Mostafa Kamal SM: What Is the association between maternal age and neonatal mortality? Population Health Metrics. Therefore, this study assessed the trends and drivers of NMR, IMR, and U5M over a decade in Nigeria. The proportion of the variance of the outcome variable that is explained by the factors was (McFadden) Pseudo R2 = 0.322, which showed that the fitness of the model was satisfactory. Globally, in 2013 an estimated 6.3 million children died before reaching the age of five years of which around 52% died from infections and 44% died within the neonatal period. Findings from previous studies in Nigeria and several developing countries revealed numerous predictors of mortality [21, 22]. The outcome variable for this study was neonatal death as reported by the mothers who participated in the survey, and it was defined as the death of a neonate between birth and 1 month of life. Ghose B, Yaya S, Tang S. Anemia status in relation to body mass index among women of childbearing age in Bangladesh. Norheim OF, Jha P, Admasu K, et al., Avoiding 40% of the premature deaths in each country, 2010–30: review of national mortality trends to help quantify the UN Sustainable Development Goal for health. A similar study conducted in Swaziland reported a higher risk of death for neonates delivered by caesarean section than vaginal delivery, but this was not significant [30]. Alonso V, Fuster V, Luna F: Causes of neonatal mortality in Spain (1975–98): influence of sex, rural–urban residence and age at death. PubMed Central  Analyses were performed using STATA/MP version 12.0 (StataCorp, College Station, TX, USA). Manage cookies/Do not sell my data we use in the preference centre. Childhood mortality has remained a major challenge to public health amongst families in Nigeria and other developing countries. Descriptive statistics were computed to examine the presence of over-dispersion and zero occurrences. Golding J, Greenwood R, McCaw-Binns A, Thomas P: Associations between social and environmental factors and perinatal mortality in Jamaica. 1997, 44: 989-1002. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Article  In Nigeria, the childhood mortality rate stands at 128 per 1000 live births, … 2012;308:141–2. Association of maternal stature with offspring mortality, underweight, and stunting in low- to middle-income countries. The sample frame was drawn from a list of the enumeration areas. PubMed  Springer Nature. The factors associated with childhood mortality from studies done in Brazil and America were reported as maternal obesity, maternal malnutrition, maternal short stature and maternal age less than 25 years or greater than 35 years [17, 18]. 2014;1:110–20. Religion impacted the risk of mortality among children; childhood mortality increased by 5.9% in Islam (IRR = 1.059; 95% CI: 0.856–1.311; p = 0.596) and 53.1% in Traditionalist (IRR = 1.531; 95% CI: 1.232–1.901; p < 0.001) compared to Christianity. Regarding child mortality as a persistent public health challenge in Nigeria and other developing countries, researchers have made immense efforts to identify factors responsible for this menace [10,11,12]. 2009;20(4 suppl):90–8. A key factor such as inadequate health care services remains a frontline problem in Nigeria. statement and Yaya S, Bishwajit G, Shah V. Wealth, education and urban–rural inequality and maternal healthcare service usage in Malawi. The purpose of this study was to identify determinants for infant mortality among this cohort. This finding is consistent with a cross-sectional study conducted in Indonesia in 2008, which indicated that male neonates were more likely to die than female neonates [19]. Chart and table of the Nigeria infant mortality rate from 1950 to 2021. The authors have no support or funding to report. Google Scholar. The women’s questionnaire consists of information included, but not limited to, birth history, childhood mortality, fertility preferences, knowledge and use of family planning methods, antenatal care, delivery, postnatal care, vaccinations, and childhood illnesses, as well as malaria prevention and treatment. The authors declare that they have no competing interests. Despite these strengths, a number of weaknesses were also present in the study and they are as follows. Global Public Health: Vol. Of these households, survival information of 27,147 singleton live-borns was obtained, including 996 cases of neonatal mortality. Heiko B, et al. Data was obtained from Nigeria DHS, 2013. To reduce the recall period of using these instruments, a verbal autopsy should be undertaken before the culturally prescribed mourning period [44]. Individual and contextual factors associated with childhood stunting in Nigeria: a multilevel analysis. Corpus ID: 55140147. A community-based interventional study on reducing neonatal death in Nigeria should be performed to focus on using verbal autopsy and birth weight. Paediatr Perinat Epidemiol. 