The Nigerian Newborn Beyond 2015: Investigating the Impact of Community Context on Neonatal Mortality. Open Access

Olorundare, Elizabeth (2015)

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Background: With approximately a quarter million newborn deaths per year, Nigeria's neonatal mortality represents the highest in sub-Saharan Africa and the second highest in the world, significantly contributing to the country's inability to achieve the United Nations 2015 target for reduction in under-five mortality. To improve chances of survival for Nigerian newborns beyond 2015, focused efforts and large-scale implementation of evidence-based interventions is required. Furthermore, identification of individual and broader contextual level factors that drive neonatal mortality in Nigeria is essential.

Objective: To investigate the influence of different domains of contextual factors on neonatal mortality in Nigeria using a recent nationally representative survey and examine the impact of individual-level determinants.

Methods: A modified conceptual framework for child survival highlighted possible factors associated with neonatal mortality. Data were drawn from the 2013 Nigeria Demographic and Health Survey (NDHS), representing 31,482 live-born infants born to women aged 15 - 49 years within the five years prior to the survey. Multivariable logistic regression models were fitted to analyze factors associated with neonatal deaths during this period using community, socio-economic status, and proximate determinants.

Results: The neonatal mortality rate (NMR) was 37 per 1000 live births, with over 80% of these deaths occurring within the first week of life. Bivariate analysis showed high community utilization of facility-based delivery, increased levels of female decision-making autonomy, older maternal age at marriage and at first childbirth, higher levels of parental educational attainment, higher household wealth status, and infant's receipt of postnatal care were associated with reduced odds of neonatal death. After adjusting for all levels of variables, the odds of death were higher for infants born into communities demonstrating higher justification of violence against women (OR 1.23; 95% CI 1.09 - 1.39) and having higher mean parity (OR 1.21; 95% CI 1.05 - 1.40). Neonatal mortality was also significantly associated with maternal illiteracy (OR 1.39; 95% CI 1.05 - 1.83), first-born infants (OR 1.76; 95% CI 1.35 - 2.31), higher rank infants with a short birth interval (OR 1.64; 95% CI 1.27 - 2.12), smaller than average-sized infants (OR 1.68; 95% CI 1.36 - 2.07), multiple gestations (OR 5.07; 95% CI 3.77 - 6.81), and male babies (OR 1.33; 95% CI 1.14 - 1.55).

Discussion: This study has provided evidence that individual, household and community factors significantly influence neonatal mortality in Nigeria. Further, it shows that norms surrounding women's fertility, autonomy, and worth have a marked impact on neonatal survival. These findings show that public health interventions targeting neonatal mortality may not achieve desired level of effectiveness unless they are coupled with community-based interventions aimed at addressing perceptions of women's worth and need for self-determination.

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List of Tables

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Chapter 1. Introduction ... 1

Chapter 2. Literature Review ... 9

Chapter 3. Methodology ...28

Chapter 4. Results ...44

Chapter 5. Discussion.... 59

Chapter 6. Recommendations ... 67

References ...70

Appendix: Modified Conceptual Framework for factors influencing neonatal mortality ...76

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