Sub-national evidence on the drivers of child mortality in Ekiti State, South-west Nigeria

Abstract Background Despite global progress in reducing child mortality, Nigeria bears a high burden, with Ekiti State having a disproportionate rate within the South-west region of the country. This study explored community and healthcare worker perspectives to understand the underlying factors of child deaths in the State. Data and methods We conducted group and individual interviews across diverse communities and undertook inductive thematic analysis to identify themes. Results The research identified structural determinants (including economic hardship— characterised by inflation, food scarcity, and poverty leading to poor nutrition), cultural-cognitive determinants (such as cultural beliefs and myths), household behavioural factors (including child abuse and neglect), and childhood illness and poor healthcare-seeking as factors contributing to under-five mortality in the study areas. Cultural beliefs and myths, like dietary restrictions during pregnancy and spiritual interpretations of illness, were reported to further exacerbate misinformation and poor health outcomes. Conclusion The study highlights a complex interplay of structural, cultural-cognitive, behavioural and health system factors that continue to threaten child survival in Ekiti State, thus underscoring the need for targeted interventions and community-based health education.