Urban area disadvantage and under-five mortality in Nigeria
Environmental Health Perspectives, ahead of print, 2010
Diddy Antai, Tahereh Moradi
Background: Living in socio-economically disadvantaged areas is associated with increased childhood mortality risks. As city-living becomes the predominant social context in low- and middle-income countries, the resulting rapid urbanization together with the poor economic circumstances of these countries greatly increase the risks of under-five mortality.
Objective: This study examined the trends in urban population growth and urban under-five mortality between 1983 and 2003 in Nigeria. We assessed whether urban area socio-economic disadvantage has an impact on under-five mortality.
Methods: Urban under-five mortality rates were directly estimated from the 1990, 1999 and 2003 Nigeria Demographic and Health Surveys. Multilevel logistic regression analysis was performed on data containing 2118 children nested within 1350 mother, who were in turn nested within 165 communities.
Results: Urban under-five mortality increased as urban population steadily increased between 1983 and 2003. Urban area disadvantage was significantly associated with under-five mortality after adjusting for individual child- and mother-level demographic and socio-economic characteristics.
Conclusions: Significant relative risks of under-five deaths both at the individual and community levels underscore the need for interventions tailored towards community- and individual-level interventions. We stress the need for further studies on community-level determinants of under-five mortality in disadvantaged urban areas.