UNDERSTANDING THE DETERMINANTS OF DECLINING UNDER-FIVE MORTALITY IN NIGERIA BETWEEN 2008 AND 2013
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Date
2018-01-25
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Johns Hopkins University
Abstract
Under-five mortality remains high in Nigeria. The country did not meet Millennium Development Goal 4. Knowledge of the determinants of under-five mortality are essential for the design of intervention programs that reduce under-five mortality. In countries with high mortality, universal coverage of key health interventions e.g. newborn care, child nutrition, vaccines; management of childhood illnesses could reduce the number of under-five deaths by more than half. Wide variations exist in the coverage of these interventions across geo-political zones in Nigeria. Determining and prioritizing the interventions driving the decline in child mortality will inform Nigeria as it drives towards the Sustainable Development Goals.
This thesis is a retrospective analysis of the different nationally representative household surveys conducted between 2008 and 2013 in Nigeria. Univariate and multivariate logistic regression models were used to explore the effects of selected socio-economic variables on under-five mortality. The Lives Saved Tool was used to determine the additional lives of under-five children saved between 2008 and 2013 based on changes in coverage of health interventions both at the national and subnational levels. The missed opportunity tool was then used to identify interventions with the highest impact for under-five children in each geo-political zone in Nigeria.
This study revealed rural-urban and geo-political zone differences in under-five mortality. There were also more deaths among children of mothers with less than secondary education and children from the poor wealth quintiles. A total of 370,000 additional lives of under-five children were saved between 2008 and 2013 with 50 percent attributable to household protection from malaria and 25 percent attributable to Vitamin A supplementation. 61 percent of the additional lives saved were from the North-East and North-West zones. ACTs for the treatment of malaria has the potential to avert the most number of deaths across all geo-political zones.
This study shows that while progress has been made to some extent, socioeconomic factors continue to play a role in under-five mortality in Nigeria, while significant improvements need to be made to drive the uptake of health interventions in the country in order to achieve the SDGs.
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Keywords
Socio-economic determinants, Lives saved, Priority setting, Under-five mortality, Missed Opportunity, LiST, Nigeria