Nigeria Demographic And Health Survey Research Articles

Adolescent pregnancy persists in Nigeria: Does household heads' age matter?

About 700,000 pregnant youths die each year in developing countries. To determine whether the persistent adolescent pregnancy in Nigeria between 2013 and 2018 was influenced by proximal factors, particularly household head age, we carried out a cross-sectional study on adolescent girls that participated in the 2018 Nigeria Demographic and Health Survey (NDHS). Age of first birth, residence type, age, and gender of household heads was collected using a 2018 standardized NDHS. Multiple logistic regression was performed to test for associations. We analyzed 8,448 adolescents who had experienced pregnancy during the study period. The results demonstrated that girls with male household heads aged 45 and older have lower odds of adolescent pregnancy (OR = 0.619; 95% CI = 0.447, 0.856; p = 0.004 compared to those with female household heads in the same age group. Girls with male household heads in three younger age groups have higher odds of adolescent pregnancy than those with female household heads in the corresponding age group (15-24: OR = 1.719, 95% CI = 1.042, 2.835, p = 0.034; 25-34: OR = 4.790, 95% CI = 1.986, 11.551, p < 0.001; 35-44: OR = 2.080, 95% CI = 1.302, 3.323, p = 0.002). Girls with household heads aged in the 15-24 and 25-34 groups had higher odds of adolescent pregnancy compared to those with household heads aged 45 and older. Higher odds of adolescent pregnancy in Nigeria were found among girls with household heads aged in the 15-24 and 25-34 groups compared to those with household heads aged 45 and older. Although girls with younger male household heads are at an increased risk nationally, those living in the rural areas with younger household heads are at an even higher risk for adolescent pregnancy. Therefore, levels of socioecological model must be considered in planning for effective interventions.

Intimate Partner Violence among Mothers of Children with Sickle Cell Disease: A Retrospective Cohort Analysis of 2018 Nigeria DHS Data

Background: The 2018 Nigeria Demographic and Health Survey (NDHS) collected data on the experience of intimate partner violence (IPV) among women aged 15-49 years and the genotype of their children aged 6-59 months. We performed a retrospective cohort analysis to ascertain if having a child with sickle cell disease (SCD) predisposes women to IPV.&#x0D; Methods: Eighty-five mothers of children living with SCD were compared with 320 mothers of children living without SCD after matching for age, number of living children, religion, place of residence and wealth index. The prevalence rates of IPV and the relative risks (RRs) of experiencing controlling behaviour, emotional, physical, sexual and any form of IPV in the 12 months preceding the survey were calculated.&#x0D; Results: Compared to mothers of children without SCD, mothers of children living with SCD were not at greater risk of experiencing controlling behaviour (RR=0.90, 95% CI: 0.54–1.49), emotional violence (RR=1.09; 95% CI=0.78–1.53), physical violence (RR=0.75, 95% CI: 0.38–1.48), sexual violence (RR=0.89, 95% CI: 0.31– 2.56) or any form of IPV (RR=0.98, 95% CI: 0.71–1.37).&#x0D; Conclusion: The study did not find sufficient evidence for increased risk of IPV among mothers of children living with SCD, despite the additional health, psychosocial and financial burdens associated with raising a child with the disease. Further research is needed to address the limitations of this study and to carefully investigate the relationship between having a child with SCD and the experience of IPV among women.

Contextual determinants of generational continuation of female genital mutilation among women of reproductive age in nigeria: analysis of the 2018 demographic and health survey

