Inequalities in Under-five Mortality in Nigeria: A Population-based Analysis of Individual- and Community-level Determinants

Background Regions with geographically diverse ecology and socio-economic circumstances may have different disease exposure and child health outcomes. This study assessed variations in the risks of under-five deaths across regions of Nigeria and determined the individualand community-level factors that explain possible variations between regions. Methods Multilevel multivariable logistic regression analysis was performed using a nationallyrepresentative sample of 6029 children from 2735 mothers aged 15-49 years and nested within 365 communities from the 2003 Nigeria Demographic and Health Survey. Odds ratios with 95% confidence intervals were used to express measures of association between the characteristics. Variance partition coefficients and Wald statistic were used to express measures of variation. Results Patterns of under-five mortality cluster within families and communities. The risks of underfive deaths were significantly higher for children of mothers resident in the South South (Niger Delta) region. Individual-level (birth order and birth interval, mother’s age, mother’s education, and household wealth index) and community-level factors (percentage of mothers who had prenatal care by doctor and hospital delivery) were significantly associated with the risks of under-five deaths. Conclusion Findings suggest the need to differentially focus on community-level interventions aimed at increasing maternal and child health care utilization, changing birth spacing behaviour, and improving maternal socio-economic position especially in disadvantaged regions, such as the South South (Niger Delta) region. Findings call for further studies on community-levels determinants of under-five mortality.