Search Results (60)

Background/Objectives: Nigeria continues to face major challenges in achieving equitable immunisation coverage, with marked subnational disparities. This study aimed to assess trends in vaccine access and utilisation across Nigeria’s six geopolitical zones between 2018 and 2024, focusing on inequities in DTP coverage, dropout rates, and zero-dose prevalence. Methods: We conducted a comparative ecological analysis using secondary data from the Nigeria Demographic and Health Surveys (2018, 2024) and the 2021 Multiple Indicator Cluster Survey/National Immunisation Coverage Survey. Geometric mean coverage for penta 1 (DTP1) and penta 3 (DTP3), DTP1–DTP3 dropout rates, and zero-dose prevalence were calculated for each of the six geopolitical zones and analysed using WHO’s Health Equity Assessment Toolkit Plus. Absolute (difference, D) and relative (ratio, R) summary measures of inequality were also assessed. Results: Findings revealed statistically significant differences in indicators across the various regions during the period of study. While the South-East maintained >90% DTP1 coverage, the North-West declined from 37.3% (2018) to 33.4% (2024). In the same period, the absolute inequality (D) in DTP1 coverage increased from 55.3 to 58.4 percentage points. Zero-dose inequities worsened sharply: prevalence in the North-West rose from 25.7% (2021) to 47.4% (2024) compared to ~4% in the South-East, with a relative inequality (R) of 11.29 in 2024. In contrast, service utilisation improved, as dropout rates in the North-West fell from 38.7% (2018) to 14.3% (2024), reducing absolute inequality to 11.0 pp. Conclusions: Despite progress in reducing dropout, access to vaccination services remains highly inequitable, particularly in northern Nigeria. Declines since 2021 suggest systemic fragility compounded by COVID-19-related disruptions. Strengthening sustainable routine immunisation systems and investing in demand generation, especially through social and behaviour change communication, are essential to achieving equity. Full article

HIV remains a significant public health challenge in sub-Saharan Africa (SSA), with vulnerable communities disproportionately affected and further marginalised by the COVID-19 pandemic. HIV self-testing (HIVST) has emerged as a transformative, empowering tool to bridge testing gaps and promote health equity. This study examined post-COVID-19 strategies for leveraging HIVST to empower vulnerable populations and advance health promotion in SSA. Analysis was performed using secondary Demographic and Health Survey (DHS) data (2015–2022) collected across 24 SSA countries. In addition, qualitative interviews were conducted with female sex workers in Port Harcourt, Nigeria (18–31 May 2023). The study adopted an explanatory sequential mixed-methods design. Quantitative analysis using complex sample logistic regression revealed low awareness (16.3%) and uptake (2.5%) of HIVST among the 594,639 respondents. Key predictors of uptake included higher education (aOR, 7.36; 95% CI, 6.62–8.18), wealth (richest quintile aOR, 3.28; 95% CI, 2.95–3.65), and knowledge of HIV transmission (aOR, 33.43; 95% CI, 11.03–101.24). Thematic analysis highlighted privacy, autonomy, and convenience as key benefits, while cost, stigma, and fear of testing alone were major barriers. The participants emphasised peer-led outreach and integration of HIVST into public health systems as effective strategies. The findings were integrated interpretively, linking macro-level testing disparities with community-level experiences to inform post-pandemic policy and programme design. The study concludes that HIVST holds strong potential to empower marginalised groups and strengthen community-driven HIV prevention post-COVID-19, but success will depend on equity-driven policies and sustainable implementation frameworks, guided by affordability and community participation. Full article