BackgroundFemale genital mutilation (FGM) has negative health implications and has long been recognised as violating sexual rights. Despite the huge efforts expended on eradicating FGM, generational continuation of the practice, i.e. the act of mutilated women also mutilating their daughters, persists in Nigeria. This study investigated the individual, household, and community factors associated with generational continuation of FGM among women in Nigeria.MethodsThe study analysed data from the 2018 Nigeria Demographic and Health Survey (NDHS). A weighted sample of 3835 women with FGM history and who had given birth to female children was analysed. Models were estimated using mixed-effects multilevel logistic regression with Stata 16.0.ResultsThe results showed that 40.0% of women continued FGM for their daughters. Regional prevalence of FGM continuation ranged from 14.9% in the South-South (the lowest) to 64.3% in the North-West (the highest). Women aged 15–24 years (uaOR = 0.40; 95% CI:0.28–0.57) and rich (uaOR = 0.44; 95% CI:0.35–0.56) had the least likelihood of generational continuation of FGM. In communities with low proportions of women unexposed to the media, the likelihood of FGM continuation was significantly higher (uaOR = 1.85; 95% CI:1.35–2.53). Generational continuation of FGM was significantly lower in communities with moderate proportions of uneducated mothers (aOR = 0.6; 95% CI:0.42–0.86).ConclusionFGM continuation was high in Nigeria, and it was most common among older and poor mothers and in communities with large proportions of uneducated women and those unexposed to the media. Existing National Policy and Plan on FGM elimination should be strengthened to target these characteristics.

Influence of intimate partner violence and male involvement on maternal healthcare services utilisation in Nigeria.

Low maternal health care services utilisation, especially antenatal care attendance and skilled birth attendance, has been documented to be responsible for maternal mortality and morbidity in Nigeria. While available evidence suggests mixed findings on uptake of maternal health care services in the context of abusive spousal relationships, male involvement in household and health decision-making has been established to promote uptake of maternal health care services. Yet, studies which consider mediating influence of intimate partner violence on male involvement and maternal health care services uptake are sorely missing in Nigeria. We hypothesised that maternal health care services uptake in abusive marital unions has implications for male involvement in pregnancy care and this has been largely overlooked in Nigeria. This study extracted data from the 2018 Nigeria Demographic and Health Survey (NDHS). The 2018 NDHS is a nationally representative secondary data which collected population, demographic and health information on women, men and households in Nigeria. The secondary data used a two-stage stratified and multistage sampling technique to collect information from the respondents. In this study, data were extracted for women who were sexually active, within the reproductive age (15-49 years) and not pregnant in five years prior the survey (n = 7,847). The results indicated (77%) antenatal care attendance and (47%) skilled delivery. The mediating influence of IPV on male involvement resulted in women who experienced sexual violence more likely to use heath facility for antenatal care (OR = 3.20; C.I: 1.20-8.50). Women whose partners were involved in health decision making had lower odds of antenatal care attendance (OR = 0.64; C.I: 0.44-0.94). Also, women whose partners were involved in spending their earnings had lower probability of antenatal care attendance (OR = 0.72; C.I: 0.55-0.96). Yet, the mediating influence of intimate partner violence on male involvement resulted in a lower likelihood of use of skilled delivery for emotionally abused women (OR = 0.58; C.I: 0.39-0.85). Women whose partners were involved in spending their earnings had higher odds of using skilled delivery (OR = 2.15; C.I: 1.79-2.56). Yet, women whose partners were involved in their health decision-making had lower odds of using skilled delivery (OR = 0.46; C.I: 0.34-0.62). This study held the philosophical stance that intimate partner violence mediated the influence of male involvement on maternal health care uptake while intimate partner violence had an inconsistent influence on maternal health care uptake. Policies and interventions should aim at addressing deep-rooted gender norms which promote IPV and limit male involvement in pregnancy care in Nigeria. Programme and policy interventions should focus on enhancing socioeconomic status of women.

Socioecological Approach to Understanding Overnutrition Among Married and Cohabiting Women in Nigeria

Overweight and obesity are currently an epidemic affecting both developed and developing countries. Sub-Saharan Africa has a double burden of being underweight and obese and has recently been battling an alarming increase in the prevalence of overweight. This study investigates the predictors of overnutrition among married women of reproductive age in Nigeria using the socioecological model (SEM) as a framework. The study hypothesizes that the Southern region will have a higher burden of overnutrition than the Northern region. The 2018 Nigeria Demographic and Health Survey (NDHS) was analyzed. A total of 8,531 non-pregnant married women met the inclusion criteria. Hierarchical multilevel logistic regression models were fitted, informed by the SEM framework. The occurrence of overnutrition was found to be 31.4%, with regional variations showing 31.7% in the South and 31.3% in the North. When all covariates were fitted in a model, being older, being a Christian, having tertiary education, having an older partner with tertiary education, being wealthy, and living in the urban area were predictors of overnutrition in multivariate analysis. Overnutrition among Nigerian married women was high, especially in the Southern region. Predictors of overweight are at all the SEM levels; therefore, it is better to consider all the levels when planning public health interventions.

