Risk factors for infant mortality in a rural community in Nigeria.

In this prospective community based study, information on births and deaths was collected for five consecutive years (1993-1997) by trained village health workers (VHW) and traditional birth attendants (TBA). The main objective was to identify factors which are associated with infant deaths in a typical rural community in southwestern Nigeria with a current mid-year population of 3,308. Infant mortality rate was found to be 68.2 per 1,000 live births and is lower than the national rate but higher than the regional rate. Neonatal deaths, with a rate of 37.6 per 1,000 live births, accounted for 55.1% of all infant deaths while postneonatal deaths accounted for 44.9% of the deaths. Twelve (44.4%) of all neonatal deaths (27) occurred within 24 h of delivery while 20 (74.1%) of all neonatal deaths occurred in the first week of life and were perinatal deaths. These high perinatal rates indicate that more efficient obstetric and public health services are needed in the community. First birth order and older mothers (> 34 years) at time of death of infant were associated with significantly higher risk for mortality in this village (p = 0.004). Females were twice as likely as males to die in infancy (p = 0.011), a finding which is contrary to what is generally found; there is a need for further studies to exclude gender discrimination in this village. Significantly more neonatal deaths occurred during the rainy season than in the dry season (p = 0.018) suggesting that environmental factors play a role in neonatal deaths. In the neonatal period, the commonest cause of death was due to complications of low birth weight while in the postneonatal period it was due to infection. VHWs and TBAs are good resource persons for obtaining accurate numerical data at the grass-roots level, and the potential of using their services to collect vital but non-existent statistics should be explored. These workers also need to be trained to recognise factors that put infants at risk. Reassessment of preventive strategies already implemented for reducing infant mortality may be required in order to further reduce the infant mortality rate in this community.