ABSTRACT

This study assesses the demographic and economic determinants of infant mortality in Nigeria. To achieve its objectives, the infant mortality rate, which serves as a measure of child health outcomes, is regressed on government health expenditure, real GDP, inflation, the population growth rate and population density. The results show that public expenditure on health and inflation have a significant effect on infant mortality, whereas real GDP does not. The population growth rate and population density also exert a significant effect on the infant mortality rate.

CHAPTER ONE

INTRODUCTION

1.1 Background Information

Reducing preventable deaths among newborns and young children has been a central objective of global development policy for more than two decades. It was the focus of the fourth Millennium Development Goal, which set a target for 1990 to 2015, and it is now embodied in Sustainable Development Goal (SDG) 3.2. That target calls for neonatal mortality of 12 or fewer deaths per 1,000 live births and under-five mortality of 25 or fewer per 1,000 live births by 2030 (Ibikunle et al., 2022).

The infant mortality rate (IMR), the probability of dying before the first birthday, is among the most sensitive indicators of the economic and health status of a community. Infants depend more heavily than any other age group on the conditions of their immediate environment, including household income, nutrition, sanitation, access to health services and the health and education of their mothers. For that reason the IMR is widely used to evaluate public health systems, to plan health strategies and to judge progress towards the health-related SDGs (Adegoke et al., 2022; Odjesa & Ighodaro, 2021).

Child survival remains a pressing concern in sub-Saharan Africa, which continues to record the highest infant, neonatal and under-five mortality rates in the world (Ibikunle et al., 2022; Popoola, 2023). Nigeria, Africa’s most populous country, contributes heavily to this burden. The 2023–24 Nigeria Demographic and Health Survey (NDHS) estimated the infant mortality rate at 63 deaths per 1,000 live births, the neonatal mortality rate at 41 and the under-five mortality rate at 110. These figures mean that about one child in nine does not survive to the fifth birthday (National Population Commission & ICF, 2025). Under-five mortality has fallen from 132 per 1,000 in the 2018 survey, but neonatal mortality has barely moved, and the survey shows wide disparities between states. Kebbi recorded the highest infant mortality rate (90 per 1,000 live births) and Jigawa the highest under-five mortality rate (161 per 1,000), whereas rates in several southern states were in single or low double digits. The north–south divide indicates that where a child is born, and the economic and demographic conditions that prevail there, strongly influence the chance of survival.

A large body of evidence links economic conditions to child survival. Higher household consumption, greater public spending on health and higher capital formation are associated with lower mortality in Nigeria, whereas unemployment is associated with higher mortality (Adegoke et al., 2022). Government health expenditure has been found to reduce mortality in Nigeria through both capital and recurrent spending (Awoyemi et al., 2023; Musa, 2022), and wider cross-country work reaches similar conclusions about the link between health spending and mortality (Owusu et al., 2021). Inflation, and food price inflation in particular, can undermine household nutrition and raise infant, neonatal and under-five mortality, while higher per capita income, government health spending and access to sanitation reduce them (Ibikunle et al., 2022). Economic downturns have likewise been estimated to raise under-five mortality across many countries (Cardona et al., 2022). On the demographic side, immunisation lowers infant mortality across sub-Saharan Africa, but a higher population growth rate is associated with higher mortality, which suggests that rapid population growth puts pressure on scarce health resources (Popoola, 2023). Maternal education and fertility patterns are also important. The 2023–24 NDHS reports higher child mortality among children of women with little or no education and among children of very young mothers, and it records a decline in the total fertility rate to 4.8 births per woman (National Population Commission & ICF, 2025).

Nigeria’s experience therefore raises a puzzle. Total output and per capita income have grown considerably over the long run, and this growth ought to improve child health indicators such as the infant mortality rate. Yet Nigeria remains off track on the health-related SDGs, and the gains in child survival have been modest relative to the country’s resources (Adegoke et al., 2022; Awoyemi et al., 2023). This study uses macro-aggregate time-series data to examine how demographic and economic factors together explain the variations in infant mortality in Nigeria.

1.2 Statement of the Problem

Young children are among the groups most vulnerable to adverse economic conditions. They are sensitive not only to the environment in which they are born but also to the demographic characteristics of their mothers, such as educational attainment and labour-force participation, and to the quality of health services, including immunisation. These conditions shape the risk of illness and the actions households and governments take to prevent and treat it (Odjesa & Ighodaro, 2021; Popoola, 2023).

In Nigeria, progress in reducing child mortality has been slow and uneven. Under-five mortality has declined from 132 to 110 deaths per 1,000 live births between the 2018 and 2023–24 surveys, yet neonatal mortality has remained stagnant at around 40 per 1,000 (National Population Commission & ICF, 2025), and the country is still far from the SDG 3.2 targets. This slow pace is difficult to reconcile with sustained economic growth. If growth raised public revenue and household incomes, child mortality would be expected to fall in step with it. Instead, studies report a paradox in which health spending and national income rise without a proportionate improvement in outcomes (Awoyemi et al., 2023; Adegoke et al., 2022).