Despite ongoing efforts to reduce maternal mortality in Nigeria, the uptake of skilled birth attendance remains persistently low, especially in rural areas. While structural and socio–demographic barriers have been widely studied, less attention has been paid to psychological determinants of maternal healthcare-seeking behavior in low-resource settings. This study explores how the locus of control influences the use of skilled birth care among postpartum women in rural Edo State, Nigeria, and whether neuroticism serves as a mediating factor in this relationship. We draw on data from a cross-sectional survey involving 1411 women aged 15–45 who had given birth within the two years preceding the study. Participants were recruited from 20 randomly selected communities across two rural Local Government Areas. Data were collected using structured interviews that included validated measures of locus of control, neuroticism, and self-reported use of skilled birth care. We applied the Baron and Kenny mediation framework using linear and logistic regression models with standardized coefficients, adjusting for education, household wealth, and women’s decision-making autonomy. The findings show that women with a more external locus of control were significantly less likely to utilize skilled birth care (p < 0.01), and that neuroticism partially mediated this effect. Higher levels of neuroticism were associated with a reduced likelihood of engaging with skilled maternity care services. These results highlight the importance of psychological traits in shaping maternal health behaviors. Integrating psychosocial interventions, such as emotional support, cognitive reframing, and community health education, into maternal healthcare programs may improve service uptake in marginalized rural populations. Full article

Background: Malaria remains a public health challenge in low- and middle-income countries (LMICs). Despite gains from strategies like Insecticide-Treated Nets (ITNs) and Intermittent Preventive Treatment during pregnancy (IPTp), significant socioeconomic inequalities persist, particularly among pregnant women and children under five. This study analyzed temporal and socioeconomic inequalities in malaria prevention in sub-Saharan Africa (SSA). Methods: Nationally representative Demographic Health Surveys from 10 SSA countries (Mozambique, Burkina Faso, Tanzania, Côte d’Ivoire, Madagascar Kenya, Rwanda, Nigeria, Uganda, and Cameroon) were used, comparing two time periods. Changes in ITN use by pregnant women and children under five, as well as IPTp coverage, were assessed. Inequalities based on socioeconomic status (SES) and residence were analyzed using the Erreygers Normalized Concentration Index and Theil index. Results: The results revealed significant variability in ITN use and IPTp coverage within countries. Eight countries showed improvements in ITN use during pregnancy, with Nigeria seeing a 173.9% increase over five years. Burkina Faso and Tanzania consistently reported high ITN use (~87%) in children under five. IPTp coverage increased in all countries except Kenya. Decomposition using the Theil index indicated that within-group inequalities, particularly based on SES and residence, were the primary drivers of disparities. Conclusions: To ensure progress toward universal health coverage, malaria prevention programs must prioritize vulnerable populations and be continuously evaluated. Full article

Background: While an abundance of evidence exists regarding infectious outcomes in children as they relate to the short-term benefits of breastfeeding, there is limited evidence related to similar impacts beyond one year and after breastfeeding has stopped. Specifically, little is known about the long-term benefits of breastfeeding for acute health outcomes after infancy, particularly in Nigeria. Methods: The Nigeria Demographic and Health Survey data was used in this study. We utilized data (n = 5391) on children who had stopped breastfeeding for at least 12 months before the survey. Breastfeeding duration was categorized into 1–6 months, 7–12 months, 13–18 months, 18–24 months, and > 24 months. Any recent incident of acute respiratory illness in children was operationalized using the responses to related questions (recent incidents of fever, cough, running nose, and short, rapid, or difficulty breathing in children). Adjusted logistic regression was used to estimate odds ratios, and statistical significance was determined at p ≤ 0.05. Results: Post-infancy and after breastfeeding had stopped, the odds of recent acute respiratory illness were significantly less (AOR = 0.37, 95% CI [0.15–0.79], p = 0.04) in children breastfed for 19–24 months compared to those breastfed for 1–6 months. No significant association was found between the other durations and ARI post-infancy (p > 0.05). Conclusions: These findings indicate that breastfeeding for up to 24 months has a long-term protective effect from an acute health condition that contributes to the high under-five mortality rates recorded for decades in Nigeria specifically, and more broadly, in sub-Saharan Africa. Full article

