Under-5 mortality rate and attendant care factors in Nigeria: implication for the attainment of the mdgs

Context: The effect of health workforce geographical distribution, mobility, rural-urban migration, and demographics on access, quality, organisation and outputs/outcomes of health service delivery. Main Objective: To determine the influence of Human Resources for Health-related factors, and mothers' level of literacy on selected outcomes of child health service delivery in Nigeria in 2006 and 2008 Methods: In the context of childhood health, the target of the Millenium Development Goals is to reduce by two-thirds, between 1990 and 2015, the under-5 mortality rate. The under-5 mortality rates for Nigeria were 192, 201 and 157 respectively for 1990, 2003, and 2008. The under-5 mortality rates were provided in the Nigeria Demographic and Health Surveys on a zonal basis, thus this was the basis for using the zones of Nigeria as unit of geographical distribution in this paper. For the 2008 data, neonatal and infant mortality rates were also analysed. In 2006 and 2008, there were complete data on the distribution of doctors in the zones. The data on distribution of nurses were not complete in 2006, and there are no available data on the distribution of nurses in 2008. This is why only doctor density is used as an independent variable in this study. Female literacy can be used as a proxy for the quality of mothers' care of the ill child. However the most definitely useful information on maternal education presented in the Nigeria Demographic and Health Surveys is the level of female illiteracy; hence this variable is used as another independent variable. Data on doctor density were obtained from Statistics of Professional health workers as at December 2006 and 2008. Data on female illiteracy (female illiteracy in this context is defined as having never attended school) and various childhood health indicators (neo-natal mortality rate, infant mortality rate and under-5 mortality rate) were obtained from the Nigerian Demographic and Health Survey. An ecological analysis was done relating two main independent variables (doctor density and female illiteracy) to outcome the childhood mortality rates of neonatal mortality, infant, under-5 mortality rates, for the 2008 data. For the 2006 figures the analysis was between doctor density, female illiteracy and under-5 mortality rate. The changes between doctor density, female illiteracy and under-5 mortality rates by zones between 2006 and 2008 were presented.