1Ogunsanya B.G. 2Adewunmi Olusola A. 3Olagbegi Moses
This study examines the level and determinant of under-five mortality in remote Area of Ikorodu Local Government, Lagos state, Nigeria. The survey was carried out through self-administered questionnaires on selected 200 respondents. A multiple stage sampling was used to select the eligible respondent. 4 wards were selected at random from the 7 wards at Ikorodu Local Government Area. Thereafter four streets were randomly picked at random from each of these houses were selected on each street using systematic random sampling method with the interval once a house is chosen. A house hold was selected randomly from a house that has more than one household. In any polygamous household the respondent were chosen among the wives by lettering method. Data collected was analysed electronically, using SPSS 21.0. The analysis revealed that eighteen (18) of the twenty four (24) indicators paired under study were significantly correlated while twenty three (23) of the twenty six (26) indicators paired were found to be significant indicators of under five years mortality in Nigeria.
Keywords: Indicators, Mortality, Nigeria, Significance, Under Five, Years.
Mortality rate is a measure of the number of deaths (in general, or due to a specific cause) in some population, scaled to the size of that population per unit time. Mortality rate is typically expressed in units of deaths per 1000 individuals per year, in that entire population, or 0.95% out of the total. It is distinct from morbidity rate, which refers to the number of individuals in poor health during a given time period (the prevalence rate) or the number who currently have that diseases (the incidence rate), scaled to size of the population.
A condition such as tuberculosis can cause morbidity and mortality (disease and death). A mortality rate is a death rate. There are a number of different types of mortality rates such as:
- The foetal mortality rate: The ratio of foetal deaths to the sum infant mortality rate.
- The maternal mortality rate: The number of maternal deaths related to child bearing divided by the number of live births or by the number of live births.
There has been increasing interest in measuring under-five mortality as a health indicator and as a critical measure of human development. In countries with complete vital registration system that capture all birth and deaths under-five, mortality can be directly calculated. In the absence of a complete vital registration system however, child mortality must be estimated using surveys that ask women to report the births and death of their children. Two survey methods exist for capturing these information: Summary Birth History and Complete Birth History. A summary birth history requires a minimum of only two questions: how many live births has each mother had and how many of them have survived. Indirect methods are then applied using the information from these two questions and the age of the mothers to estimate under-five mortality going back in time prior to the survey. Estimates generated from complete birth histories are review as the most accurate when survey are required to estimate under-Five mortality especially for most recent time period. However, it is much more costly and labour intensive to collect these detailed data especially for the purpose of generating small area estimates.
The main tenets of the fourth and fifth Millennium Development Goal (MDG 4 and 5) are to reduce under-five mortality rate and improvement in maternal health which by implication increases the chance of child survival. Child mortality is a fundamental measurement of a country’s level of socio-economic development as well as the quality of life especially of the mothers. Under-five mortality rate (5q0) represents the probability of a child who survives to age one, dying between age one and age five (Adlakha & Suchindra, 1984; National Population Commission and ICF Macro, 2009; World Health Organisation (WHO), 2011). Almost half of the child mortality (42%) in the world occurs in Africa and about 25,000 under-five children that die each day are concentrated in sub-Saharan Africa and South Asia (WHO, 2011). Under-five mortality rate (U5MR) is generally 29 times higher in developing nations compared to developed countries (Black & Liu, 2012; Gambrah & Adzadu, 2013; Marx, Coles, Prysones-Jones, Johnson, Augustin, Mackay, Bery, Hammond, Nigmann, Sommerfelt et al, 2005). Globally, under-five mortality has dropped significantly by almost 45 percent between 2009 and 2011 but this progress is not the reality for all countries. Despite much progress in advanced countries, Nigeria has failed to make significant progress in checking the rising mortality rate among the under-five. Currently, about half of the world’s under-five deaths occur in Nigeria, India, Congo, Pakistan and China (National Bureau of Statistics (NBS), 2011; World Bank, 2013).
Statistics revealed that up to 20 per cent of child deaths in sub-Saharan Africa still occur in
Nigeria. Also, the Multiple Indicator Cluster Survey (MICS4) report indicated that under-five
mortality in Nigeria increased from 138 per 1,000 live births in 2007 to 158 per 1,000 live births in 2011 (National Bureau of Statistics (NBS), 2011; World Bank, 2013).
