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


METHODS
Using 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.


RESULTS
Determinants 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.


CONCLUSION
This 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.
['Adeyinka|Daniel Adedayo|DA|https://orcid.org/0000-0003-1855-6878', 'Muhajarine|Nazeem|N|https://orcid.org/0000-0001-6781-5421', 'Petrucka|Pammla|P|https://orcid.org/0000-0003-3174-3328', 'Isaac|Elon Warnow|EW|https://orcid.org/0000-0002-9754-4615']
D000293:Adolescent D000328:Adult D046688:Child Mortality D002675:Child, Preschool D005260:Female D006040:Goals D006801:Humans D007223:Infant D007226:Infant Mortality D007231:Infant, Newborn D008875:Middle Aged D009549:Nigeria D011247:Pregnancy D000076502:Sustainable Development D055815:Young Adult
Child survival Sustainable development goals Nigeria Social determinants of health Neonatal mortality Post-neonatal mortality Child mortality Multilevel analysis Multinomial regression