Under-five Mortality In Nigeria Research Articles

Application of machine learning methods for predicting under-five mortality: analysis of Nigerian demographic health survey 2018 dataset

BackgroundUnder-five mortality remains a significant public health issue in developing countries. This study aimed to assess the effectiveness of various machine learning algorithms in predicting under-five mortality in Nigeria and identify the most relevant predictors.MethodsThe study used nationally representative data from the 2018 Nigeria Demographic and Health Survey. The study evaluated the performance of the machine learning models such as the artificial neural network, k-nearest neighbourhood, Support Vector Machine, Naïve Bayes, Random Forest, and Logistic Regression using the true positive rate, false positive rate, accuracy, precision, F-measure, Matthew’s correlation coefficient, and the Area Under the Receiver Operating Characteristics.ResultsThe study found that machine learning models can accurately predict under-five mortality, with the Random Forest and Artificial Neural Network algorithms emerging as the best models, both achieving an accuracy of 89.47% and an AUROC of 96%. The results show that under-five mortality rates vary significantly across different characteristics, with wealth index, maternal education, antenatal visits, place of delivery, employment status of the woman, number of children ever born, and region found to be the top determinants of under-five mortality in Nigeria.ConclusionsThe findings suggest that machine learning models can be useful in predicting U5M in Nigeria with high accuracy. The study emphasizes the importance of addressing social, economic, and demographic disparities among the population in Nigeria. The study’s findings can inform policymakers and health workers about developing targeted interventions to reduce under-five mortality in Nigeria.

Predictive Model and Risk Factors of Under-five Mortality in Nigeria: A Study Based on 2018 Nigeria Demographic and Health Survey

The death of children under-five years is one of the critical issues in public health and the need for improving child survival continues to be a matter of urgent concern. In this study, we develop a predictive model in order to examine the risk factors of under-five mortality in Nigeria. The study utilized data from 2018 Nigeria Demographic and Health survey. The demographic and mortality data of 127,545 children were extracted and univariate and multivariate logistic regression models were employed. The results revealed that under-five mortality was 143 deaths per 1,000 live births in Nigeria. The likelihood of death was higher among males compared to females children (OR = 1.893, P<0.05). First and second birth order have a lower chances of decreasing odds of under-five children (OR = 0.737, P<0.05) and (OR = 1.888, P<0.05).The under-five mortality was higher among children born to mothers who belong to other religions compared to Christians. Islam (OR = 1.689, P<0.05) and traditionalist (OR = 2.705, P<0.05) respectively. Public servant (OR = 1.881, P<0.05) and unmarried mother (OR = 1.896, P<0.05) were increased the odds of dying chances of under-five mortality in Nigeria. Children of mothers without education experienced more death compared to mothers who attended post-secondary education (OR = 3.372, P<0.05). Sex of child, birth order, religion, marital status, maternal occupation and maternal education were significant factors associated with under-five mortality in Nigeria. Thus, planning and implementing relevant strategies that focus on those identified risks factors of under-five mortality is required for improvement of child survival in Nigeria.

Individual and Systemic Factors of Under-five Mortality in Nigeria: A Cox Proportional Hazard Model

