Mortality In Nigeria Research Articles

Effects of public financing of essential maternal and child health interventions across wealth quintiles in Nigeria: an extended cost-effectiveness analysis

Maternal and newborn mortality rates in Nigeria are among the highest globally, and large socioeconomic inequalities exist in access to maternal, newborn, and child health (MNCH) services in the country. Inequalities also exist in catastrophic health expenditure among households in Nigeria. We aimed to estimate the health and financial risk protection benefits across different wealth groups in Nigeria if a policy of public financing of MNCH interventions were to be introduced. We did an extended cost-effectiveness analysis to estimate the health and financial risk protection benefits, across different household wealth quintiles, of a public-financing policy that assumes zero out-of-pocket costs to patients at the point of care for 18 essential MNCH services. We projected health outcomes (deaths in children aged <5 years [under-5 deaths] and maternal deaths) and private expenditure averted using the Lives Saved Tool with data extracted from national surveys. We modelled three scenarios: 1) coverage expansion at a rate equal to the trend observed between 2013 and 2018 (status quo); 2) annual coverage expansion by 5% compared with the status quo (uniform scale-up scenario); and 3) annual coverage expansion by 10%, 8%, 6%, 4%, and 2% compared with the status quo from the poorest to the wealthiest quintiles, respectively (pro-poor scale-up scenario). Our analysis shows that, if an additional 5% increase in coverage was provided for all wealth quintiles between 2019 and 2030, this uniform scale-up policy would prevent more than 0·11 million maternal deaths and 1·05 million under-5 deaths, avert US$1·8 billion in private expenditure, and avert 3266 cases of catastrophic health expenditure. The incremental cost effectiveness ratio would be $44 per life-year gained, which is highly cost-effective when compared with the gross domestic product per capita of Nigeria for 2018 ($2028). The policy would prevent a higher number of under-5 deaths and catastrophic health expenditure cases in poorer quintiles, but would prevent more maternal deaths and private expenditure in wealthier quintiles. If poorer populations experienced a greater increase in service coverage (ie, the pro-poor scale-up scenario), more maternal and under-5 deaths would be prevented in the poorer quintiles and more private expenditure would be averted than would be under previous scenarios. Public financing of essential MNCH interventions in Nigeria would provide substantial health and financial risk protection benefits to Nigerian households. These benefits would accrue preferentially to the poorest quintiles and would contribute towards reduction of health and socioeconomic inequalities in Nigeria. The distribution would be more pro-poor if public financing of MNCH interventions could target poor households. WHO Partnership for Maternal, Newborn, and Child Health.

Gender Discrepancy in Infant Mortality in Nigeria: Evidence from NDHS Data 2018

Despite overall improvements in child health and survival, gender discrepancies persist, reflecting complex interactions among socio-cultural norms, healthcare access, and socioeconomic conditions. This research paper focuses on the gender-based discrepancy in infant mortality rates in Nigeria. This paper aims to explore the elements prompting gender-based discrepancies in infant mortality. For the objective of the study, records from the NDHS 2018 were obtained. Log-rank test at level of significance was used to ascertain the factors influencing gender-based discrepancies in infant mortality. The findings of this study depict higher risk among males than females in all the variables under study with an exception of maternal age groups 35-39 (50.36%) and 40-49 (50.25%,) which depict the risk of infant mortality is higher among female infants than males. The relationship between gender and mortality can vary based on factors such as maternal age, maternal education, breastfeeding, and antenatal visits. These emphasize the need for targeted interventions and policies to address the underlying causes of gender-based discrepancies in infant mortality and to improve the health outcomes of all infants in Nigeria.

Clinical and non-clinical determinants of cervical cancer mortality: A retrospective cohort study in Lagos, Nigeria.

