Exploring the Hierarchies: Multilevel Correlates of Child Mortality in Nigeria and Implications for Interventions

This study examined the multilevel correlates of childhood mortality among women (aged 15–49 years) in Nigeria using pooled data from the 2003, 2008 and 2018 Nigeria Demographic and Health Surveys. This study considered 25,685 women who stated that they never lived outside their communities. Descriptive and multilevel regression analyses were performed. About 38% of the women reported losing at least a child. The individual-level correlates of childhood mortality were age, age at first birth, years of education, marital status and ethnicity. Household variables such as number of male children ever born (aIRR = 1.031; 95% CI = 1.026–1.036; p = 0.001), no bed net (aIRR = 1.052; 95% CI = 1.011–1.094; p = 0.012) and using biomass/charcoal (aIRR = 1.223; 95% CI = 1.013–1.475; p = 0.036) were positively associated with childhood mortality while wealth index was negatively correlated with childhood mortality. At the community level, lower childhood mortality was observed in South South region (aIRR = 0.853; 95% CI = 0.767–0.949; p = 0.003), but it was higher in North East (aIRR = 1.143; 95% CI = 1.050–1.244; p = 0.002), North West (aIRR = 1.440; 95% CI = 1.318–1.574; p = 0.001) and South East (aIRR = 1.156; 95% CI = 1.028–1.300; p = 0.016) respectively. Higher childhood mortality was associated positively with community poverty (medium: aIRR = 1.107; 95% CI = 1.013–1.210; p = 0.024), low ownership of piped water (aIRR = 1.128; 95% CI = 1.047–1.215; p = 0.002) and problematic distance to health facility (aIRR = 1.046; 95% CI = 1.006–1.088; p = 0.025). There is a need for more interventions to tackle multilevel drivers of child mortality in Nigeria

Do health service contacts with community health workers influence the intention to use modern contraceptives among non-users in rural communities? Findings from a cross-sectional study in Nigeria

Abstract Background Studies in many developing countries have shown that community health workers (CHWs) are valuable for boosting contraceptive knowledge and usage. However, in spite of the evidence, studies in Nigeria have rarely examined whether in the absence of skilled health personnel such as doctors and nurses in rural and remote communities, the health service contacts of non-users with CHWs drive the intention to use modern contraceptives. This study, therefore, examines the extent to which health service contacts with CHWs are associated with the intention to use modern contraceptives among non-users in rural communities of Nigeria. Methods This study adopted a descriptive cross-sectional design. Data were extracted from the most recent Nigeria Demographic and Health Survey (NDHS). The study analyzed a weighted sample of 12,140 rural women. The outcome variable was the intention to use modern contraceptives. The main explanatory variable was health service contacts with CHWs. Statistical analyses were performed at three levels with the aid of Stata version 14. Three multivariable regression models were estimated using an adjusted Odds Ratio (aOR) with a 95% confidence interval. Statistical significance was set at p < 0.05. Results Findings showed that more than a quarter (29.0%) of women intends to use modern contraceptives. Less than one-fifth (15.9%) of the women had health service contacts with CHWs. In Model 1, women who had health service contacts with CHWs were more likely to intend to use modern contraceptives (aOR =1.430, 95% CI: 1.212–1.687). Likewise, in Model 2, women who had health service contacts with CHWs had a higher likelihood of intending to use modern contraceptives (aOR = 1.358, 95% CI: 1.153–1.599). In Model 3, the odds of intention to use modern contraceptives were higher among women who had health service contacts with CHWs (aOR =1.454, 95% CI: 1.240–1.706). Conclusion In rural areas of Nigeria, health service contacts with CHWs are significantly associated with the intention to use modern contraceptives. Family planning programmers should leverage the patronage of CHWs for the purpose of family planning demand generation in rural areas