Despite considerable efforts to reduce under-five mortality nationwide, Nigeria has fallen short of achieving the Millennium Development Goals (MDGs) target of 67 deaths per 1,000 live births by 2015. Of all the documented factors of under-five mortality, little evidence exists on the impact of systemic barriers and individual factors (maternal health-seeking behaviour) on under-five mortality in Nigeria. The study used a nationally representative sample from Nigeria Demographic and Health Survey (NDHS) 2013 dataset. The target population was 20,192 women aged 15-59 years who had given birth to 31,480 children five years before the survey. Stata software was used for data analysis. The risk of death was estimated using Cox proportional hazard models and results are presented as hazards ratios (HR) with 95% confidence intervals (CI). Findings from the overall Model I-IV revealed individual factors (maternal health-seeking indicators) as significant factors of under-five deaths (p < 0.05). Children whose mothers received antenatal care coverage (ANC) outside health care facilities (HCF) (HR: 1.60, CI: 1.0-2.4, p < 0.05); or delivered outside HCF (HR: 1.02, CI: 0.7-1.5, p < 0.05) had elevated hazard risk of death before age five. Conversely, children who were presented for postnatal check within two weeks of delivery (HR: 0.60, CI: 0.5-0.8, p < 0.05), or delivered within the longer birth interval (HR: 0.67, CI: 0.6-0.8, p < 0.001) had significantly lower hazard risk of death before age five. As part of systemic factors, children whose mothers were covered by health insurance scheme had significantly (HR: 0.52, CI: 0.2-1.2, p < 0.001) lower risk of death when compared with their counterparts without health insurance coverage. The study emphasized the need to revitalize strategies and programs to improve women health seeking behaviour and investment in the health sector through health insurance, infrastructure, and supplies.

Challenges and recommendations for addressing under-five pneumonia morbidity and mortality in Nigeria.

Pneumonia is a severe infection and one of the most common causes of mortality among children under five years of age, when not appropriately managed. Infection of the lungs by bacteria, viruses, or fungi and consequent inflammation may lead to cough and difficult breathing. Some of the key predisposing factors are malnutrition and air pollution. WHO reports that Africa has the highest burden of global child mortality, and 16% of all deaths in pneumonia, were children under five years of age in 2016. This study aimed to explore how health providers perceive pneumonia as a cause of under-five mortality in Nigeria. A qualitative study design with in-depth interviews and focus group discussions was used to explore and understand nurses and pediatricians' views regarding the pneumonia situation, vaccinations, and preventive suggestions to reduce under five pneumonia deaths in Nigeria. Two themes and four categories emerged: participant's anxiety over the situation, their views on impediments, current policies and strategies, and suggestions on addressing severe pneumonia. The results from this study highlight contextual issues playing major roles in pneumonia mortality among children in Nigeria, which will need approaches on several levels to address them.

Identifying Factors Contributing to Under-Five Mortality in Nigeria

The under-5 mortality rate (U5MR) is the probability that a child born in a specified year will die before turning 5 years of age. U5MR is still high in Nigeria. Therefore, this study aimed to identify factors contributing to under-5 mortality in Nigeria. The data used in this study were from the 2018 NDHS, encompassing 2013–2018. The methods of analysis used for this study were frequency, percentage, and Zero Inflated Negative Binomial (ZINB) regression. Data were analyzed using R programming v.4.1.2 and p < 0.05 was considered to be statistically significant. The result showed 35.4% under-5 mortality out of the 33,924 infant mortality sample data that were collected. The findings revealed maternal age, regions (North East and North West), maternal education (no education), wealth index (poorest households), and size of child at birth (very small birth size) as significant factors associated with under-5 mortality in Nigeria. The results also showed that the odds of under-5 mortality increase as the age of the mother increases. Therefore, the Nigerian government should understand that poverty is not just an economic problem but also a significant factor in health; as a result, the battle against poverty needs to receive the necessary attention.

The impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of under-five mortality in Nigeria: a cross-sectional study

