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Monday, March 24, 2014

Esha Homenauth - A Student Perspective: Determinants of Under-five Mortality in Nigeria

Infant mortality has declined globally by 2.2% between 1990 and 2010,(Rajaratnam et al. 2010), but still falls short of the estimated 4.4% needed to achieve the 4th Millennium Development Goal (MDG 4). Nigeria, the largest country in West Africa, accounted for 12% of the global under-five mortality (U5M) in 2008 (UNICEF, 2010). An unusual trend in U5M decline exists in Nigeria as a result of inconsistencies in the data available for analyses. Currently, the rate of U5M in Nigeria is far behind the decline rate of 11.0% per year needed to acquire the MGD4 in West and Central Africa.

Interventions that target child health need to be efficient in prioritizing scarce resources. A study conducted by Akinyemi et al., published in the African Population Studies Vol 27, No.1, addressed the trends in U5M determinants in Nigeria and determined how the independent contribution of these determinants influenced changes in under-five mortality risks. In this study, a re-analysis of representative sample data collected during the Nigerian Demographic and Health Surveys (NDHS) of 1990, 1999, 2003 and 2008 was done. Eligible women between the ages of 15-49 years in selected households were interviewed. They were asked questions about their summary (number of children born and survived)and detailed reproductive history (sex and date of every live birth, survival status at time of interview, current age of surviving children and age at death).

Results from this study indicated that there was an increase in U5M deaths between 1990 - 2003, but later reduced in 2003-2008. Greater reductions however, were observed in mortality during age 1-4 years than during infancy (0-11 months). A number of variables were observed to have varying degrees of influence on U5M risk. Improvements in the level of maternal and paternal education (through the introduction of universal basic education) was observed to be a significant indicator in the decline of infant mortality. Improvements in antenatal care, skilled delivery, contraceptive use and tetanus toxoid injection during pregnancy were observed to improve U5M mortality risk, however, little change has been observed in these areas of maternal health between 1990 - 2008; largely as a result of population expansion while the number of health facilities and personnel remain unchanged. Improvements in childhood vaccination and oral rehydration therapy has also resulted in a decline in infant mortality. Reduced access to potable drinking water and toilet facilities were observed to increase the risks of under-five deaths.

This study was successful in demonstrating that the effect of changes on mortality risk is proportional to the magnitude of the changes in the determinants. Reduction in U5M risk requires a combination of factors such as maternal education, antenatal care, childhood vaccinations, improvements in household environmental health and birth spacing.

From the perspective of a Health Studies student, this study provides important policy implications for Public Health. Improvements in female education, behavioural/health-related, household environmental health factors and birth practices will result in a reduction in under-five mortality. Promoting birth space is imperative country-wide, as well as improvements in the quality of maternal and child health services. With Bioline International providing open access to articles from this journal, important discussions about the issue of under-five mortality can be stimulated, and relevant interventions can be implicated. As mentioned, disparities in under-five mortality trends in Nigeria exists as a result of insufficient data. Interventions that target improvements in collection of data and analysis is important such that policy implications can be made and resources can be efficiently targeted.

Akinyemi, J.O., Bamgboye, E.A., Ayeni, O.(2013)New trends in under-five mortality determinants and their effects on child survival in Nigeria: A review of childhood mortality data from 1990-2008. African Population Studies, 27(1): 25-42

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