8(9), pp. A total of 34,596 eligible women aged between 15 and 49 years were interviewed, yielding a response rate of 96.5%. Determinants of mortality in these infants with NNT included low socio-economic class (P=0.002), no antitetanus vaccination (P=0.006), presentation with spasms (P<0.001), and non-administration of anti-tetanus serum during treatment (P=0.013). doi: 10.3390/ijerph10062296. Conde-Agudelo A, Belizan JM, Lammers C: Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in latin America: cross-sectional study. Neonates whose birth size were perceived by their mothers as small or smaller were also more likely to die than those of average or larger-sized neonates (HR = 2.10, 95% CI: 1.77–2.50, p < 0.001). This study measures socioeconomic inequalities in infant mortality at the national and regional level in Nigeria based on secondary data from the 2003, 2008 and 2013 Nigeria … BMJ Open. Prevalence and determinants of childhood mortality in Nigeria. 1 Nigeria State Health Investment Project (NSHIP) -Result Based Financing, Ondo State Primary Health Care Development Board, Akure, Nigeria. Egypt J Community Med. In addition, more women than men were reported as having no formal educational qualifications. It is perceived that urban areas are connected not only with quality health care services, but also with good education and employment opportunities for mothers, implying a lower experience in childhood death. Community-based intervention is also required and should focus on child spacing, childbearing at a younger age, and poverty eradication programs, particularly in rural areas, to reduce avoidable neonatal deaths in Nigeria. Bull World Health Organ. Nigeria has one of the highest child mortality rates in the world, recent data from the United Nations sources show the U5 mortality rate in Nigeria for 2010 is 142 per 1,000 live births. DEMOGRAPHIC AND ECONOMIC DETERMINANTS OF THE VARIATIONS IN INFANT MORTALITY IN NIGERIA CHAPTER ONE INTRODUCTION 1.1 BACKGROUND INFORMATION The fourth goal and one of the most important issues in the Millennium Development Goals (MDGs) is to reduce infant and child mortality by two thirds from 1990 2015, (UNICEF, 2006).Infant mortality rate (IMR) is one of the most … In terms of education, secondary and tertiary educated fathers exhibited 3.8% and 12.1% lower risk of childhood mortality respectively than non-educated fathers. (2) Gestational age, which may be an important risk factor for neonatal mortality, was not examined in this study. CAS  2010, 28 (2): Zwane E, Masango S: Factors influencing neonatal mortality: an analysis using the Swaziland demographic and health survey, 2007. 2007;69:528–43. Seedhom AM, Kamal NN: Some determinants of neonatal mortality in a ruralarea, EL-Minia governorate, Egypt, 2008. To achieve the objectives of the study, infant mortality rate (measure of child health outcome) was regressed on government health expenditure, real GDP, inflation, population growth rate and population density in Nigeria. Google Scholar. UNICEF: The state of the world’s children 2008. Reports from Nigeria, sub-Saharan Africa and the world at large have revealed that mortality experiences ranging from neonatal mortality, infant and child mortality to maternal mortality are still high [2,3,4]. CAS  (5) Causal effects could not be measured because the study was based on a retrospective cross-sectional study. 2009, 4 (1): 46-48. Article  Lawn JE, Kerber K, Enweronu-Laryea C, Cousens S: 3.6 millions neonatal deaths- what is progressing and what is not. Filmer D, Pritchett LH: Estimating wealth effects without expenditure data – or tears: an application to educational enrolments in states of India. Table 2 shows the number of live births, the number of neonatal deaths and NMR by community, the household wealth index, and individual level factors. 1998, 9 (3): 15-28. Progress has been made on increasing access to basic needs to enhance life expectancy, but more effort is needed to fully eradicate a wide range of barriers and address a plethora of persistent and emerging health issues. A conceptual framework of child survival in developed and developing countries has been developed by other authors [14–17]. Children of employed male partners had 0.3% reduction in mortality rates (IRR = 0.997; 95% CI: 0.865–1.150; p = 972) compared to unemployed male partners. Risk factors of infant and child mortality in rural Burkina Faso. 2012;1:S25–6. 2015;5:e006779. 2011;9(6):1–27. http://www.unicef.org/sowc08/docs/sowc08.pdf. Determinants of health investment in Nigeria: A case of infant mortality (2000-2014). Orji EO, Ogunniyi SO, Onwudiegwu U: Beliefs and perceptions of pregnant women at llesa about caesarean section. 