%0 Journal Article
%T Regional inequalities in under-5 mortality in Nigeria: a population-based analysis of individual- and community-level determinants
%A Diddy Antai
%J Population Health Metrics
%D 2011
%I BioMed Central
%R 10.1186/1478-7954-9-6
%X Multilevel Cox proportional hazards analysis was performed using a nationally representative sample of 6,029 children from 2,735 mothers aged 15-49 years and nested within 365 communities from the 2003 Nigeria Demographic and Health Survey. Hazard ratios (HR) with 95% confidence intervals (CI) were used to express measures of association among the characteristics. Variance partition coefficients and Wald statistic were used to express measures of variation.Patterns of under-5 mortality cluster within families and communities. The risks of under-5 deaths were significantly higher for children of mothers residing in the South South (Niger Delta) region (HR: 1.30; 95% CI: 1.76-2.20) and children of mothers residing in communities with a low proportion of mothers attending prenatal care by a doctor (HR: 1.36; 95% CI: 1.15-1.86). In addition, the cross-level interaction between mothers' education and community prenatal care by a doctor was associated with a more than 40% higher risk of dying (HR: 1.41; 95% CI: 1.21-1.78).The findings suggest the need to differentially focus on community-level interventions aimed at increasing maternal and child health care utilization and improving the socioeconomic position of mothers, especially in disadvantaged regions such as the South South (Niger Delta) region. Further studies on community-levels determinants of under-5 mortality are needed.The reduction of regional and socioeconomic inequalities in mortality within countries is a major objective of national governments and international organizations [1-3]. To achieve this goal, determinants of high mortality among disadvantaged people, communities, and regions need to be identified. The physical, ecological, and political structure and impoverished socioeconomic milieu in several countries in sub-Saharan Africa account for geographic variations in childhood mortality [4-6]. One such environment is the regional environment. Poor or polluted environments tend to expose children to
%U http://www.pophealthmetrics.com/content/9/1/6