Socio-ecological determinants of under-five mortality in Nigeria: exploring the roles of neighbourhood poverty and use of solid cooking fuel

Cooking or heating with solid fuels increased the all-cause mortality risk among mid-aged and elderly People in China

BACKGROUND

Our study aimed to explore the associations between solid fuels burning for either heating or cooking and all-cause mortality based on 2859 participants from the China Health and Retirement Longitudinal Study during 2011-2018.

METHODS

Logistic regression models were performed to estimate the risk for all-cause mortality between different types of fuels in the current longitudinal study. Furthermore, the combined impacts of applying solid fuels for both cooking and heating and the effect among those who switched types of fuels in cooking or heating during follow-up were also analyzed. Interaction and stratification analysis by covariables was applied further to explore the relationship between fuel burning and all-cause mortality.

RESULTS

After full-adjustment, usage of solid fuels was associated with higher all-cause mortality (for heating: OR = 1.93, 95% CI = 1.25, 3.00; for cooking: OR = 1.76, 95% CI = 1.10, 2.82). Using solid fuels for both cooking and heating (OR = 2.36; 95% CI, 1.38, 4.03) was associated with a higher risk of all-cause mortality, while using solid fuels with a single purpose was not (OR = 1.52; 95% CI, 0.90, 2.55). Protective tendencies were detected in switching solid to clean fuel for cooking (OR = 0.62; 95% CI, 0.32, 1.17) and heating (OR = 0.62; 95% CI, 0.35, 1.10).

CONCLUSION

Either cooking or heating with solid fuels increases the risk of all-cause mortality among Chinese mid-aged and aging people in the urban area of China.

The impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of under-five mortality in Nigeria: a cross-sectional study

Background

Despite the progress in reducing under-five mortality (U-5 M) in recent years, these deaths remain considerably high in Nigeria. This could be attributed to poor health policies including inequality of health insurance coverage and access to adequate healthcare services utilisations which has remained inimical to achieving sustainable development goals (SDGs). Therefore, this study examined the impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of U-5 M in Nigeria.

Methods

The data for the study were derived from the 2018 Nigeria Demographic and Health Survey and comprised a weighted sample of 127,545 birth histories of childbearing women. Descriptive and analytical analyses were carried out, including frequency tables and multivariate using Cox proportional regression. The results were presented as hazard ratios (HR) with 95% confidence intervals (CIs). Data were analyzed using Stata software version 15.1.

Results

The results showed that 14.3% of the sampled birth histories of the childbearing women were children who died before age 5. The results further showed that 97.7% of the children were of mothers who have health insurance and over one-half (56.5%) were children whose mothers had adequate healthcare services utilisation. The risk of under-five death was significantly lower among the children of mothers who were covered by health insurance (HR: 0.66, CI: 0.42–1.02) and those whose mothers utilised adequate healthcare services (HR: 0.78, CI: 0.68–0.90). A similar result was observed among children whose mothers reported that distance to the health facility was not a problem (HR: 0.81, CI: 0.72–0.86). Some mothers’ characteristics including educational attainment, wealth quintile and region of residence significantly influenced the risk of U-5 M.

Conclusions

The study established that maternal health insurance coverage and adequate healthcare services utilisation were found to be protective factors against the risk of U-5 M. Also, the revealed low health insurance coverage of mothers calls for more pragmatic policy and intervention programmes through health insurance to achieve SDGs targets of ending preventable deaths of children under 5 years of age and ensuring quality, as well as universal access to maternal and child healthcare services.