While social determinants of health have been perennially linked to child survival in resource-limited countries, the precise and tested pathways to effect are not clearly understood. The objective of this study was therefore to identify the critical pathways as posited a priori in a model through which social factors (at maternal, household, and community levels) determine neonatal, infant, and under-five mortalities in Nigeria. Using a novel analytic approach (hierarchical path modelling for predicting accelerated failure time) to estimate (in)direct and total effects of social determinants of child survival, we analysed 30,960 live births (weighted data for representativeness), obtained from the 2016/2017 Nigeria Multiple Indicator Cluster Survey. There were three outcome variables: time until occurrence of neonatal, infant, and under-five mortalities. The independent variables were layered factors related to child, maternal, household and community. Geographical region, rurality of residence, infrastructural development, maternal education, contraceptive use, marital status, and maternal age at birth were found to operate more indirectly on neonatal, infant, and under-five survival. Child survival is due to direct effects of child’s sex (female), gestational type (singleton), birth spacing (children whose mothers delivered at least two years apart), and maternal age at delivery (20–34 years). According to the path coefficients, the indirect effects of geographical regions are the most influential determinants of child survival, accounting for 30% (neonatal), 37.1% (infant) and 39.9% (under-five) of the total effects. This study offers comprehensive set of factors, and linked pathways, at the maternal, household, and community levels that are associated with child survival in Nigeria. To accelerate progress towards Sustainable Development Goal targets for child survival and reduce geographical inequities, stakeholders should implement more impactful policies that promote maternal education, contraceptive use and improve living conditions of women (especially in rural areas of northern Nigeria). Future research should focus on identifying the most effective interventions for addressing these social determinants of child survival in Nigeria.

Globally, despite the decline in under-five mortality rate from 213 per 1000 live births in 1990 to 132 per 1000 live births in 2018, the pace of decline has been slow, and this can be attributed to poor progress in child survival interventions, including those aimed at reducing children’s exposure to household pollution. This study examined the influence of neighbourhood poverty and the use of solid cooking fuels on under-five mortality in Nigeria. Data for the study comprised a weighted sample of 124,442 birth histories of childbearing women who reported using cooking fuels in the kitchens located within their house drawn from the 2018 Nigeria Demographic and Health Survey. Descriptive and analytical analyses were carried out, including frequency tables, Pearson’s chi-squared test and multivariate analysis using a Cox proportional regression model. The results showed that the risk of under-five mortality was significantly associated with mothers residing in areas of high neighbourhood poverty (HR: 1.44, CI: 1.34–1.54) and the use of solid cooking fuels within the house (HR: 2.26, CI: 2.06–2.49). Government and non-governmental organizations in Nigeria should initiate strategic support and campaigns aimed at empowering and enlightening mothers on the need to reduce their use of solid cooking fuels within the house to reduce harmful emissions and their child health consequences.