Trends in neonatal mortality in Nigeria and effects of bio-demographic and maternal characteristics

BMC Pediatrics

Olusola Ayeni¹  Elijah Afolabi Bamgboye¹  Joshua Odunayo Akinyemi¹ 

[1] Department of Epidemiology and Medical Statistics Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria

关键词: Nigeria;    Determinants;    Trends;    Neonatal mortality;   

Others  :  1170546
DOI  :  10.1186/s12887-015-0349-0

 received in 2014-05-16, accepted in 2015-03-19,  发布年份 2015

【 摘 要 】

Background

Nigeria’s efforts to reduce under-five mortality has been biased in favour of childhood mortality to the neglect of neonates and as such the literature is short of adequate information on the determinants of neonatal mortality. Whereas studies have shown that about half of infant deaths occur in the neonatal period. Knowledge of the determinants of neonatal mortality are essential for the design of intervention programes that will enhance neonatal survival. Therefore, this study was conducted to investigate the trends and factors associated with neonatal mortality in Nigeria.

Methods

This was a retrospective analysis of the reproductive history data collected in the Nigeria Demographic and Health Surveys (NDHS) for 1990, 2003, 2008 and 2013. Neonatal mortality rates were estimated as the probability of dying before 28 completed days using synthetic cohort life table techniques. Univariate and multiple Cox proportional hazards regression models were used to explore the effects of selected maternal and bio-demographic variables on neonatal mortality. The Hazard Ratio (HR) and its 95% Confidence Interval (CI) were estimated to prioritize obtained significant factors.

Results

Nigeria neonatal mortality rate stagnated at 41 per 1000 live births between 1990 and 2013. There were rural-urban and regional differences with more deaths occurring in rural areas and northern regions. In 1990, antenatal care (HR = 0.76; CI = 0.61-0.95), facility delivery (HR = 0.69; CI = 0.53-0.90) and births interval less than 24 months (HR = 1.67; CI = 1.41-1.98) were significantly associated with neonatal deaths. Factors identified from the 2013 data were antenatal care (HR = 0.76; CI = 0.61-0.95), birth interval less than 24 months (HR = 1.67; CI = 1.41-1.98), delivery at health facility (HR = 0.69; CI = 0.53-0.90), and small birth size (HR = 1.72; CI = 1.39-2.14).

Conclusion

There was little improvement in neonatal survival in Nigeria between 1990 and 2013. Bio-demographic and health care related characteristics are significant determinants of neonatal survival. Family planning should be intensified while government should improve the quality of maternal and child health services to enhance the survival of neonates.