Under-five mortality rates within Africa also vary. In some countries, one-quarter to one-third of children die before reaching the age of five. Also, within the under-five age group, there are specific periods of increased vulnerability. For instance, 60 percent of under-five mortality can be attributed to deaths that occur during the first year of life, of which the first 24 hours of life is the most vulnerable period, followed by the first week and then the first month (Marx et al, 2005). Among the suspected factors that have contributed to drastic reduction of under-5 mortality in advanced economies include but not limited to improvement in socio-economic and environmental conditions and strategic implementation of child survival interventions (Finlay, Özaltin & Canning, 2011; Kyei, 2011; United Nations Children’s Fund, 2010, 2011, 2012).
Child mortality can be associated with two categories of acquired ailments: one is a heavy load of infectious diseases and the other, those diseases that are caused by inadequate nutrition (Cooper, Hickson, Mitchel, Edwards, Thapa & Ray, 1999; Katona & Katona-Apte, 2008). Socio-economic factors including immunizations, exclusive breastfeeding and the adoption and usage of insecticide-treated nets have been revealed by several studies have strong predictors of child mortality especially in the developing countries. Included among these proximate determinants are the risk of morbidity and mortality, education of mother, sanitation facilities, access to safe drinking water and maternal and child health care services (Uddin, Hossain & Ullah, 2008). However, despite these known factors, under-5 mortality rate in sub-Saharan Africa is abysmally far above the prevalent rate in other countries of the world.
PURPOSE OF THE STUDY
The purpose of this study is to examine the level and determinant of under five mortality in remote Area of Ikorodu Local Government, Lagos state, Nigeria.
The specific objectives are:
- Identification of socio-economic health and behavioral factors affecting under-five mortality in remote area of Ikorodu local government.
- Determining the significance of selected mortality indicators.
- Determining the correlation significance of the selected mortality indicators.
SCOPE OF THE STUDY
This study covers some selected indicators of under-five years mortality in Nigeria. The indicators were correlated and put to paired test to achieve the set purpose.
The study survey was carried out through self administered questionnaires on selected respondent. A multiple stage sampling was used to select the eligible 200 respondents. Four (4) wards were selected at random from the 7 wards at Ikorodu Local Government (case study) Area. Thereafter four streets were randomly picked at random from each of these houses were selected on each street using systematic random sampling method with the interval once a house is chosen. A house hold was selected randomly from a house that has more than one household. In any polygamous household the respondent were chosen among the wives by lettering method.
According to UNICEF (http://www.unicef.org/nigeria/children_1926.html), every single day, Nigeria loses about 2,300 under-five year olds and 145 women of childbearing age. This makes the country the second largest contributor to the under–five and maternal mortality rate in the world.
Underneath the statistics lies the pain of human tragedy, for thousands of families who have lost their children. Even more devastating is the knowledge that, according to recent research, essential interventions reaching women and babies on time would have averted most of these deaths.
Although analyses of recent trends show that the country is making progress in cutting down infant and under-five mortality rates, the pace still remains too slow to achieve the Millennium Development Goals of reducing child mortality by a third by 2015.
Preventable or treatable infectious diseases such as malaria, pneumonia, diarrhoea, measles and HIV/AIDS account for more than 70 per cent of the estimated one million under-five deaths in Nigeria.
Malnutrition is the underlying cause of morbidity and mortality of a large proportion of children under-5 in Nigeria. It accounts for more than 50 per cent of deaths of children in this age bracket.
The deaths of newborn babies in Nigeria represent a quarter of the total number of deaths of children under-five. The majority of these occur within the first week of life, mainly due to complications during pregnancy and delivery reflecting the intimate link between newborn survival and the quality of maternal care. Main causes of neonatal deaths are birth asphyxia, severe infection including tetanus and premature birth.
Similarly, a woman’s chance of dying from pregnancy and childbirth in Nigeria is 1 in 13. Although many of these deaths are preventable, the coverage and quality of health care services in Nigeria continue to fail women and children. Presently, less than 20 per cent of health facilities offer emergency obstetric care and only 35 per cent of deliveries are attended by skilled birth attendants.
