New study first to provide directly measured estimates of the causes of child death at national scale in Nigeria
Findings indicate an ongoing epidemiological transition in the South of Nigeria, with decreasing childhood mortality from infectious conditions as compared to the North
Almost all estimates of the causes of child death in sub-Saharan Africa countries come from the World Health Organization and Global Burden of Disease statistical models. These estimates are derived by applying country-level data on factors such as the percent of children who are under weight and gross national per capita income to data on the causes of child death from studies conducted around the world. Therefore, the modeled estimates may lack country specificity.
A new verbal/social autopsy (VASA) study providing the first ever direct estimates of the causes and determinants of under-five mortality in Nigeria found no North-South difference in their neonatal mortality rates, but significantly higher 1-59 month mortality in the North. Children in the South died proportionally more often at younger ages and from birth asphyxia and preterm delivery than did children in the North, while the mortality rates from pneumonia, malaria and diarrhea were 28% to 223% higher in the North. Early marriage, lack of formal education and poverty were at severe levels in the North, and health care indicators lagged behind.
These findings indicate an ongoing epidemiological transition in the South of Nigeria, with decreasing mortality from post-neonatal infectious conditions, and point the way to improved social conditions and child health programming needed for the North to begin a similar transition. The study, with findings newly published in two papers in PloS ONE, was led by researchers from the Johns Hopkins Bloomberg of Public Health and Nigeria’s National Population Commission and Ministry of Health.
The VASA study interviewed the caregivers of a representative sample of 723 neonatal (0-27 days old) and 2,057 1-59-month old child deaths from 2008 to 2013 identified by the 2013 Nigeria Demographic and Health Survey; and asked about the children’s fatal illness signs and symptoms as well as household, community and health system factors that if implemented might have prevented or cured the illnesses.
- Significantly higher proportions of under-fives and 1-59 month olds in the South, respectively, died as neonates (N=24.1%, S=32.5%) and at younger ages than in the North.
- The leading causes of neonatal death were sepsis (31.5%), birth asphyxia (22.3%) and neonatal pneumonia (19.9%); and of 1-59-month old death were malaria (36.4%), diarrhea (26.0%) and pneumonia (16.4%).
- There was no difference in the North-South total neonatal mortality rates (N=38.5/1,000 live births, S=35.2/1,000). Higher proportions of neonatal deaths in the South than in the North were due to preterm delivery (N=1.2%, S=3.7%) and birth asphyxia (N=20.6%, S=26.2%), but there were no significant differences in their mortality rates.
- Childhood ( 1-59 month) diarrhea, pneumonia and malaria mortality were all significantly higher in the North, by 222.9%, 27.6% and 50.6%, respectively, as was total 1-59 month mortality, by 82.9% (N=107.9/1,000, S=59.0/1,000).
- Significantly more deceased children in the North were born to mothers who had no education, (N=72.5%, S=11.1%), married at age 15 or younger (N=71.5%, S=5.9%), and lived in the poorest two quintiles of households (N=75.7%, S=19.5%).
- 97.1% of the 1-59 month olds’ caregivers recognized signs or symptoms of a possibly severe or severe illness, but only 63% sought formal health care, with an average delay of 2 days, and only 44% reached a provider. More children in the South (N=60.1%, S=74.3%) sought formal care, but more in the North reached a formal care provider (N=45.1%, S=39.4%). Of children who left the first provider alive, more in the South than in the North were referred to a second provider (N=10.4%, S=21.3%) and/or received home care recommendations (N=46.7%, S=60.9%).
- 38.1% of the children sought care from an informal provider, 48% of whom went to a pharmacist or drug seller. Improvement of the services provided by these shops might be an option to increase access to quality care for sick children. Of note, however, is that this frequent use of pharmacists and drug sellers was more common in the South than in the North.
Direct Estimates of Cause-Specific Mortality Fractions and Rates of Under-Five Deaths in the Northern and Southern Regions of Nigeria by Verbal Autopsy Interview. Written by Adeyinka Adewemimo, Henry D Kalter, Jamie Perin, Alain K Koffi, John Quinley and Robert E Black. PLoS ONE.
Beyond causes of death: The social determinants of mortality among children aged 1-59 months in Nigeria from 2009 to 2013. Alain K. Koffi, Henry D. Kalter, Ezenwa N. Loveth, John Quinley, Joseph Monehin, Robert E. Black. PLoS ONE.