Individual and contextual correlates of mosquito net use among women in Nigeria

Background: Malaria has been described as an urgent public health priority with almost half of the world’s population being at risk. Use of insecticide-treated nets is considered one of the effective ways of preventing malaria. Nigeria, which is ranked among the five countries that are responsible for almost half of the global malaria cases, has less than half of its women population using mosquito nets. This study examined the effects of individual and contextual factors on the use of mosquito nets among women of reproductive age in Nigeria. Methods: This study used data obtained from 2015 Nigeria Malaria Indicator Survey (NMIS) which involved 6048 women aged 15–49 who possessed at least one mosquito net. Multilevel binary logistic regression models were applied in the multivariable analysis. Results: About 53% of the women used mosquito nets with more than 60% of uneducated and poor women in this category. The use of mosquito nets was significantly associated with being from poor households, having knowledge about the cause of malaria, having access to malaria messages, possessing knowledge about the efficacy of malaria prevention drugs during pregnancy, having knowledge about the importance of tests to detect malaria, maintaining small household size and living in the most socioeconomically disadvantaged communities and states. Conclusions: The study revealed that mosquito net use among women in Nigeria is affected by individual and contextual factors. It is important for policy makers to design a mosquito-net-use model which would take individual and contextual factors into consideration

Correlates of Safe Disposal of Children’s Stool in Nigeria: Evidence from 2018 Demographic and Health Survey

Unsafe Stool disposal has been linked to high under-five morbidity and mortality in many low and middle-income countries. This paper focuses on examining the prevalence of safe disposal of stools in Nigeria and the factors affecting such behaviour. The most-recent Nigeria Demographic and Health Survey 2018 (NDHS) Child’s dataset was used for the analysis in this study. Sample size of 7,834 children under age five was analysed. Percentages and frequencies, chi-square test of association, and binary logistic regression were employed for the statistical analysis. Findings show that a little above half of the women respondents reported safe disposal of stool of their under-five children in the study area (53%). Specifically, the odds of having stool safely disposed increased by 133 percent for children whose household wealth index falls within the richer category (adjusted Odd Ratio (aOR): 2.33; p<0.001), reduced by 17 percent for children whose mothers are working (aOR: 0.83; p<0.05), increased for children whose mothers are residing only in North-East and North-West (p<0.001), increased by 19 percent for children whose mothers were exposed to media exposure to mass media (aOR: 1.19; p<0.05), reduced by 24 percent for women whose children are of first birth order (aOR: 0.76; p<0.05), reduced by 31 percent for women whose children are of small size at birth (aOR: 0.69; p<0.001), increased by 66 percent for women who reported that distance to facility was not a problem (aOR: 1.66; p<0.001), reduced by 19 percent for women who delivered their children at an health centre (aOR: 0.81; p<0.05), and increased by 114 percent for women who used improved toilet facility (aOR: 2.14; p<0.001). This study concludes that a combination of socioeconomic, maternal, child’s and environmental factors are the correlates of safe disposal of stool among women with under-five children in Nigeria. It should therefore be prioritised for interventions aimed at reducing high under-five morbidity and mortality in Nigeria

Predictors of differences in health services utilization for children in Nigerian communities

Health service utilization is an important component of child health promotion. Evidence shows that two-thirds of child deaths in low and middle income countries could be prevented if current interventions were adequately utilized. Aim of this study was to identify determinants of variation in health services utilization for children in communities in Nigeria. Multivariable negative binomial regression model attempting to explain observed variability in health services usage in Nigerian communities was applied to the 2013 Nigeria Demographic and Health Survey data. We included the index of maternal deprivation, gender of child, community environmental factor index, and maternal health seeking behavior, multiple childhood deprivation index and ethnicity diversity index as the independent variables. The outcome variable was under-fives’ hospital attendance rates for acute illness. Of the 7, 577 children from 896 communities in Nigeria that were sick 1, 936 (25.6%) were taken to the health care facilities for treatment. The final model revealed that both multiple childhood deprivation (incidence rate ratio [IRR] = 1.23, 95% confidence interval [CI] 1.12 to 1.35) and children living in communities with a high ethnic diversity were associated with higher rate of health service use. Maternal health seeking behaviour was associated with a significantly lower rate of health care service use. There are significant variations in health services utilization for sick children across Nigeria communities which appear to be more strongly determined by childhood deprivation factors and maternal health seeking behaviour than by health system functions