Cervical cancer (CCa) is the fourth most frequent and a common cause of cancer mortality in women, the majority of whom live in low- and middle-income countries. Data on CCa mortality and its determinants have been poorly studied in Nigeria, resulting in a paucity of information that can assist patient management and cancer control policy. The purpose of this study was to assess the mortality rate among CCa patients in Nigeria as well as the major factors influencing CCa mortality. Data from the medical records of 343 CCa patients seen at the Lagos University Teaching Hospital and NSIA-LUTH Cancer Center from 2015 to 2021 were used in a retrospective cohort analysis. The hazard ratios (HR) and confidence intervals (CI) associated with the exposure variables and CCa mortality were calculated using Cox proportional hazard regression. The CCa mortality rate was 30.5 per 100 women-years after 2.2 years of median follow-up. Clinical factors such as HIV/AIDS (adjusted HR [aHR]: 11.9; 95% CI: 4.6, 30.4), advanced clinical stage (aHR: 2.7; 95% CI: 1.5, 4.7), and anemia at presentation (aHR: 1.8; 95% CI: 1.1, 3.0) were associated with a higher mortality risk, as were non-clinical factors such as age at diagnosis >50 years (aHR: 1.4; 95% CI: 1.0, 1.9) and family history of CCa (aHR: 3.5; 95%CI: 1.1, 11.1). CCa has a high mortality rate in Nigeria. Incorporating these clinical and non-clinical factors into CCa management and control policies may improve women's outcomes.

Generalized Gamma-CUSUM control chart with application of COVID-19 deaths.

The increase in the number of infections and the worrisome state of mortality linked to the COVID-19 pandemic demand an optimal statistical model and efficient monitoring scheme to analyze the deaths. This paper aims to model the COVID-19 mortality in Nigeria using four non-normal distributions grouped under the generalized gamma distribution, by specifying the best-fit distribution to model the number of deaths linked to the COVID-19 pandemic. In addition, a control chart to monitor the COVID-19 deaths based on the best-fit distribution is proposed. The performance of the proposed Gamma-CUSUM chart as a monitoring scheme was compared with the standard normal-CUSUM chart. The results revealed that the Gamma-CUSUM chart first signals a change in the number of deaths on day 68 while there was no change in the number of deaths for the standard normal-CUSUM chart. Also, the exact point of change was visible on the Gamma-CUSUM chart which was impossible on a standard normal-CUSUM control chart.

Assessment of integrated community case management of childhood illness (ICCM) practices by trained patent and proprietary medicine vendors (PPMVs) in Ebonyi and Kaduna states, Nigeria

IntroductionAn Integrated Community treatment of Childhood disease (ICCM)- focused intervention involving a large number of Patent and proprietary medicine vendors (PPMVs) was conducted by Society for Family Health Nigeria to improve management of childhood, malaria, pneumonia and diarrhea with an intervention approach focused on knowledge and skill improvement. The intervention was conducted in Kaduna and Ebonyi state; recruited and trained 15 interpersonal communication agents (IPCAs) who were saddled with the responsibility to sensitize and mobilize caregivers with children within the age bracket of 2 months to 5 years to our mapped PPMVs within the communities, on the account of Malaria, Diarrhea, and Pneumonia; while the IPCAs in return monitor the quality-of-service delivery. Following the intervention, the Society for Family health conducted a study to demonstrate the effectiveness of interventions such as ICCM training, supervision and linkage to quality ICCM commodities, among PPMVs to achieve high levels of knowledge and performance in diagnosing and treating common childhood illnesses.MethodsLongitudinal research (before and after study) was adopted for the study. From the 387 PPMVs recruited and trained by SFH, 165 PPMVs were systematically selected to participate in the study, before and after the implementation of the intervention. Using SPSS version 22, data from the observation and completed questionnaires were analyzed and a chi-square test was used to examine the associations between the categorical information collected prior and after the intervention. The analysis was conducted at 5% level of significance.ResultsMore than 50 % of the study participants were females (56.4%) and majority were either Junior community extension workers (35%) or Senior community extension worker (27%). About 21.8% trained PPMVs could not appropriately treat malaria in the first quarter of the intervention, however, there was a significant decrease to 1.8% in second quarter in the number of those that cannot appropriately diagnose and treat malaria. There was also a decrease in the number of those who could not treat cough and fast breathing from 47(28.5%) to 14(8.5%) in the second quarter and for diarrhea from 33.3% in the first quarter to 2.4% in the second quarter.ConclusionThe study revealed a significant improvement in the quality of treatment provided by the trained PPMVs across the three disease areas. PPMVs in hard-to-reach areas should be trained and supported to continuously provide quality services to change the indices of under-5 mortality in Nigeria.