Fertility among Northern Nigeria women and associated factors: Negative binomial regression model approach

Objective: The 2020 sustainable development progress report shows that human population growth is a critical barrier to achieving the Sustainable Development Goals (SDG). There are very few studies on determinants of fertility particularly looking at the northern part of Nigeria that has a relatively high fertility level compared with the southern part of the country. This study therefore is aimed at identifying the factors associated with fertility among women in northern Nigeria. Methods: The data for this study was from the Nigeria Demographic and Health Survey (NDHS) 2018. The number of children ever born by women aged 15 – 49 years and other variables who lived in Northern Nigeria were extracted and analyzed using Negative Binomial Regression, where the level of significance was 0.05. Results: There were variations in factors associated with fertility among the geopolitical zones in Nigeria. Age of the respondents, sex of household head, wealth index, religion, ethnicity, use of family planning (FP) method, and child death experience were among the factors associated with fertility. Women with no/lower education, early marriage, being Muslim and Hausa/Fulani ethnic background experienced high fertility (p&lt;0.05). Conclusion: Attention to the factors mentioned above and intervention programmes designed to reduce fertility are indispensable. Education of female children should be given extra attention as this will empower them to be more informed. Hence, achieving SDGs will become a reality.

Impacts of Early Marriage on Fertility Outcomes in Nigeria

Nigeria is the most populous country in Africa and projected to be the 3rd in the World by 2050. Despite measures to control the country’s population over the years, the total fertility rate has remained high. Fertility rate is associated with various factors but there is limited evidence on the role of early marriage as a predictor or barrier to fertility outcome. This study determined the association between early marriage and fertility outcome in Nigeria. This study is based on secondary data analysis of the 2018 Nigeria Demographic and Health Survey (NDHS). It is a descriptive cross-sectional study with sample that comprised of married women aged 20-24 years old. Data was analyzed using SPSS version 20. The multivariate regression analysis revealed higher likely of women in early marriage to have childbirth in the first year of marriage (OR=2.26, 95%CI=1.96-2.61); and number of children ever born (OR=4.24, 95% CI=3.40-5.27) but lower odd of repeated childbirth in less than twenty-four months (OR=0.66, 95%CI=0.52-0.83) and ever use of contraceptive (OR=0.52, 95%CI=0.45-0.61). However, the adjusted odd ratio only showed significant association between early marriage and number of children ever born (AOR=10.28, 95%CI=2.57-41.13). The nuanced analysis indicates that marriage at any age below 18 had higher effect on fertility than marriage at 18 and above. Early marriage predisposes married women to higher fertility and women with lower age of marriage have likelihood of higher fertility. Improving access of girls to education and contraceptives will delay the timing of pregnancy and childbirth. Keywords: Child marriage, Childbirth, Contraceptive, Early marriage, Fertility, Nigeria.

The impact of armed conflicts on the nutritional status of children: Evidence from Northern Nigeria.

Armed conflicts often significantly exacerbate the magnitude and severity of malnutrition by increasing food insecurity. Evidence shows that malnutrition is among the leading causes of morbidity and mortality among children during conflicts. This study examines the impact of the armed conflicts in Northern Nigeria on nutritional status of children under the age of five. Three waves (2008, 2013, and 2018) of individual-level birth records data from the Nigeria Demographic and Health Survey (NDHS) dataset are spatially merged with information on conflict events drawn from the Armed Conflict Location and Events Dataset. All fatal incidents in the study region during the 5-year intervals 2004-2008, 2009-2013 and 2014-2018 are aggregated and mapped to the 2008, 2013 and 2018 NDHS clusters, respectively. A cluster is classified to be exposed to conflict if located within 5-10km radius of an incident with at least 1 fatality. We use matching analysis in a difference-in-differences approach to estimate the effects of the conflicts on stunting, wasting, and underweight. We find that the impact of conflict exposure differs by the dimension of child nutritional status. While it significantly lowers the risk of stunting, it has no discernible significant effect on the likelihood of wasting or being underweight among under-fives. Though nutritional support/interventions in the conflict-affected areas are crucial and must be prioritised, an all-inclusive strategy for a long-term resolution of the conflict is needed to engender development, improve food security, reduce vulnerability to malnutrition, and improve the health and wellbeing of the residents of the region.

