Ethnic disparities in child health in Nigeria: a multilevel analysis of individual and contextual factors Available to Purchase

Each ethnic group has its own peculiar cultural practices that may widen inequalities in child health and survival among ethnic groups. This study estimated ethnic disparities in mortality of under‐five‐year‐olds, controlling for individual and community level characteristics. Using multilevel multivariable regression analysis on a nationally representative sample drawn from 7,864 households in the 2003 Nigeria Demographic and Health Survey, we estimated the risks of deaths under‐five‐year‐olds for 6,029 children nested within 2,735 mothers aged 15‐49 years old, who were in turn nested within 365 communities. Results were expressed as odds ratios with 95% confidence intervals. The observed risk of under‐five death was highest among children of Hausa/Fulani/Kanuri mothers and lowest among children of Yoruba mothers. The mother's affiliation to the Yoruba ethnic group, compared to Hausa/Fulani/Kanuri, was still significantly associated with decreased under‐five mortality (OR = 0.66, 95% CI = 0.45 ‐ 0.96) after adjustment for individual and community level factors. Under‐five mortality was significantly related to socio‐economic and demographic factors (birth order/birth interval, mother's age, and mother's education), which explained much but not all of the ethnic disparities. Findings underscore the need for measures aimed at improving female education and the socio‐economic standard of women, changing short birth spacing norms and reducing inequitable distribution of maternal and child health services.