Corrigendum: Sexual behaviour and uptake of modern contraceptives among adolescents in public secondary schools in Lagos State, Nigeria

BACKGROUNDGlobally, more than 16 million adolescent girls give birth every year with additional 5 million abortions. Adolescent pregnancy has been associated with high maternal mortality rates in Nigeria. Therefore, this study was designed to assess sexual behaviour and contraceptive uptake among secondary school adolescents in an urban area in Nigeria.MATERIALS AND METHODSThe study was a descriptive cross-sectional study of students from twelve senior secondary schools in 2018. Respondents were interviewed using self-administered structured questionnaires. The questionnaire was pretested and analysis was done using SPSS version 17.0; descriptive data were presented as simple frequencies and percentages. The chi-square test was used for associations and the level of significance was set at p≤5%.RESULTSThe majority of the respondents (70.3 %) were within the age bracket of 13 to 16 years with a mean age of 15.95±1.43. Generally, there was 100% awareness of the methods of contraceptives by all, with 64.5% aware of condom usage as a method of contraception. The level of knowledge scored fairly (62.4%), and attitude was 48.9% amongst males and females who had responsibility for contraception. Peer pressure of 42.9% was stated as one of the major factors affecting the utilization of modern contraceptives.CONCLUSIONAwareness of contraception amongst adolescents was high. But with the level of knowledge identified, the government should ensure proper measures to promote sexual behaviour and uptake of contraception among adolescents in Nigeria.

Epidemiology of Respiratory Syncytial Virus-Associated Acute Lower Respiratory Tract Infection among Hospitalized Under-5s in Northwestern Nigeria

Abstract Objective Globally, 33 million cases of respiratory syncytial virus (RSV) infections occur annually among under-fives (5s). Ninety-nine percent of deaths from RSV occur in low- and middle-income countries. Under-five pneumonia mortality in Nigeria was estimated at 140,520 in 2017, but RSV epidemiological data are scant due to poor awareness and limited testing. Vaccines for RSV are currently under development and RSV mortality data from this high mortality, low resource setting are essential to maximizing the potential benefit of vaccination as well as promoting vaccine uptake. This study aimed to describe the epidemiology of RSV-associated acute lower respiratory tract infection (ALRTI) in children younger than 5 years in Zaria, Northwestern Nigeria. Methods A prospective cohort study was conducted among children aged 1 month to 5 years who were hospitalized with ALRTI in the Emergency Pediatric Unit of a tertiary hospital in Zaria from November 2018 to October 2019. Naso-pharyngeal swabs were obtained for RSV testing using a point-of-care immunoassay technique. Results Thirty-three percent (35/106) of the children had RSV-related ALRTI. The median age of RSV-positive cases was 8 months (IQR 3–14). Two-thirds of children (68.6%, 24/35) were below 12 months. The RSV mortality rate was 5.7% (2/35). RSV occurred in 10 months of the year with peaks in March and July. Conclusion A third of admitted children with ALRTI were positive for RSV. Therefore RSV significantly contributes to childhood pneumonia and the dual seasonal peak observed in our study may have implications for vaccine implementation.

Fossil Energy Consumption, Carbon Dioxide Emissions, and Mortality Rates in Nigeria

Fossil Energy Consumption, Carbon Dioxide Emissions, and Mortality Rates in Nigeria

Clinicopathological Features and Treatment Outcome of Patients with Gastric Cancer in Lagos: Is the Outlook Getting Better?

