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Background: The issue of child marriage is a form of human rights violation among young women mainly in resource-constrained countries. Over the past decades, child marriage has gained attention as a threat to women's health and autonomy. This study explores the prevalence of child marriage among women aged 20–24 years in sub-Saharan Africa countries and examines the association between child marriage and fertility outcomes. Methods: Latest DHS data from 34 sub-Saharan African countries were used in this study. Sixty thousand two hundred and fifteen women aged 20–24 years were included from the surveys conducted 2008–2017. The outcome variables were childbirth within the first year of marriage (early fertility), first preceding birth interval less than 24 months (rapid repeat of childbirth), unintended pregnancy, lifetime pregnancy termination, the use of modern contraceptive methods, lifetime fertility and any childbirth. The main explanatory variable was child marriage (< 18 years) and the associations between child marriage and fertility outcomes were examined from the ever-married subsample to estimate odds ratios (ORs) and 95% CIs using binary logistic regression models. Results: In the study population, the overall prevalence of women who experience child marriage was 54.0% while results showed large disparities across sub-Saharan African countries ranging from 16.5 to 81.7%. The prominent countries in child marriage were; Niger (81.7%), Chad (77.9%), Guinea (72.8%), Mali (69.0%) and Nigeria (64.0%). Furthermore, women who experience child marriage were 8.00 times as likely to have ≥3 number of children ever born (lifetime fertility), compared to women married at ≥18 years (OR = 8.00; 95%CI: 7.52, 8.46). Women who experience child marriage were 1.13 times as likely to use modern contraceptive methods, compared to adult marriage women (OR = 1.13; 95%CI: 1.09, 1.19). Those who married before the legal age were 1.27 times as likely to have lifetime terminated pregnancy, compared to women married at ≥18 years (OR = 1.27; 95%CI: 1.20, 1.34). Also women married at < 18 years were more likely to experience childbirth, compared to women married later (OR = 5.83; 95%CI: 5.45, 6.24). However, women married at < 18 years had a reduction in early childbirth and a rapid repeat of childbirth respectively. Conclusion: Implementing policies and programmmes against child marriage would help to prevent adverse outcomes among women in sub-Saharan Africa. Also, social change programmes on child-marriage would help to reduce child marriage, encourage the use of modern contraceptive, which would minimize lifetime terminated pregnancy and also children ever born. [ABSTRACT FROM AUTHOR]

Aims: This study investigates the rural–urban differences in infant mortality rates (IMRs) and the associated risk factors in Nigeria. Methods: The dataset from the 2013 Nigeria demographic and health survey (NDHS), disaggregated by rural–urban residence, was analyzed using complex samples statistics. A multivariable logistic regression analysis was computed to explore the adjusted relationship and identify risk factors for infant mortality. Results: In rural and urban Nigeria, IMRs were 70 and 49 deaths per 1000 live births, respectively. Risk factors in rural residence were past maternal marital union (adjusted odds ratio (AOR): 1.625, p = 0.020), small birth size (AOR: 1.550, p < 0.001), birth interval <24 months (AOR: 2.057, p < 0.001), residence in North-East (AOR: 1.346, p = 0.038) and North-West (AOR: 1.653, p < 0.001) regions, and cesarean delivery (AOR: 2.922, p = 0.001). Risk factors in urban residence were poor wealth index (AOR: 2.292, p < 0.001), small birth size (AOR: 2.276, p < 0.001), male gender (AOR: 1.416, p = 0.022), birth interval <24 months (AOR: 1.605, p = 0.002), maternal obesity (AOR: 1.641, p = 0.008), and cesarean delivery (AOR: 1.947, p = 0.032). Conclusions: Infants in rural residence had higher rates of mortality than their urban counterparts and disparities in risk factors exist between the residences. [ABSTRACT FROM AUTHOR]

Background Significant reduction in the global burden of neonatal mortality was achieved through the millennium development goals. In Nigeria, however, only a marginal reduction was realized. This study assesses the rural-urban differences in neonatal mortality rate ( NMR) and the associated risk factors in Nigeria. Methods The dataset from the 2013 Nigeria demographic and health survey ( NDHS), disaggregated by rural-urban residence (n = 20 449 and 9935, respectively), was explored using univariate, bivariate, and multivariable analysis. Complex samples analysis was applied to adjust for the unequal selection probabilities due to the multi-stage cluster sampling method used in the 2013 NDHS. The adjusted relationship between the outcome and predictor variables was assessed on multi-level logistic regression analysis. Results NMR for rural and urban populations was 36 and 28 deaths per 1000 live births, respectively. Risk factors in urban residence were lack of electricity access (adjusted OR [ AOR], 1.555; 95% CI: 1.089-2.220), small birth size (as a proxy for low birthweight; AOR, 3.048; 95% CI: 2.047-4.537), and male gender ( AOR, 1.666; 95% CI: 1.215-2.284). Risk factors in rural residence were small birth size (a proxy for low birthweight; AOR, 2.118; 95% CI: 1.600-2.804), and birth interval <2 years ( AOR, 2.149; 95% CI: 1.760-2.624). Cesarean delivery was a risk factor both in rural ( AOR, 5.038; 95% CI: 2.617-9.700) and urban Nigeria ( AOR, 2.632; 95% CI: 1.543-4.489). Conclusions Determinants of neonatal mortality were different in rural and urban Nigeria, and rural neonates had greater risk of mortality than their urban counterparts. [ABSTRACT FROM AUTHOR]

Background: Nigeria still grapples with low family planning (FP) use and a high fertility rate. This study explores the factors associated with the unmet need for FP and the coldspots of unmet need for FP in Nigeria. Methods: The 2013 Nigerian Demographic Health Survey (NDHS) data was used to investigate the unmet need for FP in Nigeria. A geo-additive model was specified to simultaneously measure the fixed, nonlinear, spatial and random effects inherent in the data. The fixed effect of categorical covariates was modelled using the diffuse prior, the nonlinear effect of continuous variable was modelled using the P-spline with second-order random walk, the spatial effects followed Markov random field priors while the exchangeable normal priors were used for the random effect of the community. The binomial distribution was used to handle the dichotomous nature of the dependent variable. Results: North East (OR: 1.8404, CI: 1.6170, 2.0941), North West (OR: 1.1145, CI: 1.1454, 1.1789), primary education (OR: 1.0441, CI: 0.9680, 1.1286), Hausa (OR: 2.7031, CI: 2.3037, 3.1513), birth interval greater than 12 months (OR: 1.0909, CI: 1.0447, 1.1379), community (OR: 1.6733, CI: 1.5261, 1.7899) and states (OR: 6.0879, CI: 2.5995, 29.6274) significantly increased the unmet need for FP. Conclusion: The unmet need for FP in Nigeria is positively associated with the Northern region, low level of education and birth interval. [ABSTRACT FROM AUTHOR]