First-day and Early Neonatal Mortality in Nigeria: A Pooled Cross-sectional Analysis of Nigeria DHS Data

Background: Deaths within the early neonatal period is constituting large proportions of child deaths. While risk factors associated with child death has been extensively studied, there appears scanty research on the risk factors associated with early neonatal period.

Methods: We conducted analysis of pooled data sets of 2003, 2008 and 2013 Nigeria Demographic and Health Survey (NDHS). Information was collected from a combined number of 79,953 women aged 15-49 years old. Multiple pregnancies were included and live birth was restricted to the most recent within the five year-period before each survey. Main outcome variables are death within the first day of life (FDM) and death within the first seven days of life (ENND). Risk of death was examined using Cox regression models.

Results: Descriptive statistics indicates that both the first-day mortality rate and early neonatal death rate are highest for newborn delivered to women less than 18 years, unwanted pregnancy, very small babies (<1500 g), born outside of home and hospital, Caesarean delivery and twin babies. Multivariate analyses indicated that twin babies, babies born to via Caesarean section and during the five year period before 2013 survey are the uniform and significant risk factors for both first-day and early neonatal mortality; while receiving less than four antenatal clinic visits, being a male baby and residing in North West are the additional significant risk factors for early neonatal death.

Conclusions: Three factors are the significant predictors of both first-day and early neonatal mortality; Caesarean section, multiple births and year of birth. Reducing first-day deaths and early neonatal deaths will requires improved ANC attendances, quality services during labour and delivery, immediate newborn care and postpartum care; maternal and child health program implementation should also be intensified.