BackgroundDespite the progress in reducing under-five mortality (U-5 M) in recent years, these deaths remain considerably high in Nigeria. This could be attributed to poor health policies including inequality of health insurance coverage and access to adequate healthcare services utilisations which has remained inimical to achieving sustainable development goals (SDGs). Therefore, this study examined the impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of U-5 M in Nigeria.MethodsThe data for the study were derived from the 2018 Nigeria Demographic and Health Survey and comprised a weighted sample of 127,545 birth histories of childbearing women. Descriptive and analytical analyses were carried out, including frequency tables and multivariate using Cox proportional regression. The results were presented as hazard ratios (HR) with 95% confidence intervals (CIs). Data were analyzed using Stata software version 15.1.ResultsThe results showed that 14.3% of the sampled birth histories of the childbearing women were children who died before age 5. The results further showed that 97.7% of the children were of mothers who have health insurance and over one-half (56.5%) were children whose mothers had adequate healthcare services utilisation. The risk of under-five death was significantly lower among the children of mothers who were covered by health insurance (HR: 0.66, CI: 0.42–1.02) and those whose mothers utilised adequate healthcare services (HR: 0.78, CI: 0.68–0.90). A similar result was observed among children whose mothers reported that distance to the health facility was not a problem (HR: 0.81, CI: 0.72–0.86). Some mothers’ characteristics including educational attainment, wealth quintile and region of residence significantly influenced the risk of U-5 M.ConclusionsThe study established that maternal health insurance coverage and adequate healthcare services utilisation were found to be protective factors against the risk of U-5 M. Also, the revealed low health insurance coverage of mothers calls for more pragmatic policy and intervention programmes through health insurance to achieve SDGs targets of ending preventable deaths of children under 5 years of age and ensuring quality, as well as universal access to maternal and child healthcare services.

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.

Geographic and socioeconomic inequalities in the survival of children under-five in Nigeria

Despite a substantial decline in child mortality globally, the high rate of under-five mortality in Nigeria is still one of the main public health concerns. This study investigates inequalities in geographic and socioeconomic factors influencing survival time of children under-five in Nigeria. This is a retrospective cross-sectional quantitative study design that used the latest Nigeria Demographic Health Survey (2018). Kaplan–Meier survival estimates, Log-rank test statistics, and the Cox proportional hazards were used to assess the geographic and socioeconomic differences in the survival of children under-five in Nigeria. The Kaplan–Meier survival estimates show most under-five mortality occur within 12 months after birth with the poorest families most at risk of under-five mortality while the richest families are the least affected across the geographic zones and household wealth index quintiles. The Cox proportional hazard regression model results indicate that children born to fathers with no formal education (HR: 1.360; 95% CI 1.133–1.631), primary education (HR: 1.279; 95% CI 1.056–1.550) and secondary education (HR: 1.204; 95% CI 1.020–1.421) had higher risk of under-five mortality compared to children born to fathers with tertiary education. Moreover, under-five mortality was higher in children born to mothers’ age ≤ 19 at first birth (HR: 1.144; 95% CI 1.041–1.258). Of the six geopolitical zones, children born to mothers living in the North-West region of Nigeria had 63.4% (HR 1.634; 95% CI 1.238–2.156) higher risk of under-five mortality than children born to mothers in the South West region of Nigeria. There is a need to focus intervention on the critical survival time of 12 months after birth for the under-five mortality reduction. Increased formal education and target interventions in geopolitical zones especially the North West, North East and North Central are vital towards achieving reduction of under-five mortality in Nigeria.

Spatial analysis of economic predictors of under-five mortality in Nigeria

Abstract Globally, under-five mortality rates declined from 93 deaths per 1,000 live births in 1990 to 38 in 2019. Despite the remarkable progress in reducing under-five mortality globally, it is still significantly high in Nigeria with 117 deaths per 1,000 live births, meaning that 1 in 8 children die before the age of 5. The extant literature on the risk factors of under-five mortality in Nigeria have been largely limited to maternal socio-economic characteristics and environmental factors, with little known about the macroeconomic predictors within a spatial context. As a result, this study examines the macroeconomic predictors of under-five mortality in Nigeria. The data were analysed using spatial statistics. Results show that some parts of northern Nigeria are hotspots of under-five mortality. The study also discovers that inflation rate is a risk factor of under-five mortality in southern Nigeria while internally generated revenue is the predictor in the northern region. The study recommends region-specific interventions such as controlling the high rate of inflation and improving internally generated revenue to reduce under-five mortality in the country.

Socio-ecological determinants of under-five mortality in Nigeria: exploring the roles of neighbourhood poverty and use of solid cooking fuel.