Gastric cancer (GC) is an important cause of morbidity and mortality in Nigeria. Significant advances in the management of GC in South-West Nigeria occurred in the last three decades. This was a retrospective comparative study of patients with GC that presented at our tertiary hospital in the last three decades. Information on clinicopathological features and treatment outcome were analysed. Data of two consecutive periods; 1991-2004 (Group I) and 2005-2018 (Group II) were compared. Ninety-one patients were studied; Group I (47 patients), Group II (44 patients). The mean age was 56.4 ± 12.7 years and male-to-female ratio was 1.8 to 1.0. The predominant symptoms were epigastric pain in 81(89.0%) (43 vs. 38) and weight loss in 63(69.2%) (32 vs. 31), whereas the signs were epigastric tenderness in 44(46.1%) (24 vs. 20) and epigastric mass in 42(46.1%) (26 vs. 16). The overall mean duration of symptom was 12.3 ± 16.9 months. Barium meal diagnosed GC in 29(61.7%) patients in Group I vs. 4(9.1%) patients in Group II. Conversely, endoscopy diagnosed GC in 23(48.9%) patients in Group I vs. 37(84.1%) patients in Group II. Operations undertaken included palliative subtotal gastrectomy 26(28.6%), potentially curative subtotal gastrectomy 15(16.5%) and non-resectional surgeries in 27(29.7%) patients. The overall incidence of major post-operative complications was 33%. Thirty-nine (42.8%) of the studied patients were lost to follow up. The median postoperative survival for Groups I and II patients was 22 weeks and 58 weeks, P = 0.012, respectively. The outcome of management of patients with GC at our tertiary hospital has improved modestly in the past three decades. Patients are still presenting late with very advanced disease.

Renal biomarkers in pre-eclampsia and their associations with severity of pre-eclampsia

Background: Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality in Nigeria and worldwide. It is not yet concluded as to whether or not elevated levels of serum creatinine and/or uric acid could be regarded as a predictive indicator for the severity of the disease. Objectives: To compare the mean serum levels of uric acid and creatinine in preeclamptic and normotensive pregnant women and assess for any associations between these renal biomarkers and the severity of preeclampsia in Nigeria. Materials and Methods: It was a cross-sectional analytical study of 132 women with preeclampsia (n = 61) and normotensive pregnant women (n = 61). The study group comprised eligible consecutive women diagnosed with preeclampsia, whereas the control group comprised appropriately matched normotensive pregnant women. Main outcome measures included the mean serum levels of uric acid and creatinine in both groups, and their levels in cases with mild and severe degrees of preeclampsia. Results: The mean serum levels of uric acid and creatinine were significantly higher in women with preeclampsia than in normotensive pregnant women (7.67 ± 2.9 versus 4.56 ± 1.1; P < 0.001, and 0.76 ± 0.3 versus 0.53 ± 0.1; P < 0.001, respectively). There was no significant difference in the mean serum levels of uric acid and creatinine in women with mild and severe degrees of preeclampsia (6.66 ± 2.3 versus 7.77 ± 2.9; P = 0.37, and 0.56 ± 0.2 versus 0.79 ± 0.4; P = 0.12, respectively). Conclusions: This study has demonstrated that serum uric acid and serum creatinine levels are elevated in pregnancies complicated by preeclampsia. However, there is no significant association between serum levels of these renal biomarkers and the severity of preeclampsia. The studied renal biomarkers are therefore important in the diagnostic workup of preeclampsia but of limited value in the disease prognostication.

Malaria eradication in Nigeria: State of the nation and priorities for action

This paper discusses the National Malaria Strategic Plan (NMSP), the Nigeria End Malaria Council (NEMC), and the National Malaria Elimination Program (NMEP) in Nigeria and their relationship towards achieving the NMSP goal of eradicating malaria by 2025. Malaria is one of the leading causes of morbidity and mortality in Nigeria. Despite implementing the NMSP in times past, the country still has sub-Saharan Africa's highest malaria mortality rate. The NMSP 2021–2025 aims to reduce malaria deaths to less than 50 per 1000 births and achieve a parasite prevalence of less than 10% by 2025. The NEMC was established in 2022 to support the NMEP in achieving the malaria eradication goal by 2030. The paper also identifies challenges to malaria elimination, such as poor accessibility to antimalarials, socio-cultural and behavioral approaches by community members, and data collection by community health workers, nurses, and doctors. The paper suggests a multidisciplinary approach involving social and behavioral scientists to incorporate community members' belief systems into account and encourages data collection and supervisory visits to ensure quality data. The sustainability of interventions and follow-up on interventions and progress reports is also highlighted as a barrier to be overcome. The paper concludes that the successful implementation of the NMSP by the NMEP will require the commitment of the NEMC, relevant stakeholders and a coordinated effort toward eliminating malaria as a public health problem in Nigeria.

