title: REGIONAL VARIATIONS IN INFANT AND CHILD MORTALITY IN NIGERIA: A MULTILEVEL ANALYSIS.
abstract: There are substantial regional disparities in under-five mortality in Nigeria, and evidence suggests that both individual- and community-level characteristics have an influence on health outcomes. Using 2008 Nigeria Demographic and Health Survey data, this study (1) examines the effects of individual- and community-level characteristics on infant/child mortality in Nigeria and (2) determines the extent to which characteristics at these levels influence regional variations in infant/child mortality in the country. Multilevel Cox proportional hazard analysis was performed on a nationally representative sample of 28,647 children nested within 18,028 mothers of reproductive age, who were also nested within 886 communities. The results indicate that community-level variables (such as region, place of residence, community infrastructure, community hospital delivery and community poverty level) and individual-level factors (including child's sex, birth order, birth interval, maternal education, maternal age and wealth index) are important determinants of infant/child mortality in Nigeria. For instance, the results show a lower risk of death in infancy for children of mothers residing in communities with a high proportion of hospital delivery (HR: 0.70, p < 0.05) and for children whose mothers had secondary or higher education (HR: 0.84, p < 0.05). Although community factors appear to influence the association between individual-level factors and death during infancy and childhood, the findings consistently indicate that community-level characteristics are more important in explaining regional variations in child mortality, while individual-level factors are more important for regional variations in infant mortality. The results of this study underscore the need to look beyond the influence of individual-level factors in addressing regional variations in infant and child mortality in Nigeria.
authors.affiliation: *Demography and Population Studies Programme, Schools of Public Health and Social Sciences,University of the Witwatersrand,Johannesburg,South Africa.
authors.forename: Sunday A
authors.initials: SA
authors.lastname: Adedini
authors.affiliation: *Demography and Population Studies Programme, Schools of Public Health and Social Sciences,University of the Witwatersrand,Johannesburg,South Africa.
authors.forename: Clifford
authors.initials: C
authors.lastname: Odimegwu
authors.affiliation: *Demography and Population Studies Programme, Schools of Public Health and Social Sciences,University of the Witwatersrand,Johannesburg,South Africa.
authors.forename: Eunice N S
authors.initials: EN
authors.lastname: Imasiku
authors.affiliation: *Demography and Population Studies Programme, Schools of Public Health and Social Sciences,University of the Witwatersrand,Johannesburg,South Africa.
authors.forename: Dorothy N
authors.initials: DN
authors.lastname: Ononokpono
authors.affiliation: *Demography and Population Studies Programme, Schools of Public Health and Social Sciences,University of the Witwatersrand,Johannesburg,South Africa.
authors.forename: Latifat
authors.initials: L
authors.lastname: Ibisomi
mesh_terms: D000293:Adolescent; D000328:Adult; D001721:Birth Intervals; D001722:Birth Order; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008297:Male; D008423:Maternal Age; D008875:Middle Aged; D009035:Mothers / Q000193:education / Q000523:psychology; D055361:Multilevel Analysis; D009549:Nigeria / Q000453:epidemiology; D011247:Pregnancy; D016016:Proportional Hazards Models; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D055815:Young Adult