title: Contextual socioeconomic factors associated with childhood mortality in Nigeria: a multilevel analysis.
abstract: BACKGROUND
  Childhood mortality is a well-known public health issue, particularly in the low and middle income countries. The overarching aim of this study was to examine whether neighbourhood socioeconomic disadvantage is associated with childhood mortality beyond individual-level measures of socioeconomic status in Nigeria.
  
  
  METHODS
  Multilevel logistic regression models were applied to data on 31 482 under-five children whether alive or dead (level 1) nested within 896 neighbourhoods (level 2) from the 37 states in Nigeria (level 3) using the most recent 2013 Nigeria Demographic and Health Survey (DHS).
  
  
  RESULTS
  More than 1 of every 10 children studied had died before reaching the age of 5 years (130/1000 live births). The following factors independently increased the odds of childhood mortality: male sex, mother's age at 15-24 years, uneducated mother or low maternal education attainment, decreasing household wealth index at individual level (level 1), residing in rural area and neighbourhoods with high poverty rate at level 2. There were significant neighbourhoods and states clustering in childhood mortality in Nigeria.
  
  
  CONCLUSIONS
  The study provides evidence that individual-level and neighbourhood-level socioeconomic conditions are important correlates of childhood mortality in Nigeria. The findings of this study also highlight the need to implement public health prevention strategies at the individual level, as well as at the area/neighbourhood level. These strategies include the establishment of an effective publicly funded healthcare system, as well as health education and poverty alleviation programmes.
authors.affiliation: Division of Health Sciences, University of Warwick Medical School, Coventry, UK Center for Evidence-based Global Health, Ilorin, Nigeria.
authors.forename: Victor T
authors.initials: VT
authors.lastname: Adekanmbi
authors.affiliation: Division of Health Sciences, University of Warwick Medical School, Coventry, UK Division of Epidemiology and Biostatistics, University of Witwatersrand, School of Public Health, Johannesburg, South Africa.
authors.forename: Ngianga-Bakwin
authors.initials: NB
authors.lastname: Kandala
authors.affiliation: Division of Health Sciences, University of Warwick Medical School, Coventry, UK Department of Population Health, Luxembourg Institute of Health (LIH), Luxembourg.
authors.forename: Saverio
authors.initials: S
authors.lastname: Stranges
authors.affiliation: Division of Health Sciences, Warwick-Centre for Applied Health Research and Delivery (WCAHRD), University of Warwick Medical School, Coventry, UK International Health Group, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Olalekan A
authors.initials: OA
authors.lastname: Uthman
mesh_terms: D000293:Adolescent; D000328:Adult; D046688:Child Mortality; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008423:Maternal Age; D009035:Mothers / Q000706:statistics & numerical data*; D055361:Multilevel Analysis; D009549:Nigeria / Q000453:epidemiology; D011204:Poverty Areas; D012111:Residence Characteristics / Q000145:classification* / Q000706:statistics & numerical data; D012424:Rural Population; D017678:Sex Distribution; D012923:Social Class; D055815:Young Adult
keywords: DEVELOPING COUNTR; MORTALITY; MULTILEVEL MODELLING; Neighborhood/place; SOCIAL EPIDEMIOLOGY