Under-5 Mortality and Its Associated Factors in Northern Nigeria: Evidence from 22,455 Singleton Live Births (2013–2018)
Abstract
:1. Background
2. Materials and Methods
2.1. Outcome Variable
2.2. Potential Mortality Associated Factors
2.3. Statistical Analysis
3. Results
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Independent Variables | Classification |
---|---|
Community level factor | |
Residence | 1 = urban; 2 = rural |
Geopolitical zone | 1 = North Central; 2 = North East; 3 = North West |
Socioeconomic factor | |
Household wealth index | 1 = Poor; 2 = Middle; 3 = Rich |
Maternal educational level | 1 = No education; 2 = Primary; 3 = Secondary or higher |
Maternal literacy level | 1 = Able to read parts of & whole sentence; 2 = Cannot read at all |
Father’s educational level | 1 = No education; 2 = Primary; 3 = Secondary or higher |
Father’s occupation | 1 = Not working; 2= Non-agricultural work; 3 = Agricultural work |
Number of women in the Household | 1 = One woman; 2 = At least 2 women |
Individual related factor | |
Mother’s age at child birth (years) | 1 = < 20; 2 = 20–29; 3 = 30–39; 4 = 40–49 |
Mother’s body mass index (kg/m2) (MBMI) | 1 = Normal (18.5 ≤ MBMI ≤ 24.9); 2 = Underweight (MBMI < 18.5); 3 = Overweight (25 ≤ MBMI ≤ 29.9); 4 = Obese (MBMI ≥ 30) |
Wanted pregnancy at the time of pregnant | 1 = Wanted then; 2 = Wanted later; 3 = Wanted no more |
Child sex | 1 = Female; 2 = Male |
Mother’s perceived baby size | 1 = Average or Larger; 2 = Small or very small |
Birth order and birth interval | 1 = Second or third child, interval > 2 years; 2 = First child; 3 = Second or third child, interval ≤ 2 years; 4 = Fourth or higher child, interval > 2 years; 5 = Fourth or higher child, interval ≤ 2 years |
Health related factor | |
Contraceptive use | 1 = Yes; 2 = No |
Place of birth | 1 = Home; 2 = Health facility |
Mode of delivery | 1 = non-caesarean; 2 = caesarean section |
Delivery assistance | 1 = Health professional; 2 = non-Health professional |
Variable | n | n% | * U5MR (95% CI) |
---|---|---|---|
Community-level factor | |||
Residence type | |||
Urban | 5818 | 490 (21) | 109 (94–125) |
Rural | 16,637 | 1858 (79) | 164(151–177) |
Geopolitical zone (North) | |||
North Central | 4422 | 324 (14) | 102 (85–118) |
North East | 5988 | 556 (24) | 127 (112–143) |
North West | 12,045 | 1468 (62) | 179 (163–194) |
Socioeconomic level factor | |||
Household wealth index ⱡ | |||
Rich | 1555 | 82 (3) | 62 (43–81) |
Middle | 7508 | 652 (28) | 120 (105–134) |
Poor | 13,392 | 1614 (69) | 176 (162–190) |
Mother’s education | |||
Secondary or higher | 4825 | 293 (12) | 77 (66–87) |
Primary | 3036 | 302 (13) | 136 (120–152) |
No education | 14,594 | 1754 (75) | 175 (162–187) |
Mother’s literacy level | |||
Able to read | 5535 | 379 (16) | 88 (78–98) |
Cannot read | 16,920 | 1969 (84) | 169 (157–181) |
Father’s education | |||
No education | 11,933 | 1382 (62) | 183 (169–196) |
Primary | 2632 | 279 (13) | 148 (129–168) |
Secondary or higher | 7627 | 551 (25) | 99 (87–111) |
Father’s occupation | |||
Not working | 1753 | 156 (7) | 120 (90–149) |
Non-agricultural work | 10,980 | 1100 (47) | 138 (124–152) |
Agricultural work | 9722 | 1092 (46) | 169 (149–188) |
Number of women in the household | |||
One woman | 12,226 | 1198 (51) | 143 (123–162) |
At least 2 women | 10,229 | 1150 (49) | 158 (147–170) |
Individual related factor | |||
Mother’s age | |||
<20 | 1225 | 148 (6) | 186 (146–226) |
20–29 | 11,382 | 1165 (50) | 149 (130–167) |
30–39 | 7686 | 767 (33) | 142 (130–155) |
40–49 | 2162 | 268 (11) | 161 (140–182) |
Mother’s body mass index (kg·m2) (MBMI) ¥ | |||
