Infant mortality in Nigeria: effects of place of birth, mother's education and region of residence

Factors associated with infant mortality in Nigeria: A scoping review

BACKGROUND

Infant mortality persists as a global public health concern, particularly in lower-middle-income countries (LIMCs) such as Nigeria. The risk of an infant dying before one year of age is estimated to be six times higher in Africa than in Europe. Nigeria recorded an infant mortality rate of 72.2 deaths per 1,000 live births in 2020, in contrast to the global estimate of 27.4 per 1,000 live births. Several studies have been undertaken to determine the factors influencing infant mortality.

OBJECTIVE

This scoping review sought to identify and summarise the breadth of evidence available on factors associated with infant mortality in Nigeria.

METHODS

This review followed the five-stage principles of Arksey and O'Malley's framework. Four electronic databases were searched with no limit to publication date or study type: Ovid MEDLINE, PubMed, CINAHL Complete, and Web of Science. Selected studies were imported into Endnote software and then exported to Rayyan software where duplicates were removed. Included articles were thematically analysed and synthesised using the socioecological model.

RESULTS

A total of 8,139 references were compiled and screened. Forty-eight articles were included in the final review. At the individual level, maternal- and child-related factors were revealed to influence infant mortality; socioeconomic and sociocultural factors at the interpersonal level; provision and utilisation of health services, health workforce, hospital resources and access to health services at the organisational level; housing/neighbourhood and environmental factors at the community level; and lastly, governmental factors were found to affect infant mortality at the public policy level.

CONCLUSION

Factors related to the individual, interpersonal, organisational, community and public policy levels were associated with infant mortality in Nigeria.

Incidence of infant mortality and its predictors in East Africa using Gompertz gamma shared frailty model

Background

Globally, infant mortality is a major public health concern and a sensitive indicator of countries' socio-economic and health status. Despite the substantial reduction of under-five mortality in sub-Saharan African countries specifically in East Africa, the infant mortality rate remains highest and too far below to achieve the WHO target. As to our search of the literature is concerned, there is a dearth of evidence on the incidence and predictors of infant mortality in East Africa. Therefore, this study investigated the incidence of infant mortality and its predictors in East Africa.

Methods

The present study has utilized 138,803 weighted samples from Demographic and Health Surveys (DHSs) of 12 East African countries. Considering the hierarchical nature of DHS data shared frailty parametric survival models were fitted and compared based on deviance (-2LLR), AIC, and BIC. Gompertz gamma shared frailty model was the best-fitted model for the data since it had the lowest deviance, AIC, and BIC values. Variables with a p-value < 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable Gompertz gamma shared analysis, the Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to declare the significant predictors of infant mortality.

Results

The infant mortality rate in East Africa was 41.41 per 1000 live births. Mothers aged 25–34 years, wanted birth, health facility delivery, 1–3 ANC visit, being 2nd- 4th birth order, 5th and above, the birth interval of 24–48 months, and birth interval of 49 months and above were significantly associated with lower risk of infant mortality. Whereas women who didn’t have formal education, women who didn't participate in making health care decisions making, being male children, cesarean delivery, small size at birth, and large size at birth were significantly associated with a higher risk of infant mortality.

Conclusion

Despite the substantial progress in improving maternal and child health, this study showed that infant mortality is still a major public health concern in East Africa. Maternal age, place of delivery, maternal education, birth size, sex of the child, mode of delivery, women's autonomy, birth order, birth interval, and ANC visit were found to be significant predictors of infant mortality. Therefore, public health interventions enhancing health facility delivery, ANC visit, maternal education, birth spacing, and empowering women are crucial for reducing the incidence of infant mortality in East Africa.

Factors Associated with Neonatal Mortality among Newborns Admitted in the Special Care Baby Unit of a Nigerian Hospital

BACKGROUND

With Nigeria being one of the countries with the highest neonatal mortality rate globally, identifying the risk factors associated with neonatal mortality is essential as we strive to proffer sustainable solutions.

AIM

This retrospective hospital-based survey aimed to bridge this gap by evaluating the trends and risk factors associated with neonatal mortality in a teaching hospital in Southwestern Nigeria.

METHODS

Records of newborns admitted at the special care baby unit from January 2018 to December 2019 (n = 1098) were accessed, and available data were extracted. Descriptive analysis and inferential statistics were performed at 0.05 level of significance.

