Nigeria Demographic Health Survey Research Articles

The Socio-Environmental Determinants of Childhood Malnutrition: A Spatial and Hierarchical Analysis.

Despite a remarkable reduction in global poverty and famines, substantial childhood malnutrition continues to persist. In 2017, over 50 million and 150 million young children suffered from acute malnutrition (wasting) and chronic malnutrition (stunting), respectively. Yet, the measurable impact of determinants is obscure. We evaluate proposed socio-environmental related determinants of stunting and wasting across Kenya and Nigeria and quantify their effectiveness. We combine health and demographic data from Kenya and Nigeria Demographic Health Surveys (2003, 2008-2009, 2013, 2014) with spatially explicit precipitation, temperature, and vegetation data. Geospatial and disaggregated data help to understand better who is at risk and where to target mitigation efforts. We evaluate the responsiveness of malnutrition indicators using a four-level random intercept hierarchical generalized logit model. We find that spatial and hierarchical relationships explain 28% to 36% of malnutrition outcome variation. Temporal variation in precipitation, temperature, and vegetation corresponds with more than a 50% change in malnutrition rates. Wasting is most impacted by mother's education, family wealth, clinical delivery, and vaccinations. Stunting is most impacted by family wealth, mother's education, clinical delivery, vaccinations, and children asymptomatic of fever, cough, or diarrhea. Remotely monitored climatic variables are powerful determinants, however, their effects are inconsistent across different indicators and locations.

Variation in Educational Attainment Levels: Statistical Evidence from The Nigeria Demographic Health Surveys (2008, 2013 and 2018)

This study focuses on the existent wide and varying disparities in the level of educational pursuit which cut across gender, geographic locations and economic divide globally. The understanding of this, contributes to the equitable distribution of educational amenities, and to the accurate measure of socio-economic, and human capital development. This study explores the Thiel’s index and the geographically weighted regression, (which are veritable tools for assessing regional disparity indices), in describing the Nigerian context using data from the National surveys of 2008, 2013 and 2018. The study findings reveal a decline in educational attainment status in the Northern region compared to their southern counterpart especially in the North-West. It also reveals an increase in the number of uneducated persons and a growing number of “Out-of-school” children over the years 2008, 2013, and 2018

Inequality gaps in modern contraceptive use and associated factors among women of reproductive age in Nigeria between 2003 and 2018

BackgroundInequalities in modern contraceptive use among women in low-income countries remain a major public health challenge. Eliminating or reducing the inequalities in modern contraceptive use among women could accelerate the achievement of Sustainable Development Goals, Targets 3.7 & 5.6. Thus, this study examined the inequality gaps in modern contraceptive use and associated factors among women of reproductive age in Nigeria between 2003 and 2018.MethodsThis study employed the World Health Organisation’s Health Equity Assessment Toolkit to analyse the 2003 and 2018 Nigeria Demographic Health Surveys. Modern contraceptive use was aggregated using five equity stratifiers: age, economic status, educational level, place, and region of residence among women of reproductive aged 15 to 49, with a sample size of 5,336 and 29,090 for 2003 and 2018, respectively. Inequality was measured in this study using difference (D), ratio (R), population-attributable risk (PAR), and a population-attributable fraction (PAF).ResultsThe study shows an increase in modern contraceptive use among women of reproductive age in Nigeria from 8.25% in 2003 to 12.01% in 2018, with the use being more prominent among women of reproductive age 20–49 and those in the richest economic quintile. In both surveys, women with primary education showed the most upward increase in modern contraceptive use. Women residing in the urban areas also show an upward use of modern contraceptives use. The study further highlights inequality gaps, with age being a substantial factor, while economic status and sub-national regions showed mild to marginal inequality gaps. Finally, the educational level of women of reproductive age in Nigeria significantly shows inequality in modern contraceptive use, with a PAF of 129.11 in 2003 and 65.39 in 2018.ConclusionThe inequality gap in modern contraceptive use among women of reproductive age in Nigeria between 2003 and 2018 reported in this study includes age, education, wealth quintile, residence, and region-related inequalities. The study highlights the need for policies and programmes that target the groups with low use of modern contraceptives to promote equity in family planning services.

