Executive Summary

This report analyzes the significant disparities in under-five mortality (U5M) within Nigeria, a critical challenge to achieving Sustainable Development Goal 3 (Good Health and Well-being). Nigeria bears the world’s highest U5M burden, contributing 17% of global childhood deaths. This national crisis is driven by severe regional inequalities, undermining SDG 10 (Reduced Inequalities). Using data from the 2018 Nigeria Demographic and Health Survey (n=32,234), this study employs spatial and Blinder-Oaxaca decomposition analyses to quantify the gap in U5M between low-risk regions (LRR) and high-risk regions (HRR). Spatial analysis identifies the North-west and parts of the North-east as mortality hotspots, while the South-west and parts of the South-east are coldspots. Decomposition analysis reveals a U5M prevalence of 11.3% in HRR compared to 6.1% in LRR, a 58.9% higher rate. The findings conclude that targeted interventions focusing on maternal education (SDG 4), economic empowerment (SDG 1), and family planning (SDG 3, SDG 5) in high-risk regions are essential for reducing U5M and advancing Nigeria’s progress towards the 2030 Agenda for Sustainable Development.

1.0 Introduction: The Challenge to Sustainable Development Goal 3 in Nigeria

1.1 Global Context and SDG Target 3.2

Global progress in reducing child mortality has been substantial since 1990; however, the rate of reduction has slowed during the Sustainable Development Goals (SDGs) era. SDG Target 3.2, which aims to end preventable deaths of newborns and children under five years of age by reducing the U5M rate to at least as low as 25 per 1,000 live births, is at risk. An estimated 59 countries, predominantly in sub-Saharan Africa, are projected to miss this target by 2030. The uneven progress highlights persistent inequalities that prevent universal child survival.

1.2 Nigeria’s Under-Five Mortality Crisis

Nigeria represents a critical focal point in the global effort to achieve SDG 3. The nation has the highest absolute number of under-five deaths worldwide, accounting for 835,030 deaths in 2022, or 17% of the global total. This staggering figure underscores the urgency of addressing the root causes of child mortality within the country. The drivers of this crisis are multifaceted and directly linked to several SDGs:

• Limited access to quality healthcare (SDG 3): Inadequate maternal and child health services are a primary contributor.
• Poverty and economic barriers (SDG 1): Financial constraints limit access to timely medical care and proper nutrition.
• Low maternal education (SDG 4): Lack of education is associated with reduced health literacy and poor health-seeking behaviors.
• High unmet need for family planning (SDG 3 & SDG 5): Risky childbearing practices, such as short birth intervals, contribute to poor maternal and child health outcomes.
• Poor environmental conditions (SDG 6): Inadequate access to clean water and sanitation increases exposure to infectious diseases.

1.3 Regional Disparities and the Threat to SDG 10

The national U5M average in Nigeria masks profound sub-national variations, presenting a direct challenge to SDG 10 (Reduced Inequalities). Mortality rates are disproportionately high in specific regions, which significantly inflates the national statistics. For instance, the 2023-24 NDHS key indicators report shows a U5M rate of 140 deaths per 1,000 live births in the North West, compared to 42 in the South West. This study aims to decompose the gap in U5M determinants between these low- and high-risk regions to provide evidence for targeted interventions that can accelerate progress towards the SDGs.

2.0 Methodology

2.1 Data Source and Variables

The analysis utilized cross-sectional data from the 2018 Nigeria Demographic and Health Survey (NDHS), focusing on the birth-recode dataset for children born within the five years preceding the survey.

1. Outcome Variable: Under-five death was the primary outcome, defined as the death of a live-born child before their fifth birthday.
2. Explanatory Variables: Key drivers of U5M were selected based on their relevance to various SDGs, including socioeconomic, bio-demographic, and health-related factors.
3. Regional Classification: Regions with a U5MR below 100 deaths per 1,000 live births were classified as low-risk regions (LRR), while those with 100 or more were designated high-risk regions (HRR).

2.2 Analytical Approach

A multi-stage analytical process was conducted to investigate the regional mortality gap:

• Spatial Analysis: Local Moran’s I statistics were used to identify statistically significant geographic clusters of U5M, mapping hotspots (high-mortality areas) and coldspots (low-mortality areas). This helps visualize the inequality central to SDG 10.
• Decomposition Analysis: The Blinder-Oaxaca decomposition method was employed to quantify the contributions of various determinants to the observed U5M gap between LRR and HRR. This method separates the gap into two components:
  • Endowment Effects: Differences attributable to the distribution of characteristics (e.g., education levels, wealth).
  • Coefficient Effects: Differences attributable to how these characteristics impact health outcomes in each region.

3.0 Key Findings

3.1 Spatial Analysis: Identifying Mortality Hotspots and Coldspots

The spatial distribution of U5M in Nigeria reveals a stark North-South divide, highlighting the geographic inequality that impedes national progress on SDG 3.

• Hotspots (High-High Clusters): The North West and parts of the North East regions were identified as clear hotspots for U5M, with significantly higher mortality rates than the national average. States such as Kebbi, Sokoto, Katsina, and Jigawa are epicenters of this crisis.
• Coldspots (Low-Low Clusters): The South West and parts of the South East and South South regions were identified as coldspots, demonstrating significantly lower U5M rates.

