Proximate Determinants: The Pathways Of Influence Of Underlying Factors On Under-Five Mortality In Nigeria

 Abstract

Nigeria is a country with one of the world’s highest rate of under-five mortality. Any innovative research aimed at bringing solutions to this problem should be considered worthwhile. This study examined how socio-economic, demographic and cultural factors (called underlying factors), influence under-five mortality in Nigeria by identifying some other direct factors (called proximate determinants) through which the underlying factors influence under-five mortality. It used data from the Nigeria Demographic and Health Survey (NDHS) of 2013. Mothers of 31,482 children born during the previous five years of the survey were interviewed on survival status of their children and also on their own characteristics and child healthcare practices. The Mosley and Chen framework for child survival was adopted to explore the pathways of influence of the underlying factors on under-five mortality. The underlying factors considered are mother’s age, marital status, education, occupation, geographical region of residence, urban/rural residence, wealth status and religious affiliation. The proximate determinants examined are, child’s birth order, number of births mother had within the previous five years of the survey, whether or not the child was ever breastfed, the household source of drinking water, type of toilet facility, type of cooking fuel and the place where the child was delivered. Statistical analyses used were the univariate, bivariate and the multivariate analyses. Due to the binary nature of the dependent variable (Dead or Alive), the multivariate analysis technique adopted was the “binary logistic regression”. The level of significance was set at 5 percent. Findings showed that all the nine underlying factors had a significant indirect bivariate relationship with under-five mortality. At the multivariate analysis level, all the underlying factors except religion and occupation maintained their significant indirect effects on under-five mortality. Further, the children who were never breastfed were twenty times more likely to die before five years of age than children who were ever breastfed (P < 0.001). The Log Likelihood Ratio (LR) test used to examine the overall level of importance of the proximate determinants as pathways of influence of the underlying factors on under-five mortality found them to be highly significant (Chi-square = 3222.423 on 12 degrees of freedom, P < 0.001). However, several of the underlying factors still maintained their significant relationships with under-five mortality after adjustments for the seven proximate variables. The result implies that, in addition to the seven proximate determinants used, there must be other proximate variables not included in the study through which the underlying factors are also influencing under-five mortality. Given that proximate determinants (e.g., child spacing), have direct effects on mortality, policies and programmes targeted to influence them will be more effective and in reducing under-five mortality than those targeted to influence underlying factors (e.g., providing higher education for women). The study conclude by recommending programmes such as those that create awareness of mothers about practices that prevent childhood mortality including extensive and prolonged breastfeeding and use of contraceptives which help to prevent frequent or multiple births within short intervals, thereby reducing the high under-five mortality in Nigeria.