Socioeconomic, bio-demographic and health/behavioral determinants of neonatal mortality in Nigeria: a multilevel analysis of 2013 demographic and health survey

Emmanuel O. Adewuyi, Yun Zhao, Reeta Lamichhane


Background: Nigeria ranks as one of the countries in the world with considerable burden of neonatal mortality. This study aims to investigate the association of socioeconomic, bio-demographic and health/behavioural factors with neonatal mortality in the country using the most current available evidence.

Methods: The 2013 Nigeria demographic and health survey (NDHS) dataset was analyzed. Multiple logistic regression analysis was applied to identify determinants associated with neonatal mortality. The role of breastfeeding was examined by conducting analyses with and without adjustment for ‘breastfeeding status’. Complex sample analysis was used to control for the complex sampling design used in NDHS.

Results: Neonatal mortality rate (NMR) stood at 33 deaths per 1000 live births. With or without adjustment for ‘breastfeeding status’, bio-demographic factors – maternal marital status, rural-urban residence, birth size, gender of child, birth interval and maternal body mass index (BMI) – were predictive of neonatal mortality. Maternal age and ethnicity became additional bio-demographic predictors after adjusting for ‘breastfeeding status’. Maternal literacy (socioeconomic factor) and mode of delivery (health/behavioral factor) were significant predictors only when breastfeeding status was not adjusted for.

Conclusions: Bio-demographic factors formed the bulk of predictors of neonatal mortality in Nigeria. The effect of socioeconomic and health/behavioural factors disappeared when breastfeeding status was adjusted for. Intervention programs would need to prioritize the identified predictors for an accelerated reduction of neonatal mortality in Nigeria.


Neonatal mortality, Nigeria, Socioeconomic, Bio-demographic, Health/behavioral determinants

Full Text:



UNICEF. Committing to Child Survival: A Promise Renewed, Progress Report. UNICEF. New York. 2014.

National Population Commission. Nigeria Demographic and Health Survey. Abuja: National Population Commission. 2014.

Akinyemi JO, Bamgboye EA, Ayeni O. Trends in neonatal mortality in Nigeria and effects of bio-demographic and maternal characteristics. BMC Pediatr. 2015;15:36.

Federal Ministry of Health. Saving newborn lives in Nigeria: Newborn health in the context of the Integrated Maternal, Newborn and Child Health Strategy. 2nd edition. Abuja: Federal Ministry of Health, Save the Children, Jhpiego. 2011.

Ezeh OK, Agho KE, Dibley MJ, Hall JJ, Page AN. Determinants of neonatal mortality in Nigeria: evidence from the 2008 demographic and health survey. BMC Public Health. 2014;14(1):521.

Merrill RM. Introduction to epidemiology. Jones & Bartlett Publishers. 2013.

Hosmer DW, Lemeshow S, Sturdivant RX. Model‐building strategies and methods for logistic regression. Applied Logistic Regression, Third Edition. 2000:89-151.

Victora CG, Huttly SR, Fuchs SC, Olinto MTA. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. International journal of epidemiology. 1997;26(1):224-227.

WHO/UNICEF. Improved and unimproved water sources and sanitation facilities. 2012.

Reinhardt E. Fuel for life: Household energy and health. UN Chronicle. 2006;43(2):70-71.

World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organization technical report series. 2000;894:i.

Upadhyay R, Dwivedi P, Rai S, Misra P, Kalaivani M, Krishnan A. Determinants of neonatal mortality in rural Haryana: a retrospective population based study. Indian pediatrics. 2012;49(4):291-4.

Kristensen J, Vestergaard M, Wisborg K, Kesmodel U, Secher NJ. Pre‐pregnancy weight and the risk of stillbirth and neonatal death. BJOG: An International Journal of Obstetrics & Gynaecology. 2005;112(4):403-8.

Mittal S, Hall S. How Does Low Maternal BMI Affect Obstetric and Neonatal Outcome? Paper presented at: Bjog-An International Journal of Obstetrics and Gynaecology. 2013.

Sebire NJ, Jolly M, Harris J, Regan L, Robinson S. Is maternal underweight really a risk factor for adverse pregnancy outcome? A population-based study in London. British Journal of Obstetrics and Gynaecology. 2001;108(1):61-6.

Ezzati M. Comparative quantification of health risks: sexual and reproductive health. Vol 2: World Health Organization. 2004.

Basu AM, Stephenson R. Low levels of maternal education and the proximate determinants of childhood mortality: a little learning is not a dangerous thing. Social science & medicine. 2005;60(9):2011-23.

Zanini RR, Moraes ABd, Giugliani ERJ, Riboldi J. Contextual determinants of neonatal mortality using two analysis methods, Rio Grande do Sul, Brazil. Revista de Saúde Pública. 2011;45(1):79-89.

Ali S, Tahir C, Qurat-ul-ain N. Effect of maternal literacy on child health: Myth or reality. Ann. PIMS-Pak. Inst. Med. Sci. 2011;7:100-3.

Raghupathy S. Education and the use of maternal health care in Thailand. Social Science & Medicine. 1996;43(4):459-471.

Rutstein SO. Effects of preceding birth intervals on neonatal, infant and under-five years mortality and nutritional status in developing countries: evidence from the demographic and health surveys. International Journal of Gynecology & Obstetrics. 2005;89:S7-S24.

Kozuki N, Lee AC, Silveira MF. The associations of parity and maternal age with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis. BMC Public Health. 2013;13(3):S2.

Navot D, Drews M, Bergh P. Age-related decline in female fertility is not due to diminished capacity of the uterus to sustain embryo implantation. Fertility and sterility. 1994;61(1):97-101.

Agho KE, Dibley MJ, Odiase JI, Ogbonmwan SM. Determinants of exclusive breastfeeding in Nigeria. BMC pregnancy and childbirth. 2011;11(1):2.

Chukuezi C. Socio-cultural factors associated with maternal mortality in Nigeria. Research journal of social sciences. 2010;1(5):22-6.

Fall CH, Sachdev HS, Osmond C. Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration). The Lancet Global Health. 2015.

Mekonnen Y, Tensou B, Telake DS, Degefie T, Bekele A. Neonatal mortality in Ethiopia: trends and determinants. BMC public health. 2013;13(1):483.

Seedhom AE, Kamal NN. Some determinants of neonatal mortality in a rural area, El-Minia governorate, Egypt, 2008. Egyptian Journal of Community Medicine. 2010;28(2).

Ugwu E, Obioha K, Okezie O, Ugwu A. A five-year survey of caesarean delivery at a Nigerian tertiary hospital. Annals of medical and health sciences research. 2013;1(1):77-84.

Oyewole WR, Umar A, Yayok RP, Shinaba ST, Atafo CI, Olusanya MO. An Evaluation of the Factors That Influences Caesarean Section in F.C.T Hospitals, Nigeria. Iosr, Journals. 2014.

Edmond KM, Zandoh C, Quigley MA, Amenga-Etego S, Owusu-Agyei S, Kirkwood BR. Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics. 2006;117(3):e380-e386.

Huffman SL, Zehner ER, Victora C. Can improvements in breast-feeding practices reduce neonatal mortality in developing countries? Midwifery. 2001;17(2):80-92.

World Health Organization. Indicators for assessing infant and young child feeding practices part 3: country profiles. 2010.

Adewuyi EO, Adefemi K. Breastfeeding in Nigeria: a systematic review. Int J Community Med Public Health. 2016;3(2):385-96.

UNICEF, Committing to Child Survival: A Promise Renewed, Progress Report 2014. 2014. New York, USA: UNICEF, 2015.