Globally, despite the decline in under-five mortality rate from 213 per 1000 live births in 1990 to 132 per 1000 live births in 2018, the pace of decline has been slow, and this can be attributed to poor progress in child survival interventions, including those aimed at reducing children's exposure to household pollution. This study examined the influence of neighbourhood poverty and the use of solid cooking fuels on under-five mortality in Nigeria. Data for the study comprised a weighted sample of 124,442 birth histories of childbearing women who reported using cooking fuels in the kitchens located within their house drawn from the 2018 Nigeria Demographic and Health Survey. Descriptive and analytical analyses were carried out, including frequency tables, Pearson's chi-squared test and multivariate analysis using a Cox proportional regression model. The results showed that the risk of under-five mortality was significantly associated with mothers residing in areas of high neighbourhood poverty (HR: 1.44, CI: 1.34-1.54) and the use of solid cooking fuels within the house (HR: 2.26, CI: 2.06-2.49). Government and non-governmental organizations in Nigeria should initiate strategic support and campaigns aimed at empowering and enlightening mothers on the need to reduce their use of solid cooking fuels within the house to reduce harmful emissions and their child health consequences.

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.

Modelling the Spatial Distribution and the Factors Associated with Under-Five Mortality in Nigeria

Globally, the risk of a child dying before celebrating their fifth birthday is still high at 5.3 million deaths in 2018 alone. Nigeria is among the few countries that are yet to achieve the Sustainable Development Goal Target of keeping under-5 death to as low as 25 deaths per 1000 live births by 2030. A recent study found that the under-5 mortality rate in Nigeria is still high with 1 in 8 Nigerian children dying before reaching the age of 5. In this study, the effect of a child’s spatial location in Nigeria on their likelihood of dying before age 5 was examined alongside other key covariates. Bayesian geo-additive regression models were fitted to the 2018 Nigeria Demographic and Health Surveys data. Statistical inference was based on the Bayesian paradigm via Markov chain Monte Carlo simulation methods, and models were assessed using the deviance information criterion. Under-five mortality rate varied significantly across spatial locations in Nigeria with Kebbi, Jigawa, Kaduna, Kogi and Gombe states having the highest rates. The likelihood of a child dying before age 5 increased among women with primary education and women aged 38 years and over. Other characteristics associated with high under-5 death are poverty, male child, low birth weight and multiple births. The current study has helped to identify geographical ‘hotspots’ as well as the key factors driving under-5 deaths in Nigeria to inform the effective design and implementation of timely and efficient interventions.

Inequities in child survival in Nigerian communities during the Sustainable Development Goal era: insights from analysis of 2016/2017 Multiple Indicator Cluster Survey

BackgroundChild survival is a major concern in Nigeria, as it contributes 13% of the global under-five mortalities. Although studies have examined the determinants of under-five mortality in Nigeria, the comparative roles of social determinants of health at the different stages of early childhood development have not been concurrently investigated. This study, therefore, aimed to identify the social determinants of age-specific childhood (0–59 months) mortalities, which are disaggregated into neonatal mortality (0–27 days), post-neonatal mortality (1–11 months) and child mortality (12–59 months), and estimate the within-and between-community variations of mortality among under-five children in Nigeria. This study provides evidence to guide stakeholders in planning for effective child survival strategies in the Nigerian communities during the Sustainable Development Goals era.MethodsUsing the 2016/2017 Nigeria Multiple Indicator Cluster Survey, we performed multilevel multinomial logistic regression analysis on data of a nationally representative sample of 29,786 (weighted = 30,960) live births delivered 5 years before the survey to 18,497 women aged 15–49 years and nested within 16,151 households and 2227 communities.ResultsDeterminants of under-five mortality differ across the neonatal, post-neonatal and toddler/pre-school stages in Nigeria. Unexpectedly, attendance of skilled health providers during delivery was associated with an increased neonatal mortality risk, although its effect disappeared during post-neonatal and toddler/pre-school stages. Also, our study found maternal-level factors such as maternal education, contraceptive use, maternal wealth index, parity, death of previous children, and quality of perinatal care accounted for high variation (39%) in childhood mortalities across the communities. The inclusion of other compositional and contextual factors had no significant additional effect on childhood mortality risks across the communities.ConclusionThis study reinforces the importance of maternal-level factors in reducing childhood mortality, independent of the child, household, and community-level characteristics in the Nigerian communities. To tackle childhood mortalities in the communities, government-led strategies should prioritize implementation of community-based and community-specific interventions aimed at improving socioeconomic conditions of women. Training and continuous mentoring with adequate supervision of skilled health workers must be ensured to improve the quality of perinatal care in Nigeria.