RESULTS

The mortality rate was determined to be 16.9% (inborn babies- 12.9% and out-born babies- 22.3%), with 83.3% of the newborns dying within the first week. Some of the factors associated with neonatal mortality were proximity of newborns' mothers home to the hospital [p = 0.041; Odds Ratio (OR) = 0.670; 95% Confidence Interval (CI) = 0.455-0.985], maturity of the baby at delivery (p < 0.001; OR = 0.514; CI = 0.358-0.738), place of delivery-inborn or out-born (p < 0.001; OR = 0.515; CI = 0.375-0.709), place of delivery-in a hospital or a non-hospital setting (p = 0.048; OR = 0.633; CI = 0.401-0.999), and baby's weight (p < 0.001; CI = -0.684 to -0.411).

CONCLUSION

Findings from the study indicate that newborns delivered at home, traditional birth attendant centres or hospitals without essential healthcare facilities have a higher mortality risk. This suggests that measures to improve the accessibility of pregnant women to essential healthcare services are a prerequisite to reducing the neonatal mortality rate in Nigeria.

Residential inequality and spatial patterns of infant mortality in Ethiopia: evidence from Ethiopian Demographic and Health Surveys

Background

Despite the remarkable decrease in infant mortality rate in most countries, the rate of decline is slow and it remains unacceptably high in Sub-Saharan Africa. The progress in infant mortality in Ethiopia is far below the rate needed to achieve the Sustainable Development Goal. Understanding the residential inequality and spatiotemporal clusters of infant mortality is essential to prioritize areas and guide public health interventions. Therefore, this study aimed to investigate the residential inequality and spatial patterns of infant mortality in Ethiopia.

Methods

A secondary data analysis was done based on the Ethiopian demographic and health surveys conducted in 2000, 2005, 2011, and 2016. A total weighted sample of 46,317 live births was included for the final analysis. The residential inequality was assessed by calculating the risk difference in infant mortality rates between urban and rural live births and presented using a forest plot. For the spatial patterns of infant mortality, the SaTScan version 9.6 and ArcGIS version 10.6 statistical software were used to identify the spatial patterns of infant mortality.

Results

The study revealed that the infant mortality rate significantly declined from 96.9 per 1000 live births [95% CI 93.6, 104.2] in 2000 to 48.0 per 1000 live births [95% CI 44.2, 52.2] in 2016 with an annual rate of reduction of 3.2%. The infant mortality rate has substantial residential inequality over time, which is concentrated in the rural area. The spatial distribution of infant mortality was significantly clustered at the national level in survey periods (global Moran’s I, 0.04–0.081, p value < 0.05). In 2000, the most likely clusters were found in east Afar and at the border areas of south Amhara and north Oromia regions (LLR = 7.61, p value < 0.05); in 2005, at the border areas of Southern Nations Nationalities and People and in the entire Amhara region (LLR = 10.78, p value< 0.05); in 2011, at Southern Nations Nationalities and People and Gambella regions (LLR = 6.63, p value< 0.05); and in 2016, at east Oromia and northeast Somali regions (LLR = 8.38, p value < 0.05).

Conclusion

In this study, though infant mortality has shown remarkable reduction, infant mortality remains a major health care concern and had significant spatial variation across regions. Besides, the study found that infant mortality was highly concentrated in rural areas. Identifying the hotspot areas of infant mortality would help in designing effective interventions to reduce the incidence of infant mortality in these areas. Therefore, the findings highlighted that public health interventions should target rural areas and identified hotspot areas to reduce the incidence of infant mortality.

Sociocultural Determinants of the Utilization of Maternal Health Care Services in the Tallensi District in the Upper East Region of Ghana

Introduction. The quality maternal health care that women receive during pregnancy and delivery is important for the health of both the mother and the baby. However, most pregnant women do not receive the minimum number of antenatal care (ANC) services (at least 4 times during pregnancy) as recommended by the WHO. This article sought to identify the types of maternal health care services (MHCS) received by women during pregnancy and delivery and after childbirth and women’s reasons for use and nonuse of MHCS. Methods. The study adopted the social survey design where 366 women were sampled using probability sampling technique. The data was collected through the use of questionnaire. Results. The study results revealed that some sociocultural factors such as age, religion, traditional belief system, education, and marital status influence women’s use of MHCS in the Talensi District. In addition, factors such as women’s National Health Insurance Scheme status, distance to health center, and attitude of health care professional determine their utilization of MHCS. To a large extent, these factors influence choice for traditional birth attendants over biomedically-based maternal health care services. Conclusion. The study recommended that there should be education for women on the need for them to utilize MHCS during pregnancy and delivery and after childbirth. Government should organize skill training for traditional birth attendants in the Talensi District.