Assessment of the Trends and Factors Associated With Unintended Pregnancy Among Women of Reproductive Age: An Analysis of the Nigerian Demographic Health Survey Between 2008 to 2018

Background Unintended pregnancy is a global public health issue with significant adverse effects which include health and economic consequences. Globally, there were 121 million unintended pregnancies annually between 2015 and 2019 among women of reproductive age between 15 and 49 mainly due to the non-uptake of modern contraceptives, harmful norms, stigma and lack of sexual and reproductive health care and information. Methods We extracted information from the Nigeria Demographic Health Survey conducted in 2008, 2013, and 2018 to assess the trends and factors associated with unintended pregnancies among women of reproductive-aged 15–49. The descriptive summaries were presented using percentages and binomial logistic regressions for the inferential analysis. All analyses were computed using Stata 15.0 at a 5% level of significance and accounted for the complex survey nature as well as the population size. Results The study included a total of 63,040 women of reproductive age. The prevalence of unintended pregnancy was highest among adolescents aged 15–19 years (15.1%, 95% CI: 13.9–16.5) and decreased with increasing age. The pooled adjusted model revealed that women had 11% lower odds of reporting unintended pregnancies in 2013 compared to 2008. Adolescent girls (aOR 2.48; 95%CI: 2.14–2.89) and young adults (aOR 1.86; 95%CI: 1.69–2.04) have higher odds of reporting unintended pregnancies compared to older women. Also, unmarried women had 9.8 times higher odds of reporting unintended pregnancies compared to ever-married women. Conclusions The findings from this study highlight the need for further family planning educational programs and initiatives that support the uptake of effective contraceptive methods to reduce the likelihood of unintended pregnancy and improve women’s sexual and reproductive health while considering regional variations within the country to ensure tailored interventions that address specific needs within each region.

Influence of knowledge about discriminatory practices towards HIV positive individuals with the uptake of HIV testing during pregnancy among reproductive-aged women in Nigeria.

The fear of positive HIV results has been reported as a determinant of HIV testing among pregnant women and women of reproductive age. When pregnant women know about discriminatory practices toward other people based on their HIV-positive status, it may impact their testing for HIV. Therefore, the purpose of this study was to examine the association between Nigerian pregnant women's knowledge of discriminatory practices against persons living with HIV and their self-reported HIV testing during antenatal visits or childbirth. A secondary analysis of data from 659 t women who had experienced pregnancy aged 15-49 years from the 2013 Nigeria Demographic Health Survey (NDHS) was done. Multivariable logistic regression analysis was done to determine the association between knowledge about discriminatory practices towards HIV-positive individuals (independent variable) and HIV testing during pregnancy (dependent variable) after controlling for covariates (demographic characteristics). A P-value of ≤ 0.05 was taken as statistically significant. Bivariate logistic regression analysis findings showed that educational level, place of residence, and religion statistically significantly predicted HIV testing of pregnant women, while age categories and marital status did not. The women's knowledge of discriminatory practices towards persons living with HIV/AIDS was not statistically significant at Alpha = 0.05 (AOR,1.51; 95% CI: .46, 4.95) Higher levels of education (Primary Education, AOR = 1.81; 95% CI: 1.03, 3.18; Secondary Education, AOR = 3.73; 95% CI: 1.92, 7.25; Higher Education, AOR = 10.92; 95% CI: 4.25, 28.05) and those living in urban areas (AOR = 1.62; 95% CI: 1.04, 2.51) were significantly associated with testing for HIV in the stepwise multivariable regression model of pregnant women's knowledge of discriminatory practices towards persons living with HIV/AIDS. Although knowledge of discriminatory practices did not predict pregnant women's HIV testing in this study, interventions by stakeholders to eliminate or reduce these practices should be stepped up towards facilitating positive social change.

Coverage and determinants of infant postnatal care in Nigeria: A population-based cross-sectional study.

In 2019, Nigeria had the largest number of under-5 child deaths globally and many of these deaths occurred within the first week of life. The World Health Organization recommends infant postnatal care (PNC) attendance to support newborn survival; however, utilization of PNC is known to be low in many contexts. This study examined coverage and individual-level determinants of infant PNC attendance in Nigeria. Nigeria Demographic Health Survey (NDHS) 2018 data were used to evaluate infant PNC coverage and determinants. Infant PNC was defined as receipt of care within 2 days of birth. Children delivered up to 2 years before the 2018 NDHS were included. We examined predictors of infant PNC with modified Poisson regression models to estimate relative risks (RRs). The national coverage of infant PNC was 37.3% (95% confidence interval [CI]: 35.8%-38.7%). Significant heterogeneity in PNC attendance existed at state and regional levels. Facility delivery was strongly associated with the uptake of PNC (RR: 6.07; 95% CI: 5.60-6.58). Greater maternal education, maternal employment, urban residence, female head of household, and greater wealth were also associated with an increased likelihood of PNC visits. The uptake of infant PNC is low and interventions are urgently needed to promote equity in access and increase demand for PNC in Nigeria.