The literature does not settle the matter. Some Nigerian studies find that government health spending significantly lowers mortality (Awoyemi et al., 2023; Musa, 2022), whereas others find that income per capita and education have a negative but statistically insignificant effect on infant mortality when spending is controlled for (Musa, 2022). Evidence on inflation points to harmful effects through food prices (Ibikunle et al., 2022), and evidence on population growth points to a positive association with infant mortality (Popoola, 2023). Much of this work, however, combines economic and demographic variables inconsistently, focuses on adult outcomes or on life expectancy, or uses samples that are not specific to Nigeria. Few studies examine, within a single country-specific time-series framework, the joint influence of government health expenditure, real GDP, inflation, population growth and population density on infant mortality in Nigeria.

The question arising from these gaps is whether the fluctuations in Nigeria’s infant mortality rate can be attributed to changing economic factors, such as health expenditure, income and inflation, or to demographic factors, such as population growth and population density. This question motivates the present study and leads to the following research questions.

1.3 Research Questions

1. What are the demographic determinants of infant/child mortality in Nigeria?
2. What are the economic determinants of infant/child mortality in Nigeria?

1.4 Research Objectives

The ultimate goal of the study is to explore the demographic and economic factors that determine variations in infant mortality in Nigeria. The specific objectives are:

1. To investigate the impact of demographic variables on infant mortality in Nigeria.
2. To investigate the impact of economic variables on infant mortality in Nigeria.

1.5 Hypotheses of the Study

H₀₁: Demographic factors have no significant influence on infant mortality in Nigeria.

H₀₂: Economic factors have no significant effect on infant mortality in Nigeria.

1.6 Policy Relevance of the Study

Studying the determinants of infant and child mortality provides an index of the health and vitality of a population, and tracking the trends shows how child survival changes over time. Children are important national assets, and investing in their survival and health lays the foundation for a stronger economy and a fairer society. High infant and child mortality rates are widely read as signs of poor living standards and weak health systems, so the rates recorded in Nigeria call for evidence-based action (Adegoke et al., 2022).

Analyses of the socio-economic and demographic drivers of mortality help identify the factors that promote child survival and those that undermine it, and they point to promising directions for health programmes. For example, evidence on Nigeria points to the importance of raising public health expenditure, reducing poverty and improving female education as ways to advance towards SDG 3 (Odjesa & Ighodaro, 2021), and forecasting work suggests that Nigeria must raise health spending and reduce unemployment substantially to reach the 2030 child and maternal health targets (Adegoke et al., 2022). Others recommend partnerships with the private sector to expand health financing (Awoyemi et al., 2023) and measures to stabilise food prices and improve sanitation (Ibikunle et al., 2022). Because the survey evidence shows sharp regional differences in mortality (National Population Commission & ICF, 2025), a clear understanding of the economic and demographic correlates of infant mortality can also help to target scarce public health resources to the places and populations where they will save the most lives.

1.7 Scope of the Study

This is a country-specific study of Nigeria covering the period 1970 to 2012. The period was chosen because of data availability and to provide enough observations for time-series analysis. The variables of interest are discussed in Chapter Three.

References

Adegoke, Y. O., Mbonigaba, J., & George, G. (2022). Macro-economic determinants, maternal and infant SDG targets in Nigeria: Correlation and predictive modeling. Frontiers in Public Health, 10, Article 999514. https://doi.org/10.3389/fpubh.2022.999514

Awoyemi, B. O., Makanju, A. A., Mpapalika, J., & Ekpeyo, R. S. (2023). A time series analysis of government expenditure and health outcomes in Nigeria. Journal of Public Health in Africa.

Cardona, M., Millward, J., Gemmill, A., Yoo, K. J., & Bishai, D. M. (2022). Estimated impact of the 2020 economic downturn on under-5 mortality for 129 countries. PLOS ONE, 17(2), Article e0263245. https://doi.org/10.1371/journal.pone.0263245

Ibikunle, J. A., Oyerinola, D. S., & Tosin-Amos, A. D. (2022). Food inflation and child health in Africa: Evidence from countries with high misery index. Acta Economica, 20(37), 167–187. https://doi.org/10.7251/ACE2237167A

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National Population Commission [Nigeria], & ICF. (2025). Nigeria Demographic and Health Survey 2023–24. NPC and ICF.

Odjesa, E., & Ighodaro, C. (2021). Socio-economic determinants of infant mortality rate in Nigeria: Evidence from autoregressive distributed lag technique. African Journal of Health Economics, 10(1), 15–34. https://doi.org/10.35202/AJHE.2021.1011534

Owusu, P. A., Sarkodie, S. A., & Pedersen, P. A. (2021). Relationship between mortality and health care expenditure: Sustainable assessment of health care system. PLOS ONE, 16(2), Article e0247413. https://doi.org/10.1371/journal.pone.0247413

Popoola, T. O. (2023). Immunisation and infant mortality in Sub-Saharan African countries. Ilorin Journal of Economic Policy, 10(1), 46–57.