Modeling and Forecasting Under-Five Mortality Rate in Nigeria using Auto-Regressive Integrated Moving Average Approach

Nigeria’s efforts aimed at reducing avoidable child deaths have been met with gradual and sustained progress. Despite the decline in childhood mortality in Nigeria in the last two decades, its prevalence still remain high in comparison to the global standard of mortality for children under the age of five which stands at 25 deaths per 1000 live births. Knowledge of the chances of Nigeria achieving this goal for childhood mortality will aid proper interventions needed to reduce the occurrence. Therefore, this paper employed the Auto-Regressive Integrated Moving Average (ARIMA) model for time series analysis to make forecast of under-five mortality in Nigeria up to 2030 using data obtained from the United Nation’s Inter Agency Group for Childhood Mortality Estimate (UN-IGME). The ARIMA (2, 1, 1) model predicted a reduction of up to 37.3% by 2030 at 95% confidence interval. Results from the study also showed that a reduction of over 300% in under-five mortality is required for Nigeria to be able to achieve the SDG goal for under-five mortality.

Domestic Resource Mobilization and Under-Five Mortality in Nigeria

This study considered domestic resource mobilisation and allocation to healthcare service delivery due to the high rate of infant deaths in Nigeria. Value addition in the agricultural sector is captured as a major source of revenue which could be channelled towards increased government expenditure in healthcare. As such, the paper applies vector error correction technique on yearly data for the period 1981 to 2015. It investigates the long-run relationship and short-run dynamics between under-five mortality on the one hand, with female literacy, agricultural productivity, tax revenue, and gross capital formation on the other hand. Outcome of the study indicates, from a long run perspective, under-five mortality is positively related to tax revenue, female literacy rate and gross capital formation. However, there is a negative relationship between under-5 mortality and agricultural productivity. Moreover, as Nigeria diversifies away from crude oil towards agriculture, increased productivity and tax revenues could be channelled towards better health outcomes and rural transformation. Furthermore, enhanced management of tax and better budgeting towards the agricultural sector is recommended. In addition, infrastructure development, agro-allied investments will ensure reduction in agricultural waste and supply costs. The outcomes portend significant relevance for meeting Sustainable Development Goals 2, 3, 4, & 10.

Public Health Expenditure and Under-five Mortality in Nigeria: An Overview for Policy Intervention

AIM: This study looked at the contribution of the health expenditure by the government on under-five mortality in Nigeria.
 METHODS: The autoregressive distribution lag technique was employed in this study in examining the long-run effect of public health expenditure on under-five mortality in Nigeria. Data were sourced from the World Development Indicators for the period 1985–2017.
 RESULTS: Results from the study showed that though public health expenditure is statistically significant, it showed a positive relationship with the under-five mortality.
 CONCLUSION: The implication of this result is that 1 unit increase in public health expenditure would improve increase under-five mortality rate by 1.56 units. However, in the Nigerian context, this can be better explained by the lack of proper health-fund coordination and other factors such as maternal education. Therefore, the study concluded by recommending that proper health-fund coordination should be put in place to ensure that budget allocated to the health sector is being spent properly.

