Migration and child health inequities in Nigeria: a multilevel analysis of contextual- and individual-level factors.
OBJECTIVE
To assess the role of rural-urban migration in the risks of under-five death; to identify possible mechanisms through which migration may influence mortality; and to determine individual- and community-level relationships between migration status and under-five death.


METHODS
Multilevel Cox regression analysis was used on a nationally representative sample of 6029 children from 2735 mothers aged 15-49 years and nested within 365 communities from the 2003 Nigeria Demographic and Health Survey. Hazard ratios with 95% confidence intervals were used to express the measures of association between the characteristics, and intra-class coefficients were used to express the measures of variation.


RESULTS
Children of rural non-migrant mothers had significantly lower risks of under-five death than children of rural-urban migrant mothers. The disruption of family and community ties, low socio-economic position and vulnerability, and the difficulties migrants face in adapting into the new urban environment, may predispose the children of rural-urban migrants to higher mortality.


CONCLUSIONS
Our results stress the need for community-level and socio-economic interventions targeted at migrant groups within urban areas to improve their access to health care services, maternal education, as well as the general socio-economic situation of women.
Antai
Diddy
D
Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden. diddy.antai@ki.se
Wedrén
Sara
S
Bellocco
Rino
R
Moradi
Tahereh
T
D000293:Adolescent; D000328:Adult; D002669:Child Welfare / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D003906:Developing Countries; D004812:Epidemiologic Methods; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D011157:Population Dynamics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult