In 2019, Nigeria outpaced India as the world’s leading contributor to deaths of children under the age of five. Ever since then, the country has maintained a top spot among nations without the enabling environment for child health.
Due to years of government neglect and underinvestment in healthcare, children born in Nigeria have a 152 percent chance of dying before five than children born in the Gaza Strip of the State of Palestine, where fully-blown armed conflict is unfolding, data show.
Nigeria has an under-five mortality rate of 110.8 per 1,000 live births, according to data from the United Nations Children’s Fund (UNICEF).
This rate is worse than tumultuous countries such as Syria (22.3), Sudan (54.9), Iraq (24.5), Ukraine (8.2) Afghanistan (55.7), and Yemen (61.9).
Infants, in particular, bear the brunt of this healthcare crisis as many hardly live to see their first birthday.
Hafsat Hassan, a student in Abuja, is still haunted by the memory of her brother, who died from malaria at the age of two.
“I still remember how my baby brother died. He fell asleep and never woke up. He was throwing up, and when we went to the hospital, we were told it was malaria. He took the prescribed drugs for two days but died,” she recounted.
Hassan’s story is one of countless others which reflect the bitter realities of today’s Nigeria.
Just recently, Muyi Aina, executive director of the National Primary Healthcare Development Agency, disclosed that Nigeria still loses about 2,300 under-five children and 145 women daily.
These preventable deaths expose a nationwide public health crisis dominant across the country, highlighting the toll of lack of investment on Nigeria’s most vulnerable citizens.
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Rising infant, maternal deaths
According to the United Nations Children’s Fund (UNICEF), while Nigeria accounts for less than 2.5 percent of the world’s population, it represents 10 percent of the global burden of infant, child, and maternal mortality.
An analysis of the 2021 Multiple Indicator Cluster Survey (MICS) and National Immunization Coverage (NICS), as well as a 2023 report by the Nigerian Economic Summit Group, revealed that states like Zamfara, Bauchi, Sokoto, Kebbi, and Jigawa have some of the worst health outcomes. Many of these states have failed to access the Basic Healthcare Provision Fund (BHCPF), exacerbating their healthcare challenges.
Sokoto has the highest under-five mortality and infant mortality at 202 deaths per 1,000 live births and 104 deaths per 1, 000 live births respectively.
Other states with alarming death rates include Jigawa (175 and 95 per 1,000 live births) and Kebbi (179 and 95 per 1000 live births). In Borno, Zamfara and Bauchi, rates are similarly high. Nationally, Nigeria had the third-highest infant and child mortality rates globally in 2021, with 111 deaths per 1,000 live births, according to a World Bank report.
Causes of infant, maternal deaths
The World Health Organization (WHO) attributes the leading causes of infant mortality in Nigeria to neonatal disorders, malaria, diarrhea, acute respiratory infections, preterm complications, and malnutrition.
Malnutrition alone is a factor in 50 percent of child deaths. Additional factors include: poor access to quality healthcare, lack of prenatal care, and limited child health services.
According to the WHO, maternal and child health are critical indicators of a nation’s overall well-being and the government’s commitment to its citizens’ welfare.
Ekanem Ekure, president of the Paediatric Association of Nigeria (PAN), observed that Nigeria has recorded significant growth in the survival of children compared to the 1990s through efforts to tackle the leading causes of childhood deaths.
However, an unacceptably high proportion of Nigerian children have also become impoverished as poverty levels rise, leading to starvation and poor living conditions for many families, Ekure said.
She explained that pediatricians are increasingly noting a gradual return of severe cases of malnutrition to hospitals and the re-emergence of previously controlled infectious diseases such as measles, diphtheria and cholera.
“PAN is not oblivious of the economic difficulties the country is currently battling with. The pattern of distribution of essential food commodities such as reliefs to families need to be reviewed to prevent the ‘middleman’ effect, which still makes the food commodities unavailable to the desired end-consumers,” Ekure said in an address on Nigeria’s 64th independence anniversary.
Many under-five deaths result from easily treatable or preventable conditions, yet for many families, accessing even basic healthcare is a challenge. In rural communities, where nearly half of the population reside, healthcare centres are often ill-equipped, understaffed, and located too far away to provide timely intervention.
Read also: Out-of-school children projects raise hope as focus shifts to underserved communities
Underinvestment is a problem
BusinessDay analysis shows that chronic underinvestment in the healthcare sector has fostered conditions that perpetuate high infant and child mortality. States that fail to access and utilise the BHCPF, which is designed for primary healthcare delivery, experience higher maternal, infant, and child mortality rates, along with low immunisation coverage and widespread malnutrition.
The ONE Campaign, a global advocacy group, specifically identified Zamfara as the worst state for healthcare access in Nigeria, while the Federal Capital Territory (FCT) was ranked the best. The report also evaluated BHCPF implementation, budgetary commitments, under-five mortality rates, public health facility conditions, and health personnel resources.
Immunisation rates are also abysmally low in many states. In Sokoto, 50.7 percent of children have never been vaccinated. Bauchi and Gombe are not far behind, with 35.3 percent and 34.4 percent of children, respectively, categorised as ‘zero-dose’ — meaning they have never received any vaccines. States like Zamfara, Ondo, Ogun, and Kano also suffer from low immunisation rates.
Due to low investment, healthcare facilities are in dire condition, lacking basic amenities such as electricity, water, and proper sanitation, which critically impact the quality of healthcare.
Out of 35,514 Primary Healthcare Centres (PHCs) in the country, only 7,250 are functional and capable of delivering basic services, data show.
Nigeria continues to occupy unenviable spots on the global disease burden list, with children being the most vulnerable. Malaria, for example, is responsible for 36 percent of under-five mortality in the country, yet Nigeria has not fully rolled out WHO-approved malaria vaccines like RTS,S (Mosquirix) or the more effective R21/Matrix-M, which has shown 77 percent efficacy in trials.
While other African countries such as Uganda, Burundi, and Cameroon have begun deploying these vaccines, Nigeria lags peers in this life-saving intervention, leaving its youngest citizens to suffer the consequences.
Light at the end of the tunnel
However, it is not all bad news for Nigeria.
“Nevertheless, PAN congratulates Nigeria and all stakeholders for the successful eradication of the wild poliovirus. It is hoped that other killer vaccine-preventable diseases such as pneumonia and diarrhoea will also be tackled with greater vigour,” president of PAN said.
“PAN is concerned about the problem of ‘zero-dose’ children who have never been immunised. The current unacceptably low vaccine coverage rates may likely decline further in the months to come as a result of the current socioeconomic and security challenges, especially in areas that recently witnessed natural disasters.”
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