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. Full article

In the last ten years, multimorbidity in children under the age of five years has become an emerging health issue in developing countries. The study of multimorbidity of anaemia, malaria, and malnutrition (MAMM) among children in Nigeria has not received significant attention. This study aims to investigate what risk factors are associated with the prevalence of multimorbidity among children aged 6 to 59 months in Nigeria. This study used two nationally representative cross-sectional surveys, the 2018 Nigeria Demographic and Health Survey and the 2018 National Human Development Report. A series of multilevel mixed-effect ordered logistic regression models were used to investigate the associations between child/parent/household variables (at level 1), community-related variables (at level 2) and area-related variables (at level 3), and the multimorbidity outcome (no disease, one disease only, two or more diseases). The results show that 48.3% (4917/10,184) of the sample of children aged 6–59 months display two or more of the disease outcomes. Being a female child, the maternal parent having completed higher education, the mother being anaemic, the household wealth quintile being in the richest category, the proportion of community wealth status being high, the region being in the south, and place of residence being rural were among the significant predictors of MAMM (p < 0.05). The prevalence of MAMM found in this study is unacceptably high. If suitable actions are not urgently taken, Nigeria’s ability to actualise SDG-3 will be in grave danger. Therefore, suitable policies are necessary to pave the way for the creation/development of integrated care models to ameliorate this problem. Full article

Multimorbidity of malaria, anemia, and malnutrition (MAMM) is a condition in which an individual has two or more of these health conditions, and is becoming an emergent public health concern in sub-Saharan African countries. The independent associations of a child’s demographic variables and household socioeconomic (HSE) disparities with a child’s health outcomes have been established in the literature. However, the effects of the intersection of these factors on MAMM, while accounting for other covariates, have not been studied. Therefore, this study aimed to determine how children’s sex, age, and household socioeconomic status interact to explain the variations in MAMM among children aged 6–59 months in Nigeria. Data from the 2018 Nigeria Demographic and Health Survey and the 2018 National Human Development Report (NHDR) were used. This study included weighted samples of 10,184 children aged 6–59 months in Nigeria. A three-level multilevel mixed effect ordinal logistic regression model was used, such that individual characteristics at level 1 were nested in communities at level 2 and nested in states at level 3. Subsequently, predictive probability charts and average adjusted probability tables were used to interpret the intersectional effects. Five models were created in this scenario. Model 1 is the interaction between the child’s sex and household wealth status; model 2 is the interaction between the child’s sex and age; model 3 is the interaction between the child’s age and household wealth status; model 4 has the three two-way interactions of the child’s sex, age, and household wealth status; and model 5 includes model 4 and the three-way interactions between a child’s sex, age, and household wealth quintiles; while accounting for other covariates in each of the models. The prevalence of children with a ‘none of the three diseases’ outcome was 17.3% (1767/10,184), while 34.4% (3499/10,184) had ‘only one of the diseases’, and 48.3% (4918/10,184) had ‘two or more’ MAMMs. However, in the multivariate analyses, model 3 was the best fit compared with other models, so the two-way interaction effects of a child’s age and household wealth status are significant predictors in the model. Children aged 36–47 months living in the poorest households had a probability of 0.11, 0.18, and 0.32 of existing with MAMM above the probability of children of the same age who live in the middle class, more prosperous, and richest households, respectively, while all other covariates were held constant. Thus, the variation in the prevalence of MAMM in children of different ages differs depending on the household wealth quintile. In other words, in older children, the variations in MAMM become more evident between the richer and the poorer household quintiles. Therefore, it is recommended that policies that are geared toward economic redistribution will help bridge the disparities observed in the prevalence of multiple diseases among children aged 6–59 months in Nigeria. Full article

Urban population growth in Nigeria may exceed the availability of affordable housing and basic services, resulting in living conditions conducive to vector breeding and heterogeneous malaria transmission. Understanding the link between community-level factors and urban malaria transmission informs targeted interventions. We analyzed Demographic and Health Survey Program cluster-level data, alongside geospatial covariates, to describe variations in malaria prevalence in children under 5 years of age. Univariate and multivariable models explored the relationship between malaria test positivity rates at the cluster level and community-level factors. Generally, malaria test positivity rates in urban areas are low and declining. The factors that best predicted malaria test positivity rates within a multivariable model were post-primary education, wealth quintiles, population density, access to improved housing, child fever treatment-seeking, precipitation, and enhanced vegetation index. Malaria transmission in urban areas will likely be reduced by addressing socioeconomic and environmental factors that promote exposure to disease vectors. Enhanced regional surveillance systems in Nigeria can provide detailed data to further refine our understanding of these factors in relation to malaria transmission. Full article