【 授权许可】

   
2015 Akinyemi et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]UNICEF, WHO, World Bank, United Nations: Levels and Trends in Child Mortality: Report 2014 In Levels and Trends in Child Mortality: Report 2014. United Nations Children’s Fund, New York, 10017 USA; 2014.
• [2]Lawn JE, Kinney MV, Black RE, Pitt C, Cousens S, Kerber K, et al.: Newborn survival: a multi-country analysis of a decade of change. Health Policy Plan 2012, 27:iii6-28.
• [3]Lawn JE, Cousens S, Zupan J: 4 million neonatal deaths: when? where? why? Lancet 2005, 365:891-900.
• [4]Oesterggaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, Cousens S, et al. Neonatal mortality levels for 193 countries in 2009 with trends since 1990: A systematic analysis of progress, projections, and priorities. PLoS Med. 2011; 8. doi:10.1371/journal.pmed.1001080.
• [5]National Population Commission [Nigeria]: Nigeria Demographic and Health Survey 2013. National Population Commission and ORC Macro International, Calverton MD; 2014.
• [6]Ahonsi BA: Age variations in the proximate determinants of child mortality in south-west Nigeria. J Biosoc Sci 1995, 27:19-30.
• [7]Manda SOM: Birth intervals, breastfeeding and determinants of childhood mortality in Malawi. Soc Sci Med 1999, 48:301-12.
• [8]Titaley CT, Dibley MJ, Agho K, Roberts CL, Hall J. Determinants of neonatal mortality in Indonesia. BMC Public Health. 2008; 8. doi:10.1186/1471-2458-1188-1232.
• [9]Kamal SMM: Maternal education as a determinant of neonatal mortality in Bangladesh. J Health Manag 2012, 14:269-81.
• [10]Mekonnen Y, Tensou B, Telake DS, Degefie T, Bekele A: Neonatal mortality in Ethiopia: trends and determinants. BMC Public Health 2013, 13:1-14. BioMed Central Full Text
• [11]Mosley W, Chen LC: An analytical framework for the study of child survival in developing countries. Population Dev Rev 1984, 10:25-45.
• [12]Bamgboye EA, Familusi JB: Mortality pattern at a children’s emergency ward, University College Hospital, Ibadan, Nigeria. Afr J Med Med Sci 1990, 19:127-32.
• [13]Aikhionbare HA, Yakubu AM, Naida AM: Mortality pattern in the Emergency Paediatric Unit of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Cent Afr J Med 1989, 35:393-6.
• [14]Njokanma OF, Sule-Odu AO, Akesode FA: Perinatal mortality at the Ogun State University Teaching Hospital, Sagamu, Nigeria. J Trop Paediatr 1994, 40:78-81.
• [15]Njokanma OF, Olanrewaju DM: A study of neonatal deaths at the Ogun State University Teaching Hospital, Sagamu, Nigeria. J Trop Med Hyg 1995, 98:155-60.
• [16]Adimora GN, Odetunde IO: Perinatal mortality in University of Nigeria Teaching Hospital (UNTH) Enugu at the end of the last millennium. Niger J Clin Pract 2007, 10:19-23.
• [17]Udo JJ, Anah MU, Ochigbo SO, Etuk IS, Ekanem AD: Neonatal morbidity and mortality in Calabar, Nigeria: a hospital-based study. Niger J Clin Pract 2008, 11:285-9.
• [18]Omoigberale AI, Sadoh WE, Nwaneri DU: A 4 year review of neonatal outcome at the University of Benin Teaching Hospital, Benin City. Niger J Clin Pract 2010, 13:321-5.
• [19]National Population Commission: National and State Population Housing Tables: Priority Tables Volume I. 2006 Population and Housing Census of the Federal Republic of Nigeria. National Population Commission, Abuja; 2009.
• [20]Library of Congress: Nigeria Country Profile. Nigeria Country Profile Library of Congress - Federal Research Division. 2008.
• [21]National Population Commission [Nigeria: Nigeria Demographic and Health Survey 2008. National Population Commission and ORC Macro International, Calverton MD; 2009.
• [22]Akinyemi JO, Bamgboye EA, Ayeni O: New trends in under-five mortality determinants and their effects on child survival in Nigeria: A review of childhood mortality data from 1990-2008. Afr Popul Stud 2013, 27:25-42.
• [23]Uthman OA, Uthman MB, Yahaya I: A population-based study of effect of multiple birth on infant mortality in Nigeria. BMC Pregnancy Childbirth 2008, 8:41. BioMed Central Full Text
• [24]National Population Commission [Nigeria]: Nigeria Demographic and Health Survey. National Population Commission and ORC Macro International, 2000. Calverton, Maryland; 1999.
• [25]National Population Commission [Nigeria]: Population and the quality of life in Nigeria. National Population Commission, Abuja; 2003.
• [26]Hall S: Neonatal mortality in developing countries: what can we learn from DHS data? Applications and Policy Working Paper A05/02. University of Southampton, Southampton; 2005.
• [27]Hill K, Choi Y: Neonatal mortality in the developing world. Demogr Res 2006, 14:429-52.
• [28]Hong R, Ayad M, Rutstein S, Ren R: Childhood mortality in Rwanda: Levels, trends and differentials. Further analysis of the Rwanda Demographic Health Surveys 1992-2007/8. ICF Macro, Calverton, Maryland, USA; 2009.
• [29]Bicego GT, Bicego GT, Ahmad OB: Infant and child mortality. DHS Comparative Studies No 20. Macro International Inc, Calverton, Maryland; 1996.
• [30]Fayehun O, Omololu O: Ethnicity and child survival in Nigeria. Afr Popul Stud 2011, 25:92-112.
• [31]Ogunjuyigbe PO: Under-five mortality in Nigeria: perception and attitudes of the Yorubas towards the existence of “Abiku”. Demogr Res 2004, 11:41-56.
• [32]Adedini SA, Odimegwu C, Bamiwuye O, Fadeyibi O, De Wet N: Barriers to accessing health care in Nigeria: implications for child survival. Glob Health Action 2014, 7:23499.
• [33]Antai D: Regional inequalities in under-5 mortality in Nigeria: a population-based analysis of individual- and community-level determinants. Popul Health Metrics 2011, 9:6. BioMed Central Full Text
• [34]Adebowale AS, Yusuf BO, Fagbamigbe AF: Survival probability and predictors for woman experience childhood death in Nigeria: “analysis of North-South differentials”. BMC Public Health 2012, 12:430. BioMed Central Full Text
• [35]Obono O: Cultural diversity and population policy in Nigeria. Popul Dev Rev 2003, 29:103-11.
• [36]Sastry N: Urbanization, development and under-five mortality differentials by place of residence in Sap Paulo, Brazil, 1970-1991. Demogr Res Spec Collect 2004, 2:354-86.
• [37]Fotso J: Urban-Rural differentials in child malnutrition: trends and socio-economic correlates in Sub-Saharan Africa. Health Place 2006, 13:205-23.
• [38]Gakidou E, Cowling K, Lozano R, Murray CJ: Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis. Lancet 2010, 376:959-74.
• [39]Caldwell JC: Cultural and social factors influencing mortality levels in developing countries. Ann Am Acad Pol Soc Sci 1990, 510:44-59.
• [40]Brockerhoff N, Derose LF: Child survival in East Africa: the impact of preventive health care. World Dev 1996, 24:1841-57.
• [41]Fayehun O: Household environmental health hazards and child survival in Sub-Saharan Africa. DHS Working Papers No 74. ICF Macro, Calverton, Maryland, USA; 2010.
• [42]Kassar SB, Melo AMC, Coutinho SB, Lima MC, Lira PIC. Determinants of neonatal death with emphasis on health care during pregnancy, childbirth and reproductive history. J Pediatr. 2013. http://dx.doi.org/10.1016/j.jped.2012.11.005.
• [43]Titaley CT, Dibley MJ, Roberts CL: Type of delivery attendant, place of delivery and risk of early neonatal mortality: analyses of the 1994-2007 indonesian Demographic and Health Surveys. Health Policy Plan 2012, 27:405-16.
• [44]Rutstein S: Effects of preceding birth intervals on neonatal, infant and under-five years mortality and nutritional status in developing countries: evidence from the demographic and health surveys. Int J Gynecol Obstet 2005, 89:7-24.
• [45]Curtis SL: Assessment of the quality of data used for direct estimation of infant and child mortality in DHS-II surveys. Occasional Papers No 3. Macro International Inc, Calverton, Maryland; 1995.