title: Trends in neonatal mortality in Nigeria and effects of bio-demographic and maternal characteristics.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Epidemiology and Medical Statistics Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria. jakinyemi@cartafrica.org.
authors.forename: Joshua Odunayo
authors.initials: JO
authors.lastname: Akinyemi
authors.affiliation: Department of Epidemiology and Medical Statistics Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria. folabibam@yahoo.co.uk.
authors.forename: Elijah Afolabi
authors.initials: EA
authors.lastname: Bamgboye
authors.affiliation: Department of Epidemiology and Medical Statistics Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria. ayenisolaz@yahoo.com.
authors.forename: Olusola
authors.initials: O
authors.lastname: Ayeni
mesh_terms: D000328:Adult; D001721:Birth Intervals; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008297:Male; D009549:Nigeria; D011295:Prenatal Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012424:Rural Population; D012959:Socioeconomic Factors; D055815:Young Adult