The persistence of geographic inequities in vaccination coverage often evidences the presence of zero-dose and missed communities and their vulnerabilities to vaccine-preventable diseases. These inequities were exacerbated in many places during the coronavirus disease 2019 (COVID-19) pandemic, due to severe disruptions to vaccination services. Understanding changes in zero-dose prevalence and its associated risk factors in the context of the COVID-19 pandemic is, therefore, critical to designing effective strategies to reach vulnerable populations. Using data from nationally representative household surveys conducted before the COVID-19 pandemic, in 2018, and during the pandemic, in 2021, in Nigeria, we fitted Bayesian geostatistical models to map the distribution of three vaccination coverage indicators: receipt of the first dose of diphtheria-tetanus-pertussis-containing vaccine (DTP1), the first dose of measles-containing vaccine (MCV1), and any of the four basic vaccines (bacilli Calmette-Guerin (BCG), oral polio vaccine (OPV0), DTP1, and MCV1), and the corresponding zero-dose estimates independently at a 1 × 1 km resolution and the district level during both time periods. We also explored changes in the factors associated with non-vaccination at the national and regional levels using multilevel logistic regression models. Our results revealed no increases in zero-dose prevalence due to the pandemic at the national level, although considerable increases were observed in a few districts. We found substantial subnational heterogeneities in vaccination coverage and zero-dose prevalence both before and during the pandemic, showing broadly similar patterns in both time periods. Areas with relatively higher zero-dose prevalence occurred mostly in the north and a few places in the south in both time periods. We also found consistent areas of low coverage and high zero-dose prevalence using all three zero-dose indicators, revealing the areas in greatest need. At the national level, risk factors related to socioeconomic/demographic status (e.g., maternal education), maternal access to and utilization of health services, and remoteness were strongly associated with the odds of being zero dose in both time periods, while those related to communication were mostly relevant before the pandemic. These associations were also supported at the regional level, but we additionally identified risk factors specific to zero-dose children in each region; for example, communication and cross-border migration in the northwest. Our findings can help guide tailored strategies to reduce zero-dose prevalence and boost coverage levels in Nigeria. Full article

Maternal mortality ratios in sub-Saharan Africa remain high and worrisome. Moreover, maternal health indicators have remained poor despite large efforts in the last two decades. This study assesses maternal mortality patterns by age and country. The demographic and health survey data were used for the study. Based on the results, countries with the lowest adult female mortality rate include Senegal, Comoros, Rwanda, Mauritania, Sao Tome and Principe, Gambia, and Ethiopia. In addition, Chad (44.7%), Niger (38.7%), the Congo Democratic Republic (34.8%), Nigeria (34.2%), Mauritania (32.0%), Senegal (29.2%), Liberia (28.8%), Benin (27.8%), and Guinea (27.5%), respectively, reported the highest female deaths that are pregnancy-related. Overall, Lesotho (1024; 95% CI: 731–1318), Liberia (913; 95% CI: 638–1189), Chad (860; 95% CI: 728–993), Congo Democratic Republic (846; 95% CI: 690–1003), Sierra Leone (796; 95% CI: 632–960) and Guinea (724; 95% CI: 531–916) had the leading pregnancy-related mortality ratio per 100,000 live births. The study found that the patterns of death vary across different countries. There is a need for concerted efforts to reduce pregnancy-related deaths in sub-Saharan countries. Full article

Nigerian women continue to die in childbirth due to inadequate health services such as antenatal care (ANC). Among other factors, the inadequate receipt or non-use of ANC appears to be associated with the age of women, remoteness, and poor households. This cross-sectional study aimed to compare the factors associated with inadequate receipt of the components and non-use of ANC among pregnant adolescents, and young and older women in Nigeria. Data for this study were from the 2018 Nigeria Demographic and Health Survey (NDHS) and covered a weighted total of 21,911 eligible women. Survey multinomial logistic regression analyses that adjusted for cluster, and survey weights were conducted to examine factors associated with adolescent, young, and older women. Adolescent women reported a higher prevalence of inadequate receipts and non-use of ANC than young and older women. Increased odds of inadequate receipt of the components of ANC were associated with residence in the North–East region and rural areas for all three categories of women. For adolescent women, the increased odds of inadequate receipt of the components of ANC were associated with delivering a baby at home and a big problem with distance to health facilities. Limited education or no schooling was associated with the increased odds of receiving inadequate ANC among older women. Implementing interventions to improve maternal and child health care should focus on the factors associated with the increased odds of receipt of inadequate or non-use of ANC services among Nigerian adolescent women, particularly those living in rural areas in the North–East region. Full article