Health insurance coverage and access to maternal healthcare services by women of reproductive age in Nigeria: a cross-sectional study

BackgroundInequitable financial access to maternal healthcare services (MHS) has contributed to maternal deaths, especially in low and middle-income countries. Evidence in the literature on women’s health insurance status and access...

Slim north, fat south: explaining regional differences in abnormal weights in Nigeria.

Weight abnormalities (underweight, overweight, and obesity) can cause life-threatening ailments. This study investigates disparities in the prevalence of underweight, overweight, and obesity between northern and southern Nigeria and their associated factors. Using the 2018 Nigeria Demographic and Health Survey (NDHS), the study analysed a sample of 12,333 women with complete records of body mass index. The study found that southern women had lower odds of being underweight than women in the north, but the reverse was the case for overweight and obesity. The prevalence of underweight was 11.6%, and it varies from 6.9% in the southern state of Enugu to 31.6% in the northern state of Jigawa. The national prevalence of overweight was 17.9%, ranging from 6.7% in Jigawa State of the northern region to 39.9% in Lagos State of the south. Similarly, the prevalence of obesity in the north was 6.1% compared to 14.4% in the south, with Anambra State of the southern region recording the highest figure of 35.5% compared to 2.1% in the Yobe State of the northern region. In all, the rate of abnormal weight was significantly higher in the south than in the north. However, the type of weight abnormality varies between the two regions. Religion, education, use of contraceptives, and wealth were associated with the three forms of abnormal weights. However, while religion was significantly associated with obesity in the north, the association was not significant in the south. This study found that wealth and education have dissimilar influences on overnutrition. While the odds of being overweight and obese increase with wealth, being educated up to a secondary level significantly reduces the odds in Nigeria and across the two regions.

Socioeconomic predictors of access to improved water sources, sanitation facilities, and household water treatment in Nigeria

Abstract In Nigeria, the widespread lack of access to water, sanitation, and hygiene (WASH) represents a critical public health challenge. Yet, the socioeconomic determinants of WASH access at the national level remain poorly understood. This study uses 2018 Nigeria Demographic and Health Surveys (NDHS) cross-sectional data to investigate the socioeconomic factors associated with WASH access. The majority of survey respondents lived in rural areas (57%); used an improved source of drinking water (73%) and an improved sanitation facility (55%); and did not treat their drinking water (92%). Binary logistic regression showed that Nigerians living in rural areas were less likely to have access to an improved water source (p &amp;lt; 0.001, OR = 0.42 [0.41, 0.44]) and less likely to have access to an improved sanitation facility (p &amp;lt; 0.001, OR = 0.79 [0.77, 0.81]). A sub-group regression analysis of respondents without access to improved WASH found that rural residence (OR = 0.84 [0.76, 0.93]), along with lower levels of education and wealth were associated with non-treatment of their unimproved drinking water. This study suggests that efforts are needed to increase WASH access in rural areas and to improve household water treatment in areas without access to improved water and sanitation.

Trend Analysis and Determinants of under-5 Mortality in Nigeria: A Machine Learning Approach

The study aimed to examine the trend of the under-five mortality rate in Nigeria from 2003 to 2018 and the determinants of under-five mortality using the Nigeria Demographic and Health Survey (NDHS) data. The data for the study was the Nigeria Demographic and Health Survey data conducted in 2003, 2008, 2013, and 2018. These four surveys were used to study under-five mortality trends within the study period, while machine learning was applied only to the 2018 dataset being the latest in Nigeria. The data were partitioned into training and testing sets. 30% of the dataset was randomly selected for testing, while 70% was used in training the model. Before applying logistic regression and neural networks, the essential under-five mortality variables were first selected using a random forest classifier.&#x0D; The trend showed that the mortality rates were 200.72, 156.86, 128.05, and 132.02 in 2003, 2008, 2013, and 2018 respectively, per 1,000 live births. This result means that one in every five children died before their fifth birthday in 2003, one in six in 2008, one in eight in 2013, and one in seven in 2018. The forecast result indicated that the under-five mortality rate would likely be 102.17 in 2023. The variable importance result of the random forest showed that breastfeeding (when the child was put to the breast after birth) had the highest contribution to under-five mortality. The breakdown of breastfeeding from the logistic regression result showed that delaying the breastfeeding of a child to 6-23 hours in comparison with 0-5 hours after birth increases by 1.4 fold the likelihood of child death. The accuracy of logistic regression (LR) on the test set was 60%, and that of deep neural network (DNN) was 74%, recall (sensitivity) for LR was 63%, and DNN was 75%), Precision (LR=97%, DNN=95), F1 score (LR=76%, DNN=84%) and area under the curve (AUC) (LR=79%, DNN=77%).&#x0D; Both logistic regression and deep neural network models performed very well in discriminative ability and accuracy. The deep neural network had a better performance than the logistic regression.