This shows the close relationship between the well being of the mother and the child, and justifies the need to integrate maternal, newborn and child health interventions.
It is important to note that wide regional disparities exist in child health indicators with the North-East and North-West geopolitical zones of the country having the worst child survival figures.
Under-five mortality rate (U5MR) is the probability of a child born in a specified year dying before reaching the age of five if subject to current age-specific mortality rates and expressed as a rate per 1,000 live births (United Nations Children’s Fund, 2012; United Nations Inter-agency Group for Child Mortality Estimation, 2013). It also refers to as the death of infants and children under the age of five. Child mortality has remained a national and global concern and its import in socioeconomic rating of country’s development cannot be overemphasised. Sub-Saharan Africa and Southern Asia face the greatest challenges in child survival, and currently accounted for more than 80 per cent of global under-five deaths (United Nations Children’s Fund, 2012). Several factors had been identified as contributors to the increasing levels of child mortality in most developing countries. Studies have shown that there is a close relationship between educational attainment and lower mortality rates (Antai, 2011; Fayehun & Omolulu, 2009; National Population Commission and ICF Macro, 2009). This was further established through the results in the Nigeria Demographic and Health Survey (NDHS) Report (2009), that children born to mothers with no education have the highest under-five mortality rates (209 deaths per 1,000 live births), while mothers with secondary education have 68 per 1,000 live births.
Although, there are vagaries of statistics and estimations for child mortality for different countries and the world by different sources, the patterns and trends are specifically similar. Among the general patterns is that the global under-five mortality rate has declined by almost 47 percent between 1990 and 2012 (measuring 90 deaths per 1,000 live births in 1990 and 48 in 2012) while the trend in sub-Saharan Africa is apt to increase (United Nations Inter-agency Group for Child Mortality Estimation (2013). Globally, several causes of under-five mortality were noted among which are: pneumonia which contribute up to 17 percent of the entire death, preterm birth complications that cause about 15 percent of child death, intrapartum-related complications (10 percent), diarrhoea (9 percent) and up to seven percent due to malaria (United Nations Inter-agency Group for Child Mortality Estimation, 2013). Also, a survey carried out in Bangladesh shows that child mortality rate was highest (1.64%) for the children of illiterate mothers and lowest (0.54%) for the children whose mother’s educational level is secondary and above (Uddin, Hossain & Ullah, 2009). Educated mothers are more likely than non-literate mothers to ensure a healthy environment, nutritious food, and have better knowledge about reproductive health at conception and health care facilities for their children. Literate mothers will give birth to healthier babies because they themselves tend to be healthier and are likely to experience lower mortality among their children at all ages (Pandey, 2009).
Several of diseases causing child mortality have connections with hygiene condition and unclean environment these are not limited to dirty feeding bottles, utensils, inadequate disposal of household refuse, poor storage water, to mention but few (Jinadu, Olusi, Agun & Fabiyi, 1991; NBS, 2011). Other reports have shown that maternal education is a significant factor influencing child survival (Caldwell, 2009; Osonwa, Iyam, & Osonwa, 2012). Children from poorer or rural households are reported to be more vulnerable than their counterparts from other regions (United Nations Children’s Fund, 2010). A child born to a financially deprived and less educated family is at risk of perinatal death or within the first month of life. The reasons for these are obvious since the mother may be poorly nourished during pregnancy, had little or no antenatal care and likely to deliver in ill-equipped health facility. Besides, the level of competition over resources when the family is large could enhance poor care among the family members including the very young ones. All these factors are further aggravated by limited access to health services due to poor income and low levels of maternal education, often leading to the non-immunization of the child (Policy Project/Nigeria, 2002).
The most widely available type of data on child mortality is report by mothers on the number of children still surviving. Frequency distribution, bivariate correlation analysis and paired t-test were employed as analysis techniques for the study.
