Examining the determinants of under-five mortality in Nigeria, Sierra Leone, and Guinea: a comparative study

Abstract

Background: West Africa is one of the regions that still battles with a high rate of Under-five mortality, which exceeds the global target. Global under-five mortality has declined to 37 deaths per 1,000 live births; however, countries such as Sierra Leone, Nigeria, and Guinea reported the highest levels, ranging from 111 to 96 deaths per 1,000 live births. Hence, the need to examine factors associated with underfive mortality in Nigeria, Sierra Leone, and Guinea Methods: The study used secondary data extracted from the 2018 Nigeria Demographic and Health Survey , 2019 Sierra Leone Demographic and Health Survey, and 2018 Guinea Demographic and Health Surbey. The study population consisted of women aged 15-49 who had given birth within the five years preceding each survey and were distributed as follows: 29,949 in Nigeria, 11,457 in Sierra Leone, and 7,689 in Guinea. Brass children ever born and children surviving method was used to estimate under-five mortality rate. The Chi-square test and logistic regression modelling were employed to explore the relationship between social and demographic factors and under-five mortality in the three countries. Results: The study estimated that Nigeria recorded 146 deaths per 1,000 live births, followed by 140 in Sierra Leone and 118 in Guinea. The results of logistic regression indicate that for Sierra Leone maternal age, sex of child, preceding birth interval and maternal education were significantly related to under-five mortality. For Nigeria, logistic regression indicates that sex of child, preceding birth interval, wealth index combined, place of delivery, and source of drinking water were significantly related to under five mortality. For Guinea, logistic regression shows that preceding birth interval, breastfeeding, education, wealth index combined were significantly related to child mortality. The results further show a strong statistical relationship between under-five mortality, preceding birth intervals, and maternal education. Children who are born after longer birth intervals and those whose mothers had higher education levels were less likely to die before age five. However, the maternal education was stronger in Nigeria than in Sierra Leone and Guinea. Conclusion and recommendations: To accelerate progress towards SDG 3.2 on child survival, this analysis recommends a multi-pronged approach. Key priorities include strengthening health systems to ensure equitable, quality care for all mothers, regardless of education or wealth, through investment in facilities, staff, and regulation. This must be coupled with targeted community-based support, including family planning services to promote healthy birth intervals and focused care for vulnerable populations such as young, old, poor and uneducated women. Furthermore, future interventions must address underlying socioeconomic conditions by improving access to clean water, tackling urban slum conditions, and strengthening social safety nets to protect the most vulnerable families from poverty.