Search

While social determinants of health have been perennially linked to child survival in resource-limited countries, the precise and tested pathways to effect are not clearly understood. The objective of this study was therefore to identify the critical pathways as posited a priori in a model through which social factors (at maternal, household, and community levels) determine neonatal, infant, and under-five mortalities in Nigeria. Using a novel analytic approach (hierarchical path modelling for predicting accelerated failure time) to estimate (in)direct and total effects of social determinants of child survival, we analysed 30,960 live births (weighted data for representativeness), obtained from the 2016/2017 Nigeria Multiple Indicator Cluster Survey. There were three outcome variables: time until occurrence of neonatal, infant, and under-five mortalities. The independent variables were layered factors related to child, maternal, household and community. Geographical region, rurality of residence, infrastructural development, maternal education, contraceptive use, marital status, and maternal age at birth were found to operate more indirectly on neonatal, infant, and under-five survival. Child survival is due to direct effects of child's sex (female), gestational type (singleton), birth spacing (children whose mothers delivered at least two years apart), and maternal age at delivery (20–34 years). According to the path coefficients, the indirect effects of geographical regions are the most influential determinants of child survival, accounting for 30% (neonatal), 37.1% (infant) and 39.9% (under-five) of the total effects. This study offers comprehensive set of factors, and linked pathways, at the maternal, household, and community levels that are associated with child survival in Nigeria. To accelerate progress towards Sustainable Development Goal targets for child survival and reduce geographical inequities, stakeholders should implement more impactful policies that promote maternal education, contraceptive use and improve living conditions of women (especially in rural areas of northern Nigeria). Future research should focus on identifying the most effective interventions for addressing these social determinants of child survival in Nigeria. [ABSTRACT FROM AUTHOR]

Introduction: the ravaging COVID-19 pandemic has worsened the levels of unmet need (UMN) for family planning (FP). A pulse survey showed that FP services were interrupted during the lockdown in 68% of countries. There is a need to investigate the demand gap for FP among women in the postpartum period. This study aimed to determine the prevalence and predictors of UMN of FP among women in the extended postpartum period attending immunization clinics. Methods: this was a facility-based cross-sectional study among 485 women recruited from 5 health facilities using a random sampling technique and proportional to size allocation. Data was collected using an interviewer-structured questionnaire. Analysis was done using IBM SPSS version 26. Adjusted odds ratios with 95% confidence intervals were computed. The level of significance was 5%. Results: the total unmet need was 45.4% (95% CI: 40.2--50.7) with a higher need for child spacing (60.4%) compared to limiting pregnancies (39.6%). The mean age was 30.3 ± 6.1 years. The significant predictors included age [35-39 years (aOR=5.39, 95% CI: 1.61-18.06); ≥ 40 years (aOR= 32.48, 95% CI: 6.48-162.77)], lower education status (aOR= 5.21, 95% CI: 2.09-13.01), lower income (aOR =2.21, 95% CI: 1.10-4.46), rural residence (aOR= 4.27, 95% CI: 2.15-8.47), denomination [Pentecostal (aOR= 4.09, 95% CI: 1.77-9.43); Orthodox (aOR= 5.44, 95% CI: 2.03-14.58)] and poor knowledge of postpartum FP (PPFP) (aOR= 33.93, 95% CI: 13.21-87.12). The commonest reason for FP non-use was fear of side effects. Conclusion: close to half of the women in the extended postpartum period experienced UMN for PPFP. Policymakers should consider these factors when designing FP interventions. [ABSTRACT FROM AUTHOR]

Nigeria like most developing nations still faced with a higher rate of short birth interval (SBI), and its associated consequences, such as adverse maternal and child health outcomes. This study aimed to determine the distribution and factors associated with SBI in rural and urban Nigeria. The data for this study were extracted from the 2018 Nigeria Demographic and Health Survey (2018 NDHS). Statistical analyses were descriptive analysis and binary logistic model. The proportions of SBI in rural and urban Nigeria were 20.7% and 20.3% respectively. Women's age, geopolitical region, education level, and the number of children ever born were significantly associated with SBI in rural and urban Nigeria. Maternal Wealth index and antenatal care visits were only significant in rural while working status was only significant in urban Nigeria after controlling for other factors. Higher odds of SBI for middle class women than poor women (AOR = 1.19, 95% CI = 1.06–1.35), and increase in ANC visits reduces the odds of having SBI: 4–7 visits (AOR = 0.87, 95% CI = 0.77–0.98) and > 7visits (AOR = 0.83, 95% CI = 0.69–0.99). There were slight disparities in the prevalence of short birth intervals in rural and urban areas. Wealth index and ANC visits were only significant in rural Nigeria. Public health awareness campaigns should be strengthened to drive the importance of birth spacing techniques such as the utilization of modern contraceptives and breastfeeding in all the geo-political regions and across all age strata. Women particularly those residing in the rural areas should be encouraged to advance their education to at least a secondary level and enlightened on the importance of ANC. [ABSTRACT FROM AUTHOR]