From the analysis, 59(29.5%) of the respondents were currently in the age bracket of 30-34 years while only 1(0.5%) of the respondents was in the age bracket of 15-19 years. 81(40.5%) had their first marriage in the age bracket of 20-24 years while 7(2.5%) had their first marriage in the age bracket of 30-34 years. 72(36.0%) of the respondents were civil servants while 7(3.5%) were into Nursing. 73(36.5%) delivered their children at private hospital while 15(7.5%) deliver at home. 53(26.5%) have 4 children while only 1(0.5) has more than 10 children. 107(53.5%) have pregnancy interval of two years between children. 101(50.5%) of the respondents have only primary education while 4(2.0%) have post secondary education.
Table 13 revealed that there is a negative but imperfect correlation between indicators Paired 1, 2, 3, 4, 5, 6, 7, 8, 16, 17, 20 and 23, while there is a positive but imperfect correlation between Paired 9, 10, 11, 12, 13, 14, 15, 18, 19, 21, 22 and 24. However, of these correlations, only correlations for Paired 1, 2, 3, 5, 6, 7, 8, 10, 11, 12, 15, 16, 17, 18, 20, 21, 23 and 24 were significant at 0.05 level of significance.
Table 14 revealed that twenty three (23) of the twenty six (26) indicators paired were found to be significant indicators at 0.05 level of significance.
From the analysis of the research study, it can be concluded that eighteen (18) of the twenty four (24) indicators paired under study were significantly correlated while twenty three (23) of the twenty six (26) indicators paired were found to be significant indicators of under-five years mortality in Nigeria.
- Care during labour and child birth should be provided by a skilled attendance. Early recognition of slow progress in labour and timely interventions to prevent prolonged labour and intra partum foetal distress which can reduce mortality.
- Poor sanitation, lack of accessible clean water and inadequate personal and domestic hygiene are responsible for an estimated 88 percent of diarrhea cases everywhere. Proven prevention measures that can significantly reduce the burden of diarrhea include early and exclusive breast feeding (a non-breastfeed child is 10 times more likely to die diarrhea in the first 6 months of life than an exclusively breastfeed child).
- To accelerate progress and achieve improved health outcomes for all children ensuring universal-access to high quality care safe water and sanitation, safe and nutritious food and safe housing is crucial as is access to education, social security and other social services.
- In addition, investment in women’s health and education and in the empowerment of women and the poorest and most disadvantage population groups is vital to ensure an effective response to under-five mortality rate.
 Adlakha, A.L. & Suchindra, C.M. (1984). Biological and Social Factors affecting Infant and Child Mortality in Jordan, Tunisia, Egypt and Yemen Arab Republic. Final Report, July 1984. DOI: PN-AAT-222.
 Antai, D., (2011). Regional Inequalities in Under-5 Mortality in Nigeria: A Population-based Analysis of Individual and Community-Level Determinants. Population Health Metrics, Vol. 9, No. 6, 2011.
 Black, R.E., & Li, Liu (2012). Global Under Five Mortality: Where Do We Stand Today? Johns Hopkins, Bloomberg School of Public Health for the Child Health Epidemiology Reference Group of WHO and UNICEF.
 Cooper, O. William, Hickson B. Gerald, Mitchel F. Edward, Edwards M. Kathryn, Thapa B. Purushottam & Ray A. Wayne (1999). Early Childhood Mortality from Communityacquired Infections. American Journal of Epidemiology, Vol. 150, No. 5, 1999. The Johns Hopkins University School of Hygiene and Public Health, USA. 1999. Pp 517-527.
 Fayehun, O. & Omololu, O., (2009). Ethnic Differentials in Childhood Mortality in Nigeria. Paper Presented at Detroit, Michigan, USA. April 30 – May 2, 2009.
 Finlay, E Jocelyn, Özaltin, Emre, Canning, David (2011). The association of maternal age with infant mortality, child anthropometric failure, diarrhoea and anaemia for first births: evidence from 55 low- and middle-income countries. BMJ Open, Vol. 1, Issue 2, 2011. DOI:10.1136/bmjopen-2011-000226. ISSN 2044-6055.
 Gambrah, Patience Pokuaa & Adzadu, Yvonne (2013). Using Markov Chain to Predict the Probability of Rural and Urban Child Mortality Rates Reduction in Ghana. International Journal of Scientific & Technology Research, Vol. 2, Issue 11, November 2013. P73-78. ISSN 2277-8616.
