title: Determinants of neonatal mortality in rural and urban Nigeria: Evidence from a population-based national survey.
abstract: BACKGROUND
  Significant reduction in the global burden of neonatal mortality was achieved through the millennium development goals. In Nigeria, however, only a marginal reduction was realized. This study assesses the rural-urban differences in neonatal mortality rate (NMR) and the associated risk factors in Nigeria.
  
  
  METHODS
  The dataset from the 2013 Nigeria demographic and health survey (NDHS), disaggregated by rural-urban residence (n = 20 449 and 9935, respectively), was explored using univariate, bivariate, and multivariable analysis. Complex samples analysis was applied to adjust for the unequal selection probabilities due to the multi-stage cluster sampling method used in the 2013 NDHS. The adjusted relationship between the outcome and predictor variables was assessed on multi-level logistic regression analysis.
  
  
  RESULTS
  NMR for rural and urban populations was 36 and 28 deaths per 1000 live births, respectively. Risk factors in urban residence were lack of electricity access (adjusted OR [AOR], 1.555; 95%CI: 1.089-2.220), small birth size (as a proxy for low birthweight; AOR, 3.048; 95%CI: 2.047-4.537), and male gender (AOR, 1.666; 95%CI: 1.215-2.284). Risk factors in rural residence were small birth size (a proxy for low birthweight; AOR, 2.118; 95%CI: 1.600-2.804), and birth interval <2 years (AOR, 2.149; 95%CI: 1.760-2.624). Cesarean delivery was a risk factor both in rural (AOR, 5.038; 95%CI: 2.617-9.700) and urban Nigeria (AOR, 2.632; 95%CI: 1.543-4.489).
  
  
  CONCLUSIONS
  Determinants of neonatal mortality were different in rural and urban Nigeria, and rural neonates had greater risk of mortality than their urban counterparts.
authors.affiliation: 2 Div Hospital, Adekunle Fajuyi Cantonment, Ibadan, Nigeria.|Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
authors.forename: Emmanuel O
authors.identifier: http://orcid.org/0000-0002-4533-0340
authors.initials: EO
authors.lastname: Adewuyi
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhao
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009549:Nigeria / Q000453:epidemiology; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D014504:Urban Health / Q000706:statistics & numerical data*
keywords: determinant; electricity access; mode of delivery; neonatal mortality; rural-urban Nigeria