This study aimed to assess the changes in neonatal and infant mortality rates in Nigeria over the period 1990 to 2018 using Nigerian Demographic and Health Survey (NDHS) data, and assess their socio-demographic determinants using data from the most recent survey conducted in 2018. The infant mortality rate was 87 per 1000 live births in 1990, and this increased to 100 per 1000 live births in 2003 - an increase of around 15% over 13 years. Neonatal and infant mortality rates started to decline steadily thereafter and continued to do so until 2013. After 2013, neonatal morality rose slightly by the year 2018. Information for 27,465 infants under 1 year of age from the NDHS-2018 was analysed using bivariate and multivariate analysis and the Cox proportional hazard technique. In 2018, infant deaths decreased as wealth increased, and the incidence of infant deaths was greater among those of Islam religion than among those of other religions. A negative association was found between infant deaths and the size of a child at birth. Infant mortality was higher in rural than in urban areas, and was higher among male than female children. Both neonatal and infant death rates varied by region and were found to be highest in the North West region and lowest in the South region. An increasing trend was observed in neonatal mortality in the 5-year period from 2013 to 2018. Policy interventions should be focused on the poor classes, women with a birth interval of less than 2 years and those living in the North West region of the country. [ABSTRACT FROM AUTHOR]

Against the background of the solution-defying incidence of child labourers in Nigerian cities, this study examined the relationship between public spaces and incidence of child labourers in Ibadan Municipality, Nigeria. Data were obtained through direct counting of child labourers and cursory observation of the physical and environmental compositions of their places of operation. The direct counting was conducted for seven days of the week in the morning, afternoon and evening within defined activity-nuclei purposively selected across three densities of residential areas of the municipality: high, medium and low. The data collected were subjected to descriptive statistics. Findings showed that the incidence and categories of child labourers varied with public spaces and density of residential areas, and also followed the concentric, sector and multiple nuclei theories of urban land use. The study, therefore, recommended that urban planners and government have roles to play in offering lasting solution to the menace of child labour. [ABSTRACT FROM AUTHOR]

Background: Fertility decline characterised by inter-birth intervals remains rather slow or stall in many countries of sub-Saharan African (SSA). Non-adherence to optimal inter-birth intervals often occasioned by low prevalence of contraceptive use and high fertility desires often lead to poor maternal and child health outcomes. Additionally, information on the influence of contraception and fertility desire on interval between first and second births (SBI) is rarely available. This study therefore aimed to examine the influence of fertility desire and contraception on SBI among women in four SSA countries.Methods: We analysed cross-sectional data on women aged 15-49 years who participated in the recent Demographic and Health Surveys in DR Congo, Ethiopia, Nigeria and South Africa. Semi-parametric Cox proportional hazards regression was employed for the analysis at 5% significance level.Results: The median time to second birth was 34 months in DR Congo; 35 months, Nigeria; 42 months, Ethiopia; and 71 months, South Africa. About 70% of the women desired additional child(ren) and two-thirds have never used contraceptive in both Nigeria and DR Congo. The hazard of second birth was significantly lower among women who desired additional child(ren) compared to desired for no more child in DR Congo (aHR = 0.93; CI: 0.89-0.97), Ethiopia (aHR = 0.64; CI: 0.61-0.67) and South Africa (aHR = 0.51; CI: 0.47-0.55). Women who had never used contraceptive were 12%, 20% and 24% more likely to lengthen SBI than those who were current users in DR Congo, Nigeria and South Africa respectively. DR Congo and Nigerian women were about two times more likely to shorten SBI compared with their South African counterparts. Other significant determinants of SBI include ethnicity, rural residential, age and marital status at first birth, wealth and employment status.Conclusion: Findings showed differentials in the linkage between second birth interval and the desired fertility and contraception by country, demonstrating the importance of context. The contribution of these factors to second birth interval requires country context-specific attention if further decline in fertility and poor health outcomes associated with sub-optimal inter-birth interval is to be attained in SSA. [ABSTRACT FROM AUTHOR]

