title: Determinants of neonatal mortality in Nigeria: evidence from the 2008 demographic and health survey.
abstract: BACKGROUND
  Nigeria continues to have one of the highest rates of neonatal deaths in Africa. This study aimed to identify risk factors associated with neonatal death in Nigeria using the 2008 Nigeria Demographic and Health Survey (NDHS).
  
  
  METHODS
  Neonatal deaths of all singleton live-born infants between 2003 and 2008 were extracted from the 2008 NDHS. The 2008 NDHS was a multi-stage cluster sample survey of 36,298 households. Of these households, survival information of 27,147 singleton live-borns was obtained, including 996 cases of neonatal mortality. The risk of death was adjusted for confounders relating to individual, household, and community level factors using Cox regression.
  
  
  RESULTS
  Multivariable analyses indicated that a higher birth order of newborns with a short birth interval ≤ 2 years (hazard ratio [HR] = 2.19, confidence interval [CI]: 1.68-2.84) and newborns with a higher birth order with a longer birth interval > 2 years (HR = 1.36, CI: 1.05-1.78) were significantly associated with neonatal mortality. Other significant factors that affected neonatal deaths included neonates born to mothers younger than 20 years (HR = 4.07, CI: 2.83-5.86), neonates born to mothers residing in rural areas compared with urban residents (HR = 1.26, CI: 1.03-1.55), male neonates (HR = 1.30, CI: 1.12-1.53), mothers who perceived their neonate's body size to be smaller than the average size (HR = 2.10, CI: 1.77-2.50), and mothers who delivered their neonates by caesarean section (HR = 2.80, CI: 1.84-4.25).
  
  
  CONCLUSIONS
  Our study suggests that the Nigerian government needs to invest more in the healthcare system to ensure quality care for women and newborns. Community-based intervention is also required and should focus on child spacing, childbearing at a younger age, and poverty eradication programs, particularly in rural areas, to reduce avoidable neonatal deaths in Nigeria.
authors.affiliation: School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, New South Wales (NSW) 2571, Australia. ezehosita@yahoo.com.
authors.forename: Osita Kingsley
authors.initials: OK
authors.lastname: Ezeh
authors.forename: Kingsley Emwinyore
authors.initials: KE
authors.lastname: Agho
authors.forename: Michael John
authors.initials: MJ
authors.lastname: Dibley
authors.forename: John
authors.initials: J
authors.lastname: Hall
authors.forename: Andrew Nicholas
authors.initials: AN
authors.lastname: Page
mesh_terms: D000293:Adolescent; D000328:Adult; D001721:Birth Intervals; D003710:Demography; D005191:Family Characteristics; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D011247:Pregnancy; D011795:Surveys and Questionnaires