A Statistical Comparative Analysis of Changes in Selected Determinants of Maternal Mortality in Bangladesh: A Road Map for Nigeria

Nigeria failed to achieve the Millennium Development Goal (MDG) 5 and is currently on track to miss the Sustainable Development Goal (SDG) 3 of reducing the maternal mortality rate in the country to under 70 death per 100,000 live births. This study aims to examine trends of maternal mortality in Nigeria and Bangladesh and analyse the impact of changes in selected determinants on maternal mortality in both countries between 1985 and 2020. Pearson correlation and linear regression tests were used to identify the strength and impact of the association between these determinants and maternal mortality. The results from this study reveal that Bangladesh witnessed a significant rise in female literacy rates and female secondary school enrolment which were strongly negatively associated with maternal mortality. The increase in female literacy and female secondary school enrolment was approximately twice that experience in Nigeria, in the same period. In Bangladesh, every unit decline in adolescent fertility rate averted 7.16 deaths per 100,000 live births. The percentage of government total expenditure on health in Nigeria shows a moderate negative Pearson correlation when compared to the maternal mortality ratio. The opposite was however the case in Bangladesh. This may suggest that health expenditure alone is incapable of reducing maternal mortality. From the empirical result of this study, policymakers in Nigeria will need to pay close attention to the sociocultural determinants of maternal mortality in a multi-sectoral approach.

Perceived Factors Influencing Delay in Attending Antenatal Care Clinic among Expectant Mothers in Anyigba, Kogi State, Nigeria

Antenatal care is a key strategy for reducing maternal and neonatal morbidity and mortality in Nigeria because adequate utilization of antenatal health care services is associated with improved maternal and neonatal health outcomes. However, some expectant mothers delay the utilization of these health care services, hence, the need to investigate the social factors causing their delay. This cross-sectional descriptive survey examined the factors associated with delay in the utilization of Antenatal Care Services among pregnant women in Anyigba, Dekina Local Government Area of Kogi State, Nigeria. The sample size consists of 400 pregnant women which cut across a public hospital and three private clinics that are not in close proximity to one another. Specific objectives include: to determine if expectant mothers in Anyigba, Kogi State attend Antenatal Care Clinic early (that is, in their first trimester which is before 14 weeks of gestation), to establish factors responsible for delay in attending Antenatal Care, to identify perceived benefits of Antenatal Care services and to explore the perceived consequences for delay in attending Antenatal Care among expectant mothers. The study made use of primary data. The questionnaire method was used to gather the needed data. Descriptive statistical method was used to analyze the data generated and hypotheses were tested using multiple linear regression and level of significance was set at 5% (0.05).The Findings from the study revealed among others, that expectant mothers in Anyigba delay in attending Antenatal Care Clinic and that majority of the respondents agreed that cost, long waiting time during Antenatal Care visit, attitudes of the expectant mothers are major factors influencing delay in the utilization of Antenatal Care Clinic in Anyigba, Kogi State. The study also found that delay in attending Antenatal Care Clinic come with consequences such as poor opportunity to monitor pregnancy, general complications and detection of diseases. Socio demographic factors, the perceived benefits of Antenatal Care (ANC), and the knowledge of the consequences associated with delay in attending ANC significantly influenced the utilization of ANC in Anyigba, Kogi State. The study concludes that, delayed Antenatal Care visit is dangerous to both the health of the expectant mother and that of the unborn child. Hence to reduce the risk of maternal and neonatal morbidity and mortality, expectant mothers should be encouraged through the policy developments and governments interventions to book early for Antenatal Care within the first trimester of their pregnancy as recommended by the World Health Organization (WHO) and that government and non-governmental institutions should increase enlightenment drive on both the benefits of early antenatal attendance and the consequences of delayed or non antenatal attendance.