Food insecurity and associated factors among households with under-5 children in slum communities in Ibadan, Nigeria

IntroductionFood insecurity is a leading cause of childhood morbidity and mortality. This study assessed the prevalence of household food insecurity and its associated factors among under-5 children in Ibadan, Nigeria.MethodsThis was a cross-sectional household survey of 1,027 under-5 children and their caregivers in urban and rural slums in Ibadan. We used an electronic interviewer-administered, semi-structured questionnaire adapted from the Nigeria Demographic Health Survey and Household Food Insecurity Access Scale was used to report sociodemo-economic characteristics, food insecurity, and anthropometric measurement. The household food insecurity scale consisted of nine questions graded from 0 (Never) to 3 (Often) computed to determine the presence of food insecurity. Nutrition indices were computed, and the results were classified according to World Health Organization 2006 cut-off points. Chi-square tests were used to assess associations between food insecurity and the independent variables. Binary logistic regression analyses were conducted to identify the predictors of food insecurity (α = 0.05).ResultsThe mean ages of the caregivers and under-5 children were 31.7 ± 7.47 years and 34.49 ± 15.8 months respectively. Overall, 530 (51.7%) children were females, and 765 (74.5%) had normal weight for height. In all, 195 (19.0%) households had food insecurity, while 832 (81.0%) households had food security (Chi-square = 103.364, p = < 0.001). Under-5 children living in urban slums were seven times more likely to experience household food insecurity compared to those in rural slums (AOR = 6.859, 95%CI = 4.524–10.509, p = < 0.001).DiscussionHousehold food insecurity was more prevalent in urban slums. Strengthening of the school health program would help identify children with nutritional deficits, and improve the overall health status of children living in slum communities.

Family planning needs to limit childbearing are unmet, yet our parity is high: characterizing and unveiling the predictive factors

BackgroundThe unmet need for limiting childbearing (UNLC) remains a problem in Nigeria. Conception after four pregnancies is considered a high-risk pregnancy. We examined the level, reasons for non-use of contraception, and predictors of UNLC among high parity (≥ 4 live birth) women in Nigeria.MethodsThis cross-sectional design study was based on the analysis of nationally representative weighted data (2018 Nigeria Demographic Health Survey). The study focused on high-parity women of reproductive age (n = 4260) who do not want to have any more children irrespective of the number of their surviving children. Multi-stage cluster sampling approach was used for sample selection. Data were analyzed using logistic regression (α0.05).ResultsMean age of the respondents and children ever born was 38.92 ± 5.7 and 6.54 ± 2.3 respectively. The prevalence of UNLC was 40.9%, higher in the rural (48.8%) than urban (32.8%) areas, highest among women with no formal education (52.0%), higher among Muslims (48.4%) than Christians (34.8%), highest in the North-West (51.7%) and least in the South-East (26.1%). The most reported reasons for non-use of family planning (FP) were; respondents opposed (25.0%), infrequent sex (15.0%), fatalistic (13.2%), husband/partner opposed (11.2%), fear of side effects/health (8.5%), and religious prohibition (3.3%). The odds of UNLC was 100% higher among women aged 40–49 years compared to the younger women in age group 20–29 years. Living in the rural area predisposes high parity women of reproductive age to higher risks of UNLC (OR = 1.35, 95% C.I = 1.14–1.59, p < 0.001). Lack of access to family planning information through health workers (OR = 1.94, 95% C.I = 1.63–2.30, p < 0.001) increased the risks of UNLC. Being an Igbo or a Yoruba ethnic group was protective for UNLC compared to Fulani/Hausa women.ConclusionsA high level of UNLC was found among high-parity women in Nigeria. Access to FP information reduces the risk of UNLC. Expanding FP services would help respond to the expressed desires for contraception among high-parity Nigerian women who want to stop childbearing.

