J Biosoc Sci. 2015 Mar;47(2):165-87. doi: 10.1017/S0021932013000734. Epub 2014 Jan 10.


There are substantial regional disparities in under-five mortality in Nigeria, and evidence suggests that both individual- and community-level characteristics have an influence on health outcomes. Using 2008 Nigeria Demographic and Health Survey data, this study (1) examines the effects of individual- and community-level characteristics on infant/child mortality in Nigeria and (2) determines the extent to which characteristics at these levels influence regional variations in infant/child mortality in the country. Multilevel Cox proportional hazard analysis was performed on a nationally representative sample of 28,647 children nested within 18,028 mothers of reproductive age, who were also nested within 886 communities. The results indicate that community-level variables (such as region, place of residence, community infrastructure, community hospital delivery and community poverty level) and individual-level factors (including child's sex, birth order, birth interval, maternal education, maternal age and wealth index) are important determinants of infant/child mortality in Nigeria. For instance, the results show a lower risk of death in infancy for children of mothers residing in communities with a high proportion of hospital delivery (HR: 0.70, p < 0.05) and for children whose mothers had secondary or higher education (HR: 0.84, p < 0.05). Although community factors appear to influence the association between individual-level factors and death during infancy and childhood, the findings consistently indicate that community-level characteristics are more important in explaining regional variations in child mortality, while individual-level factors are more important for regional variations in infant mortality. The results of this study underscore the need to look beyond the influence of individual-level factors in addressing regional variations in infant and child mortality in Nigeria.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Birth Intervals
  • Birth Order
  • Child
  • Child Mortality*
  • Child, Preschool
  • Female
  • Health Surveys
  • Humans
  • Infant
  • Infant Mortality*
  • Male
  • Maternal Age
  • Middle Aged
  • Mothers / education
  • Mothers / psychology
  • Multilevel Analysis
  • Nigeria / epidemiology
  • Pregnancy
  • Proportional Hazards Models
  • Residence Characteristics
  • Socioeconomic Factors
  • Young Adult