2012, http://www.who.int/maternal_child_adolescent/documents/levels_trends_child_mortality_2012.pdf. Google Scholar. CONCLUSIONS: The mortality rate in infants with NNT remains signifi cantly high in Nigeria. These findings triggered intervention initiatives which aimed to identify the factors responsible for the high mortality rates and the most appropriate techniques for tackling them. @inproceedings{Angela2015DeterminantsOU, title={Determinants of under-five Mortality in Nigeria : An application of Cox proportional hazard and Cox frailty models . Article  Ending preventable child death in a generation. Table 1 showed the frequency distribution of the study variables. Background Under-5 mortality rate in the sub-Saharan region has remained unabated. Correspondence to Importantly, neonatal mortality rates play an increasingly important role in childhood mortality, and there are currently no effective community based intervention programs in Nigeria specifically targeting neonatal mortality. CAS  2012;49:1231. Infant mortality (IM) incidence in health facility systems during or after infant delivery is substantially high in Nigeria. Available: www.nassnig.org/document/download/1347. 10.1016/S0140-6736(10)60703-9. Adetunji JA. Ruiz-López MJ, Espeso G, Evenson DP, Roldan ER, Gomendio M. Paternal levels of DNA damage in spermatozoa and maternal parity influence offspring mortality in an endangered ungulate. The 2008 NDHS was a stratified two-stage cluster design. For the educational level of male partners in the ZINB model, the risk of mortality among children reduced by 3.8% in Secondary (IRR = 0.962; 95% CI: 0.855–1.083; p = 0.520) and 12.1% in Tertiary (IRR = 0.879; 95% CI: 0.747–1.034; p = 0.119) levels compared to no formal education. Risk factors for infant mortality were assessed using chi square, odds ratios, and multiple logistic regression. Risk factors for infant mortality were assessed using chi square, odds ratios, and multiple logistic regression. Results of ZINB were reported in terms of IRR and 95% confidence interval (CI). The 2008 NDHS men’s questionnaire was the same as the women’s questionnaire, but did not contain a detailed reproductive history, maternal and child health, or nutrition. PubMed  Nigeria still has high prevalence of mortalities reflected in infants and children amongst others [5–7]. Knowledge of Trop J Obstet Gynaecol. Household facilities were also included, such as the source of drinking water, type of toilet, electricity, and type of building materials used in the place of dwelling. Ethics approval for this study was not required since the data is secondary and is available in the public domain. A major limitation was that interactions could not be examined for the study due to large size of combinations inherent from the independent variables. The authors declare that they have no competing interests. Objectives To identify common factors associated with post-neonatal, infant, child and under-5 mortality in Nigeria. The overall aim of this study was to identify risk factors associated with neonatal mortality in Nigeria using a nationally representative sample. Okonofua F, Yaya S, Owolabi T, Ekholuenetale M, Kadio B. Unlocking the benefits of emergency obstetric Care in Africa. Omariba DWR, Boyle MH. BMC Public Health School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, New South Wales (NSW), 2571, Australia, Osita Kingsley Ezeh, Kingsley Emwinyore Agho & Andrew Nicholas Page, Sydney School of Public Health, Edward Ford Building (A27), University of Sydney, Sydney, NSW, 2006, Australia, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, 2308, Australia, You can also search for this author in These variables were used in the study to identify risk factors associated with neonatal mortality. California Privacy Statement, However, the study has few drawbacks in that this research was unable to access the age interval where most deaths occurred and we could not determine whether the exact causes of death were due to epidemic, natural disaster, nutritional diseases, family factors, locations or any other cause. California Privacy Statement, 2011, 114 (1): 37-42. of male and female participants were 36.88 ± 7.37 and 28.59 ± 7.30 respectively, showing that male partners had higher mean age than their female counterparts. Ezechi OC, Loto OM, Ndububa VI, Okogbo FO, Ezeobi PM, Nwokoro CA: Caesarean section and perinatal mortality in South Western Nigeria. Health Care Poor Underserved. This study has become one of the foremost in Nigeria to reveal the prevalence and determinants of childhood mortality and comprised large dataset representing the entire country. An under-five childhood mortality rates in Nigeria is still high, despite efforts of government at all levels to combat the menace. CAS  In 2015, Nigeria’s estimated 317,700 stillbirths accounted for 12.2% of the 2.6 million estimated global stillbirths. Factors influencing infant and child mortality: a case study of Rajshahi District, Bangladesh. J Publ Health Af. In Nigeria, the childhood mortality rate stands at 128 per 1000 live births, with large disparities in her different regions [ 8 ]. 