Background: Nigeria�s efforts to reduce under-five mortality has been biased in favour of childhood mortality to\nthe neglect of neonates and as such the literature is short of adequate information on the determinants of neonatal\nmortality. Whereas studies have shown that about half of infant deaths occur in the neonatal period. Knowledge of\nthe determinants of neonatal mortality are essential for the design of intervention programes that will enhance\nneonatal survival. Therefore, this study was conducted to investigate the trends and factors associated with neonatal\nmortality in Nigeria.\nMethods: This was a retrospective analysis of the reproductive history data collected in the Nigeria Demographic\nand Health Surveys (NDHS) for 1990, 2003, 2008 and 2013. Neonatal mortality rates were estimated as the\nprobability of dying before 28 completed days using synthetic cohort life table techniques. Univariate and multiple\nCox proportional hazards regression models were used to explore the effects of selected maternal and bio-demographic\nvariables on neonatal mortality. The Hazard Ratio (HR) and its 95% Confidence Interval (CI) were estimated to prioritize\nobtained significant factors.\nResults: Nigeria neonatal mortality rate stagnated at 41 per 1000 live births between 1990 and 2013. There\nwere rural-urban and regional differences with more deaths occurring in rural areas and northern regions. In\n1990, antenatal care (HR = 0.76; CI = 0.61-0.95), facility delivery (HR = 0.69; CI = 0.53-0.90) and births interval less\nthan 24 months (HR = 1.67; CI = 1.41-1.98) were significantly associated with neonatal deaths. Factors identified\nfrom the 2013 data were antenatal care (HR = 0.76; CI = 0.61-0.95), birth interval less than 24 months (HR = 1.67;\nCI = 1.41-1.98), delivery at health facility (HR = 0.69; CI = 0.53-0.90), and small birth size (HR = 1.72; CI = 1.39-2.14).\nConclusion: There was little improvement in neonatal survival in Nigeria between 1990 and 2013. Bio-demographic\nand health care related characteristics are significant determinants of neonatal survival. Family planning should be\nintensified while government should improve the quality of maternal and child health services to enhance the\nsurvival of neonates.
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