American Journal of Public Health Research
ISSN (Print): 2327-669X ISSN (Online): 2327-6703 Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Public Health Research. 2015, 3(4A), 19-26
DOI: 10.12691/ajphr-3-4A-4
Open AccessResearch Article

Surviving the First Day in Nigeria: Risk Factors and Protectors

Tukur Dahiru1,

1Department of Community Medicine Ahmadu Bello University Zaria, Nigeria

Pub. Date: June 26, 2015
(This article belongs to the Special Issue Maternal and Child Health)

Cite this paper:
Tukur Dahiru. Surviving the First Day in Nigeria: Risk Factors and Protectors. American Journal of Public Health Research. 2015; 3(4A):19-26. doi: 10.12691/ajphr-3-4A-4


Background: Deaths occurring within the first twenty-four hours of life constitutes a large proportion of child mortality; about 36% of all neonatal deaths took place within the first twenty-fours of delivery globally. Nigeria contributes around 9% of the global first-day mortality. Objectives: To determine the levels and determinants of first-day mortality using the 2013 Nigeria DHS data. Methods: This study utilized the 2013 Nigeria DHS which is a cross-sectional involving a nationally representative sample of 38, 948 women aged 15-49 years. First-day mortality rates were estimated for all births within the past five year prior to the survey and disaggregated by background characteristics and Cox proportional hazard models were generated to assess the relationship between some background characteristics and first-day mortality. Analysis was conducted using Stata v13. Results: The first-day mortality rate was found to be 19 per 1000 live births which was found to be higher among younger aged women, overweight women, babies in Southern part of Nigeria, rural residents, male babies and those babies delivered in health facilities among others. Factors that significantly predict first-day mortality are maternal age of more than 35 years (HR=1.12, 95%CI: 1.01-1.24), residing in Northern Nigeria (HR=1.18, 95%CI: 1.10-1.26), living in rural areas (HR=1.30, 95%CI: 1.22-1.40) and increasing maternal education (HR=1.20, 95%CI: 1.10-1.32). Utilization of at least four ANC visits (HR=0.87, 95%CI: 0.80-0.93) and having postnatal care within 24 hours (HR=094, 95%CI: 0.89-0.99) are all associated with decreased hazard of first-day mortality. Conclusion: First-day mortality rate in Nigeria is high; provision and expansion of both antenatal and postnatal care services particularly in rural areas and northern part of Nigeria will potential contribute in the reduction of first-day mortality.

