Socio-ecological Determinants of Under-five Mortality in Nigeria: Exploring the Interaction Effects of Neighbourhood Poverty and Solid Cooking Fuel

Abstract Background: In the context of global child health priority, under-five mortality remains considerably high with the current rate of 132 deaths per 1,000 live births in Nigeria, which translates to 1 in 8 children dying before his or her fifth birthday. This has been attributed to exposure of children to household air pollution due to environmental context and inefficient cooking practices. Therefore, this study examined the interaction effects of neighbourhood poverty and use of solid cooking fuels on under-five mortality in Nigeria.Methods: Data for the study were drawn from the 2018 Nigeria Demographic and Health Survey and covered a weighted sample of 124,442 birth history of childbearing women who reported using cooking fuels in kitchens located within the house. Descriptive and analytical analyses were carried out, including frequency tables, Pearson’s chi-square test, and multivariate using Cox proportional regression model.Results: The findings of this study showed that the risks of under-five mortality were significantly higher for children whose mothers were found in the areas of high neighbourhood poverty (HR: 1.44, CI: 1.34-1.54) and those whose mothers reported using solid cooking fuels within the house (HR: 2.26, CI: 2.06-2.49). The results further showed that the risks of death significantly reduced for children whose mothers had secondary or tertiary education (HR: 0.82, CI: 0.75-0.90) and children of mothers whose partners had at least primary education, but increased for children of mothers who were rural residents (HR: 1.25, CI: 1.16-1.35); and those found in the North-east (HR: 1.31, CI: 1.18-1.46) and North-west (HR: 1.84, CI: 1.68-2.02), compared with those in the reference categories. Conclusion: The risks of under-five mortality are significantly linked to areas of high neighbourhood poverty and use of solid cooking fuels in kitchens located within the house in Nigeria. There is the need for more pragmatic strategies to re-educate people, especially mothers on the need to use clean cooking fuels from the little resources they have to reduce the children’s exposure to harmful emissions within the house.