy of women and maternal healthcare utilization in Nigeria? A cross-sectional survey

BackgroundDespite legislation and intervention programmes, the rates of maternal and child mortality in Nigeria remain high. Sustainable development goals on mother and child mortality would be a mirage if this continues. The study investigated the autonomy of women (women’s decision-making autonomy) and the use of maternal health-care services in Nigeria.MethodsSecondary data obtained from the Nigeria Demographic and Health Survey, 2018 were used in this investigation. Women who indicated they gave birth in the five-year before the surveys were considered in the study. The association between autonomy of women and maternal health-care utilization was studied using binary logistic regression models.ResultsIn total, about one-fifth of the women (19.6%) indicated they had at least eight ANC visits for their most recent birth. Overall, 40.5% of the women gave birth in a health institution, and 20.1% went for postnatal checkups. The use of health-care services was significantly related to the autonomy of women. Women’s and husbands/partners’ educational levels, residency and ethnicity were socio-demographic characteristics that influenced women’s healthcare service consumption.ConclusionsFor most recent childbirth, most women did not utilise the health-care services in Nigeria. To enhance the autonomy of women and, as a result, maternal health-care services use in Nigeria, effective interventions, policies, and programmes are required.

Macro-economic determinants, maternal and infant SDG targets in Nigeria: Correlation and predictive modeling.

Unambiguously, Nigeria is off-track in achieving the health-related SDGs. Consequentially, this study aligns with SDG 3 which calls for "good health and wellbeing for people by ensuring healthy lives and promoting wellbeing for all at all ages". This article examines the combined effect of health expenditure and other key macro-economic factors on health indices such as maternal and newborn and child mortality in Nigeria. Contrary to existing literature, we formulated a model that predicts the level of macro-economic determinants needed to achieve the SDG targets for maternal and newborn and child mortality in Nigeria by 2030. The study used Autoregressive Distributed Lag (ARDL), which is usually used for large T models. The study period spans from 1995 to 2020. We found a significant negative relationship between health outcomes and macro-economic determinants namely, household consumption, total health expenditure, and gross fixed capital while we determined a significant positive relationship between health outcomes and unemployment. Our findings are further supported by out-of-sample forecast results suggesting a reduction in unemployment to 1.84 percent and an increase in health expenditure, gross fixed capital, household consumption, control of corruption to 1,818.87 billon (naira), 94.46 billion (naira), 3.2 percent, and -4.2 percent respectively to achieve SDG health targets in Nigeria by 2030. The outcome of this result will give the Nigerian government and stakeholders a deeper understanding of the workings of the macro-economic factors, concerning health performance and will help position Nigeria, and other SSA countries by extension, toward reducing maternal mortality to 70 per 100,000 and newborn and child mortality to 25 per 1,000 births by 2030. The African leaders should consider passing into law the need for improvement in macro-economic factors for better health in Africa. We also recommend that the Nigerian government should steadily increase health expenditure to reach and move beyond the forecast level for improvement in maternal and infant mortality, given the present low and unimpressive funding for the health sector in the country.

Under age five children survival times in Nigeria: a Bayesian spatial modeling approach

BackgroundNigeria is among the top five countries in the world with the highest under-five mortality rates. In addition to the general leading causes of under-five mortality, studies have shown that disparity in sociocultural values and practices across ethnic groups in Nigeria influence child survival, thus there is a need for scientific validation. This study quantified the survival probabilities and the impact of socioeconomic and demographic factors, proximate and biological determinants, and environmental factors on the risk of under-five mortality in Nigeria.MethodsThe Kaplan-Meier survival curve, Nelson Aalen hazard curve, and components survival probabilities were estimated. The Exponential, Gamma, Log-normal, Weibull, and Cox hazard models in a Bayesian mixed effect hierarchical hazard modeling framework with spatial components were considered, and the Deviance and Watanabe Akaike information criteria were used to select the best model for inference. A 5% level of significance was assumed throughout this work. The 2018 Nigeria Demographic and Health Survey dataset was used, and the outcome variable was the time between birth and death or birth and the date of interview for children who were alive on the day of the interview.ResultsFindings show that the probability of a child dying within the first two months is 0.04, and the probability of a boy child dying before attaining age five is 0.106, while a girl child is 0.094 probability. Gender, maternal education, household wealth status, source of water and toilet facility, residence, mass media, frequency of antenatal and postnatal visits, marital status, place of delivery, multiple births, who decide healthcare use, use of bednet are significant risk factors of child mortality in Nigeria. The mortality risk is high among the maternal age group below 24 and above 44years, and birth weight below 2.5Kg and above 4.5Kg. The under-five mortality risk is severe in Kebbi, Kaduna, Jigawa, Adamawa, Gombe, Kano, Kogi, Nasarawa, Plateau, and Sokoto states in Nigeria.ConclusionThis study accentuates the need for special attention for the first two months after childbirth as it is the age group with the highest expected mortality. A practicable way to minimize death in the early life of children is to improve maternal healthcare service, promote maternal education, encourage delivery in healthcare facilities, positive parental attitude to support multiple births, poverty alleviation programs for the less privileged, and a prioritized intervention to Northern Nigeria.