First-Day Child Mortality Risk Nigeria

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  UNICEF. (2009). State of the world’s children 2010. New York, USA: United Nations Children’s Fund.
[2]  United Nations. (2009). The millennium development goals report 2009. New York: United Nations.
[3]  WHO. (2009). World health statistics 2009. Geneva: World Health Organization.
[4]  Cabral, S. A., & de Moura, A. T. S. Overview of the global health issues facing children. Pediatrics 2012; 129 (1), 1-3.
[5]  Rajaratnam, J. K., Marcus, J. R., Flaxman, A. D., Wang, H., Levin-Rector, A., et al. Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: a systematic analysis of progress towards Millennium Development Goal 4. Lancet 2010; 375: 1988-2008.
[6]  Save the Children. State of the World’s Mothers 2013. Save the Children, May 2013.
[7]  Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. for the Child Health Epidemiology Reference Group of WHO and UNICEF.. Global, Regional and National Causes of Child Mortality: An Updated Systematic Analysis for 2010 with Time Trends since 2000. Lancet 2012; 379: 2151-2161.
[8]  Kathryn D and Begum K. Long-Term Consequences of Stunting in Early Life. Maternal & Child Nutrition 2011; 7: S3, October 2011. p. 8.
[9]  UNICEF Global Databases (Accessed March 11, 2013).
[10]  Pathfinder International. Creating Partnerships to Prevent Early Marriage in the Amhara Region. 2006.
[11]  UNICEF. Child Protection from Violence, Exploitation and Abuse: A Statistical Snapshot. (New York: 2011) p. 3.
[12]  UNICEF. The State of the World’s Children 2012. Table 111.
[13]  Joy L, Kinney M, Black R, Pitt C, Cousens S, Kerber K, Corbett E, Moran A, Morrissey C and Oestergaard M. Newborn Survival: A Multi-country Analysis of a Decade of Change. Health Policy and Planning: A Decade of Change for Newborn Survival (2000-2010): A Multi-Country Evaluation of Progress towards Scale. Health Policy and Planning 2012; 27, Suppl 3: 6-28.
[14]  United Nations Population Division. World Contraceptive Use 2011.
[15]  United Nations, Department of Economic and Social Affairs, Population Division. World Contraceptive Use 2012 (POP/DB/CP/Rev2012).
[16]  UNFPA. State of World Population 2012. (New York: 2012) pp. 112-114.
[17]  UNICEF Global Databases (Accessed March 11, 2013).
[18]  UNICEF Global Databases (Accessed March 11, 2013).
[19]  UNICEF. The State of the World’s Children 2012. Table 8, p. 116.
[20]  MEASURE DHS’s STATcompiler (Accessed on March 11 2013).
[21]  National Population Commission (NPC) [Nigeria] and ICF International. 2014. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International.
[22]  Cox DR. Regression models and life tables. J Roy Statist Soc B 1972; 34: 187-220.
[23]  StataCorp. Stata statistical software: Release 13. College Station: StataCorp LP. 2014.
[24]  Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Published Online October 1, 2014. Accessed on April 20, 2015
[25]  Adejuwon J.2008. Vulnerability in Nigeria: A national-level assessment. In N Leary, C Conde, A Nyong, and J Pulhin (Eds.), Climate Change and Vulnerability (198-217). London: Earthscan.
[26]  Agunwamba A, Bloom D, Friedman A, et al. 2009. Nigeria: The Next Generation-Literature Review. British Council 2009.
[27]  Villar J, Ba’aqeel H, Piaggio G, et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet 2001; 357: 1551-64.
[28]  Singh K, Prodish P, Suchindra C. A regional multilevel analysis: can skilled birth attendant uniformly decrease neonatal mortality? Maternal Child Health Journal 2014; 18: 242-49.
[29]  Di Mario S et al. 2005. What is the effectiveness of antenatal care? (Supplement) Copenhagen, WHO Regional Office for Europe (Health Evidence Network report;, accessed 28 December 2014).
[30]  Ram F and Singh A. Is antenatal care effective in improving maternal health in rural Uttar Pradesh? Evidence from a district level household survey. Journal of Biosocial Science 2006; 38(4): 433-448.
[31]  de Allegri M., Ridde V, Louis V R., et al. Determinants of utilisation of maternal care services after the reduction of user fees: a case study from rural Burkina Faso. Health Policy 2011; 99: 210-218.
[32]  Guliani H, Sepehri A, & Serieux J. What impact does contact with the prenatal care system have on women’s use of facility delivery? Evidence from low-income countries. Social Science & Medicine 2012; 74: 1882-1890.
[33]  Darmstadt GL, Bhutta ZA, Cousens S, et al., for the Lancet Neonatal Survival Steering Team. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet 2005; 365: 977-88.
[34]  Bhutta ZA, Das JK, Bahl R, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet 2014; 384: 347-70.
[35]  Singh A, Yadav Aand Singh A. Utilization of postnatal care for newborns and its association with neonatal mortality in India: An analytical appraisal. BMC Pregnancy and Childbirth 2012 12: 33.
[36]  Titaley CR, Dibley MJ, Roberts CL. Type of delivery attendant, place of delivery and risk of early neonatal mortality: analyses of the 1994-2007 Indonesia Demographic and Health Surveys. Health Policy and Planning 2011; 27: 405-416.
[37]  Shakya K, McMurray C. Neonatal mortality and maternal health care in Nepal: searching for patterns of association. Journal of Biosocial Science 2002; 33: 87-105.
[38]  Ezeh OK, Agho KE, Dibley MJ, et al. Determinants of neonatal mortality in Nigeria: evidence from the 2008 demographic and health survey. BMC Public Health 2014, 14: 521.
[39]  Wu Z, Viisainen K, Wang Y, et al. Perinatal mortality in rural China: retrospective cohort study. Brit Med J 2003; 327 6 December.
[40]  Oti S, Odimegwu C. 2011. Perinatal mortality in Nigeria: Do place of delivery and delivery assistants matter? The Open Demography Journal 4: 1-10.
[41]  Tura G., Fantahun M, Worku A. 2013. The effect of health facility delivery on neonatal mortality: systematic review and meta-analysis. BMC Pregnancy and Childbirth 13: 18.