Correlates of childhood morbidity in Nigeria: Evidence from ordinal analysis of cross-sectional data.

BACKGROUND:Child mortality records show that 1 in every 13 children dies before age five in sub-Saharan Africa with diseases such as pneumonia, diarrhoea and malaria considered to be the leading causes of such deaths. In Nigeria where 50% of all under-five deaths are attributed to morbidity, much attention has been directed to single health conditions. This study aims at examining the factors that are associated with single health conditions and comorbidity among children in Nigeria. MATERIALS AND METHODS:This study was based on data from 2013 Nigeria Demographic and Health Survey (DHS) which involved 27,571 under-five children who suffered from acute respiratory infection, diarrhoea or fever within two weeks of data collection exercise. Descriptive statistics and generalized ordinal logistic regression model were used for the analysis. RESULTS:About 14% of children suffered from a single health condition and 9% suffered from comorbidity. The likelihood of suffering from a single health condition and comorbidity is higher for children who are of third order birth or more (OR = 1.24, 95% CI = 1.11-1.39 & OR = 1.31, 95% CI = 1.12-1.55) compared to those who are of first order birth. The likelihood also increased for children whose mothers live in Northeast (OR = 3.19, 95% CI = 2.86-3.55 & OR = 3.88, 95% CI = 3.30-4.57) compared to children whose mothers live in North Central. The odds of suffering from a single health condition and comorbidity reduced for children who are from richest households, aged 3 years and above and were of average size at birth. Children of women who obtained water from improved source are less likely to experience any morbidity (OR = 0.93, 95% CI = 0.87-0.99) compared to children whose mothers obtained water from non-improved source. CONCLUSIONS:The study has demonstrated that children in Nigeria are not only exposed to the risk of single health conditions but they are also exposed to the risk of comorbidity. Efforts should be made to design appropriate health care models that would facilitate a considerable reduction in childhood morbidity in the country

Factors associated with adverse nutritional status of children in sub‐Saharan Africa: Evidence from the Demographic and Health Surveys from 31 countries

Abstract Undernutrition is linked to almost half of all deaths in under‐five children. In 2019, 144 million under‐five children suffered from stunting and 47 million suffered from wasting. This study examined the factors that influence adverse nutritional status of children in sub‐Saharan Africa. The study used data from the Demographic and Health Surveys (DHS) of 31 countries, which involved 189,195 children under age 5. Binary logistic regression was used to examine the relationships between the independent variables and adverse nutritional status of children. About 26% of the children in the 31 countries in sub‐Saharan Africa considered in this study are stunted, 6% are wasted and 21% are underweight. Close to 31% of children whose mothers have no education are stunted, 9% are wasted and 28% are underweight. Adverse nutritional status of children is significantly associated with maternal age, education, household wealth, residence, antenatal care attendance, mass media exposure, child's sex and size of child at birth. This study has shown that adverse nutritional status of children is a major challenge in sub‐Saharan Africa. Efforts at improving nutritional status of children should include poverty alleviation initiatives at individual and household levels, increase in women's educational level and improvement in living conditions in rural areas

Women who have not utilized health Service for Delivery in Nigeria: who are they and where do they live?

