Infant mortality remains a pressing public health issue, especially in low- and middle-income countries such as Nigeria. Defined as the number of infants who die before reaching their first birthday per 1,000 live births in a year, the infant mortality rate (IMR) serves as a critical indicator of a nation's health and socio-economic development. Globally, significant progress has been made in reducing infant deaths, with the IMR declining from 65 deaths per 1,000 live births in 1990 to 27.4 in 2020. However, in sub-Saharan Africa, the burden remains disproportionately high, with an average IMR of 50.2 deaths in 2020. Alarmingly, Nigeria recorded an IMR of 72.2 deaths per 1,000 live births in the same year, far exceeding the global average. In 2019 alone, Nigeria accounted for an estimated 548,116 infant deaths, representing 28% of all infant deaths in sub-Saharan Africa.
The slow progress in reducing Nigeria's IMR raises concerns, particularly when compared to countries like South Africa, Kenya, and Ghana, which have made significant strides toward achieving the Sustainable Development Goal (SDG) 3.2 of reducing under-five mortality to at least 25 per 1,000 live births by 2030. Despite being one of Africa's largest economies, with a GDP of $448 billion in 2019, Nigeria struggles with high infant mortality rates. Researchers have sought to understand the multifaceted factors driving these statistics through a systematic scoping review.
The review identified a range of factors influencing infant mortality in Nigeria, categorized using the socio-ecological model. This framework highlights the interplay between individual, interpersonal, organizational, community, and public policy levels. At the individual level, maternal and child-related factors significantly contribute to infant mortality. Poor maternal health, inadequate prenatal care, and limited access to skilled birth attendants were found to be key determinants. Furthermore, low levels of maternal education and poor nutritional status during pregnancy exacerbate the risks of adverse birth outcomes. Infant-specific factors, such as low birth weight and prematurity, also play a significant role in neonatal and post-neonatal mortality.
At the interpersonal level, socio-economic and sociocultural factors are critical. Poverty remains a pervasive issue, with many families unable to afford healthcare services or proper nutrition for their children. Cultural practices, such as home births without skilled attendants and reliance on traditional medicine, further contribute to poor health outcomes. The lack of awareness and education about child health and nutrition within families also perpetuates the cycle of infant mortality.
The organizational level focuses on the healthcare system's role in addressing infant mortality. Nigeria's health system faces numerous challenges, including inadequate health infrastructure, insufficient healthcare personnel, and limited access to essential medicines and equipment. The unequal distribution of healthcare facilities, with rural areas often underserved, exacerbates these issues. Moreover, delays in seeking care, reaching healthcare facilities, and receiving quality treatment (as outlined in the three-delay model) contribute significantly to neonatal and infant deaths.
At the community level, environmental and housing conditions play a significant role. Poor sanitation, lack of clean drinking water, and inadequate waste management increase the risk of infectious diseases, such as diarrhea and respiratory infections, which are leading causes of infant mortality. Housing conditions, such as overcrowding and poor ventilation, further expose infants to health risks. Community-level factors also include the availability and accessibility of healthcare services. In many rural areas, the nearest healthcare facility may be several kilometers away, discouraging families from seeking timely medical attention.
Finally, at the public policy level, governmental factors influence infant mortality rates. Policies related to healthcare funding, maternal and child health programs, and social welfare significantly impact infant health outcomes. Despite various government initiatives to reduce infant mortality, such as immunization programs and maternal health campaigns, inadequate implementation and monitoring often hinder their effectiveness. Corruption, mismanagement of resources, and a lack of political will further undermine these efforts.
Several studies have sought to identify specific predictors of infant mortality in Nigeria. One conceptual framework categorizes risk factors into personal, community, and societal levels. Personal factors include maternal sociodemographic characteristics, such as age, education, and income, as well as medical factors like antenatal care and delivery practices. Community-level factors encompass the availability of healthcare facilities, urbanization, and poverty rates. Societal factors include government policies, healthcare expenditure, and social welfare programs. Another model, the three-delay framework, emphasizes delays in seeking care, reaching healthcare facilities, and receiving adequate treatment as critical contributors to neonatal mortality.
The literature also highlights the role of maternal health and well-being in determining infant mortality outcomes. Maternal education and employment status significantly impact a child's survival chances, as educated and employed mothers are more likely to access healthcare services and provide proper nutrition for their children. Similarly, the quality of prenatal and postnatal care received by mothers plays a crucial role in reducing infant mortality.
Environmental factors, such as access to clean water and proper sanitation, are also critical. Infants in households with poor water and sanitation facilities are more likely to suffer from diarrhea and other waterborne diseases, increasing their risk of death. In addition, exposure to environmental pollutants, such as smoke from cooking fuels, poses significant health risks to infants, particularly in rural and low-income communities.
The scoping review also emphasizes the need for targeted interventions to address the specific challenges faced by Nigeria in reducing infant mortality. Strengthening the healthcare system by increasing funding, improving infrastructure, and ensuring equitable access to healthcare services is essential. Policies aimed at improving maternal education and economic empowerment can also have a significant impact on infant health outcomes. Community-based interventions, such as health education campaigns and the promotion of safe delivery practices, can help address cultural and social barriers to accessing healthcare.
Addressing Nigeria's high infant mortality rate requires a multi-faceted approach that considers the complex interplay of individual, interpersonal, organizational, community, and policy-level factors. While progress has been made in reducing global infant mortality, Nigeria's slow decline highlights the need for concerted efforts to tackle the underlying determinants of poor infant health outcomes. By addressing these factors through evidence-based interventions and policies, Nigeria can make significant strides toward achieving the SDG target of reducing under-five mortality and improving the health and well-being of its youngest citizens.
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