Estimation of the Family and Community Unobserved Heterogeneity Effects on the Risk of Under-Five Mortality in Nigeria using Frailty Model

The Under-five mortality (U5M) rate is an important determinant of societal and national advancement- a key marker of wellbeing, value, and access. In spite of efforts to identify the predictors of U5M to reduce its high level in Nigeria, the problem remains a major cause for concern. This study estimated the potential role of unmeasured/unobserved factors at both family and community levels, using shared frailty models on the 2013 Nigeria Demographic and Health Survey (2013 NDHS) data. The Log-rank test was used to identify variables associated with U5M- hazard ratio estimates with P<0.05 were considered as statistically significant. Our findings suggested region, marital status, place of residence and place of delivery were significant determinants of U5M in both frailty models. We also found evidence of frailty effect on the risk, particularly at the community level- heterogeneity due to unmeasured/unobserved factors, which are generally ignored when we assess the risk using only observed variables. We, therefore, suggest that to achieve the sustainable development goals relating to child health in Nigeria, more significant efforts should be directed at identifying more determinants, such as to reduce the influence of unobserved factors and facilitate an extension of interventions to these factors.

Unobserved Heterogeneity in Determinants of Under-five Mortality in Nigeria: Frailty Modeling in Survival Analysis

Unobserved Heterogeneity in Determinants of Under-five Mortality in Nigeria: Frailty Modeling in Survival Analysis

PO 8430 A GEOSPATIAL APPROACH TO PREDICTING DIARRHEA PREVALENCE IN NIGERIA

BackgroundNigeria ranks second globally only behind India in under-five mortality prevalence. In Nigeria, 108.8 children die per 1000 live births before their 5th birthday. It is of note that diarrhoea (15.3% prevalence) is the second leading cause of under-five mortality in Nigeria after pneumonia. General poor hygiene and nutritional status are contributory factors to diarrhea.MethodsData was collected for severe acute malnutrition (SAM) using the weight for height z-value (WHZ) and/or oedema criteria. In addition, data on diarrhoea prevalence, oral rehydration salt therapy (ORST), improved source of drinking water and improved sanitation were collected. These were obtained for 36 states and federal capital territory (FCT) from the National Bureau of Statistics headquarters in FCT, Abuja for 2015. Correlation analysis was first carried out to determine relationships followed by geographically weighted regression analysis (GWR). GWR was used to predict under-five mortality pattern and accuracy mapped.ResultsObserved correlation coefficients to diarrhoea prevalence were 0.59,–0.49, −0.35 and −0.63 for SAM, ORST, improved drinking water access, and improved sanitation, respectively. R2 varied across states, though positive, from 0.29 in Akwa Ibom to 0.95 in Kebbi states. Standard deviation of residuals in the regression model ranged from −3.89 to 3.33 in Borno and Gombe states respectively, while Sokoto and Bauchi had 0.006 and 0.024 respectively, thus having the best accuracy in predictions across all states in the country. Both correlation and GWR were at p<0.05.ConclusionThe results obtained support literature, confirming the inverse relationship between ORST prevalence, improved drinking water access and improved sanitation to diarrhea prevalence. It also supports the already confirmed positive relationship between poor nutrition of children and susceptibility to diarrhoea. The study however expanded knowledge by incorporating geocomputation to predict diarrhoea prevalence.

Unobserved Heterogeneity in Determinants of Under-five Mortality in Nigeria: Frailty Modeling in Survival Analysis

La mortalite infantile est l’une des mesures du statut socioeconomique d’une population. Plusieurs etudes ont ete menees pour identifier les determinants de la mortalite infantile, mais la nature de l'effet aleatoire et de l'heterogeneite dans la plupart des donnees d'enquetes en grappes n'a pas ete bien documentee. La presente etude a ete concue pour utiliser un modele de fragilite partagee afin d'evaluer les determinants de la mortalite des moins de cinq ans (U5M) a l'aide de donnees hierarchiques au Nigeria.