Religion and Fertility Behavior Among Ever-Married Women in Nigeria: Evidence from the Nigeria Demographic Health Survey 2018

Using the 2018 Nigeria Demography and Health Survey (NDHS), this study was designed to examine the impact of religion on fertility behaviour. The theoretical basis of this study was Philip Jenkins’s Fertility and Faith hypothesis and the Religious Alloparenting hypothesis. The NDHS used a stratified sample that was chosen in two steps. First, a household listing operation was conducted in each of the chosen Enumeration Areas. Next, a fixed number of 30 households were chosen through equal probability systematic sampling in each cluster, yielding a total sample size of about 42,000 households. 42,121 women between the ages of 15 and 49 were found in the various houses, and individual interviews with 41,821 of them were later conducted. In this study, 8061 respondents were used in the analysis. Data gleaned from the NDHS was analyzed in this study, using descriptive statistics. The respondents’ religions were Catholic, other Christians, Islam and other religions. Catholic (9.4%), non-Catholic Christians (34.4%), Islam (55.5%), and other religions (0.7%). Islamic religion had low use of contraceptives i.e., 90.3% of no method, Catholics made more use of the traditional method of 12.5% than other religions. There was also a significant association between the use of contraceptives and religion. Muslim respondents got married below the age of 19 (77.3%), age 19 and 30 (22.1%) while Catholic got married below the age of 19 (34.2%), 19 and 30 (61.4%) Other Christians (36.7%) of its respondents below age 18, 19-30 (58.7%) and 31 and above (4.4%). Some of the recommendations made were to bring enlightenment to the public on the National Population Policy to guide or restrict the number of children by couples through religious leaders and also to make modern contraceptives acceptable by all religions.

A Spatio-Temporal Mapping and Bayesian Modelling of Fever, Cough and short Rapid Breaths, as Symptoms of Pneumonia in Under-Five Children in Nigeria

Background Pneumonia remains a public health challenge in most parts of the world, with Nigeria having the highest number of pneumonia-related deaths. Understanding the geographical distribution, trends and risk factors associated with some symptoms of pneumonia can aid an appropriate preventive intervention towards abating its burden in Nigeria. Method This cross-sectional study used data from the 2008, 2013, and 2018 Nigeria Demographic Health Surveys. The outcome variables include fever, cough, and short, rapid breaths as selected symptoms of pneumonia. Optimized hotspot analysis was used to identify areas with a significantly high prevalence of fever, cough, and short rapid breaths, and a MCMC random-intercept logistic regression model was fitted to each symptom. Results The prevalence of cough was 12.1%, 10.1% and 16.9% in 2008, 2013 and 2018 respectively, 16.2%, 13.3%, and 25.7% for fever; and 41.7%, 42.5% and 6.5% for short rapid breaths respectively with variations across the states. Children aged 6-11 months had the highest higher odds (adjusted odds ratio (aOR) =1.95, 95% Credible Interval (CrI): 1.77, 2.18) of having cough, compared to children of other age groups. Similar pattern was noticed for fever and short rapid breaths. Other significantly associated factors with symptoms include the mother’s education, mother’s age, residence type, housing quality, wealth index and region. Conclusion The northern states were more characterized by short, rapid breaths while the southern states were more characterized by fever but both regions have a fair share of cough among under-five children. For cough and fever symptoms, the increased prevalence between 2013 and 2018 indicates more attention is needed. There are also higher odds of finding the symptoms amongst children aged 6-11 months compared to children of other age groups, especially in the North-eastern part of the country. Hence, government needs to strengthen immunization against diseases such as Hib, pneumococcus, measles and whooping cough (pertussis) which has been shown to be the most effective way to prevent pneumonia. Adequate nutrition is also key to improving children's natural defenses. Educated mothers needs to be adequately sensitized to understand that exclusive breastfeeding for the first 6 months of life of a child is paramount.