Determinants of Use of Contraceptive Methods Among Sexually Active Married Men in Nigeria

Using a cross-sectional research design, the men’s dataset of the 2018 Nigeria Demographic and Health Survey (NDHS) and a weighted sample size of 7,991 sexually active married men (15–59 years) were used to examine determinants of the use of contraceptive methods. Data were analyzed using frequency tables, proportions, Pearson’s chi-square, and multinomial logistic regression. The relative risk of using male-controlled contraception relative to not using any contraception was 3% significantly lower (arrr = 0.7, 95% CI [0.5, 1.0], p &lt; .05) among polygamous married men than for monogamists. In comparison, the relative risk of using female-controlled contraception relative to not using any contraception was 4% significantly higher (arrr = 1.4, 95% CI [1.0, 2.0], p &lt;.05) for polygamous married men compared to the corresponding risk for monogamists. Other factors influencing the risk of using male-controlled contraception include tertiary education (arrr = 2.8, 95% CI [1.9, 4.0], p &lt; .05), Yoruba (arrr = 3.8, 95% CI [2.8, 5.2], p &lt; .05), richer (arrr = 1.5, 95% CI [0.8, 1.7], p &lt; .05), and desire for more children (arrr = 0.8, 95% CI [0.7, 0.9], p &lt; .05), media exposure (arrr= 1.5, 95% CI [1.3, 1.7], p &lt; .05) and the number of sexual partners in the last 12 months (arrr = 5.7, 95% CI [4.6, 7.0], p &lt; .05). Findings suggest strengthening male-controlled contraceptive methods by sexually active married men to reduce high fertility levels.

Individual and Systemic Factors of Under-five Mortality in Nigeria: A Cox Proportional Hazard Model

Despite considerable efforts to reduce under-five mortality nationwide, Nigeria has fallen short of achieving the Millennium Development Goals (MDGs) target of 67 deaths per 1,000 live births by 2015. Of all the documented factors of under-five mortality, little evidence exists on the impact of systemic barriers and individual factors (maternal health-seeking behaviour) on under-five mortality in Nigeria. The study used a nationally representative sample from Nigeria Demographic and Health Survey (NDHS) 2013 dataset. The target population was 20,192 women aged 15-59 years who had given birth to 31,480 children five years before the survey. Stata software was used for data analysis. The risk of death was estimated using Cox proportional hazard models and results are presented as hazards ratios (HR) with 95% confidence intervals (CI). Findings from the overall Model I-IV revealed individual factors (maternal health-seeking indicators) as significant factors of under-five deaths (p &lt; 0.05). Children whose mothers received antenatal care coverage (ANC) outside health care facilities (HCF) (HR: 1.60, CI: 1.0-2.4, p &lt; 0.05); or delivered outside HCF (HR: 1.02, CI: 0.7-1.5, p &lt; 0.05) had elevated hazard risk of death before age five. Conversely, children who were presented for postnatal check within two weeks of delivery (HR: 0.60, CI: 0.5-0.8, p &lt; 0.05), or delivered within the longer birth interval (HR: 0.67, CI: 0.6-0.8, p &lt; 0.001) had significantly lower hazard risk of death before age five. As part of systemic factors, children whose mothers were covered by health insurance scheme had significantly (HR: 0.52, CI: 0.2-1.2, p &lt; 0.001) lower risk of death when compared with their counterparts without health insurance coverage. The study emphasized the need to revitalize strategies and programs to improve women health seeking behaviour and investment in the health sector through health insurance, infrastructure, and supplies.

