Analytical Assessment of Child Mortality Trends and Determinants in Rural Niger Delta Communities

Under-five mortality in the Niger Delta region of Nigeria is shaped by the intersection of oil economy-related environmental hazards, healthcare infrastructure gaps, and poverty, creating a distinctive epidemiological context that warrants analytical characterisation separate from national trends. This study analytically assessed under-five mortality trends and their determinants in rural Niger Delta communities in Bayelsa, Delta, and Akwa Ibom States. A retrospective community-based analytical study was conducted using birth history data collected from 480 women aged 15 to 49 years, supplemented by facility-based mortality record review and key informant interviews with community health workers and LGA health officers. Cox proportional hazards regression was used to model time-to-death for children born in the preceding ten years, with sociodemographic, environmental, and healthcare utilisation covariates. Results showed an under-five mortality rate of 82 deaths per 1,000 live births, above both the national average and WHO SDG target. Environmental contamination of water sources (attributed to oil spills) was significantly associated with diarrhoea-related mortality (HR 2.3; p < 0.001). Postnatal care non-attendance within 48 hours (HR 3.1; p < 0.001), non-use of bed nets (HR 1.9; p < 0.01), and home delivery (HR 2.4; p < 0.001) were the strongest modifiable determinants. The study provides the first multi-state analytical mortality assessment for rural Niger Delta communities and recommends environmental remediation linkage with child health programming as an integrated approach. Keywords: under-five mortality, child mortality, Niger Delta, environmental health, South South Nigeria