Background: Short birth intervals, defined by the World Health Organization as less than 33 months, may damage the health and wellbeing of children, mothers, and their families. People in northern Nigeria recognise many adverse effects of short birth interval (kunika in the Hausa language) but it remains common. We used fuzzy cognitive mapping to systematize local knowledge of causes of kunika to inform the co-design of culturally safe strategies to address it. Methods: Male and female groups in twelve communities built 48 maps of causes and protective factors for kunika, and government officers from the Local Government Area (LGA) and State made four maps. Each map showed causes of kunika or no-kunika, with arrows showing relationships with the outcome and between causes. Participants assigned weights for the perceived strength of relationships between 5 (strongest) and 1 (weakest). We combined maps for each group: men, women, and government officers. Fuzzy transitive closure calculated the maximum influence of each factor on the outcome, taking account of all relationships in the map. To condense the maps, we grouped individual factors into broader categories and calculated the cumulative net influence of each category. We made further summarised maps and presented these to the community mapping groups to review. Results: The community maps identified frequent sex, not using modern or traditional contraception, and family dynamics (such as competition between wives) as the most influential causes of kunika. Women identified forced sex and men highlighted lack of awareness about contraception and fear of side effects as important causes of kunika. Lack of male involvement featured in women's maps of causes and in the maps from LGA and State levels. Maps of protective factors largely mirrored those of the causes. Community groups readily appreciated and approved the summary maps resulting from the analysis. Conclusions: The maps showed how kunika results from a complex network of interacting factors, with culture-specific dynamics. Simply promoting contraception alone is unlikely to be enough to reduce kunika. Outputs from transitive closure analysis can be made accessible to ordinary stakeholders, allowing their meaningful participation in interpretation and use of the findings. Plain English summary: For people in Bauchi State, northern Nigeria, kunika describes a short interval between successive births, understood as becoming pregnant again before the previous child is weaned. They recognise it is bad for children, mothers and households. We worked with 12 communities in Bauchi to map their knowledge of the causes and protective factors for kunika. Separate groups of men and women built 48 maps, and government officers at local and state level built four maps. Each group drew two maps showing causes of kunika or of no-kunika with arrows showing the links between causes and the outcome. Participants marked the strength of each link with a number (between 5 for the strongest and 1 for the weakest). We combined maps for women, men and government officers. We grouped similar causes together into broader categories. We calculated the overall influence of each category on kunika or no-kunika and produced summary maps to communicate findings. The maps identified the strongest causes of kunika as frequent sex, not using modern or traditional contraception, and family dynamics. Women indicated forced sex as an important cause, but men focused on lack of awareness about contraception and fear of side effects. The maps of protective factors mirrored those of the causes. The groups who created the maps approved the summary maps. The maps showed the complex causes of kunika in Bauchi. Promoting contraception is unlikely to be enough on its own to reduce kunika. The summary maps will help local stakeholders to co-design culturally safe ways of reducing kunika. [ABSTRACT FROM AUTHOR]

Prevalence of Stunting among under-five children is very high in many developing countries of the World. As step towards reducing the prevalence, there is need to identify the important determinants and the Trend of Stunting in the specific context. This paper examined the general trend and determinants of stunting among children 0-59 months in Nigeria. The anthropometric indices Height for age z-score was used to determine a child's nutritional status as whether a child is stunted and the impacts of some socioeconomic, Demographic, Community level, Environmental and maternal factors on this are determined. Results from this study shows that Child's sex, mother's birth interval, Mother's and their partner's educational status, Locality, geopolitical zones of the mother's, Wealth index, parents source of drinking water among others contributed positively to Stunting among children 0-59 months in Nigeria (p < 0.05). The general results showed that Stunting among less than five years children in Nigeria has significantly improves over time between 1990 and 2003 (p < 0.05). Although following a sinusoidal pattern. Five waves of national data from the Nigerian Demographic and Health Surveys for 1990, 1999, 2003, 2008 and 2013 were employed in the study. [ABSTRACT FROM AUTHOR]