Abstract Background Health facility delivery has been described as one of the major contributors to improved maternal and child health outcomes. In sub-Saharan Africa where 66% of the global maternal mortality occurred, only 56% of all births take place in health facility. This study examined the individual and contextual predictors of non-use of health service for delivery in Nigeria where less than 40% births occur in health facility. Methods Data from 2013 Nigeria Demographic and Health Survey (DHS) involving 20,192 women who had delivery within 5 years of the survey were used in the study. Multilevel multivariable logistics regression models which had the structure of non-use of health service for delivery defined at individual, community and state levels were applied in the analysis. Spatial analysis was also used to capture the locations where the phenomenon is prevalent in the country. Results About 62% of the women did not utilize health service during delivery. More than three-quarter of those with no education and 92% of those who did not attend antenatal clinic during pregnancy never utilized health service for delivery. The odds of non-use of health service during delivery increased for women who had no education, from poor households, aged 25–34 years, unmarried, never attended antenatal clinic, experienced difficulty getting to health facility and lived in the most socioeconomically disadvantaged communities and states. Conclusions This study has demonstrated that non-utilization of health service for delivery is influenced by individual, community and state level factors, with substantial proportions of women not utilizing such service residing in the northern region of Nigeria. Each level should be adequately considered in the design of the appropriate interventions

Determinants of partial and adequate maternal health services utilization in Nigeria: analysis of cross-sectional survey

Abstract Background Access to health services during pregnancy, childbirth and the period after birth provides a substantial opportunity to limit cases of maternal mortality. In sub-Saharan Africa, the proportions of women who utilize health services remain below 70%. This study examined the factors associated with partial and adequate maternal health services utilization in Nigeria. Methods This paper used data from 2018 Nigeria Demographic and Health Survey (DHS) comprising 21,792 women aged 15–49 years who had given births within five years of the survey. The study focused on antenatal care attendance, place of birth and postnatal care using a combined model. Multinomial logistic regression was applied in the analysis. Results About 74% of the women attended antenatal care, 41% gave birth in health facilities and 21% attended postnatal care. While 68% of the women partially utilized health services, 11% adequately utilized the services. The odds of partially and adequately utilizing health services increased for ever married women, women with secondary or higher education, from richest households, living in urban area, having no problem either getting permission to visit health facility or reaching health facility. Conclusions This study has revealed the factors associated with partial and adequate utilization of maternal health services in Nigeria. Such factors include education, household wealth, marital status, employment status, residence, region, media exposure, getting permission to use health service, unwillingness to visit health facility without being accompanied and distance to health facility. Efforts aimed at improving maternal health services utilization should place emphasis on these factors

Incomplete childhood immunization in Nigeria: a multilevel analysis of individual and contextual factors

Abstract Background Under-five mortality remains high in sub-Saharan Africa despite global decline. One quarter of these deaths are preventable through interventions such as immunization. The aim of this study was to examine the independent effects of individual-, community- and state-level factors on incomplete childhood immunization in Nigeria, which is one of the 10 countries where most of the incompletely immunised children in the world live. Methods The study was based on secondary analyses of cross-sectional data from the 2013 Nigeria Demographic and Health Survey (DHS). Multilevel multivariable logistic regression models were applied to the data on 5,754 children aged 12–23 months who were fully immunized or not (level 1), nested within 896 communities (level 2) from 37 states (level 3). Results More than three-quarter of the children (76.3%) were not completely immunized. About 83% of children of young mothers (15–24 years) and 94% of those whose mothers are illiterate did not receive full immunization. In the fully adjusted model, the chances of not being fully immunized reduced for children whose mothers attended antenatal clinic (adjusted odds ratio [aOR] = 0.49; 95% credible interval [CrI] = 0.39–0.60), delivered in health facility (aOR = 0.62; 95% CrI = 0.51–0.74) and lived in urban area (aOR = 0.66; 95% CrI = 0.50–0.82). Children whose mothers had difficulty getting to health facility (aOR = 1.28; 95% CrI = 1.02–1.57) and lived in socioeconomically disadvantaged communities (aOR = 2.93; 95% CrI = 1.60–4.71) and states (aOR = 2.69; 955 CrI =1.37–4.73) were more likely to be incompletely immunized. Conclusions This study has revealed that the risk of children being incompletely immunized in Nigeria was influenced by not only individual factors but also community- and state-level factors. Interventions to improve child immunization uptake should take into consideration these contextual characteristics

Contextual factors associated with health care service utilization for children with acute childhood illnesses in Nigeria.