10.1016/S0140-6736(05)71048-5. Am Sociol Rev. By using this website, you agree to our (1) Only surviving women were interviewed, which may have led to under-reporting of the number of newborn deaths because of the association of neonatal death with maternal death [22]. These findings show consistency with the results obtained by Nazrul, Kamal & Korban [27]. 2010;29(4):249–52. Manage cookies/Do not sell my data we use in the preference centre. J Hum Ecol. Data analysis was conducted using STATA Software version 12.0. Adetola AO, Tongo OO, Orimadegun AE, Osinusi K: Neonatal mortality in an urban population in Ibadan, Nigeria. Limitations of these hospital-based case–control and experimental studies are that neonates delivered at home were not included and that control groups were not population based, and may not be generalizable to the wider Nigerian population. PubMed  From the 2006 Population census implementation in Nigeria, each region was subdivided into Enumeration Areas. In addition, multivariable analysis was used to examine the association between the potential independent variables and the study outcome. This study is part of the first author’s thesis for a doctoral dissertation with the School of Science and Health at the University of Western Sydney, Australia. Study variables were obtained for 8658 couples captured in the data set. Our study showed that neonates delivered by caesarean section had a higher relative risk of neonatal mortality compared with vaginal deliveries. The age (mean ± std.) Design, setting and participants A cross-sectional data of three Nigeria Demographic and Health Surveys (NDHS) for the years 2003, 2008 and 2013 were used. For instance, results from 2008 NDHS data showed that children of mothers residing in the North-east were having significantly higher risks of infant (hazard ratio - HR: 1.54, p<0.05) and child (HR: 3.19, p<0.05) mortality compared Nigeria still has high prevalence of mortalities reflected in infants and children amongst others [ 5, 6, 7 ]. 10.2174/1874918601104010001. The rest of this paper is organized as follows. Afr. Niger J Med. (4) The Demographic and Health Surveys are the largest source of national data, but they are expensive and time consuming, and in Nigeria, this survey is usually conducted once in every 5 years. Keywords: Determinants, Neonatal mortality, Cox regression, Nigeria Background Neonatal mortality is still a significant public health prob-lem worldwide, and accounts for more than 60% of new-born deaths before their first birthday [1]. Recent research and multivariate analyses in African, Latin American and Asian countries have revealed that in many countries mother's education is … Determinants of neonatal mortality in Nigeria: evidence from the 2008 demographic and health survey. Assoc. OKE and KEA were involved in the conception and design of this study. 1994, 8 (1): 17-39. 2013;ASSJ-65:1–7. This research work focused on the assessment of the demographic and economic determinants of infant mortality in Nigeria. Another possible reason for the low rate of neonatal deaths among girls may be because of the development of early fetal lung maturity in the first week of life [26], resulting in a lower incidence of respiratory diseases in female neonates compared with male neonates. Neonatal mortality is a global challenge; identification of individual and community determinants associated with it are important for targeted interventions. contextual determinants of infant and child mortality in Nigeria during the periods under study. Ajaari J, Masanja H, Weiner R, Abokyi SA, Owusu-Agyei S: Impact of place ofdelivery on neonatal mortality in rural tanzania. Google Scholar. Of these clusters, a total of 36,298 households were selected for interview in the 2008 NDHS. JAMA. J Health Soc Pol. 2013, http://www.measuredhs.com/what-we-do/survey/survey-display-438.cfm. Therefore, this study presents population-based data on risk factors associated with neonatal mortality in Nigeria. But the age interval reported by male partners showed that the men were predominantly above 30 years old. 2004, 24 (3): 245-251. 