This technical brief summarises findings that child mortality is clustered among a small proportion of women in rural communities in Northern Nigeria. It concludes that lack of individual social support is a key factor driving the skewed burden of ill health. Health programmes that ignore issues of social support may exacerbate divides among the poor and are likely to make slow progress towards achievement of maternal, newborn and child health targets. A comprehensive and holistic approach to primary health care in Nigeria would place greater emphasis on social factors alongside improvements to service delivery. This is one of a series of technical briefs on the theme of community engagement which draw on the results and lessons learned from the PRRINN-MNCH programme.