Estimation of HIV prevalence and burden in Nigeria: a Bayesian predictive modelling study

The cost of population-based surveys is high and obtaining funding for a national population-based survey may take several years, with follow-up surveys taking up to five years. Survey-based prevalence estimates are prone to bias owing to survey non-participation, as not all individuals eligible to participate in a survey may be reached, and some of those who are contacted do not consent to HIV testing. This study describes how Bayesian statistical modeling may be used to estimate HIV prevalence at the state level in a reliable and timely manner. We analysed national HIV testing services (HTS) data for Nigeria from October 1, 2020, to September 30, 2021, to derive state-level HIV seropositivity rates. We used a Bayesian linear model with normal prior distribution and Markov Chain Monte Carlo approach to estimate HIV state-level prevalence for the 36 states+1 FCT in Nigeria. Our outcome variable was the HIV seropositivity rates and we adjusted for demographic, economic, biological, and societal covariates collected from the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS), 2018 Nigeria Demographic and Health Survey (NDHS) and 2016-17 Multiple Indicator Cluster Surveys (MICS). The estimated population of 15-49 years olds in each state was multiplied by estimates from the estimated prevalence to generate state-level HIV burden. Our estimated national HIV prevalence was 2.1% (95% CI: 1.5-2.7%) among adults aged 15-49 years in Nigeria, which corresponds to approximately 2 million people living with HIV, compared to previous national HIV prevalence estimates of 1.4% from the 2018 NAIIS and UNAIDS estimation and projection package PLHIV estimation of 1.8 million in 2022. Our modelled HIV prevalence in Nigeria varies by state, with Benue (5.7%, 95% CI: 5.0-6.3) having the highest prevalence, followed by Rivers (5.2%, 95% CI: 4.6-5.8%), Akwa Ibom (3.5%, 95% CI: 2.9-4.1%), Edo (3.4%, 95% CI: 2.9-4.0%) and Taraba (3.0%, 95% CI: 2.6-3.7%) placing fourth and fifth, respectively. Jigawa had the lowest HIV prevalence (0.3%), which was consistent with prior estimates. This model provides a comprehensive and flexible use of evidence to estimate state-level HIV seroprevalence for Nigeria using program data and adjusting for explanatory variables. Thus, investment in program data for HIV surveillance will provide reliable estimates for HIV sub-national monitoring and improve planning and interventions for epidemiologic control. This article was made possible by the support of the American people through the United States Agency for International Development (USAID) under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).

Household Vulnerability and Childhood Immunization Status in Nigeria

Immunization is considered one of the most cost-effective public health interventions for reducing childhood morbidity, mortality, and disability globally. However, while global achievement of over 70% coverage rates was sustained in 1990s, wide variations exist between and within countries. In some developing countries, immunization rates increased substantially, but in sub-Saharan Africa, immunization rates plummeted, leaving millions of children vulnerable to life-threatening diseases. In Nigeria, coverage rates for routine immunization for all antigens still fall below 50%. The study examined the overall influence of household vulnerability dimensions, maternal health practices on childhood immunization status in Nigeria. The study used secondary data from 2013 Nigeria Demographic and Health Surveys (NDHS). The analytical weighted sample size was 5,824women of reproductive ages (15–49 years) with a live birth in the past 3 years, whose children were within age 12 to 23 months at the time of the survey. The data was analyzed using frequency distribution, chi-square test, and binary logistic regression. The results showed a decreasing regional variation in the proportion of fully immunized children from high of 23.6% in South-West, to a low of 9.1% in North-East. The overall household vulnerability status showed that children in more and most vulnerable households were 62% (OR = 0.38; p &lt; .001; CI [0.32-0.46]) and 89%less likely (OR = 0.11; p &lt; .001; CI [0.08-0.14]) to receive full vaccination compared with their counterpart in non-vulnerable households. The study revealed significant relationship between mothers’: (i) number of antenatal visits (OR = 1.66; p &lt; .05; CI [0.25-1.77]); (ii) quality of antenatal care (OR = 2.61; p &lt; .05; CI [1.45-4.67]); (iii) place of delivery (OR = 0.62; p &lt; .05; CI [0.45-0.86]); (iv) assistance during delivery (OR = 0.41; p &lt; .001; CI [0.28-0.57]); (v) time of postnatal check (OR = 1.81; p &lt; .001; CI [1.49-2.19]) and full childhood immunization status.