Risk factors for postneonatal, infant, child and under-5 mortality in Nigeria: a pooled cross-sectional analysis

OBJECTIVES

To identify common factors associated with post-neonatal, infant, child and under-5 mortality in Nigeria.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional data of three Nigeria Demographic and Health Surveys (NDHS) for the years 2003, 2008 and 2013 were used. A multistage, stratified, cluster random sampling method was used to gather information on 63,844 singleton live-born infants of the most recent birth of a mother within a 5-year period before each survey was examined using cox regression models.

MAIN OUTCOME MEASURES

Postneonatal mortality (death between 1 and 11 months), infant mortality (death between birth and 11 months), child mortality (death between 12 and 59 months) and under-5 mortality (death between birth and 59 months).

RESULTS

Multivariable analyses indicated that children born to mothers with no formal education was significantly associated with mortality across all four age ranges (adjusted HR=1.30, 95% CI 1.01 to 1.66 for postneonatal; HR=1.38, 95% CI 1.11 to 1.84 for infant; HR=2.13, 95% CI 1.56 to 2.89 for child; HR=1.19, 95% CI 1.02 to 1.41 for under-5). Other significant factors included living in rural areas (HR=1.48, 95% CI 1.16 to 1.89 for postneonatal; HR=1.23, 95% CI 1.03 to 1.47 for infant; HR=1.52, 95% CI 1.16 to 1.99 for child; HR=1.29, 95% CI 1.11 to 1.50 for under-5), and poor households (HR=2.47, 95% CI 1.76 to 3.47 for postneonatal; HR=1.40, 95% CI 1.10 to 1.78 for infant; HR=1.72, 95% CI 1.19 to 2.49 for child; HR=1.43, 95% CI 1.17 to 1.76 for under-5).

CONCLUSIONS

This study found that no formal education, poor households and living in rural areas increased the risk of postneonatal, infant, child and under-5 mortality among Nigerian children. Community-based interventions for reducing under-5 deaths are needed and should target children born to mothers of low socioeconomic status.

REGIONAL VARIATIONS IN INFANT AND CHILD MORTALITY IN NIGERIA: A MULTILEVEL ANALYSIS

There are substantial regional disparities in under-five mortality in Nigeria, and evidence suggests that both individual- and community-level characteristics have an influence on health outcomes. Using 2008 Nigeria Demographic and Health Survey data, this study (1) examines the effects of individual- and community-level characteristics on infant/child mortality in Nigeria and (2) determines the extent to which characteristics at these levels influence regional variations in infant/child mortality in the country. Multilevel Cox proportional hazard analysis was performed on a nationally representative sample of 28,647 children nested within 18,028 mothers of reproductive age, who were also nested within 886 communities. The results indicate that community-level variables (such as region, place of residence, community infrastructure, community hospital delivery and community poverty level) and individual-level factors (including child's sex, birth order, birth interval, maternal education, maternal age and wealth index) are important determinants of infant/child mortality in Nigeria. For instance, the results show a lower risk of death in infancy for children of mothers residing in communities with a high proportion of hospital delivery (HR: 0.70, p < 0.05) and for children whose mothers had secondary or higher education (HR: 0.84, p < 0.05). Although community factors appear to influence the association between individual-level factors and death during infancy and childhood, the findings consistently indicate that community-level characteristics are more important in explaining regional variations in child mortality, while individual-level factors are more important for regional variations in infant mortality. The results of this study underscore the need to look beyond the influence of individual-level factors in addressing regional variations in infant and child mortality in Nigeria.

Barriers to accessing health care in Nigeria: implications for child survival

BACKGROUND

Existing studies indicate that about one in every six children dies before age five in Nigeria. While evidence suggests that improved access to adequate health care holds great potential for improved child survival, previous studies indicate that there are substantial barriers to accessing health care in Nigeria. There has not been a systematic attempt to examine the effects of barriers to health care on under-five mortality in Nigeria. This study is designed to address this knowledge gap.

DATA AND METHOD

Data came from a nationally representative sample of 18,028 women (aged 15-49) who had a total of 28,647 live births within the 5 years preceding the 2008 Nigeria Demographic and Health Survey. The risk of death in children below age five was estimated using Cox proportional hazard models and results are presented as hazards ratios (HR) with 95% confidence intervals (CI).

RESULTS

Results indicate higher under-five mortality risks for children whose mothers had cultural barriers and children whose mothers had resource-related barriers to health care (HR: 1.44, CI: 1.32-1.57, p<0.001), and those whose mothers had physical barriers (HR: 1.13, CI: 1.04-1.24, p<0.001), relative to children whose mothers reported no barriers. Barriers to health care remained an important predictor of child survival even after adjusting for the effects of possible confounders.