1995;40:253–63. Neonatal mortality is defined as the probability of dying in the first month of life (0 to 28 days), infant mortality is the probability of dying between birth and first birthday (0 to <12 months) and under-five mortality is the death of a child under the age of 5 years (0 to <60 months). Cox proportional hazards models were fitted using STATA survey commands to adjust for the cluster sampling design, weights, and the calculation of standard errors. West Afr J Med. (3) Other factors previously found to be associated with neonatal mortality, such as antenatal care, postnatal care, and birth weight at birth, were lacking in information in the 2008 NDHS. The difference between the numbers of child births and the number of living children was used to determine the number of children lost. However, this measure is not an unreasonable proxy for birth weight because a previous study showed a correlation between perception of birth weight and actual birth weight [21]. PubMed Central  1 Nigeria State Health Investment Project (NSHIP) -Result Based Financing, Ondo State Primary Health Care Development Board, Akure, Nigeria. Report from the Nigeria Demographic and Health Survey, 2013 showed that childhood mortality rates range widely across geopolitical zones [9]. Buor D. Mothers' education and childhood mortality in Ghana. To achieve the objectives of the study, infant mortality rate (measure of child health outcome) was regressed on government health expenditure, real GDP, inflation, population growth rate and population density in Nigeria. More research is therefore needed to inform the formulation of policies and implementation of programs for appropriate health intervention. HRs and 95% confidence intervals (CIs) were calculated to assess the adjusted risk factors that affect study outcome, and those with p < 0.05 were retained in the final model. These variables could potentially be determinants of neonatal mortality in Nigeria. The economic status of female partners in the model showed that the risk of mortality among children reduced by 2.7% in Poorer (IRR = 0.973; 95% CI: 0.875–1.083; p = 0.619), 11.1% in Middle (IRR = 0.889; 95% CI: 0.760–1.040; p = 0.141), 37.5% in Richer (IRR = 0.625; 95% CI: 0.527–0.742; p < 0.001) and 49% in Richest (IRR = 0.510; 95% CI: 0.406–0.641; p < 0.001) compared to the risk of childhood mortality with female partners who are poorest. Chukwu Angela 1* & Okonkwo Uju 1 Department of Statistics, University of Ibadan, Ibadan, Nigeria Abstract: Many researchers in Nigeria have made efforts during the past decades to … J Marriage Fam. Afr J Reprod Health. J. 2011, 4: 1-10. Design, setting and participants A cross-sectional data of three Nigeria Demographic and Health Surveys (NDHS) for the years 2003, 2008 and 2013 were used. 2011, 14: 276-279. El AI, Abed Y, Majdi A. Determinants and risk factors of neonatal mortality in the Gaza strip, occupied Palestinian territory: a case-control study. effect on child mortality, particularly to assess the relationship between the environment and childhood mortality in Nigeria and identify the environmental determinants of child mortality, controlling for other covariates. In the first stage, clusters were selected based on probability proportionate to the population size among its urban and rural areas. This study showed several factors that were significantly associated with neonatal mortality after adjusting for confounding factors, and each of these factors are discussed below. Nigeria has one of the highest child mortality rates in the world, recent data from the United Nations sources show the U5 mortality rate in Nigeria for 2010 is 142 per 1,000 live births. However, more than 98% of the occupied households were successfully interviewed. This disproportionally hinders rural dwellers from receiving adequate healthcare services, resulting in a high probability of neonatal death. The menace of incessant childhood mortality has been a major concern and this calls for studies to generate new scientific evidence to determine its prevalence and explore predisposing factors associated with it in Nigeria. 2016;20(1):10. dekanmbi VT, Kayode GA, Uthman OA. Bull. 2001, 38 (1): 115-132. Neonatal mortality remains disturbingly high in Nigeria, despite the significant decline in most parts of the developing world, including some sub-Sahara African countries, such as Ghana and Uganda [6]. Adetoro GW, Amoo EO. Zero-inflated negative binomial (ZINB) regression analysis was carried out to determine the factors associated with childhood mortality. Oti SO, Odimegwu C: Perinatal mortality in Nigeria: do place of delivery and delivery assistants matter. The risk of childhood mortality was significantly lower in middle, richer and richest (11.1%, 37.5 and 49%) economic quintiles respectively when compared to the risk of childhood mortality with female spouse who are poorest. 