A flexible parametric approach for analyzing arbitrarily censored data that are potentially subject to left truncation under the proportional hazards model.

The proportional hazards (PH) model is, arguably, the most popular model for the analysis of lifetime data arising from epidemiological studies, among many others. In such applications, analysts may be faced with censored outcomes and/or studies which institute enrollment criterion leading to left truncation. Censored outcomes arise when the event of interest is not observed but rather is known relevant to an observation time(s). Left truncated data occur in studies that exclude participants who have experienced the event prior to being enrolled in the study. If not accounted for, both of these features can lead to inaccurate inferences about the population under study. Thus, to overcome this challenge, herein we propose a novel unified PH model that can be used to accommodate both of these features. In particular, our approach can seamlessly analyze exactly observed failure times along with interval-censored observations, while aptly accounting for left truncation. To facilitate model fitting, an expectation-maximization algorithm is developed through the introduction of carefully structured latent random variables. To provide modeling flexibility, a monotone spline representation is used to approximate the cumulative baseline hazard function. The performance of our methodology is evaluated through a simulation study and is further illustrated through the analysis of two motivating data sets; one that involves child mortality in Nigeria and the other prostate cancer.

Social autopsy analysis of the determinants of neonatal and under-five mortalities in Nigeria, 2013-2018

Background Nigeria suffers from one of the world’s highest child mortality rates, with about 900,000 deaths in a single year, despite being classified as a middle-income country. Over the past few years, substantial efforts have been made to reduce child mortality, with under-five mortality declining by 31.6% between 1990 and 2018. However, this decline is slower than needed to reduce child mortality significantly. This study presents the social autopsy component of the 2019 verbal and social autopsy (VASA) survey to provide an in-depth understanding of the social determinants of under-five mortality in Nigeria. Methods The study was a cross-sectional inquiry into the social determinants of neonatal and 1-59 months child deaths from the 2018 Nigeria Demographic and Health Survey (NDHS) weighted to represent the Nigerian population. The social autopsy survey asked about maternal care for neonates and 1-59 months children during the final illness. Results Child mortality in Nigeria in children aged 1-59 months is strongly associated with levels of wealth, place of residence, and maternal education. The association of these same socio-economic factors with neonatal mortality is weaker. While there were significant associations with wealth quintiles and geopolitical zones, higher maternal education was not significantly associated with lower neonatal death rates. Maternal complications in pregnancy and/or labour and delivery were common and strongly associated with stillbirths and deaths in the first two days. Severity scores at the inception of the illnesses did not show differences between children who only received informal care versus those who went to formal care providers. The main barriers to care were distance, cost, transport, and the need to travel at night, and these barriers were interlinked. More distant facilities usually required vehicle transport, which was expensive for low-income families. Travelling for an emergency at night was even more difficult in terms of finding and paying for transport and involving problems with insecurity and bad roads. Conclusions The family, community, and health system factors related to neonatal and 1-59 months child deaths in Nigeria were highlighted in this study. Deaths were commonly associated with numerous factors, each of which could contribute to the sequence of events resulting in a preventable death.

Predictors of knowledge, attitudes and ever practice family planning among public secondary school teachers in Enugu East Senatorial District, Nigeria.

Family planning deficiencies are responsible for high maternal, newborn, and child mortality in Nigeria, and more than half of all death among adult female is linked to maternal death. To ascertain the predictors of good knowledge, positive attitudes, and ever practice family planning among public secondary school teachers in Enugu East Senatorial District, Nigeria. A cross-sectional research was carried out among public secondary school teachers aged between 18 and 60 years in Enugu East Senatorial District, Nigeria, using probability proportional to size sampling and systematic random sampling from a selection of 1,000 participants. Factors considered included sources of information on family planning, partner involvement, history of family planning methods, and healthcare facilities. Bivariate and multivariable logistic regression analysis was employed to establish the relationship. An odds ratio of 95% confidence interval (CI) was estimated to ascertain the level of significance. A majority (65.9%) of respondents had a good knowledge of family planning, more than half had positive attitudes (52.7%), and most of them had ever practice family planning (55.0%). Television (AOR = 2.17; 95% CI 1.54-3.06) and social media (AOR = 1.89; 95% CI 1.29-2.78) were effective sources of information to establish significant predictors of good knowledge on family planning. Healthcare (AOR = 0.68; 95% CI 0.51-0.92) and partner discussion (AOR = 3.19; 95% CI 1.94-5.27) were also significant determinants of positive attitudes towards family planning. Cost of obtaining family planning methods (AOR = 0.003; 95% CI 0.001-0.013) and proximity of family planning facilities (AOR = 0.04; 95% CI 0.02-0.10) were notable predictors of ever practice family planning. The level of knowledge, attitudes, and ever practiced family planning among teachers are moderate and a significant number of predictors were identified. Effective awareness is recommended and making use of television as a channel to increase levels of knowledge will hopefully encourage utilization of family planning among teachers.