CONCLUSION

Findings of this study stressed the need for improved access to adequate health care in Nigeria through the elimination of barriers to access. This would enable the country to achieve a significant reduction in childhood mortality.

Risk factors and a predictive model for under-five mortality in Nigeria: evidence from Nigeria demographic and health survey

Background

Under-5 mortality is a major public health challenge in developing countries. It is essential to identify determinants of under-five mortality (U5M) childhood mortality because these will assist in formulating appropriate health programmes and policies in order to meet the United Nations MDG goal. The objective of this study was to develop a predictive model and identify maternal, child, family and other risk factors associated U5M in Nigeria.

Methods

Population-based cross-sectional study which explored 2008 demographic and health survey of Nigeria (NDHS) with multivariable logistic regression. Likelihood Ratio Test, Hosmer-Lemeshow Goodness-of-Fit and Variance Inflation Factor were used to check the fit of the model and the predictive power of the model was assessed with Receiver Operating Curve (ROC curve).

Results

This study yielded an excellent predictive model which revealed that the likelihood of U5M among the children of mothers that had their first marriage at age 20-24 years and ≥ 25 years declined by 20% and 30% respectively compared to children of those that married before the age of 15 years. Also, the following factors reduced odds of U5M: health seeking behaviour, breastfeeding children for > 18 months, use of contraception, small family size, having one wife, low birth order, normal birth weight, child spacing, living in urban areas, and good sanitation.

Conclusions

This study has revealed that maternal, child, family and other factors were important risk factors of U5M in Nigeria. This study has identified important risk factors that will assist in formulating policies that will improve child survival.

Factors determining client satisfaction with hospital-based perinatal care in Sri Lanka

OBJECTIVES

To describe mothers' satisfaction with perinatal care received during hospitalization for delivery, and to identify sociodemographic and health-care-related factors associated with satisfaction.

METHOD

A cross-sectional study of 446 mother-newborn pairs from five hospitals in Puttalam district, Sri Lanka, was carried out by stratified randomization. Client satisfaction was measured using a 16-item survey instrument with high internal consistency (Cronbach's alpha=0.81), through exit interview.

RESULTS

The proportion of mothers who were fully satisfied varied from 10.8% to 31.4% for interpersonal aspects, and from 10.1% to 28.9% for technical aspects of care. The satisfaction rates were lower with physical environment (6.1-10.1%) and higher with outcome of care (41.0-48.0%). Multivariate analyses indicated that mothers were more satisfied with the services available from lower level hospitals. Multiparae were more satisfied than primiparae. Determinants of satisfaction included providing immediate mother-newborn contact, information after examination and counselling on family planning. Higher satisfaction with the physical environment was associated with being Moor or Tamil as opposed to Sinhalese and with lower family income.

CONCLUSIONS

The factors associated with client satisfaction identified in this study may be helpful in improving quality of care. Hospital staff should ensure that these are addressed and develop interpersonal relationships, especially with the first-time mothers and in higher level hospitals. Maternity units of lower level institutions should be upgraded with essential facilities.

Analysing child mortality in Nigeria with geoadditive discrete-time survival models

Child mortality reflects a country's level of socio-economic development and quality of life. In developing countries, mortality rates are not only influenced by socio-economic, demographic and health variables but they also vary considerably across regions and districts. In this paper, we analysed child mortality in Nigeria with flexible geoadditive discrete-time survival models. This class of models allows us to measure small-area district-specific spatial effects simultaneously with possibly non-linear or time-varying effects of other factors. Inference is fully Bayesian and uses computationally efficient Markov chain Monte Carlo (MCMC) simulation techniques. The application is based on the 1999 Nigeria Demographic and Health Survey. Our method assesses effects at a high level of temporal and spatial resolution not available with traditional parametric models, and the results provide some evidence on how to reduce child mortality by improving socio-economic and public health conditions.

Analyzing infant mortality with geoadditive categorical regression models: a case study for Nigeria

In this paper, we analyze infant mortality in Nigeria based on the data set from the 1999 Nigeria Demographic and Health Survey (NDHS). We investigate spatial patterns at a highly disaggregated level of Nigerian states and consider non-linear effects of mother's age at birth. Time to the occurrence of a child's death can intuitively be considered to be categorical in nature and the determinants of a child's death may differ in different age groups. Thus, it may be desirable to investigate separately the death of a child in the first month and in the remaining 11 months of the first year of life. To avoid selection bias, the data set used for this case study is based on information on children who were born 12 months preceding the survey. Inference is Bayesian and is based on Markov chain Monte Carlo (MCMC) techniques. We find that spatial variation and the determinants of death indeed differ considerably for the two age groups considered.