The COVID-19 disease has infected many countries, causing generalized impacts on different income categories. We carried out a survey among households (n = 412) representing different income groups in Nigeria. We used validated food insecurity experience and socio-psychologic tools. Data obtained were analyzed using descriptive and inferential statistics. The earning capacities of the respondents ranged from 145 USD/month for low-income earners to 1945 USD/month for high-income earners. A total of 173 households (42%) ran out of food during the COVID-19 pandemic. All categories of households experienced increasing dependency on the general public and a perception of increasing insecurity, with the high-income earners experiencing the greatest shift. In addition, increasing levels of anger and irritation were experienced among all categories. Of the socio-demographic variables, only gender, educational level of the household head, work hours per day, and family income based on society class were associated (p < 0.05) with food security and hunger due to the COVID-19 pandemic. Although psychological stress was observed to be greater in the low-income earning group, household heads with medium and high family income were more likely to have satisfactory experiences regarding food security and hunger. It is recommended that socio-economic groups should be mapped and support systems should target each group to provide the needed support in terms of health, social, economic, and mental wellness. Full article

Introduction: Understanding the specific geospatial variations in childhood stunting is essential for aligning appropriate health services to where new and/or additional nutritional interventions are required to achieve the Sustainable Development Goals (SDGs) and national targets. Objectives: We described local variations in the prevalence of childhood stunting at the second administrative level and its determinants in Nigeria after accounting for the influence of geospatial dependencies. Methods: This study used the 2018 national Nigeria Demographic and Health Survey datasets (NDHS; N = 12,627). We used a Bayesian geostatistical modelling approach to investigate the prevalence of stunting at the second administrative level and its proximal and contextual determinants among children under five years of age in Nigeria. Results: In 2018, the overall prevalence of childhood stunting in Nigeria was 41.5% (95% credible interval (CrI) from 26.4% to 55.7%). There were striking variations in the prevalence of stunting that ranged from 2.0% in Shomolu in Lagos State, Southern Nigeria to 66.4% in Biriniwa in Jigawa State, Northern Nigeria. Factors positively associated with stunting included being perceived as small at the time of birth and experience of three or more episodes of diarrhoea in the two weeks before the survey. Children whose mothers received a formal education and/or were overweight or obese were less likely to be stunted compared to their counterparts. Children who were from rich households, resided in households with improved cooking fuel, resided in urban centres, and lived in medium-rainfall geographic locations were also less likely to be stunted. Conclusion: The study findings showed wide variations in childhood stunting in Nigeria, suggesting the need for a realignment of health services to the poorest regions of Northern Nigeria. Full article

Increased risk of intimate partner violence (IPV) has been well documented among women and girls living in conflict zones. However, how residence in a conflict area differentially impacts adolescent girls and young women (AGYW) compared to older women is less understood. This paper examines whether the levels of IPV changed more among AGYW compared to older women in six Boko Haram (BH)-affected States in Nigeria. The Nigeria Demographic and Health Survey data was used to compare the level of the three types of IPV (emotional, physical, and sexual) among AGYW compared to older women before and during the BH conflict (2008 and 2018). We ran a multiple linear regression model with an interaction term for ever-partnered female respondents living in six Northeast States, adjusting for relevant covariates. A significantly higher proportion of both older and younger women reported experiencing emotional and sexual IPV in 2018 than in 2008, with a higher increase reported among AGYW. Sexual IPV increased by six percentage points more among AGYW compared to older women. AGYW in the BH-affected States are more vulnerable to experiencing sexual IPV relative to older women. This study highlights the need for youth-focused IPV interventions in the BH-affected States. Full article