DETERMINANTS OF NEONATAL MORTALITY AMONG A NATIONALLY REPRESENTATIVE SAMPLE OF MOTHERS IN NIGERIA

Abstract

Neonatal mortality is a global challenge and Nigeria continues to bear the greatest burden in Africa. Therefore identification of individual and community determinants associated with neonatal mortality are important for targeted interventions. However in most developing countries, including Nigeria this problem has not been adequately investigated particularly the effect of proximate and community factors . Therefore this study seeks to investigate the effects of proximate and community level factors on neonatal mortality. This is a secondary data analysis of 31428 women of reproductive age (15-49yrs) who had child birth 5 years prior to the Nigeria Demographic and Health Survey (2008-2013). The 2013 NDHS was a three-stage cluster sample survey of 40,680 households from 36 states of the federation and the federal capital. The outcome variable was neonatal mortality as reported by their mothers, frequency tables were generated to summarize variables of interest and neonatal mortality rates by individual and community level factors were determined. A Kaplan- meier curve was used to describe the probability of neonatal survival and death. Sampling ,weights were applied to correct for sampling variability during the study design using STATA 12 svy command. Chi-square test was used to determine the association of social, economic and demographic characteristics of mothers and neonatal death. Logistic regression was used to estimate the independent effect of factors on neonatal mortality. Level of significance was at 5%. The mean age of the mothers was 29±7years, 56 .1% were educated, 95.3% married while 70.6% were unemployed. Neonatal mortality was 37/1000 live births, across geopolitical zone the Nort~ West had highest NMR (45.5) while South South had the lowest NMR.(30.5) Residing in a rural areas(OR=l.29, CI=1.10-1.52), Neonates delivered through cesarean section(OR=1.81 Cl=1.13-2.74) and delivered by unskilled birth attendants were significantly associated with neonatal death. However, breastfed babies(OR=0.39,CI:0.33-045),adequately spaced infants(OR=0.56, CI:0.33-0.45) of a higher birth order(OR=0.61 CI=0.46-0.82) had a higher odds of survival compared to male neonates not breastfed. Both individual and community characteristics showed a significant effect on neonatal survival. Implementation of community-based interventions targeting basic education, poverty alleviation, women empowerment and an increased focus on the continuum-of-care approach in health care service will improve neonatal survival.