A Review of Caesarean Delivery at the Kogi State Specialist Hospital, Lokoja, Nigeria

Background: Caesarean delivery rate is increasing globally including in Nigeria. Caesarean delivery is a life-saving surgery for both mother and child. Objective: The aim of the study was to assess the caesarean delivery rate at the Kogi State Specialist Hospital, Lokoja, Nigeria over a one-year period. Methods: This was a prospective assessment of the demographic characteristics of patients, indications, types, rates and outcomes of Caesarean delivery in Kogi State Specialist Hospital, Lokoja, Nigeria from December 15, 2020 to December 14, 2021. Data collected were analyzed using SPSS version 20.0 statistical package (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). The categorical data were displayed using tables and charts. Results: There was a total of 491 deliveries, out of which were 113 Caesarean deliveries and 378 spontaneous vaginal deliveries making the Caesarean delivery rate in Kogi State Specialist Hospital, Lokoja, Nigeria 23.0%. There were no instrumental deliveries during the study period. The commonest indication for Caesarean section was obstructed labour in 31% of cases. There was no maternal mortality. There were three early neonatal deaths due to severe birth asphyxia. Conclusion: The rate of Caesarean delivery in this study was 23.0% and obstructed labour was the leading indication in 31% of cases. The rate of Caesarean delivery in this study is high, albeit the overall outcome was good for both mother and child. Caesarean delivery, therefore, remains one of the means for reducing maternal and perinatal morbidity and mortality in Nigeria.

Serum magnesium levels of term neonates with birth asphyxia and relationship to severity of asphyxia.

Birth asphyxia is one of the three main causes of neonatal mortality in Nigeria. Hypomagnesaemia has been reported amongst severely asphyxiated babies. Despite this, the prevalence of hypomagnesaemia amongst newborns with birth asphyxia has not been well researched in Nigeria. This study set out to determine the prevalence of hypomagnesaemia in term neonates with birth asphyxia and the relationship (if any) between magnesium levels and the severity of birth asphyxia or encephalopathy. In this cross-sectional analytical study, the serum magnesium levels of consecutive cases of birth asphyxia were compared to that of gestational age-matched healthy term neonates. Babies with Apgar scores <7 in the 5th minute of life were recruited into the study. Blood samples were taken from each baby at birth and 48 h. Serum magnesium was measured using spectrophotometry. Hypomagnesaemia was found in 36 (35.3%) babies with birth asphyxia and 14 (13.7%) healthy controls; this difference was statistically significant (χ2 = 18.098, P = 0.001), with an odds ratio of 3.4 (95% confidence interval = 1.7, 6.9). The median (interquartile range) levels of serum magnesium in babies with mild, moderate and severe asphyxia were 0.7 mmol/L (0.5-1.1), 0.7 mmol/L (0.4-0.9) and 0.7 mmol/L (0.5-1.0), respectively (P = 0.316), while those of babies with mild (stage 1), moderate (stage 2) and severe (stage 3) encephalopathy were 1.2 mmol/L (1.0-1.3), 0.7 mmol/L (0.5-0.8) and 0.8 mmol/L (0.6-1.0), respectively (P = 0.789). This study has shown that hypomagnesaemia was more common in babies with birth asphyxia and there was no relationship between magnesium levels and the severity of asphyxia or encephalopathy.

Comparative Study of Lee Carter and Arch Model in Modelling Female Mortality in Nigeria

Using Nigeria mortality data from 2009 to 2020, this study compares and contrasts how well the Lee-Carter and ARCH models performed. Singular value decomposition (SVD) method, Langrage multiplier test, and autoregressive conditional heteroskedasticity (ARCH) effects were examined. Five (5) different ARIMA and ARCH models were fitted together with their criteria, i.e., AIC and BIC in order to determine the best model for Nigeria mortality data. ARIMA (0,1,0) had the lowest AIC and BIC values, and was determined to be the best ARIMA model. The mortality index is then modelled using ARIMA (0,1,0) and plugged back into the Lee-Carter model to predict the future mortality rate. Also ARCH (1) turned out to be the best ARCH model among other candidate models. The performance of Lee-Carter model and ARCH model was compared using error measures. Results obtained revealed that the ARCH model had the minimum RMSE and MAPE when compared with the Lee-carter model, therefore it was concluded that the ARCH model performs better than the Lee-Carter model on Nigeria mortality data.