3.2 Decomposition Analysis: Quantifying the Drivers of Inequality

The analysis revealed a significant gap in mortality risk, with the U5M prevalence in HRR (11.3%) being 58.9% higher than in LRR (6.1%). The decomposition of this gap provides critical insights for policy intervention.

1. Explained Gap (Endowments): Approximately 60% of the mortality gap is explained by differences in the distribution of socioeconomic and demographic characteristics. This indicates that if HRR had the same profile as LRR in these areas, the gap would shrink by 60%. The most significant factors include:
   • Mother’s Educational Status (SDG 4): Explained 29.4% of the gap.
   • Household Wealth Quintile (SDG 1): Explained 25.7% of the gap.
   • Family Structure: Explained 19.2% of the gap.
   • Child’s Birth Order: Explained 15.5% of the gap.
   • Mother’s Family Planning Status (SDG 3 & 5): Explained 12.5% of the gap.
2. Unexplained Gap (Coefficients): The remaining 40% of the gap is due to differences in how these factors affect child survival in each region, suggesting contextual and systemic issues like healthcare quality and cultural norms.

4.0 Discussion: Implications for Achieving the SDGs

4.1 Addressing Regional Inequalities (SDG 10)

The findings confirm that Nigeria’s failure to reduce child mortality uniformly is a primary obstacle to achieving SDG 3. The pronounced North-South disparity underscores the need for geographically targeted interventions. Closing this regional gap is not only a health imperative but also a core requirement for fulfilling the pledge of SDG 10 to “leave no one behind.”

4.2 The Role of Socioeconomic Factors (SDG 1, SDG 4, SDG 5)

The strong contribution of maternal education and household wealth to the mortality gap highlights the interconnectedness of the SDGs.

• SDG 4 (Quality Education): Educated mothers are more likely to adopt health-promoting behaviors and utilize healthcare services, leading to better child survival outcomes. Investing in female education in HRR is a powerful, long-term strategy for reducing U5M.
• SDG 1 (No Poverty): Economic empowerment allows households to afford nutritious food, access healthcare, and live in healthier environments. Poverty alleviation programs in HRR are crucial for improving child health.
• SDG 5 (Gender Equality): Empowering women through education and economic opportunity is intrinsically linked to improved child survival.

4.3 The Impact of Health and Demographic Factors (SDG 3)

The significance of family planning uptake and birth spacing reinforces the importance of strengthening health systems, a central tenet of SDG 3. Expanding access to modern, culturally acceptable contraceptive methods in HRR can reduce high-risk pregnancies and subsequent child deaths. Promoting healthy timing and spacing of pregnancies is a cost-effective intervention that directly supports the achievement of SDG Target 3.2.

5.0 Conclusion and Recommendations

5.1 Summary of Findings

This report establishes that the under-five mortality rate in Nigeria’s high-risk regions is more than double that of its low-risk regions. This gap is largely driven by disparities in maternal education, household wealth, family planning use, and birth spacing. These findings demonstrate that achieving national progress on SDG 3 is contingent upon addressing the deep-seated regional inequalities that violate the principles of SDG 10.

5.2 Policy Recommendations for SDG Attainment

To accelerate progress towards SDG Target 3.2 and reduce regional disparities, interventions should be targeted at the identified high-risk regions with a focus on an integrated, multi-sectoral approach:

1. Enhance Female Education (SDG 4 & 5): Implement and scale up programs to increase school enrollment and retention for girls in the North West and North East regions.
2. Strengthen Economic Empowerment (SDG 1): Introduce social protection schemes and livelihood programs targeted at impoverished households to reduce financial barriers to healthcare and nutrition.
3. Expand Access to Family Planning (SDG 3 & 5): Increase investment in family planning services, ensuring the availability of a wide range of contraceptive methods and culturally sensitive counseling to promote healthy birth spacing.
4. Improve Healthcare Access and Quality (SDG 3): Strengthen primary healthcare systems in HRR to ensure consistent access to essential maternal and child health services, including prenatal and postnatal care.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article on under-five mortality (U5M) in Nigeria connects to several Sustainable Development Goals (SDGs) due to the multifaceted nature of child survival, which is influenced by health, poverty, education, and inequality.

1. SDG 3: Good Health and Well-being

   This is the most central SDG addressed. The entire article focuses on under-five mortality, a key health indicator. It directly discusses Nigeria’s failure to meet global child survival targets and analyzes the health-related factors contributing to child deaths, such as “limited access to quality child healthcare,” “delays in seeking care,” and “high unmet need for family planning.”

2. SDG 1: No Poverty

   The article establishes a strong link between economic status and child mortality. It identifies “access to economic resources” and “household poverty” as significant drivers. The analysis uses the “wealth index” and finds that disparities in “household wealth status” contribute significantly to the gap in U5M between high-risk and low-risk regions.