A multilevel Bayesian Markov Chain Monte Carlo Poisson modelling of factors associated with components of antenatal care offered to pregnant women in Nigeria

BackgroundThe most recent WHO guideline on antenatal care (ANC) utilization reaffirmed the necessary and compulsory care and services a pregnant woman should receive to maximize the importance and gains of ANC. While most studies focused on the time of initiation and number of ANC contacts, emphasis was rarely placed on the components of ANC offered to women. This study assessed how complete the components of ANC received by pregnant women are as a proxy for the quality of ANC services offered in Nigeria. We also assessed the clustering of the components and state-level differentials and inequalities in the components of ANC received in Nigeria.MethodsWe used nationally representative cross-sectional data from the 2018 Nigeria Demographic Health Survey. We analysed the data of 11,867 women who had at least one ANC contact during the most recent pregnancy within five years preceding the survey. The assessed components were tetanus injection, blood pressure, urine test, blood test, iron supplement, malaria intermittent preventive treatment in pregnancy (IPTp), and told about danger signs. Others are intestinal parasite drugs (IPD)intermittent and HIV/PMTCT counsel. Descriptive statistics, bivariable and multivariable multilevel Bayesian Monte Carlo Poisson models were used.ResultsIn all, 94% had blood pressure measured, 91% received tetanus injection, had iron supplement-89%, blood test-87%, urine test-86%, IPTp-24%, danger signs-80%, HIV/PMTC-82% and IPD-22%. The overall prevalence of receiving all 9 components was 5% and highest in Ogun (24%) and lowest in Kebbi state (0.1%). The earlier the initiation of ANC, the higher the number of contacts, and the higher the quality of ANC received. Respondents with higher education have a 4% (adjusted incidence risk ratio (aIRR): 1.04, 95% credible interval (CrI): 1.01–1.09) higher risk of receiving more components of ANC relative to those with no education. The risk of receiving more ANC components was 5% (aIRRR: 1.05, 95% CI: 1.01–1.10) higher among pregnant women aged 40 to 49 years than those aged 15 to 19 years. Women who decide their healthcare utilization alone had a 2% higher risk of getting more components than those whose spouses are the only decision taker of healthcare use. Other significant factors were household wealth status, spouse education, ethnicity, place of ANC, and skill of ANC provider. Pregnant women who had their blood pressure measured were very likely to have blood and urine tests, tetanus injections, iron supplements, and HIV talks.ConclusionsOnly one in every 20 pregnant women received all the 9 ANC components with wide disparities and inequalities across the background characteristics and the States of residence in Nigeria. There is a need to ensure that all pregnant women receive adequate components. Stakeholders should increase supplies, train, and create awareness among ANC providers and pregnant women in particular.

Spatial distribution and multilevel analysis of factors associated with long-acting reversible contraceptive use among sexually active women of reproductive age in Nigeria

BackgroundLong-acting reversible contraceptives (LARCs), including hormonal implants and intrauterine devices, are highly effective pregnancy prevention methods. Aside its advantages over other hormonal methods, LARCs are cost-effective, easy to maintain, and have a low risk of non-compliance-related method failure. Besides, LARCs are also relatively safe for all sexually active women in the postpartum or post-abortion period. However, despite its effectiveness, most sexually active women use other short-term methods, such as condoms and contraceptive pills, which are associated with high discontinuation rates. Thus, this study examines the spatial distribution and multilevel factors associated with LARC use among sexually active reproductive-age women in Nigeria.MethodsThis is a cross-sectional analysis of a population-based study from the 2018 Nigeria Demographic Health Survey (NDHS). The NDHS is a nationally representative survey that collects data on socio-demographic characteristics, sexual and reproductive health-related indicators such as contraceptive use and child & maternal health. A sample of 3,978 sexually active reproductive-age women (15–49 years) in Nigeria was used in the analysis. Frequency distribution and spatial analysis of LARC use were displayed with tables and maps, respectively, while multilevel analysis at a 95% confidence interval (CI) and a p-value of less than 0.05 was used to determine factors associated with LARC use among the sample.ResultsThe spatial distribution of LARC use among sexually active women of reproductive age in Nigeria ranges between 20 and 34.8%. Fifteen of the 36 states (excluding the Federal Capital Territory, FCT) recorded low utilization of LARCs. These states include Adamawa, Lagos, Ogun, Enugu, Anambra, Imo, Abia, Rivers, Kogi, Taraba, Yobe, Gombe, Jigawa, Borno, and Kebbi. Besides, the likelihood of LARC use was lower among participants with a prior history of pregnancy termination [aOR = 0.62; 95%(CI = 0.48–0.80)] compared to their counterparts without pregnancy termination history. Also, participants with no fertility intention had a higher likelihood of using LARCs [aOR = 1.65; 95%(CI = 1.30–2.08)] compared to those with fertility intention. At the community level, women with higher socioeconomic status were less likely to use LARCs [aOR = 0.66; 95%(CI = 0.45–0.97)] compared to women with lower socioeconomic status.ConclusionsThis study showed a relatively low utilisation of LARC among sexually active reproductive-age women in Nigeria. Notably, this low utilisation is also common in states that could be described as cosmopolitan, indicating a need for closer investigation to understand context-specific factors associated with LARC use. Population-specific family planning education and counselling for this population are important to address common misconceptions about LARCs in particular and modern contraceptive use in general.

