title: The impact of water and sanitation on childhood mortality in Nigeria: evidence from demographic and health surveys, 2003-2013.
abstract: In Nigeria, approximately 109 million and 66 million people lack access to sanitation facilities and water, respectively. This study aimed to determine whether children under 5 years old without access to improved water and sanitation facilities are at higher risk of death in Nigeria. Pooled 2003, 2008 and 2013 Nigeria Demographic and Health Survey data were used to examine the impact of water and sanitation on deaths of children aged 0-28 days, 1-11 months, and 12-59 months using Cox regression analysis. Survival information of 63,844 children was obtained, which included 6285 deaths of children under 5 years old; there were 2254 cases of neonatal mortality (0-28 days), 1859 cases of post-neonatal mortality (1-11 months) and 2,172 cases of child mortality (1-4 years old). Over a 10-year period, the odds of neonatal, post-neonatal and child deaths significantly reduced by 31%, 41% and 47% respectively. The risk of mortality from both unimproved water and sanitation was significantly higher by 38% (Adjusted hazard ratios (HR) = 1.38, 95% confidence interval (CI): 1.14-1.66) for post-neonatal mortality and 24% (HR = 1.24, 95% CI: 1.04-1.48) for child mortality. The risk of neonatal mortality increased by 6% (HR = 1.06, 95% CI: 0.85-1.23) but showed no significant effect. The Nigerian government needs to invest more in water and sanitation to reduce preventable child deaths.
authors.affiliation: School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2571, Australia. ezehosita@yahoo.com.
authors.forename: Osita K
authors.initials: OK
authors.lastname: Ezeh
authors.affiliation: School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2571, Australia. k.agho@uws.edu.au.
authors.forename: Kingsley E
authors.initials: KE
authors.lastname: Agho
authors.affiliation: Sydney School of Public Health, Edward Ford Building (A27), University of Sydney, Sydney, NSW 2006, Australia. michael.dibley@sydney.edu.au.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Dibley
authors.affiliation: School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW 2308, Australia. John.Hall@newcastle.edu.au.
authors.forename: John
authors.initials: J
authors.lastname: Hall
authors.affiliation: School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2571, Australia. a.page@uws.edu.au.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Page
mesh_terms: D046688:Child Mortality; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D009549:Nigeria; D012044:Regression Analysis; D012307:Risk Factors; D012499:Sanitation; D014881:Water Supply