Normal (18.5 ≤ MBMI ≤ 24.9) | 14,745 | 1506 (65) | 146 (134–159) |
Underweight (MBMI < 18.5) | 4828 | 521 (23) | 158 (142–175) |
Overweight (25 ≤ MBMI ≤ 29.9) | 2166 | 241 (11) | 155 (124–185) |
Obese (MBMI ≥ 30) | 34 | 37 (1) | 131 (47–214) |
Wanted pregnancy at the time of pregnant | |||
Wanted then | 21,073 | 2228 (95) | 151 (141–162) |
Wanted later | 1085 | 97 (4) | 119 (87–151) |
Wanted no more | 297 | 23 (1) | 119 (62–177) |
Mother’s perceived baby size ¥ | |||
Average or larger | 19,056 | 1893 (81) | 144 (133–155) |
Small or very small | 3247 | 436 (19) | 185 (156–213) |
Sex | |||
Female | 11,065 | 1106 (47) | 148 (124–172) |
Male | 11,390 | 1242 (53) | 152 (137–166) |
Birth order/birth interval | |||
First | 3924 | 469 (20) | 165 (131–199) |
2nd or 3rd rank, interval ≤ 2 yrs | 2072 | 289 (12) | 179 (148–209) |
2nd or 3rd rank, interval > 2 yrs | 4759 | 360 (15) | 108 (95–120) |
4th or higher rank, interval ≤ 2 yrs | 8402 | 714 (30) | 134 (122–146) |
4th or higher rank, interval > 2 yrs | 3298 | 516 (22) | 202 (180–224) |
Health-related factor | |||
Contraceptive use | |||
Yes | 2130 | 133 (6) | 85 (65–104) |
No | 20325 | 2215 (94) | 157 (146–168) |
Place of birth | |||
Home | 16,972 | 1902 (81) | 162 (150–174) |
Health facility | 5483 | 446 (19) | 109 (92–125) |
Mode of delivery ¥ | |||
Non-caesarean | 22,186 | 2314 (99) | 150 (140–160) |
Caesarean ‴ | 243 | 34 (1) | 179 (111–240) |
Delivery assistance ¥ | |||
Health professional | 5871 | 457 (20) | 106 (91–121) |
Non-health professional ^ | 16,042 | 1831 (80) | 165 (152–178) |
Variable | Crude Model †,§ | p-Value | Adjusted Model †,§ | p-Value |
---|---|---|---|---|
Community level factor | ||||
Residence type | ||||
Urban | Ref | |||
Rural | 1.35 (1.14–1.60) | <0.001 | ― | ― |
Geopolitical zone | ||||
North Central | Ref | Ref | ||
North East | 1.30 (1.08–1.55) | 0.005 | 1.06 (0.88–1.27) | 0.563 |
North West | 1.71 (1.45–2.01) | <0.001 | 1.36 (1.14–1.61) | 0.001 |
Socioeconomic level factor | ||||
Household wealth index + | ||||
Rich | Ref | Ref | ||
Middle | 1.73 (1.22–2.45) | 0.002 | 1.42 (0.99–2.03) | 0.056 |
Poor | 2.37 (1.71–3.30) | <0.001 | 1.64 (1.14–2.36) | 0.008 |
Mother’s education | ||||
Secondary or higher | Ref | Ref | ||
Primary | 1.52 (1.24–1.86) | <0.001 | 1.28 (1.02–1.60) | 0.034 |
No education | 1.92 (1.61–2.30) | <0.001 | 1.32 (1.05–1.67) | 0.018 |
Mother’s literacy level | ||||
Able to read | Ref | |||
Cannot read | 1.71 (1.47–1.99) | <0.001 | ― | ― |
Father’s education | ||||
Secondary or higher | Ref | Ref | ||
Primary | 1.48 (1.23–1.78) | <0.001 | 1.20 (0.99–1.45) | 0.051 |
No education | 1.73 (1.51–1.99) | <0.001 | 1.30 (1.12–1.52) | 0.001 |
Father’s occupation | ||||
Not working | Ref | Ref | ||
Non-agricultural work | 1.37 (0.99–1.87) | 0.052 | 1.58 (1.16–2.15) | 0.004 |
Agricultural work | 1.51 (1.11–2.06) | 0.009 | 1.44 (1.06–1.96) | 0.020 |
Number of women in household | ||||
One woman | Ref | |||
At least 2 women | 1.17 (1.04–1.31) | 0.009 | ― | ― |
Individual related factor | ||||
Mother’s age | ||||
<20 | 1.60 (1.24–2.05) | <0.001 | ― | ― |
20–29 | 1.08 (0.97–1.21) | 0.152 | ― | ― |
30–39 | Ref | |||
40–49 | 1.21 (1.02–1.42) | 0.027 | ― | ― |
Mother’s body mass index (kg/m2) (MBMI) | ||||
Normal (18.5 ≤ MBMI ≥ 24.9) | Ref | |||
Underweight (MBMI< 18.5) | 1.06 (0.94–1.19) | 0.394 | ― | ― |
Overweight (25 ≤ MBMI ≥ 29.9) | 1.07 (0.88–1.29) | 0,457 | ― | ― |
Obese (MBMI≥ 30) | 0.85 (0.53–1.37) | 0.573 | ― | ― |
Wanted pregnancy at the time of pregnant | ||||
Wanted then | Ref | |||
Wanted later | 0.83 (0.64–1.09) | 0.178 | ― | ― |
