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Open Access Highly Accessed Research article

Determinants of neonatal mortality in Nigeria: evidence from the 2008 demographic and health survey

Osita Kingsley Ezeh1*, Kingsley Emwinyore Agho1, Michael John Dibley2, John Hall3 and Andrew Nicholas Page1

Author Affiliations

1 School of Science and Health, University of Western Sydney, Locked Bag 1797, Penrith, New South Wales (NSW) 2571, Australia

2 Sydney School of Public Health, Edward Ford Building (A27), University of Sydney, Sydney, NSW 2006, Australia

3 School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW 2308, Australia

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BMC Public Health 2014, 14:521  doi:10.1186/1471-2458-14-521

Published: 29 May 2014



Nigeria continues to have one of the highest rates of neonatal deaths in Africa. This study aimed to identify risk factors associated with neonatal death in Nigeria using the 2008 Nigeria Demographic and Health Survey (NDHS).


Neonatal deaths of all singleton live-born infants between 2003 and 2008 were extracted from the 2008 NDHS. The 2008 NDHS was a multi-stage cluster sample survey of 36,298 households. Of these households, survival information of 27,147 singleton live-borns was obtained, including 996 cases of neonatal mortality. The risk of death was adjusted for confounders relating to individual, household, and community level factors using Cox regression.


Multivariable analyses indicated that a higher birth order of newborns with a short birth interval ≤ 2 years (hazard ratio [HR] = 2.19, confidence interval [CI]: 1.68–2.84) and newborns with a higher birth order with a longer birth interval > 2 years (HR = 1.36, CI: 1.05–1.78) were significantly associated with neonatal mortality. Other significant factors that affected neonatal deaths included neonates born to mothers younger than 20 years (HR = 4.07, CI: 2.83–5.86), neonates born to mothers residing in rural areas compared with urban residents (HR = 1.26, CI: 1.03–1.55), male neonates (HR = 1.30, CI: 1.12–1.53), mothers who perceived their neonate’s body size to be smaller than the average size (HR = 2.10, CI: 1.77–2.50), and mothers who delivered their neonates by caesarean section (HR = 2.80, CI: 1.84–4.25).


Our study suggests that the Nigerian government needs to invest more in the healthcare system to ensure quality care for women and newborns. Community-based intervention is also required and should focus on child spacing, childbearing at a younger age, and poverty eradication programs, particularly in rural areas, to reduce avoidable neonatal deaths in Nigeria.

Determinants; Neonatal mortality; Cox regression; Nigeria