26/05/2026
WHY SO MANY PEOPLE DIE IN AREWA: THE SILENT CRISIS OF NEGLIGENCE, POVERTY, ILLITERACY, AND MISUNDERSTOOD BELIEF
The North of Nigeria - Arewa - holds about 70% of the country’s land mass, but also carries the heaviest burden of preventable deaths. Men, women, and children here die younger and more often than in the South, not because of one single disease, but because poverty, illiteracy, health negligence, and certain cultural interpretations create a cycle that keeps killing.
This isn’t about blaming anyone. It’s about seeing the pattern clearly so we can break it.
1. The Numbers Tell a Harsh Story
Child Mortality
- Under-5 mortality in the North is consistently higher than in the South.
- In the North West, it reached 150 deaths per 1,000 live births between 2013-2018. Compare that to 89 deaths per 1,000 births in the South West.
- Sokoto State alone recorded 202 under-5 deaths and 104 infant deaths per 1,000 live births in 2021 - the highest in Nigeria.
Maternal Mortality
- Northern Nigeria has the highest maternal mortality rates in the country.
- A study in Jahun, Jigawa State found an MMR of 1,791 deaths per 100,000 live births. For context, the SDG target is below 70.
- In Jigawa, the lifetime risk of maternal death for women under 30 was 1 in 10.
Education and Poverty
- 73% of mothers in the North East and 69% in the North West have no formal education. In the South West, only 17% have no education.
- Poverty is more endemic in the North West. Sokoto, Jigawa, Yobe, Kebbi, and Gombe rank among the 5 states with the lowest multidimensional poverty indices.
- Northern Nigeria has the lowest rate of child school enrolment and highest number of out-of-school children - over 9.5 million.
2. How Poverty, Illiteracy, Negligence, and Belief Kill
These four feed each other. Here’s how:
2a. No Education = No Health Knowledge
Education is directly protective. Women with secondary/higher education in the North have a 23% lower risk of maternal mortality.
- Illiteracy means mothers don’t recognize danger signs in pregnancy, delay seeking care, and don’t understand the need for immunization and antenatal visits.
- In the North, 84% of births in the North West happen outside health facilities. At home, hemorrhage, sepsis, and obstructed labor become death sentences.
2b. Misinterpreted Religious Beliefs About Sickness and Death
In some communities, a belief persists that suffering and dying from illness increases a person’s reward in the hereafter. The idea goes: “The more you endure pain without seeking help, the more accepted your soul becomes.”
This isn’t rooted in the core teachings of Islam or Christianity. Both traditions emphasize preserving life and seeking treatment. The Prophet Muhammad ﷺ said: “Make use of medical treatment, for Allah has not made a disease without appointing a remedy for it.” Yet when combined with illiteracy and low access to health education, the misinterpretation becomes deadly.
The result:
- People delay going to the hospital, calling it “God’s will” from the start, instead of seeing medical care as a means Allah provided.
- Suffering is reframed as a path to prosperity in the afterlife, so seeking early care is seen as weak faith or impatience.
- Preventable deaths from malaria, diarrhea, and obstructed labor are accepted as fate, not as failures of action.
When ignorance meets fatalism, negligence looks like piety. Breaking this requires religious leaders and health workers to correct the narrative: seeking treatment _is_ trust in God, not a lack of it.
2c. Poverty = No Access
Even where clinics exist, the poor can’t afford transport, drugs, or to miss work.
- Community wealth reduces maternal mortality risk by 83% in the North.
- Children from poor households have nearly 3x the under-5 mortality of rich households in the North.
- Insecurity and poor roads in the North East and North West make facilities physically unreachable.
2d. Health Negligence = Preventable Deaths
“Negligence” here means delay in seeking care, non-use of antenatal services, and low immunization.
- 40% of childhood deaths in Northern Nigeria are from vaccine-preventable diseases like measles and neonatal tetanus.
- Unbooked patients - women who don’t attend antenatal care - have 5x higher risk of maternal death.
- Leading causes of death for children under 5 in the North are malaria, diarrhea, pneumonia, malnutrition, and neonatal conditions. All are preventable or treatable with basic care.
3. Diseases Taking the Most Lives in the North
The disease pattern is similar across Nigeria, but the death rate is higher in the North because of late presentation and weak systems.
For Children:
1. Neonatal conditions: Birth asphyxia, prematurity, neonatal sepsis. These caused 44% and 22% of neonatal deaths in a Northern hospital study.
2. Malaria: Still a top killer of under-5s.
3. Diarrhea and pneumonia: Linked to poor water, sanitation, and malnutrition.
4. Vaccine-preventable diseases: Measles, tetanus, polio in hard-to-reach areas.
For Women:
1. Hemorrhage: 26% of maternal deaths.
2. Puerperal sepsis: 19%.
3. Obstructed labor: 5%.
4. Hypertensive disorders: Often missed without antenatal care.
4. Why the North-South Gap Persists
It’s not genetics. It’s context:
- Education: 56% of mothers in the South West have secondary education vs 9% in the North East.
- Wealth: 49% of households in the South West are “rich” by wealth index vs 6% in the North West.
-Health system investment: States with low health spending have the worst outcomes. Zamfara was ranked worst for healthcare access in 2021.
- Cultural and religious interpretations: Earlier marriage, lower contraceptive use, higher home delivery rates, and fatalistic views on illness in the North.
5. What Needs to Change
The data points to 4 leverage points:
1. Girls’ Education: Every extra year of schooling reduces maternal and child death risk. This is the single most powerful intervention for the North.
2. Primary Healthcare Access: Immunization, antenatal care, skilled birth attendance. The WHO’s Hard-to-Reach project in Kano, Bauchi, Borno, and Yobe shows it works when you bring services to people.
3. Community Health Literacy: Teaching families to recognize danger signs and seek care early. Media exposure and social autonomy are protective in the North.
4. Engaging Religious Leaders: Imams, pastors, and traditional rulers need to lead the correction: Islam and Christianity both command seeking treatment and preserving life. When faith leaders say it, communities listen.
Arewa isn’t “cursed”. It’s underserved and misinformed. The founding leaders of the North understood this - they built schools, hospitals, and agricultural systems. The challenge now is to return to that vision: a North where a child’s chance of survival doesn’t depend on their mother’s literacy, their father’s wallet, or a misunderstanding of faith.
Death from malaria, diarrhea, or childbirth isn’t inevitable in 2026. It’s a signal that the system and the message aren’t reaching people. And both can be changed.
~ Dr Zainab Suleiman Buhari
