Age variations in the proximate determinants of child mortality in south-west Nigeria

J Biosoc Sci. 1995 Jan;27(1):19-30. doi: 10.1017/s0021932000006970.


Age variations in the influences of three sets of proximate factors on child survival in Ondo State, Nigeria, during 1981-86 are described. Biodemographic factors covary very strongly with mortality risks during the first month of life, weakly during months 1-11, and imperceptibly beyond infancy. Microenvironmental factors progressively strongly covary with mortality after the neonatal period, while health services accessibility and care factors broadly covary strongly with mortality throughout early childhood. Patterns in the size of the hypothetical population-level impacts of these factors suggest that promoting assisted use of toilet facilities within households by under-5s and wider provision of dispensaries and hospitals would yield cost-effective and notable reductions in overall childhood mortality levels in the study setting.

PIP: Proximate determinants of neonatal, infant, and child mortality were examined based on birth history data (1981-86) from the 1986 Nigerian Demographic and Health Survey for Ondo State. Child survival was determined to be affected by maternal/biodemographic factors, sanitation and water supply factors, and health services use and access factors. 15.4% of births were high-risk births due to short birth intervals, 1st or higher than 5th order births, and births to teenagers. Almost 75% of children under 5 years old in homes with toilet facilities were not allowed to use them. Almost 50% of young children obtained drinking water from wells, ponds, and rains. 9.4% of children lacked access to soap. 71.2% of mothers had received tetanus vaccinations. Findings indicated that males were 1.64 times more likely to die in the first month of life than females. 1st births and higher than 5th order births had a higher probability of dying in the first month of life. Neonatal mortality risk was higher for births among teenagers. The risk of infant mortality remained high for births to teenagers (1.67) compared to mothers 20-34 years old (0.77). Births following a short birth interval (24 months) had at least a 33% higher infant mortality risk. Sanitation and safe drinking water in the home was a minor determinant of neonatal mortality; the impact was determined by the extent to which infants were given drinking water in the third week of life. Survival gains were lost by keeping children's toilet facilities separate from adults: a common practice. Access and use of modern health services was positively associated with survival at all ages under 5 years. In general, biodemographic factors had stronger associations with infant mortality and weak associations with mortality at 12-47 months. Environmental conditions in the home contributed more the mortality risk at 12-47 months. Health care use and access broadly affected risk at all age groups. Public health campaigns should encourage use of sanitary toilet facilities by children under 5 years old. Policy for improving child survival could focus on increased birth spacing, discouragement of first births to teenagers, and a renewed focus on greater provision of health services.

MeSH terms

  • Adolescent
  • Adult
  • Cause of Death
  • Child, Preschool
  • Cross-Sectional Studies
  • Developing Countries*
  • Female
  • Humans
  • Incidence
  • Infant
  • Infant Mortality*
  • Infant, Newborn
  • Male
  • Middle Aged
  • Nigeria / epidemiology
  • Sanitation