Wanted no more | 0.71 (0.44–1.14) | 0.151 | ― | ― |
Mother’s perceived baby size | ||||
Average or larger | Ref | Ref | ||
Small or very small | 1.44 (1.22–1.69) | <0.001 | 1.34 (1.16–1.55) | <0.001 |
Sex | ||||
Female | Ref | |||
Male | 1.07 (0.95–1.22) | 0.277 | ― | ― |
Birth order/birth interval | ||||
First | 1.63 (1.39–1.91) | <0.001 | 1.62 (1.39–1.90) | <0.001 |
2nd or 3rd rank, interval ≤ 2 yrs | 1.82 (1.45–2.30) | <0.001 | 1.79 (1.43–2.23) | <0.001 |
2nd or 3rd rank, interval > 2 yrs | Ref | Ref | ||
4th or higher rank, interval ≤ 2 yrs | 1.17 (1.01–1.36) | 0.033 | 1.07 (0.92–1.24) | 0.374 |
4th or higher rank, interval > 2 yrs | 1.92 (1.63–2.27) | <0.001 | 1.68 (1.42–1.98) | <0.001 |
Health related factor | ||||
Contraceptive use | ||||
Yes | Ref | Ref | ||
No | 1.87 (1.53–2.29) | <0.001 | 1.41 (1.13–1.75) | 0.002 |
Place of birth | ||||
Home | 1.36 (1.17–1.58) | <0.001 | ― | ― |
Health facility | Ref | |||
Mode of delivery | ||||
Non-caesarean | Ref | Ref | ||
Caesarean ‡ | 1.58 (0.93–2.69) | 0.093 | 2.68 (1.55–4.63) | <0.001 |
Delivery assistance | ||||
Health professional | Ref | |||
Non-health professional ^ | 1.40 (1.21–1.61) | <0.001 | ― | ― |
Variable | n% * | aOR ‡ | PAR% (95% CI) |
---|---|---|---|
Geopolitical zone | |||
North Central | 0.138 | Ref | |
North East | 0.237 | 1.06 | ― |
North West | 0.625 | 1.36 | 17 (7–25) |
Household wealth index | |||
Rich | 0.035 | Ref | |
Middle | 0.278 | 1.42 | ― |
Poor | 0.687 | 1.64 | 27 (8–42) |
Mother’s education | |||
Secondary or higher | 0.125 | Ref | |
Primary | 0.128 | 1.28 | 3 (0–6) |
No education | 0.747 | 1.32 | 18 (3–31) |
Father’s education | |||
Secondary or higher | 0.249 | Ref | |
Primary | 0.126 | 1.2 | ― |
No education | 0.625 | 1.3 | 14 (6–23) |
Father’s occupation | |||
Not working | 0.066 | Ref | |
Non-agricultural work | 0.468 | 1.58 | 17 (6–27) |
Agricultural work | 0.465 | 1.44 | 14 (2–25) |
Mother’s perceived baby size | |||
Average or larger | 0.813 | Ref | |
Small or very small | 0.187 | 1.34 | 5 (2–8) |
Birth order/birth interval | Ref | ||
First | 0.2 | 1.62 | 8 (5–11) |
2nd or 3rd rank, interval ≤ 2 yrs | 0.123 | 1.79 | 5 (3–8) |
2nd or 3rd rank, interval > 2 yrs | 0.153 | Ref | |
4th or higher rank, interval ≤ 2 yrs | 0.304 | 1.07 | ― |
4th or higher rank, interval > 2 yrs | 0.22 | 1.68 | 9 (6–12) |
Mode of delivery | |||
Non-caesarean | 0.986 | Ref | |
Caesarean | 0.014 | 2.68 | 1 (0–2) |
Contraceptive use | |||
Yes | 0.057 | Ref | |
No | 0.943 | 1.41 | 27 (11–41) |
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Ezeh, O.K.; Ogbo, F.A.; Odumegwu, A.O.; Oforkansi, G.H.; Abada, U.D.; Goson, P.C.; Ishaya, T.; Agho, K.E. Under-5 Mortality and Its Associated Factors in Northern Nigeria: Evidence from 22,455 Singleton Live Births (2013–2018). Int. J. Environ. Res. Public Health 2021, 18, 9899. https://doi.org/10.3390/ijerph18189899
Ezeh OK, Ogbo FA, Odumegwu AO, Oforkansi GH, Abada UD, Goson PC, Ishaya T, Agho KE. Under-5 Mortality and Its Associated Factors in Northern Nigeria: Evidence from 22,455 Singleton Live Births (2013–2018). International Journal of Environmental Research and Public Health. 2021; 18(18):9899. https://doi.org/10.3390/ijerph18189899
Chicago/Turabian StyleEzeh, Osita K., Felix A. Ogbo, Anastasia O. Odumegwu, Gladys H. Oforkansi, Uchechukwu D. Abada, Piwuna C. Goson, Tanko Ishaya, and Kingsley E. Agho. 2021. "Under-5 Mortality and Its Associated Factors in Northern Nigeria: Evidence from 22,455 Singleton Live Births (2013–2018)" International Journal of Environmental Research and Public Health 18, no. 18: 9899. https://doi.org/10.3390/ijerph18189899