Exploring the Hierarchies: Multilevel Correlates of Child Mortality in Nigeria and Implications for Interventions

This study examined the multilevel correlates of childhood mortality among women (aged 15–49 years) in Nigeria using pooled data from the 2003, 2008 and 2018 Nigeria Demographic and Health Surveys. This study considered 25,685 women who stated that they never lived outside their communities. Descriptive and multilevel regression analyses were performed. About 38% of the women reported losing at least a child. The individual-level correlates of childhood mortality were age, age at first birth, years of education, marital status and ethnicity. Household variables such as number of male children ever born (aIRR = 1.031; 95% CI = 1.026–1.036; p = 0.001), no bed net (aIRR = 1.052; 95% CI = 1.011–1.094; p = 0.012) and using biomass/charcoal (aIRR = 1.223; 95% CI = 1.013–1.475; p = 0.036) were positively associated with childhood mortality while wealth index was negatively correlated with childhood mortality. At the community level, lower childhood mortality was observed in South South region (aIRR = 0.853; 95% CI = 0.767–0.949; p = 0.003), but it was higher in North East (aIRR = 1.143; 95% CI = 1.050–1.244; p = 0.002), North West (aIRR = 1.440; 95% CI = 1.318–1.574; p = 0.001) and South East (aIRR = 1.156; 95% CI = 1.028–1.300; p = 0.016) respectively. Higher childhood mortality was associated positively with community poverty (medium: aIRR = 1.107; 95% CI = 1.013–1.210; p = 0.024), low ownership of piped water (aIRR = 1.128; 95% CI = 1.047–1.215; p = 0.002) and problematic distance to health facility (aIRR = 1.046; 95% CI = 1.006–1.088; p = 0.025). There is a need for more interventions to tackle multilevel drivers of child mortality in Nigeria.