Published in PLOS One on 2026-02-05, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Chekwube Madichie, James Lomas, Luigi Siciliani
Source: PLOS One • DOI 10.1371/journal.pone.0337367
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Reducing under-five mortality and ensuring universal access to maternal healthcare are central goals of the Sustainable Development Goals (SDGs). Despite global progress, Nigeria continues to report one of the highest under-five mortality rates and the lowest access to maternal healthcare worldwide.
This study examines whether maternal education is associated with under-five mortality and access to maternal care in Nigeria. It also investigates whether these associations differ between rural and urban areas and whether they are explained by socioeconomic, ethnic, and religious factors. In addition, we assess whether literacy exerts an independent influence alongside formal education.
Using the 2021 Nigeria Malaria Indicator Survey (MIS) and a sample of 10,820 women of reproductive age, we employ a bivariate probit framework supplemented by propensity score matching (PSM) to examine the robustness of the findings.
Higher levels of maternal education, particularly secondary schooling, were significantly associated with a 2.08 ppt reduction in under-five mortality and a 6.74 ppt increase in access to maternal care. Economic status modestly attenuated the size of the education association with under-five mortality but strengthened it for maternal care, while ethnicity and religion partly explained the observed associations. Literacy displayed similar patterns to formal education when examined separately but did not retain an independent association with either outcome in fully adjusted models or when included alongside education. These findings are robust across alternative specifications.
Economically and culturally tailored policies that improve female educational attainment remain critical for enhancing access to maternal healthcare and reducing child mortality in Nigeria.
1. Introduction
Reducing child mortality and ensuring universal access to maternal healthcare remain critical global health priorities under the United Nations Sustainable Development Goals (SDGs). Specifically, SDG 3 targets a reduction in the under-five mortality rate to 25 deaths per 1,000 live births in every country by 2030 [1]. Although global under-five mortality has declined significantly from 93 per 1,000 in 1990–37 in 2022 [2], progress in Nigeria has been markedly slower. In 2023, the country recorded 111 under-five deaths per 1,000 live births [3], placing it among the top five countries with the highest child mortality and accounting for 15% of global under-five deaths, despite making up just 2.78% of the world’s population.
Neonatal disorders, malaria, diarrhoea, and lower respiratory infections remain the leading causes of under-five mortality in Nigeria, jointly accounting for over 73% of such deaths (Statista, 2024). One factor that has consistently emerged in global health literature as an important determinant of improved child health outcomes is education. Higher educational attainment improves individuals’ understanding of health-promoting behaviours and facilitates better use of healthcare services [4,5]. Numerous studies have shown strong associations between educational attainment and health outcomes [6,7,8], with maternal education particularly emphasized as a key predictor of child survival [9,10,11,12].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Chekwube Madichie, James Lomas, Luigi Siciliani. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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