Environmental Factors, Neighbourhood Deprivation, And Under-Five Mortality In Nigeria: An Exploratory Spatial Data Analysis

摘要

Aim: to examine the impact of state-level access to basic environmental services and neighbourhood deprivation on under-five mortality rate Methods: Using data from most recent Nigeria Demographic and Health Survey for a sample of 6029 live births between 1999 and 2003 and exploratory spatial data analyses, the study analyzed the state-level association between environmental, neighbourhood deprivation and under-five mortality rate. Results: The spatial distribution of rates of under-five mortality rate was non-random and clustered with a Moran's I = 0.654 (p = .001). Spatial clustering suggested that North-east and North-west can be group as under-five mortality "hot-spot", and South-west, South-south, and South-east can be group as under-five mortality "cold-spot". The results outlined seemingly consistent finding that access to safe water, proper sanitation, and low pollution cooking fuel are important factors that can increase the chances of child survival. Conclusion: The maps could be used by policy makers for targeting development efforts at a glance for resource allocation and scaling up preventive efforts to achieve Millennium Development Goal, MDG-4 to reduce by two-thirds, between 1990 and 2015, the under-five mortality and MDG-7 to halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. Multifaceted geographically differentiated intervention may represent a potentially effective approach for addressing issues related to child survival. Introduction Global under-five deaths over the last four decades have fallen from 20.4 million to 10.9 million annually 1 . During this time deaths in sub-Saharan Africa almost doubled from 2.3 million to 4.5 million annually 1 . The region's perilous situation is aggravated by the increasing number of under-five deaths due to HIV/AIDS and low immunization coverage as a result of weak health care systems 1 . Despite a steady decline during this century, the Nigeria still has one of the highest infant mortality rates among developing nations. Researchers typically evaluate the characteristics of mothers or infants (usually from vital statistics data) as factors that elevate the risk of infant death. The associations between neighbourhood context and various indicators of physical health are receiving growing empirical attention, and multiple studies have shown that poor health is partly a function of macro-level socioeconomic disadvantage 2,3 . Neighbourhoods constitute a key determinant of socioeconomic disparities in health, as they shape individual opportunities and expose residents to multiple risks and resources over the life course 4,5 . To expand our understanding of the aetiology of child health, the study argue that it is necessary to consider as additional risk factors the characteristics of the communities in which mothers and children live. Thus policy-related programs employed to address the relatively high U5MR in Nigeria may be less effective if based solely on evidence generated from individual-level of observation. Goal 7 of the Millennium Development Goals (MDGs) addresses environmental sustainability, with a target (target 10) to “halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation”. Water supply, sanitation and hygiene, given their direct impact on infectious disease and are important for preventing child mortality 6 . Public health measures in developed countries, such as water purification, sanitary sewerage, trash and garbage collection, and reduction in food contaminations, have led to a substantial decline in morbidity and mortality 7 . According to The world health report 2002 indoor air pollution is responsible for 2.7% of the global burden of disease 8 . Indoor air pollution comprises a range of health-damaging pollutants, such as small particles and carbon monoxide, and is responsible for up to 1.6 million deaths every year, most of them due