Housing materials as predictors of under-five mortality in Nigeria: Evidence from 2013 demographic and health survey

Background: Nigeria is among countries with high Under-Five Mortality (U5M) rates worldwide. Both maternal and childhood factors have been linked to U5M in the country. However, despite the growing global recognition of the association between housing and quality of life, the role of housing materials as predictors of U5M remain largely unexplored in Nigeria. This study, therefore, investigated the relationship between housing materials and U5M in Nigeria. Methods: The study utilised the 2013 Nigeria Demographic and Health Survey data. A representative sample of 40,680 households was selected for the survey. The sample included 18,516 women of reproductive age who had given birth in the past 5 years prior the survey; with attention on the survival status of the index child (the most recent delivery). Data were analysed using descriptive statistics, Chi-square, Cox-proportional hazard and Brass 2-parameter models (α = 0.05). Results: The hazard ratio of U5M was 1.46 (C.I = 1.02-1.47, p < 0.001) and 1.23 (C.I = 1.24-1.71, p < 0.001) higher among children who lived in houses built with inadequate and moderate housing materials respectively than those in good housing materials. Under-five deaths show a downward trend (slope = -0.4871) relative to the housing materials assessment score. The refined U5M rate was 143.5, 127.0 and 90.8 per 1000 live birth among women who live in houses built with inadequate, moderate and adequate housing materials respectively. Other predictors of U5M were; the size of the child at birth, preceding birth interval, prenatal care provider, residence and education. Under-five death reduces with increasing maternal level of; education, wealth quintile, media exposure and housing material type and mostly experienced by Muslim women (6.0%), rural women (6.5%) and women residence in the North-West geopolitical zones (6.9%). Conclusions: Living in houses built with poor housing materials promoted U5M in Nigeria. Provision of sustainable housing by the government and the maintenance of existing housing stock to healthful conditions will play a significant role in reducing the burden of U5M in Nigeria.