DETERMINANTS OF CHILD SURVIVAL IN NIGERIA

Abstract

Under-five mortality remains a major public health problem particularly in Nigeria. Studies have shown that socio demographic, environmental, bio-demographic and maternal factors influence the under-five mortality. This study identified some key predictors of child mortality and assessed the influence of housing conditions, household size, socio-demographic and biodemographic factors on child mortality in Nigeria. There were a total of 3201 under-5 deaths of the 28647 children whose records were present in the Nigeria Demographic and Health Survey (NDHS) 2008. The outcome variable was ' child alive', while the explanatory variables against socio-demographic variable, bio-demographic variables and basic housing conditions. Pearson 's Chi Square test and Cox proportional hazard regression, using forward likelihood ratio method was performed. We defined time to event for the children that were alive as their current ages and how many months lived for children that were dead. Hazard Ratios (HR) with 95% confidence intervals (CI) were used to depict association among variables. The Under-five Mortality rate was 157 per 1000. The hazard ratio for under-five mortality by region of residence showed that mortality was about two times higher for children of mothers residing in the South South (HR=2.03 l; 95% C.I= 1.272 - 3.243 , p<0.05) and 10 times higher for children residing in the North Western region (HR = 10.053; 95% C.I= 6.665- 15.162, p<0.05) compared with children from mothers in the North Central region. The risk of dying before the fifth birthday was higher for children whose mothers are Muslims (HR = 2.343; 95% C.l= 1.407 - 3.903, p<0.05) and lower for children whose mothers are traditional worshipers (HR = 0.053; 95% C.I= 0.030 - 0.095, p<0.05) compared with children whose mothers are Christians.Children from the mothers belonging to "Rich" wealth index category had higher chances of surviving (HR= 0.785; 95% C.I= 0.620 - 0.996, p<0.05) and those from the middle category of wealth indices had twice the chance of surviving till their fifth birthday (HR= 0.435; 95% C.I= 0.337 - 0.563, p<0.05) compared with children from relatively poor mothers. Furthermore, the odds of surviving was higher for children with mothers from homes with basic toilet facilities and household size less than five than from mothers from homes without any toilet facility( HR = 0.776; 95% C.I= 0.628 - 0.958, p<0.05) and household size greater than 5 respectively ( HR = 0.8 IO; 95% C.I= 0.678 - 0.969, p<0.05). The risk were about two times higher for children whose mothers use biomass cooking materials than children of mothers who use non-biomass cooking materials.( HR= 0.448; 95% C.l= 0.354 - 0.567, p<0.05). The findings showed that Under-five mortality is still high in Nigeria and factors influencing it include region of residence, religion, wealth index, household size, condition of floor, availability of good toilet facility, cooking fuel material, size of baby at birth and mother's postnatal visit within the first 2 months of birth. Therefore, there is need to focus on improving child survival particular in Northern region. In addition, educating mothers on the danger of several births to reduce household size, awareness on the danger of using biomass materials for cooking, improving housing conditions and the importance of postnatal visits for check-ups should be encourage.