SUB-NATIONAL DISPARITIES IN UNDER-FIVE MORTALITY IN NIGERIA: AN ELEVEN-FOLD GAP AND ITS CORRELATES

Abstract

Nigeria's national under-5 mortality rate (U5MR) of 110 per 1000 live births conceals substantial sub-national variation, and disaggregated evidence is needed to target Nigeria's child survival programmes effectively. This study used state-level indicators from the 2023-24 Nigeria Demographic and Health Survey to quantify inter-state disparities in U5MR and their association with birth registration coverage and fertility, using independent-samples t-tests and Pearson correlations with states as the unit of analysis. U5MR ranged from 14 per 1000 live births in Kwara State to 161 per 1000 in Jigawa State, an 11.5-fold gap. Northern states had significantly higher mean U5MR than southern states (110.2 vs. 53.2 per 1000; P < 0.001) and lower birth registration coverage (32.7% vs. 61.6%; P < 0.001). U5MR correlated positively with total fertility rate (r = 0.83) and negatively with birth registration coverage (r = -0.66; both P < 0.001). Fieldwork was not completed in 20 of 1400 sampled clusters across seven states because of insecurity, likely understating mortality in the highest-risk areas. Nigeria's child survival crisis is geographically concentrated in the north and closely tied to low civil registration and high fertility. Disaggregated, state-specific programming is needed to accelerate progress toward the SDG 3.2 target of 25 per 1000 live births, prioritising: (i) intensified primary health care delivery in the North West and North East zones; and (ii) parallel investment in civil registration and family planning to address the two strongest correlates of the gap identified here.