3. SDG 4: Quality Education

   The role of education, particularly for mothers, is highlighted as a critical determinant of child survival. The study concludes that interventions aimed at “enhancing factors like maternal education” could be effective. The decomposition analysis reveals that “mother’s educational status” explains the largest part of the disparity (29.4%) in U5M between different regions.

4. SDG 5: Gender Equality

   This goal is relevant through its focus on women’s health and empowerment. The article emphasizes the importance of “family planning uptake” and addressing the “high unmet need for family planning.” These elements are crucial for empowering women to make informed decisions about their reproductive health, which in turn impacts child survival through factors like birth spacing.

5. SDG 6: Clean Water and Sanitation

   The article mentions environmental factors that contribute to child mortality, including “poor sanitation, and inadequate access to clean water.” It notes that these conditions “contribute to child mortality by increasing exposure to poor nutrition and infectious diseases.”

6. SDG 10: Reduced Inequalities

   A primary focus of the study is the stark inequality in child mortality within Nigeria. The article quantifies the “gaps in U5M between the country’s low-risk regions (LRR) and high-risk regions (HRR)” and highlights the “huge sub-national variations.” The spatial analysis identifies “hotspots” and “coldspots,” directly addressing the issue of geographic and socioeconomic inequality in health outcomes.

2. What specific targets under those SDGs can be identified based on the article’s content?

The article’s discussion allows for the identification of several specific SDG targets:

• Target 3.2: End preventable deaths of newborns and children under 5 years of age.

  This target is explicitly mentioned in the article: “…progress towards attaining the SDG target 3.2, which aims for reduction of under-five mortality rate (U5MR) to at least 25 deaths per 1,000 live births across the world’s regions…” The entire study is framed around Nigeria’s high U5M rate and the country’s struggle to meet this specific target.

• Target 3.7: Ensure universal access to sexual and reproductive health-care services.

  The article points to the “high unmet need for family planning” and identifies “family planning uptake” as a significant factor in explaining mortality gaps. This directly relates to ensuring access to family planning services, a core component of this target.

• Target 1.2: Reduce at least by half the proportion of men, women and children of all ages living in poverty.

  The analysis consistently refers to “household poverty” and uses the “household’s wealth quintile” as a key variable. The finding that wealth status is a major driver of the U5M gap connects the issue directly to the goal of poverty reduction.

• Target 4.1: Ensure that all girls and boys complete free, equitable and quality primary and secondary education.

  The study’s conclusion that “maternal education” is a primary factor in reducing child mortality supports this target. The decomposition analysis shows that a significant portion of the mortality gap is explained by disparities in mothers having “primary education” or “secondary+ education,” underscoring the importance of educational attainment for women.

• Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights.

  Similar to Target 3.7, the emphasis on “family planning uptake” and “contraceptive use” as interventions to improve child survival by enabling “healthy timing and spacing of pregnancy” aligns perfectly with this target’s goal of ensuring reproductive rights and access to relevant services.

• Target 10.2: Empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.

  The study’s core objective is to analyze and explain the deep inequalities in child survival based on geographic location (“low-risk regions” vs. “high-risk regions”). By decomposing the “LRR-HRR gap in under-five mortality risks,” the article directly addresses the need to reduce inequalities in life-or-death outcomes for children based on where they are born.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions or implies several official SDG indicators used to measure progress:

• Indicator 3.2.1: Under-five mortality rate (U5MR).

  This is the primary indicator used throughout the article. It is explicitly defined and measured as “deaths per 1,000 live births.” The text provides numerous data points for this indicator, such as the global rate (37/1000 in 2022), the rate in Nigeria’s South West (42/1000), and the North West (140/1000).

• Indicator 3.7.1: Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods.

  This indicator is implied through the discussion of “family planning uptake,” “unmet need for family planning,” and “contraceptive use.” The analysis identifies these as key variables that differ significantly between high-risk and low-risk regions, suggesting their importance in measurement.

• Indicator 1.2.1: Proportion of population living below the national poverty line, by sex and age.

  The article implies this indicator by using the “household wealth status” and “wealth quintile” as a proxy for economic well-being. The finding that these factors significantly contribute to the U5M gap shows that tracking household wealth is a way to measure progress on poverty-related health outcomes.

• Indicator 4.1.1: Proportion of children and young people achieving a minimum proficiency level in reading and mathematics.

  While not a direct measure, the article’s use of “maternal educational attainment” (categorized as no education, primary, and secondary+) serves as a proxy for the outcomes of the education system. It measures the level of education achieved, which is a fundamental prerequisite for proficiency.

• Indicator 6.1.1: Proportion of population using safely managed drinking water services.

  This is implied when the article mentions “households with improved drinking water” as a characteristic more common in low-risk regions and “inadequate access to clean water” as a risk factor.

• Indicator 10.2.1: Proportion of people living below 50 per cent of median income, by age, sex and persons with disabilities.

  The article’s entire methodology of comparing outcomes between different geographical and socioeconomic groups (LRR vs. HRR, wealth quintiles) is a practical application of measuring inequality. The disaggregation of the U5MR by region is a powerful indicator of health inequality, which is a core component of SDG 10.

4. Table of SDGs, Targets, and Indicators

Source: nature.com