OBJECTIVE:To examine the independent contribution of individual, community and state-level factors to health care service utilization for children with acute childhood illnesses in Nigeria. MATERIALS AND METHODS:The study was based on secondary analyses of cross-sectional population-based data from the 2013 Nigeria Demographic and Health Survey (DHS). Multilevel logistic regression models were applied to the data on 6,427 under-five children who used or did not use health care service when they were sick (level 1), nested within 896 communities (level 2) from 37 states (level 3). RESULTS:About one-quarter of the mothers were between 15 and 24 years old and almost half of them did not have formal education (47%). While only 30% of the children utilized health service when they were sick, close to 67% lived in the rural area. In the fully adjusted model, mothers with higher education attainment (Adjusted odds ratio [aOR] = 1.63; 95% credible interval [CrI] = 1.31-2.03), from rich households (aOR = 1.76; 95% CrI = 1.35-2.25), with access to media (radio, television or magazine) (aOR = 1.18; 95% CrI = 1.08-1.29), and engaging in employment (aOR = 1.18; 95% CrI = 1.02-1.37) were significantly more likely to have used healthcare services for acute childhood illnesses. On the other hand, women who experienced difficulty getting to health facilities (aOR = 0.87; 95% CrI = 0.75-0.99) were less likely to have used health service for their children. CONCLUSIONS:Our findings highlight that utilization of healthcare service for acute childhood illnesses was influenced by not only maternal factors but also community-level factors, suggesting that public health strategies should recognise this complex web of individual composition and contextual composition factors to guide provision of healthcare services. Such interventions could include: increase in female school enrolment, provision of interest-free loans for small and medium scale enterprises, introduction of mobile clinics and establishment of more primary health care centres

Factors associated with caregivers’ consistency of use of bed nets in Nigeria: a multilevel multinomial analysis of survey data

Abstract Background Malaria remains endemic in Nigeria despite programmes and policies put in place toward malaria elimination. Long-lasting insecticidal nets have been documented to offer protection from malaria by preventing mosquito bites. While many studies have examined the factors associated with the use of bed nets in Nigeria and across Africa, little information is available on the factors associated with consistency of use of bed nets. Methods The data for this study were derived from a household survey conducted in three states in Nigeria (Akwa Ibom, Kebbi and Nasarawa) between July and September 2015 by the Health Communication Capacity Collaborative, a 5-year cooperative agreement supported by the United States Agency for International Development and the US President’s Malaria initiative and led by the Johns Hopkins Center for Communication Programs. The analysis was limited to a total of 3884 men and women selected from 2863 households with at least one bed net. Multilevel multinomial logistic regression was used to assess the factors associated with consistency of use of bed nets. Results The findings revealed 43.2% of the respondents use bed nets every night, while 38.4% use bed nets most nights. The factors associated with using a bed net every night rather than rarely or never using a bed net included sociodemographic and household variables (age, gender, religion, household size, net density, and household wealth), ideational variables (perceptions about severity, susceptibility, self-efficacy to use nets, and response-efficacy of bed net; awareness of place of purchase; willingness to pay for bed nets; attitudes towards net use; and descriptive norm about nets), and state of residence. The three study states differ significantly in terms of most of the independent variables included in the estimated model. Conclusions The study recommends that efforts designed to promote consistent use of bed nets should be state-specific and include strategies targeting ideational variables. Furthermore, given the significance of unmeasured heterogeneity at the cluster level, strategies to engage and mobilize the community, such as community dialogue, home visits and engaging community leadership, are relevant