Attitude of postpartum women towards multiple postnatal clinic schedule in south-west Nigeria.

The postnatal period is a critical in the lives of mothers and babies due to the risk of maternal and perinatal morbidity and mortality. According to the Nigeria Demographic Health Survey 2018, only 38% of women and 42;% of newborns received a postnatal check in the first 2 days after birth. The World Health Organisation (WHO) recommends that postpartum women should have contact with healthcare providers within 24h, at day 3, days 10-14 and 6 weeks post-delivery. Multiple postnatal clinic (PNC) visits will allow assessment and prompt treatment of complications arising from delivery. This study assessed the attitude of postpartum women towards multiple PNC schedule. This descriptive cross-sectional study assessed the attitude of postpartum women towards multiple PNC schedules. A total of 167 respondents participated in the study and data was collected using a semi-structured interviewer administered questionnaire. Information on awareness, knowledge and purpose of postnatal care, preference for multiple schedules and the timing of postnatal care visits were obtained. Data was analysed using IBM SPSS version 23; and the level of significance was set at p<0.05. Of the respondents, 71.9% had poor or incorrect knowledge. About 87.4% perceived PNC as beneficial; and that mothers and newborns should be seen at least three times (47.9%) in the postnatal period. A high proportion of women were willing to come for PNC on day 3 (74.3%), days 10-14 (86.2%) and six weeks postpartum (91.6%). Also, 69.5% were willing to come for multiple PNC visits. Parity was significantly associated with willingness to attend multiple PNC visits. Despite suboptimal knowledge of the components of postnatal care services, postpartum women have a good attitude to postnatal care and are willing to attend scheduled and multiple PNC schedules. However, fewer women wanted the multiple PNC schedules. Health education and quality postnatal care will enhance postpartum surveillance with prompt detection and treatment of maternal and neonatal complications to forestall life-threatening complications or mortality.

What factors are associated with anaemia in pregnancy among Nigerian women? Evidence from a national survey.

Anaemia in pregnancy remains a severe public health problem in sub-Saharan African countries including Nigeria. To assess factors associated with anaemia in pregnancy among Nigerian women. A secondary analysis of the 2018 Nigeria demographic health survey was conducted to determine the predictors of anaemia among Nigerian pregnant women (N=1522). SAS 9.4 was used for the analysis. The prevalence of anaemia in pregnancy was 61.1%. On multivariable logistic regression analysis, women in the North-central (AOR=2.52, CI=1.46-4.35) and South-south (AOR=2.21, CI=1.06-4.59) had increased odds of anaemia in pregnancy, compared to those in the Northwest. Women with no education (AOR=2.38, CI=1.28-4.44), primary education (AOR=3.06, CI=1.58-5.96) and secondary education (AOR=1.75, CI=1.04-2.94) had increased odds of anaemia in pregnancy compared to women with teriary education. Also, women not in marital union had increased odds of anaemia in pregnancy compared to women in a union (AOR=2.56, CI=1.15-5.72). Women in the second (AOR=2.42, CI=1.79-3.29) and third trimesters of pregnancy (AOR=2.83, CI=2.07-3.89) had increased odds of anaemia. These findings are important for the control of anemia among pregnant Nigerian women. Women in the Northcentral and Southsouth zones are particularly at risk for anaemia in pregnancy and should receive special attention during antenatal care.

Proximate determinants and decomposition of changes in fertility levels across Nigeria regions: Evidence from Nigeria Demographic Health Survey, 2003-2018.