Exploring the Hierarchies: Multilevel Correlates of Child Mortality in Nigeria and Implications for Interventions

Exploring the Hierarchies: Multilevel Correlates of Child Mortality in Nigeria and Implications for Interventions

Addressing child health inequity through case management of under-five malaria in Nigeria: an extended cost-effectiveness analysis

BackgroundUnder-five malaria in Nigeria is a leading cause of global child mortality, accounting for 95,000 annual child deaths. High out-of-pocket medical expenditure contributes to under-five malaria mortality by discouraging care-seeking and use of effective anti-malarials in the poorest households. The significant inequity in child health outcomes in Nigeria stresses the need to evaluate the outcomes of potential interventions across socioeconomic lines.MethodsUsing a decision tree model, an extended cost-effectiveness analysis was done to determine the effects of subsidies covering the direct and indirect costs of case management of under-five malaria in Nigeria. This analysis estimates the number of child deaths averted, out-of-pocket (OOP) expenditure averted, cases of catastrophic health expenditure (CHE) averted, and cost of implementation. An optimization analysis was also done to determine how to optimally allocate money across wealth groups using different combinations of interventions.ResultsFully subsidizing direct medical, non-medical, and indirect costs could annually avert over 19,000 under-five deaths, 8600 cases of CHE, and US$187 million in OOP spending. Per US$1 million invested, this corresponds to an annual reduction of 76 under-five deaths, 34 cases of CHE, and over US$730,000 in OOP expenditure. Due to low initial treatment coverage in poorer socioeconomic groups, health and financial-risk protection benefits would be pro-poor, with the poorest 40% of Nigerians accounting for 72% of all deaths averted, 55% of all OOP expenditure averted, and 74% of all cases of CHE averted. Subsidies targeted to the poor would see greater benefits per dollar spent than broad, non-targeted subsidies. In an optimization scenario, the strategy of fully subsidizing direct medical costs would be dominated by a partial subsidy of direct medical costs as well as a full subsidy of direct medical, nonmedical, and indirect costs.ConclusionSubsidizing case management of under-five malaria for the poorest and most vulnerable would reduce illness-related impoverishment and child mortality in Nigeria while preserving limited financial resources. This study is an example of how focusing a targeted policy-intervention on a single, high-burden disease can yield large health and financial-risk protection benefits in a low and middle-income country context and address equity consideration in evidence-informed policymaking.

Community perspectives and caregivers' healthcare practices and responses to the four major childhood killer diseases in Nigeria.

Two-thirds of Nigeria's childhood deaths is attributable to four preventable/curable diseases-diarrhoea, malaria, meningitis and pneumonia (DMMP). Community perspectives and caregivers' practices about these child-killer diseases are poorly documented. Drawing on individual and group interviews (n=259), we explored community members' perspectives, and caregivers' practices/responses regarding DMMP among children across Nigeria's three major ethnic groups. Using deductive reasoning and data analysis in Atlas.ti, results from the narratives formed four thematic issues-respondents' perception and knowledge about the causes of the diseases; perception and knowledge about prevention; perception and knowledge of symptoms and fatality of the diseases; and caregivers' practices regarding the prevention and management of the diseases. Results demonstrate significant misconception about the aetiology of pneumonia and meningitis. We found ostensible disconnection between knowledge and practice. Interventions including health education programmes/sensitizations on the causes, prevention/management of DMMP are necessary to achieve reduction in the burden of childhood mortality in Nigeria.

