American Journal of Public Health Research, 2015, Vol. 3, No. 4A, 19-26 Available online at http://pubs.sciepub.com/ajphr/3/4A/4 © Science and Education Publishing DOI:10.12691/ajphr-3-4A-4 Surviving the First Day in Nigeria: Risk Factors and Protectors Tukur Dahiru * Department of Community Medicine Ahmadu Bello University Zaria, Nigeria *Corresponding author: tukurdahiru2012@gmail.com Received April 08, 2015; Revised April 29, 2015; Accepted June 26, 2015 Abstract Background: Deaths occurring within the first twenty-four hours of life constitutes a large proportion of child mortality; about 36% of all neonatal deaths took place within the first twenty-fours of delivery globally. Nigeria contributes around 9% of the global first-day mortality. Objectives: To determine the levels and determinants of first-day mortality using the 2013 Nigeria DHS data. Methods: This study utilized the 2013 Nigeria DHS which is a cross-sectional involving a nationally representative sample of 38, 948 women aged 15-49 years. First-day mortality rates were estimated for all births within the past five year prior to the survey and disaggregated by background characteristics and Cox proportional hazard models were generated to assess the relationship between some background characteristics and first-day mortality. Analysis was conducted using Stata v13. Results: The first-day mortality rate was found to be 19 per 1000 live births which was found to be higher among younger aged women, overweight women, babies in Southern part of Nigeria, rural residents, male babies and those babies delivered in health facilities among others. Factors that significantly predict first-day mortality are maternal age of more than 35 years (HR=1.12, 95%CI: 1.01-1.24), residing in Northern Nigeria (HR=1.18, 95%CI: 1.10-1.26), living in rural areas (HR=1.30, 95%CI: 1.22-1.40) and increasing maternal education (HR=1.20, 95%CI: 1.10-1.32). Utilization of at least four ANC visits (HR=0.87, 95%CI: 0.80-0.93) and having postnatal care within 24 hours (HR=094, 95%CI: 0.89-0.99) are all associated with decreased hazard of first-day mortality. Conclusion: First-day mortality rate in Nigeria is high; provision and expansion of both antenatal and postnatal care services particularly in rural areas and northern part of Nigeria will potential contribute in the reduction of first-day mortality. Keywords: First-Day, Child, Mortality, Risk, Nigeria Cite This Article: Tukur Dahiru, “Surviving the First Day in Nigeria: Risk Factors and Protectors.” American Journal of Public Health Research, vol. 3, no. 4A (2015): 19-26. doi: 10.12691/ajphr-3-4A-4. 1. Introduction The global agenda for several decades now has been the emphasis on reducing under-five mortality and to some extent neonatal mortality ignoring the critical and crucial twenty four hours of life described as the most vulnerable period in human life [1-5]. The birth of a child is an event of celebration, but for several parents it is silent grief due to the loss of a precious life that has not been named, documented or properly celebrated. UNICEF estimates that of the 6.9 million under-five deaths in 2013, 16% or 1.05 million deaths occurred among newborn that did not live beyond their first twenty four hours of life; eighty percent of these first-day deaths occur in only two regions of the world: sub-Saharan Africa and South Asia; and that sub-Saharan Africa contributes around 397,000 first-day deaths [6]. Furthermore, four of the ten countries that shoulder 64% (673,200) of the global first-day mortality are in sub-Saharan Africa: Nigeria, DR Congo, Ethiopia and Tanzania, in that order; and among the top twenty countries with the highest first-day mortality rate only Pakistan and Afghanistan are outside of sub-Saharan Africa [6]. Worldwide, two factors are responsible for the largest portion of first-day mortality: complications arising from prematurity and birth complications; these two factors constituting 58% of first-day deaths [7]. However, in sub-Saharan Africa the factors are multitudes ranging from maternal undernutrition, early child marriage, shorter birth interval from low contraceptive use to increase birth intervals, poor skilled attendance at delivery and shortage of skilled health workforce to deliver essential health care [8-20]. In the Nigerian context the situation of child mortality continues to be public health challenge despite great effort to reduce child mortality under the global effort of Millennium Development Goals (MDGs). Efforts under the MDGs in reducing child mortality in Nigeria showed a negligible impact with an annual average reduction of 1.4%, which is not enough to achieve MDG 4 by the deadline [7]. In terms of first-day mortality, the situation is equally gloomy where Nigeria is ranked as the 11 th in terms of first-day mortality rate of 14 per 1000 live births and contributing about 90,000 first-day deaths or 9% of global first-day deaths, second only to India [7]. With huge coverage gaps in the essential maternal, newborn and child health packages with respect to ANC, skilled birth attendance and postnatal care the unacceptable high first- day mortality rate for Nigeria does not come as a surprise.