 Jinadu, M.K., Olusi, S.O., Agun, J.I. and A.K. Fabiyi (1991). “Childhood Diarrhea in Rural Nigeria: Studies on Prevalence, Mortality and Socio-Environmental Factors” Journal of Diarrhea Diseases Research, Vol. 9, No. 4, 1991. P323-327.
 Katona, Peter & Katona-Apte Judit (2008). The Interaction between Nutrition and Infection, In (ed.) Ellie J. C. Goldstein, Clinical Practice Invited Article, Clinical Infectious Diseases, Oxford Journals, Vol. 46, No. 10, 2008. Pp1582-1588. DOI: 10.1086/587658
 Kyei, A. Kwabena (2011). Socio – Economic Factors Affecting Under Five Mortality in South Africa – An Investigative Study. Journal of Emerging Trends in Economics and Management Sciences (JETEMS), Vol. 2, No. 2, 2011. Scholarlink Research Institute Journals. Pp104-110. ISSN: 2141-7024.
 Marx, M., Coles, C., Prysones-Jones, S., Johnson, C., Augustin, R., Mackay, N., Bery, R., Hammond, W., Nigmann, R., Sommerfelt, E., Lee Benntt, H.J., and Lambert, R. (2005). Child survival in Sub-Saharan Africa: Taking Stock. Washington DC, USA: Support for Analysis and Research in Africa (SARA) Project.
 National Bureau of Statistics (NBS) (2011). Nigeria: Monitoring the situation of children and women. Nigeria Multiple Indicator Cluster Survey 2011Summary Report. National Bureau of Statistics, Abuja Nigeria. 2011.
 National Population Commission and ICF Macro (2009). Nigerian Demographic and Health Survey 2008. National Population Commission, Federal Republic of Nigeria, Abuja, Nigeria and ICF Macro Calverton, Maryland, USA. 2009. P630
 Osonwa, O.K., Iyam, M.A., & Osonwa, R.H., (2012). Under-Five Mortality in Nigeria: Perception and Attitudes of the IKWERRES in Rivers State towards the Existence of “OGBA – NJE”. Journal of Sociological Research, Vol. 3, No. 2, 2012. ISSN 1948-5468.
 Pandey, M. J. (2009). Maternal Health and Child Mortality in Rural India. ASARC Working Paper 12. Institute of Economic Growth, Delhi, INDIA.
 Policy Project/Nigeria, (2002). Child Survival in Nigeria: Situation, Response, and Prospects.
 Uddin, M., Hossain, M., & Ullah M.O., (2009). Child Mortality in a Developing Country: A Statistical Analysis. Journal of Applied Quantitative Method, Vol. 4, No. 3, 2009.
 UNICEF (nd). http://www.unicef.org/nigeria/children_1926.html
 United Nations Children’s Fund (2010). Levels and Trends in Child Mortality – Report 2010. Estimates Developed by the United Nations Inter-agency Group for Child Mortality Estimation. United Nations Children’s Fund. 2010.
 United Nations Children’s Fund (2012). Levels and Trends in Child Mortality – Report 2012. Estimates Developed by the United Nations Inter-agency Group for Child Mortality Estimation. United Nations Children’s Fund. 2012. http://www.unicef.org/videoaudio/PDFs/UNICEF_2012_child_mortality_for_web_0904.pdf.
 United Nations Inter-agency Group for Child Mortality Estimation (2013). Levels & Trends in Child Mortality – Report 2013. UN Inter-agency Group for Child Mortality Estimation. United Nations, New York. 2013. http://www.mamaye.org.ng/evidence/levels-trendschild- mortality-report-2013.
 World Bank (2013). World Development Indicators: Mortality (Table 2.21). World Bank Group. 2013. http://wdi.worldbank.org/table/2.21
 World Health Organisation, WHO (2011). Child Mortality: Millennium Development Goal (MDG) 4. The Partner for Maternal and New Born Birth, World Health Organisation. September, 2011. http://www.who.int/pmnch/media/press_materials/fs/fs_mdg4_childmortality/en/.