![Mother and child used to illustrate the story. [Photo credit: Management Sciences for Health, Lola Akinmade, Nigeria. Courtesy of Photoshare]](https://ekohotblog.com/wp-content/uploads/2026/03/20260323_193608.jpg)
Nigeria has an annual budget running into tens of trillions of naira, specifically ₦58.18 trillion for the 2026 budget. It also has the highest rate of under-five child deaths in the world. That contradiction is not a medical puzzle. It is a political one.
The country’s ranking — 115 deaths per 1,000 live births, according to the UN’s 2024 Levels & Trends in Child Mortality report — is not an accident of geography or fate.
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An analysis by EKO HOT BLOG shows that it is the product of compounding, largely man-made failures that have persisted across governments and decades.
A Health System Built to Fail
At the immediate level, the UN report identifies the killers clearly: complications from premature birth and labour account for the majority of newborn deaths, while malaria, diarrhoea, and pneumonia are the primary destroyers of children who survive their first month.
What connects all of these causes is a single thread: they are all treatable, and in well-functioning health systems, largely preventable.
Nigeria does not have a well-functioning health system. It has a patchwork of facilities that are chronically understaffed, undersupplied, and underfunded.
Skilled birth attendance — the single most effective intervention against neonatal mortality — remains out of reach for millions of Nigerian women, particularly in the rural north, where a woman may travel hours to reach a functional health post, only to find it locked or unstocked. Oral rehydration therapy for diarrhoea costs almost nothing to administer; yet children still die from it in states where supply chains have collapsed and community health workers have gone unpaid for months.
Nigeria spends less than five per cent of its national budget on health, well below the Abuja Declaration target of 15 per cent that African heads of state committed to in 2001. That commitment has been renewed in various communiqués ever since. It has never been meaningfully honoured.
Malnutrition: The Silent Multiplier
The report introduces a figure that has not previously been captured at this scale: more than 100,000 children aged one to 59 months died directly from severe acute malnutrition globally in 2024.
The report notes that the actual toll is likely higher because malnutrition is routinely unrecorded as a cause of death. In Nigeria, malnutrition does not merely kill directly — it weakens children sufficiently that malaria, pneumonia, and diarrhoea finish the job. It is, in effect, a force multiplier for every other killer on the list.
The roots of child malnutrition in Nigeria are both structural and immediate. At the structural level, decades of agricultural neglect, land insecurity, and the collapse of extension services have left smallholder farmers — who produce the majority of Nigeria’s food — increasingly unable to guarantee nutritional adequacy for their own households.
At the immediate level, the economic shocks of the past two years — petrol subsidy removal, naira devaluation, and the resulting food price inflation — have eroded the purchasing power of ordinary families with devastating speed. Children pay the price first.
Conflict, Governance, and the Geography of Death
WHO director-general Tedros Adhanom Ghebreyesus noted in the report that children in fragile and conflict-affected settings are nearly three times more likely to die before age five.
Nigeria contains multitudes of such settings: the long-running insurgency in Borno and the broader Lake Chad Basin, the banditry crisis across the northwest, and communal violence in the Middle Belt have displaced millions, dismantled health infrastructure, and severed supply chains for vaccines and essential medicines across entire regions.
But conflict alone does not explain Nigeria’s position at the very top of this ranking. Niger Republic, in second place, is poorer and more conflict-ridden. Somalia, in third, has spent decades in near-total state collapse.
Nigeria’s distinction is that it has the resources — the oil revenues, the tax base, the technical capacity — to do far better, and has consistently chosen not to deploy them where they would matter most.
FURTHER READING
That is ultimately the answer to the headline’s question. Nigeria leads the world in under-five mortality not because it lacks the means to change it, but because it has not yet decided that the lives of its poorest children are worth the political cost of trying.
Philip Ibitoye is a Special Correspondent with EKO HOT BLOG. Click here to find daily analysis and critical insight on trending issues in Lagos and other parts of Nigeria.
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