Whose child is dying? Household characteristics and under-5 mortality in Nigeria

Background. Over 2 000 under-5-year-olds die daily in Nigeria from vaccine-preventable diseases, placing the country as the third largest contributor to the global under-5 mortality rate. Nigeria is at serious risk of not meeting the Millennium Development Goal (MDG) of reducing child mortality by two-thirds (i.e. from an under-5 mortality rate of 93/1 000 in 1990 to 31/1 000 in 2015). Objective. To examine the association between household-level variables and under-5 mortality in Nigeria. Methods. Data were drawn from the 2008 Nigeria Demographic and Health Survey, which elicited information on demographic and health indicators at the national and state levels. A nationally representative sample of 36 800 households was selected. Data were collected from 33 385 women of reproductive age (15 - 49 years) and who had given birth to at least one live infant in the 5 years preceding the survey. Data were analysed using a multilevel-model approach. Results. In total, there were 104 808 live births; 18 121 (17.29%) children died as under-5s and 86 687 (82.71%) survived. Poverty, number of children ever born in a household, number of under-5s in the household, place and region of residence, maternal and paternal age, and maternal and paternal education level were critical determinants of under-5 mortality. Conclusion. The rate of under-5 mortality remains high in Nigeria. This will not be resolved until household-focused interventions are implemented using a tailored framework, and the need to improve maternal education in the country is addressed.