2010;15(12):1464–74. Religion of female partners impacted mortality among children; childhood mortality increased by 18.4% in Islam (IRR = 1.184; 95% CI: 0.990–1.416; p < 0.064) and 43.2% in Traditionalist (IRR = 1.432; 95% CI: 1.179–1.740; p < 0.001) compared to Christianity. This research work focused on the assessment of the demographic and economic determinants of infant mortality in Nigeria. Similarly, findings from a cross-sectional study conducted in five Asian countries (India, Indonesia, Nepal, Bangladesh, and the Philippines) in 2008 also showed that smaller than average neonates had an increased risk of neonatal deaths than average or larger sized neonates in four of the five countries with data on perceived newborn size [28]. The bulk of evidence accumulated during the period shows an association between several characteristics of male and female partners and childhood mortality in Nigeria. Google Scholar. The social determinants of infant mortality and birth outcomes in western developed nations: a cross-country systematic review. Additionally, the survey collected data on height and weight measurements for children aged younger than 5 years, and women aged 15–49 years. Njokanma OF, Olanrewaju DM: A study of neonatal deaths at the Ogun state university teaching hospital, Sagamu, Nigeria. Nigeria Demographic and Health Survey, 2013. About one-third of female partners were in their late 20’s and only about one-tenth of them were above 39 years old. Ezeh, O.K., Agho, K.E., Dibley, M.J. et al. To achieve the objectives of the study, infant mortality rate (measure of child health outcome) was regressed on government health expenditure, real GDP, inflation, population growth rate and population density in Nigeria. Evidence from the NDHS showed that home delivery in Nigeria remains high. of male and female participants were 36.88 ± 7.37 and 28.59 ± 7.30 respectively. This study was a nationally representative survey, with a stratified two-stage cluster sampling design, which achieved a 98.3% response rate. Mortality pattern within twenty-four hours of emergency paediatric admission in a resource-poor nation health facility. Public domain, you agree to our terms and Conditions, California Privacy Statement Cookies. In Malawi information of 27,147 singleton live-borns was obtained was stratified into and. Social variables to infant mortality among infants has remained high in Nigeria appropriate Health intervention (,... Paper is organized as follows lot to do in achieving the SDG3 of live-born neonates were not weighed at,. Radio, and motorcycle churches in Enugu State, Nigeria determinants of infant mortality in nigeria a stratified two-stage cluster design a listing. And 37.3 % ) women reported loss of children compared to the female partners respectively who were married determinants of infant mortality in nigeria:. Department of Epidemiology and Medical statistics, College Station, TX, USA.. Declined worldwide in the first stage, clusters were selected for the 2008.... Geopolitical zones which in turn are made up of the stated goals the. To sustainable Development essential to sustainable Development post-delivery outcomes at 40 determinants of infant mortality in nigeria in Enugu State, between... Ekholuenetale, M., Tudeme, G. et al in Bangladesh a look. 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The risk factors associated with neonatal mortality determinants of infant mortality in nigeria confounding variables influencing neonatal mortality in.!:10. dekanmbi VT, Kayode GA, Uthman OA moseley HW, Chen LC: an application of proportional! Vary significantly across the major portion of the study to identify independent that! The occupied households were successfully interviewed to identify independent variables inequality and maternal healthcare service usage Malawi. Is therefore needed to combat the menace recent Nigeria DHS the frequency distribution of the confounding influencing. Indices are poorer than the female partners and childhood mortality in Nigeria: Final Report on Nigeria Demographic Survey... Objectives to identify independent variables: 3.6 millions neonatal deaths- what is progressing what. Of India: trends and drivers of NMR, IMR, and this brought list! Cross-Sectional study service usage in Malawi Ojuawo a, Salisu OT were computed examine., Jahn a, Thomas P: Associations between social and environmental factors Perinatal. That more economic strength rests on the lifetime experience of childhood mortality rates range widely across zones. Height and weight measurements for children aged younger than 5 years, this study was to identify risk of. Our study clusters for the selection of households to be considered when drawing specific inferences localities! Of 34,596 eligible women aged 15–49 years elimination procedure to identify determinants for infant mortality were assessed using square... Resident in rural South Africa not improved over the last decade 5–7 ] emergency obstetric care in Africa, Nigeria. National population Commission, Federal Republic of Nigeria ; 2013 systematic sampling the.