Barriers to Utilization of Prenatal Care Services in Turkey

PURPOSE

To identify barriers to utilization of prenatal care services in Turkey, including pregnant women's attitudes toward pregnancy and prenatal care.

DESIGN

Descriptive. The population was Turkish women who lived in Erzurum and had delivered their infants but were still hospitalised.

METHODS

The sample of 446 women had or had not received prenatal care, had no complications during pregnancy, carried their pregnancies to term, and were considered to have normal deliveries. Attitudes toward pregnancy and prenatal care and barriers to prenatal care services were measured by use of a questionnaire.

FINDINGS

Low education of pregnant women and unwanted pregnancy were barriers to use of prenatal care services. Additional barriers were negative attitudes toward pregnancy and attitudes toward prenatal care. These barriers decreased frequency of use and delayed early initiation of prenatal care. The most important barrier reported by the women was being too busy at home to seek care.

CONCLUSIONS

Although this sample was limited, the findings indicate barriers for attention by health care providers to ensure appropriate prenatal care and maternal and infant health.

Implications of women's work for child nutritional status in sub-Saharan Africa: a case study of Nigeria

The study examines the relationships between women's work and child nutritional status (stunting and wasting) of 5331 Nigerian children aged 0-59 months, using data from the 1990 Nigerian Demographic and Health Survey. In defining women's work, the study considers whether women earned cash from their work and carried their children to work in order to assess the importance of childcare and income, which are the principal pathways through which women's work affects child nutritional status. The study also examines infants and children differently in order to assess the influence of child's age on nutritional status. The results reveal that wasting among infants increased when mothers did not take them to work. Furthermore, mothers' work reduced stunting in their children, but the expected positive effect of earning cash from work on childhood nutrition was less visible from the results. Other results from the study revealed that during infancy, having recent episodes of diarrhea or shorter breast-feeding duration increased wasting. Additionally, wasting was lower during infancy for children in households with pit toilets and children with Christian mothers. For infants, immunization reduced stunting, but longer duration of breast-feeding, being a higher parity child, being in households with pit toilets increased stunting. During childhood, higher birth weight, immunization, and having a Christian mother reduced stunting and wasting. Children in wealthy households are less likely to be stunted, while mother's education and being a higher parity child increased stunting. Also during childhood, having a Christian mother reduced wasting while recent episodes of fever increased wasting.

Indices and sociodemographic determinants of childhood mortality in rural Upper Egypt

There is a general agreement that childhood mortality in Egypt has substantially declined during the last two decades. The decline has been traditionally attributed to the impact of the National Control of Diarrhoeal Diseases Program (NCDDP). However, a controversy still exists over the magnitude of that decline and the claimed impact of the NCDDP on diarrhoea related mortality. This study was carried out in six sites in rural Upper Egypt to determine indices, leading causes, and sociodemographic determinants of childhood mortality. Verbal autopsy was conducted with mothers or caretakers who had reported the death of a child under the age of five (U5) before the study to determine the leading cause of death. Then, the association between childhood mortality and a wide set of sociodemographic risk factors was examined by comparing these children with 1025 living U5 children using a multivariate logistic regression analysis. Results showed that the average infant and U5 mortality rates are 97.2 and 130.8 per 1000 live births respectively. Verbal autopsy revealed that the leading causes of U5 mortality are: diarrhoeal diseases (39.4%), acute respiratory infection (26.8%), combined episode of both (5.1%), febrile illnesses including meningitis (10.6%), neonatal causes (12.6%), and accidents (2.5%). Diagnosis was not determined in 3.0% of the cases. Child age (< 12 month) and mother age at childbirth are the strongest determinants of childhood mortality. Other determinants include parental illiteracy, parental age difference, house ownership, child order and average household meat consumption.

The socio-economic determinants of maternal health care utilization in Turkey

The purpose of this study is to investigate the individual-, household- and community-level factors that affect women's use of maternal health care services in Turkey. The data used for the study come from the 1993 Turkey Demographic and Health Survey (TDHS), a nationally representative survey of ever married women 15 to 49 years of age. In order to assess the impact of socio-economic factors on maternal health care utilization, we use logistical regression techniques to estimate models of the prenatal care use and birth delivery assistance among women who have had at least one birth in the three years prior to the survey. Separate models are also estimated for urban and rural women. The results indicate that educational attainment, parity level, health insurance coverage, ethnicity, household wealth and geographic region are statistically significant factors that affect the use of health care services thought essential to reduce infant and child mortality rates. The results of the model are used to provide insights for both micro- and macro-level planning of maternal health service delivery.