There is disparity in fertility level across the six geopolitical zones in Nigeria. Deeper uunderstanding about the drivers of fertility trends are necessary to prioritize zonal specific strategies for fertility reduction in Nigeria. Thus, this study examined the proximate determinants (PDs) of fertility and decomposed the change in its level across the six geo-political zones in Nigeria. Data from Nigeria Demographic and Health Surveys of 2003 and 2018 were analyzed. Fertility data were based on the report of full birth history from women of reproductive age. The Revised Bongaarts framework was used to estimate PDs and fertility levels. The contribution of each PDs to the observed changes in fertility levels was quantified using Das Gupta's five- factor decomposition method. The Total fertility rate (TFR) in 2003 and 2008 across the zones are South-South (5.04 vs 4.36), South-West (4.88 vs 4.26), North West (7.25 vs 6.85), North East (6.87 vs 6.54), North Central (5.72 vs 5.48), South East (5.06 vs 4.86), Nigeria (6.00 vs 5.59). Across the zones, there was a change in the fertility inhibiting effect of Contraception (Cc) between 2003 and 2018. The fertility inhibiting effect of Postpartum Infecundability (Ci) and Abortion was the highest and smallest respectively across the zones. Delayed sexual exposure (Cm) and contraceptive use (Cc) contributed the most to the change across the regions. The percentage contribution of Cm in South-South, South West, and South East was 87.04%, 52.89%, and 172.85% respectively. Furthermore, most of the fertility change observed in North Central was attributable to Cc. Abortion index was not an important inhibiting factor of fertility in Nigeria. Delayed sexual exposure and contraceptive use accounted for the largest change observed in fertility levels across the six geo-political zones in Nigeria between 2003 and 2018. Strategies that promote delayed sexual exposure, contraceptive use and breast feeding practices will enhance fertility transition in Nigeria.

Factors associated with the uptake of Intermittent Preventive Treatment (IPTp-SP) for malaria in pregnancy: Further analysis of the 2018 Nigeria Demographic and Health Survey.

Pregnancy-associated malaria is preventable and curable with intermittent preventive treatment with Sulfodoxine-Pyrimethamine (IPTp-SP). However, despite the effectiveness of IPTp-SP against malaria in pregnancy, the uptake among pregnant women in Nigeria remains very low. Thus, this study aimed to establish the factors associated with the uptake of at least one dose and optimal doses of IPTp-SP among pregnant women aged 15 to 49 years living in Nigeria in 2018. The study included 12,742 women aged 15 to 49 years with live births two years before or during the 2018 Nigeria Demographic Health Survey (NDHS) in the analysis. Descriptive analysis was carried out to determine the prevalence of IPTp-SP uptake. Multivariable logistic regression was used to establish the factors associated with receiving IPTp-SP during pregnancy, adjusting for possible confounding factors. Given the complex survey design, all analyses are adjusted for sampling weight, stratification, and clustering. The p-value of <0.05 was considered significant. In 2018, the prevalence of at least one dose of IPTp-SP was 63.6% (95% CI:62.0-65.1), and optimal doses of IPTp-SP were 16.8% (95% CI:15.8-17.8) during pregnancy. After the multivariable analysis, age group, region, frequency of ANC visits, belief in IPTp-SP effectiveness, and morbidity caused by malaria predicted the uptake of at least one IPTp-SP dose. Similar maternal characteristics, including household wealth index, spouse's educational level, and media exposure were significantly associated with taking optimal IPTp-SP doses. For instance, women in the wealthiest households whose husbands had secondary education predicted a four-fold increase in uptake of at least one IPTp-SP dose (aOR:4.17; 95% CI:1.11-8.85). The low prevalence and regional variations of IPTp-SP uptake in the study area imply that most pregnant women in Nigeria are at substantial risk of pregnancy-associated malaria. Therefore, stakeholders should explore context-specific strategies to improve the IPTp-SP coverage across the regions in Nigeria.

Spatial Variation of Female Contraceptive Use in Nigeria

The research investigated the geographical distribution of female contraceptive utilization in Nigeria, employing a retrospective methodology to gather archived population data. For over six years, data regarding contraceptive practices among women aged 15-49 has extracted from the National Bureau of Statistics (NBS) and the Nigeria Demographic Health Survey (NDHS). Spatial variations in contraceptive usage across Nigeria were assessed using the ANOVA statistical technique. Results indicated an increase in female contraceptive prevalence from 15.3% in 2016 to 18.1% in 2021, with Oyo, Imo, and Lagos states exhibiting the highest rates of usage. The study noted a higher prevalence of modern contraceptive methods in the southern region, attributed to increased awareness. Significant disparities in contraceptive usage among Nigerian women were confirmed (P&lt;0.05), with notably low utilization rates in the north-eastern geopolitical zones. Furthermore, analysis revealed significant differences (P&lt;0.05) in the types of modern contraception employed, particularly in the pronounced variance between injectables and other methods. The study underscores the importance of providing accurate and timely information on diverse contraceptive options to Nigerian women, emphasizing the need for informed family planning strategies

Women's empowerment and attitudes towards female genital mutilation abandonment in Nigeria: A cross-sectional analysis of the Nigeria demographic health survey.

