Geographic and socioeconomic inequalities in the survival of children under-five in Nigeria.

Despite a substantial decline in child mortality globally, the high rate of under-five mortality in Nigeria is still one of the main public health concerns. This study investigates inequalities in geographic and socioeconomic factors influencing survival time of children under-five in Nigeria. This is a retrospective cross-sectional quantitative study design that used the latest Nigeria Demographic Health Survey (2018). Kaplan-Meier survival estimates, Log-rank test statistics, and the Cox proportional hazards were used to assess the geographic and socioeconomic differences in the survival of children under-five in Nigeria. The Kaplan-Meier survival estimates show most under-five mortality occur within 12 months after birth with the poorest families most at risk of under-five mortality while the richest families are the least affected across the geographic zones and household wealth index quintiles. The Cox proportional hazard regression model results indicate that children born to fathers with no formal education (HR: 1.360; 95% CI 1.133-1.631), primary education (HR: 1.279; 95% CI 1.056-1.550) and secondary education (HR: 1.204; 95% CI 1.020-1.421) had higher risk of under-five mortality compared to children born to fathers with tertiary education. Moreover, under-five mortality was higher in children born to mothers' age ≤ 19 at first birth (HR: 1.144; 95% CI 1.041-1.258). Of the six geopolitical zones, children born to mothers living in the North-West region of Nigeria had 63.4% (HR 1.634; 95% CI 1.238-2.156) higher risk of under-five mortality than children born to mothers in the South West region of Nigeria. There is a need to focus intervention on the critical survival time of 12 months after birth for the under-five mortality reduction. Increased formal education and target interventions in geopolitical zones especially the North West, North East and North Central are vital towards achieving reduction of under-five mortality in Nigeria.