Trends in the association between educational assortative mating, infant and child mortality in Nigeria

BackgroundExisting knowledge has established the connection between maternal education and child survival, but little is known about how educational assortative mating (EAM), relates to childhood mortality. We attempt to examine this association in the context of Nigeria.MethodsData was obtained from the 2008, 2013, and 2018 waves of the Nigeria Demographic and Health Survey, which is a cross-sectional study. The sample includes the analysis of 72,527 newborns within the 5 years preceding each survey. The dependent variables include the risk of a newborn dying before 12 months of age (infant mortality), or between the age of 12–59 months (child mortality). From the perspective of the mother, the independent variable, EAM, includes four categories (high-education homogamy, low-education homogamy, hypergamy, and hypogamy). The Cox proportional hazard regression was employed for multivariate analyses, while the estimation of mortality rates across the spectrum of EAM was obtained through the synthetic cohort technique.ResultsThe risk of childhood mortality varied across the spectrum of EAM and was particularly lowest among those with high-education homogamy. Compared to children of mothers in low-education homogamy, children of mothers in high-education homogamy had 25, 31 to 19% significantly less likelihood of infant mortality, and 34, 41, and 57% significantly less likelihood of child mortality in 2008, 2013 and 2018 survey data, respectively. Also, compared to children of mothers in hypergamy, children of mothers in hypogamous unions had 20, 12, and 11% less likelihood of infant mortality, and 27, 36, and 1% less likelihood of child mortality across 2008, 2013 and 2018 surveys, respectively, although not significant at p < 0.05. Both infant and child mortality rates were highest in low-education homogamy, as expected, lowest in high-education homogamy, and lower in hypogamy than in hypergamy. Furthermore, the trends in the rate declined between 2008 and 2018, and were higher in 2018 than in 2013.ConclusionThis indicates that, beyond the absolute level of education, the similarities or dissimilarities in partners’ education may have consequences for child survival, alluding to the family system theory. Future studies could investigate how this association varies when marital status is put into consideration.

A semiparametric mixture model approach for regression analysis of partly interval-censored data with a cured subgroup.

Failure time data with a cured subgroup are frequently confronted in various scientific fields and many methods have been proposed for their analysis under right or interval censoring. However, a cure model approach does not seem to exist in the analysis of partly interval-censored data, which consist of both exactly observed and interval-censored observations on the failure time of interest. In this article, we propose a two-component mixture cure model approach for analyzing such type of data. We employ a logistic model to describe the cured probability and a proportional hazards model to model the latent failure time distribution for uncured subjects. We consider maximum likelihood estimation and develop a new expectation-maximization algorithm for its implementation. The asymptotic properties of the resulting estimators are established and the finite sample performance of the proposed method is examined through simulation studies. An application to a set of real data on childhood mortality in Nigeria is provided.

Approximation of the Cox survival regression model by MCMC Bayesian Hierarchical Poisson modelling of factors associated with childhood mortality in Nigeria

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.

Exploring mechanisms that explain how coalition groups are formed and how they work to sustain political priority for maternal and child health in Nigeria using the advocacy coalition framework

BackgroundThe unacceptably high rate of maternal and child mortality in Nigeria prompted the government to introduce a free maternal and child health (MCH) programme, which was stopped abruptly following a change in government. This triggered increased advocacy for sustaining MCH as a political priority in the country and led to the formation of advocacy coalitions. This study set out to explain the process involved in the formation of advocacy coalition groups and how they work to bring about sustained political prioritization for MCH in Nigeria. It will contribute to the understanding of the Nigerian MCH sector subsystem and will be beneficial to health policy advocates and public health researchers in Nigeria.MethodsThis study employed a qualitative case study approach. Data were collected using a pretested interview guide to conduct 22 in-depth interviews, while advocacy events were reviewed pro forma. The document review was analysed using the manual content analysis method, while qualitative data audiotapes were transcribed verbatim, anonymized, double-coded in MS Word using colour-coded highlights and analysed using manual thematic and framework analysis guided by the advocacy coalition framework (ACF). The ACF was used to identify the policy subsystem including the actors, their belief, coordination and resources, as well as the effects of advocacy groups on policy change. Ethics and consent approval were obtained for the study.ResultsThe policy subsystem identified the actors and characterized the coalitions, and described their group formation processes and resources/strategies for engagement. The perceived deep core belief driving the MCH agenda is the right of an individual to health. The effects of advocacy groups on policy change were identified, along with the factors that enabled effectiveness, as well as constraints to coalition formation. External factors and triggers of coalition formation were identified to include high maternal mortality and withdrawal of the free MCH programme, while the contextual issues were the health system issues and the socioeconomic factors affecting the country.ConclusionOur findings add to an increasing body of evidence that the use of ACF is beneficial in exploring how advocacy coalitions are formed and in identifying the effects of advocacy groups on policy change.

Changing patterns of gender inequities in childhood mortalities during the Sustainable Development Goals era in Nigeria: findings from an artificial neural network analysis

ObjectivesIn line with the child survival and gender equality targets of Sustainable Development Goals (SDG) 3 and 5, we aimed to: (1) estimate the age and sex-specific mortality trends in...