Female genital mutilation (FGM) is a human rights violation that impacts the social, physical, psychological, sexual, and gynecological wellbeing of women and girls. Even so, FGM persists in many Nigerian communities. Using data from the 2018 Nigeria Demographic and Health Survey, we investigated the association between women's empowerment and attitudes towards FGM abandonment. A weighted logistic regression adjusting for demographic factors, contraceptive use, contraceptive decision-making power, and severity of FGM was used to assess the influence of the validated African Women's Empowerment Index-West on women's favorability to abandoning FGM as a practice. This study found that higher education level, zero acceptance of violence against women, and higher access to healthcare as indicators of empowerment were associated with support for FGM abandonment. Additional research is needed to understand further the influences on decision making and to further research the various empowerment scales and their impact on FGM abandonment.

Childhood Diarrhea Prevalence and Uptake of Oral Rehydration Solution and Zinc Treatment in Nigeria.

Given the disproportionate burden of childhood diarrhea deaths in Nigeria, this study assessed the prevalence and predictors of the disease and the uptake of ORS and zinc supplementation as treatments in a population-based national survey. Cross-sectional data from the 2018 Nigeria Demographic Health Survey were used. A log-Poisson regression was used to estimate the relative risks (RR) for the individual-level predictors of childhood diarrhea and the uptake of ORS and zinc treatments. A total of 30,713 children under 5 years of age were included in the survey. The period prevalence of reported diarrhea in the last two weeks was 12.9% (95% CI: 12.5%, 13.3%). Among the children with diarrhea, the proportion who received ORS was 39.7% (95% CI:38.2%, 41.3%), while 29.1% of them received zinc supplements (95% CI:27.7%, 30.5%), and 21.8% of them received both the ORS and zinc treatments as recommended. Children under 6 months of age with diarrhea had a significantly lower likelihood of being given ORS or zinc when they were compared to the older children. The institutional delivery of them, maternal employment, and improved water sources were also independent predictors of the uptake of ORS and zinc treatments for diarrhea (p-values &lt; 0.05). Interventions to prevent childhood diarrhea and improve the coverage of ORS and zinc treatments may reduce the large burden of childhood diarrhea deaths in Nigeria.

Hierarchical modelling of factors associated with anaemia among under-five children in Nigeria.

This study used a nationally representative cross-sectional data from 2018 Nigeria Demographic Health Survey (NDHS) to investigate the prevalence and factors associated with anaemia in children aged less than five years in Nigeria. Anaemia was defined as haemoglobin level <11.0g/dl, while explanatory variables included parental profile, social and environmental factors. Descriptive analyses and multivariable Poisson regression models were fitted using Stata 15 software. Associated factors were quantified using Prevalence Ratio (PR) with 95% confidence interval (CI). Of the 5834 children aged 6-59 months, 51.9% were male. The prevalence of anaemia among under-five children was 71.6% (95% CI: 69.9-73.2). Childhood anaemia was associated with history of maternal anaemia (PR 1.06; CI 1.05-1.08); having underweight mothers (PR 1.02; CI 1.00-1.05); being a Muslim (PR 1.05; CI 1.02-1.08), Igbo (PR 1.07; CI 1.01-1.14) and Hausa (PR 1.04; CI 1.01-1.07) ethnic group. Further, children from South-South (PR 1.09; CI 1.06-1.13) and South-West (PR 1.06; CI 1.02-1.10) and those currently breastfeeding (PR 1.06; CI 1.04-1.07) had higher risk of anaemia. However, children from middle (PR 0.94; CI 0.91-0.97), or higher wealth indices were less likely to have anaemia. Maternal socio-economic and nutritional characteristics were identified as key predictors of under-five anaemia. Strategies are needed to mitigate the effect of poverty and tweak new and existing nutritional intervention programs to make them responsive to socio-cultural peculiarities across the various geo-political regions of Nigeria.