The Effects of Early Marriage on the Utilization of Maternal Health Services in Nigeria

Antenatal and delivery care are essential maternal health services (MHS) for survival and wellbeing. Nigeria has the highest global burden of maternal mortality with low utilization antenatal and delivery services. Though early marriage is a strong predictor of early pregnancy and childbirth, it is not clear if it is associated with low use of MHS. This study assessed early marriage as a determinant of poor MHS utilization in Nigeria. This study used data from the 2018 Nigeria Demographic and Health Survey (NDHS) which is based on descriptive cross-sectional survey design. The data was limited to ever married women aged 15-24 years. Data was analyzed using SPSS version 20. This study indicates lower likelihood of women who marry early to use antenatal care (OR=0.25, 95%CI=0.21-0.31), receive minimum 4 ANC (OR=0.22, 95% CI=0.18-0.26), receive iron supplementation (OR=0.38, 95%CI=0.33-0.45) and IPTp for malaria prevention (OR=0.57, 95%CI=0.50-0.66). Conversely, Early marriage was found to be associated with higher likelihood of facility delivery (OR=4.6, 95%CI=4.02-5.26) and lower likelihood of delivery by unskilled attendant (OR=0.31, 95%CI=0.26-0.31). These associations disappear in the adjusted model. Nevertheless, the nuanced analysis showed association in the adjusted odd ratio for use of antenatal care (AOR=0.44, 95%CI=0.20-0.99) and number of antenatal care visits (AOR=0.37, 95%CI=0.14-0.95) among women who married at less than fourteen years. Early marriage below age 14 years negatively affect utilization of MHS. There is the need to strengthen legislation against early marriage below 14 years and address socioeconomic challenges that exacerbate vulnerability. Keywords: Antenatal care, Child marriage, Delivery, Early marriage, Maternal health services, Nigeria.

Using Andersen’s behavioral model of health care use for intermittent preventive treatment of malaria in pregnancy in Nigeria

BackgroundStudies in Nigeria and elsewhere in sub-Saharan Africa (sSA) have explored factors influencing usage of intermittent preventive treatment of malaria in pregnancy (IPTp). Most studies, however, are not model or theory-based, which provides less satisfactory guidance to malaria control programming. This study fills the knowledge gap by adapting Andersen’s behavioral model of health care use to IPTp usage in Nigeria.MethodsThis study adopted a cross-sectional design that utilized secondary data extracted from the 2018 Nigeria Demographic and Health Survey (NDHS). A weighted sample of 4,772 women who had given birth in the past year preceding the survey, was analyzed. Outcome variable was usage of IPTp, dichotomized into optimal or otherwise. Explanatory variables cut across individual and community levels and were divided into predisposing, enabling and need factors in line with the theoretical constructs of the Andersen model. Two multilevel mixed-effects logistic regression models were fitted to identify factors which influenced optimal usage of IPTp. Analyses were performed using STATA 14. Statistical significance was set at 5%.ResultsRealised level of optimal IPTp usage was 21.8%. Factors that either predispose or enable pregnant women to take optimal doses of IPTp were maternal education, being employed, being autonomous in their own healthcare, health insurance enrolment, partner education, receiving antenatal care in public health facilities, rural residence, being resident in northern geo-political zones, community literacy level and community perception of the consequences of malaria. Two significant need factors affecting optimal usage of IPTp were timing of the first antenatal care visit and sleeping under mosquito bed nets.ConclusionOptimal usage of IPTp is low among pregnant women in Nigeria. There is a need to devise additional public health educational programs promoting IPTp usage through the formation of Advocacy, Communication and Social Mobilisation (ACSM) in every ward in all local government areas, particularly in the rural and northern parts of the country. In addition, health planners should adopt the Andersen model for assessing key determinants of IPTp usage among childbearing women in Nigeria.

