Peri-urban Kano Setting

The cohort was more educated than Nigerian women nationally, likely reflecting hospital-based recruitment and the demands of informed consent procedures. The hospital-enrolled design limits generalisability to rural families, those using home births, and more affluent urban groups attending private or federal hospitals. Only about 9.2% of enrolled households reported any health insurance coverage. Mean monthly household income in the cohort was approximately US$52, placing per-person spending well below the World Bank poverty threshold of US$3.65 per day. Many households in peri-urban Kano are large, multigenerational, and lack adequate sanitation infrastructure, with frequent proximity to open dumpsites. Nigeria is the most populous African country and has a high burden of neonatal sepsis and antibiotic consumption.