Adeyinka Daniel Adedayo, Muhajarine Nazeem
Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, SK, Canada.
Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
J Biosoc Sci. 2024 Mar;56(2):357-375. doi: 10.1017/S0021932023000305. Epub 2023 Dec 14.
While social determinants of health have been perennially linked to child survival in resource-limited countries, the precise and tested pathways to effect are not clearly understood. The objective of this study was therefore to identify the critical pathways as posited a priori in a model through which social factors (at maternal, household, and community levels) determine neonatal, infant, and under-five mortalities in Nigeria. Using a novel analytic approach (hierarchical path modelling for predicting accelerated failure time) to estimate (in)direct and total effects of social determinants of child survival, we analysed 30,960 live births (weighted data for representativeness), obtained from the 2016/2017 Nigeria Multiple Indicator Cluster Survey. There were three outcome variables: time until occurrence of neonatal, infant, and under-five mortalities. The independent variables were layered factors related to child, maternal, household and community. Geographical region, rurality of residence, infrastructural development, maternal education, contraceptive use, marital status, and maternal age at birth were found to operate more indirectly on neonatal, infant, and under-five survival. Child survival is due to direct effects of child's sex (female), gestational type (singleton), birth spacing (children whose mothers delivered at least two years apart), and maternal age at delivery (20-34 years). According to the path coefficients, the indirect effects of geographical regions are the most influential determinants of child survival, accounting for 30% (neonatal), 37.1% (infant) and 39.9% (under-five) of the total effects. This study offers comprehensive set of factors, and linked pathways, at the maternal, household, and community levels that are associated with child survival in Nigeria. To accelerate progress towards Sustainable Development Goal targets for child survival and reduce geographical inequities, stakeholders should implement more impactful policies that promote maternal education, contraceptive use and improve living conditions of women (especially in rural areas of northern Nigeria). Future research should focus on identifying the most effective interventions for addressing these social determinants of child survival in Nigeria.
在资源有限的国家，健康的社会决定因素一直与儿童生存息息相关，但影响儿童生存的精确且经过验证的途径尚不清楚。因此，本研究的目的是确定一个模型中预先设定的关键途径，通过该途径社会因素（在母亲、家庭和社区层面）决定尼日利亚新生儿、婴儿和五岁以下儿童的死亡率。我们采用一种新颖的分析方法（用于预测加速失效时间的分层路径建模）来估计儿童生存社会决定因素的（直接和间接）效应及总效应，分析了从2016/2017年尼日利亚多指标类集调查中获得的30960例活产（为代表性进行加权的数据）。有三个结局变量：新生儿、婴儿和五岁以下儿童死亡发生的时间。自变量是与儿童、母亲、家庭和社区相关的分层因素。研究发现，地理区域、居住的农村性质、基础设施发展、母亲教育程度、避孕措施使用、婚姻状况和母亲生育年龄对新生儿、婴儿和五岁以下儿童生存的影响较为间接。儿童生存归因于儿童性别（女性）、妊娠类型（单胎）、生育间隔（母亲生育间隔至少两年的儿童）和母亲分娩年龄（20 - 34岁）的直接影响。根据路径系数，地理区域的间接效应是儿童生存最具影响力的决定因素，分别占总效应的30%（新生儿）、37.1%（婴儿）和39.9%（五岁以下儿童）。本研究提供了一套全面的因素以及在母亲、家庭和社区层面与尼日利亚儿童生存相关的关联途径。为加快实现儿童生存可持续发展目标并减少地理不平等，利益相关者应实施更具影响力的政策，促进母亲教育、避孕措施使用并改善妇女生活条件（特别是在尼日利亚北部农村地区）。未来研究应侧重于确定解决尼日利亚儿童生存这些社会决定因素的最有效干预措施。