To what extent is antenatal care in public health facilities associated with delivery in public health facilities? Findings from a cross-section of women who had facility deliveries in Nigeria

BackgroundFacility delivery remains an important public health issue in Nigeria. Studies have confirmed that antenatal care may improve the uptake of facility delivery. However, information is rarely available in Nigeria on the extent to which antenatal care in public health facilities is associated with delivery in public health facilities. The objective of the study was thus to examine the extent of the association between antenatal care in public health facilities and delivery in public health facilities in Nigeria. The study was guided by the Andersen behavioral model of health services use.MethodsThe cross-sectional design was adopted. Data were extracted from the most recent Nigeria Demographic and Health Survey (NDHS). A sample of 9,015 women was analyzed. The outcome variable was the facility for delivery. The main explanatory variable was the antenatal care facility. The predisposing factors were maternal age, age at first birth, parity, exposure to mass media, and, religion. The enabling factors were household wealth, work status, partners’ education, women’s autonomy, health insurance, and, perception of distance to the health facility. The need factors were pregnancy wantedness, the number of antenatal care visits, and the timing of the first antenatal care. Statistical analyses were performed with the aid of Stata version 14. Two binary logistic regression models were fitted.ResultsFindings showed that 69.6% of the women received antenatal care in public health facilities, while 91.6% of them subsequently utilized public health facilities for deliveries. The significant predisposing factors were age at first birth, parity, maternal education, and religion, while household wealth, work status, women’s autonomy, and partners’ education were the significant enabling factors. The timing of the first antenatal contact, pregnancy wantedness, and the number of antenatal care visits were the important need factors.ConclusionTo a significant extent, antenatal care in public health facilities is associated with deliveries in public health facilities in Nigeria. It is imperative for governments in the country to take more steps to ensure the expanded availability of public health facilities in all parts of the country since their use for antenatal care is well-associated with their use for delivery care.

Determinants of cigarette smoking and smoking frequency among women of reproductive age in Nigeria: evidence from a nationwide cross-sectional survey

BackgroundSmoking is a leading cause of avoidable deaths and attributable disability-adjusted life years globally. Yet, the determinants of smoking practices among women are understudied. This study assessed the determinants of smoking and smoking frequency among women of reproductive age in Nigeria.Methods and materialsData from the 2018 Nigeria Demographic and Health Survey (NDHS) were used in this study (n = 41,821). The data were adjusted for sampling weight, stratification, and cluster sampling design. The outcome variables were smoking status and smoking frequency (daily smoking and occasional smoking). The predictor variables included women’s socio-demographic and household characteristics. Pearson’s chi-squared test was used to evaluate the association between outcome and predictor variables. All variables significant in bivariate analyses were further analysed using complex sample logistics regression. Statistical significance was set at a p-value < 0.05.ResultsThe prevalence of smoking among women of reproductive age is 0.3%. The prevalence of smoking frequency is 0.1% (daily) and 0.2% (occasionally). Overall, women aged 25-34 (AOR = 2.13, 95%CI: 1.06-4.29, ρ = 0.034), residing in the South-south region (AOR = 9.45, 95%CI: 2.04-43.72, ρ <0.001), being formerly married (AOR = 3.75, 95%CI: 1.52-9.21, ρ = 0.004), in female-headed households (AOR = 2.56, 95%CI: 1.29-5.08, ρ = 0.007) and owning mobile phones (AOR = 2.10, 95%CI: 1.13-3.90, ρ = 0.020) were more likely to smoke. Whereas female-headed households (AOR = 4.34, 95%CI: 1.37-13.77, ρ = 0.013) and being formerly married (AOR = 6.37, 95%CI: 1.67-24.24, ρ = 0.007) predisposed to daily smoking, age 15-24 (AOR = 0.11, 95%CI: 0.02-0.64, ρ = 0.014) was protective of daily smoking among women. Owning mobile phones (AOR = 2.43, 95%CI: 1.17-5.06, ρ = 0.018) increased the odds of occasional smoking among women.ConclusionsThe prevalence rates of smoking and smoking frequency are low among women of reproductive age in Nigeria. Women-centred approaches to tobacco prevention and cessation must become evidence-informed by incorporating these determinants into interventions targeting women of reproductive age in Nigeria.