Preconception Care: An Untapped Route towards Reducing Infant and Maternal Mortality in Nigeria

The aim of preconception care is to reduce parental risk factors before pregnancy through health promotion and intervention which reduces maternal and infant morbidity and mortality. Healthcare providers play important roles in providing this care to women and men of childbearing age. In Nigeria however, the implementation of preconception care by healthcare providers remains low. In this review, an overview of preconception care in Nigeria and the barriers that affects its delivery will be explored. Peer reviewed articles were searched using key words related to preconception care and implementation of the care by healthcare providers. Publications were deemed eligible if they reported on preconception care and barriers influencing the provision of preconception care. A careful analysis of existing literatures on the topic shows that, there is a low understanding of preconception care among women of reproductive age in Nigeria. Furthermore, preconception care is not yet widely practiced in the Nigeria as part of health care due to unplanned and recurrent pregnancies, high parity, poor health care seeking behavior and low level of maternal health care. In view of the aforementioned challenges, there is a need to develop and implement preconception policies and guidelines to be applied in the existing health care system. Considering the importance of this care in improving pregnancy and neonatal outcomes, there is a need to educate and engage members of the society as well as health care providers in its importance and delivery.

Trends in under 5 mortality in Nigeria: how much has really changed geographically and among wealth subgroups?

Trends in under 5 mortality in Nigeria: how much has really changed geographically and among wealth subgroups?

The Link between Government Health Expenditure and Health Outcome in Nigeria, 1981-2019

This study examines the relationship between government health expenditure and health outcome in Nigeria using time series data on infant mortality, government health expenditure, school enrollment ratio and the gross domestic product for the period covering 1981 to 2020. The study sourced data from the World Bank data base and Central Bank of Nigeria (CBN) statistical bulletin. Infant mortality rate was used as a proxy for health outcome based on data availability and the literature. As dictated by the data, the study used Vector Autoregressive model (VAR) to analyse the relationship between government health expenditure and health outcome in Nigeria for the period under study. The variables in the model were all integrated of order one and were cointegrated using the Johansen’s cointegration test. Government health expenditure is found to have a negative relationship with infant mortality in Nigeria; an indication that an increase in health expenditure has the tendency to decrease infant mortality in Nigeria. The study finds school enrollment to be significant. Therefore, the study recommends among other things that government expenditure should be increased to diminish infant mortality as well as enhance school enrolment.

Macro-economic determinants, maternal and infant SDG targets in Nigeria: Correlation and predictive modeling.

Unambiguously, Nigeria is off-track in achieving the health-related SDGs. Consequentially, this study aligns with SDG 3 which calls for "good health and wellbeing for people by ensuring healthy lives and promoting wellbeing for all at all ages". This article examines the combined effect of health expenditure and other key macro-economic factors on health indices such as maternal and newborn and child mortality in Nigeria. Contrary to existing literature, we formulated a model that predicts the level of macro-economic determinants needed to achieve the SDG targets for maternal and newborn and child mortality in Nigeria by 2030. The study used Autoregressive Distributed Lag (ARDL), which is usually used for large T models. The study period spans from 1995 to 2020. We found a significant negative relationship between health outcomes and macro-economic determinants namely, household consumption, total health expenditure, and gross fixed capital while we determined a significant positive relationship between health outcomes and unemployment. Our findings are further supported by out-of-sample forecast results suggesting a reduction in unemployment to 1.84 percent and an increase in health expenditure, gross fixed capital, household consumption, control of corruption to 1,818.87 billon (naira), 94.46 billion (naira), 3.2 percent, and -4.2 percent respectively to achieve SDG health targets in Nigeria by 2030. The outcome of this result will give the Nigerian government and stakeholders a deeper understanding of the workings of the macro-economic factors, concerning health performance and will help position Nigeria, and other SSA countries by extension, toward reducing maternal mortality to 70 per 100,000 and newborn and child mortality to 25 per 1,000 births by 2030. The African leaders should consider passing into law the need for improvement in macro-economic factors for better health in Africa. We also recommend that the Nigerian government should steadily increase health expenditure to reach and move beyond the forecast level for improvement in maternal and infant mortality, given the present low and unimpressive funding for the health sector in the country.