There is a knowledge gap on abnormal birth weight in urban Nigeria where specific community contexts can have a significant impact on a child's health. Abnormal birth weight, classified into low birth weight and high birth weight, is often associated with adverse health outcomes and a leading risk for neonatal morbidity and mortality. The study used datasets from the birth recode file of 2013 and 2018 Nigeria Demographic and Health Survey (NDHS); a weighted sample of pooled 9,244 live births by 7,951 mothers within ten years (2008–2018) in urban Nigeria. The effects of individual, healthcare utilization and community-level variables on the two abnormal birth weight categories were explored with a multinomial logistic regression models using normal birth weight as a reference group. In urban Nigeria, the overall prevalence of ABW was 18.3%; high birth weight accounted for the majority (10.7%) of infants who were outside the normal birth weight range. Predictors of LBW were community (region), child characteristic (the type of birth) and household (wealth index) while that of HBW were community (regions), child characteristics (birth intervals and sex), maternal characteristic (education) and healthcare utilization (ANC registration). LBW was significantly more prevalent in the northern part while HBW was more common in the southern part of urban Nigeria. This pattern conforms to the expected north-south dichotomy in health indicators and outcomes. These differences can be linked to suggested variation in regional exposure to urbanization in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Family planning helps individuals and couples to avoid unwanted pregnancies, regulate interval between pregnancies, and determine the number of children in the family. Family planning is an effective intervention for promoting maternal health, but its acceptability and utilization are impeded by many factors. Aim: This study was conducted to assess the rural women's awareness and practice of family planning in two communities in Ogun State. Materials and Methods: This was a cross-sectional study conducted among 561 women of reproductive age. Data collection was done using interviewer administered questionnaire. Data were analyzed using IBM SPSS version 20. Frequencies were generated and Chi-square test was used to explore associations. Binary logistic regression was used to determine predictors of ever-used family planning. Results: Majority were aware of family planning (410, 73.1%). The method most commonly known was male condom (348, 84.9%), pills (276, 67.3%), and injectables (231, 56.3%). Respondents who had ever-used family planning were (265, 47.2%). The methods commonly used were injectables (104, 39.2%) and pills (85, 32.1%). Reasons for not using family planning include the desire for more children (78, 26.3%), lack of spousal support (56, 18.9%), and fear of undesirable effects (44, 14.9%). Determinants of ever-used family planning after logistic regression were age and occupation. Women between 31 and 40 years of age were two times more likely than women <20 years to have used family planning (adjusted odds ratio [AOR] 2.17, 95% confidence interval [CI] 2.17–1.23). Farmers were 53% less likely than traders to have ever-used family planning (AOR: 0.47, 95% CI: 0.29–0.78). Conclusion: Although the awareness of family planning was high in this study, it did not correspond to practice. Campaigns promoting the use of family planning for child spacing, male involvement in family planning and dispelling of fears is recommended to improve practice of family planning. [ABSTRACT FROM AUTHOR]

Background: In Northern Nigeria, short birth interval is common. The word kunika in the Hausa language describes a woman becoming pregnant before weaning her last child. A sizeable literature confirms an association between short birth interval and adverse perinatal and maternal health outcomes. Yet there are few reported studies about how people view short birth interval and its consequences. In support of culturally safe child spacing in Bauchi State, in North East Nigeria, we explored local perspectives about kunika and its consequences.Methods: A qualitative descriptive study included 12 gender-segregated focus groups facilitated by local men and women in six communities from the Toro Local Government Area in Bauchi State. Facilitators conducted the groups in the Hausa language and translated the reports of the discussions into English. After an inductive thematic analysis, the local research team reviewed and agreed the themes in a member-checking exercise.Results: Some 49 women and 48 men participated in the 12 focus groups, with an average of eight people in each group. All participants were married with ages ranging from 15 to 45 years. They explained their understanding of kunika, often in terms of pregnancy while breastfeeding. They described many disadvantages of kunika, including health complications for the mother and children, economic consequences, and adverse impact on men's health and family dynamics. The groups concluded that some people still practise kunika, either intentionally (for example, in order to increase family size or because of competition between co-wives) or unintentionally (for example, because of frequent unprotected sex), and explained the roles of men and women in this.Conclusion: Men and women in our study had a clear understanding of the concept of kunika. They recognized many adverse consequences of kunika beyond the narrow health concerns reported in quantitative studies. Their highlighted impacts of kunika on men's wellbeing can inform initiatives promoting the role of men in addressing kunika. [ABSTRACT FROM AUTHOR]

Studies have focused on the effect of short birth spacing on childhood mortality, yet very little attention has been paid to the possibility of an inverse relationship such that child mortality might also positively or negatively affect birth spacing. In Nigeria, where both fertility and child mortality are high, this inverse relationship is a possible reason for the country's high fertility. The objective of this study was to examine the effect of child death on time to birth of the next child. Data were drawn from the 2013 Nigerian Demographic Health Survey. The study sample comprised 188,986 live births born to women aged 15-49 years within the five years preceding the survey. A multivariate Cox proportional hazard regression model was fitted to the data, and hazard ratios with 95% confidence intervals calculated. More than half of the mothers (68%) already had a next birth by 36 months after the death of the index child. Controlling for other covariates, the Cox regression model showed that the likelihood of next birth was higher when the index child had died compared with when the index child survived (HR: 2.21; CI: 2.03-2.41). Sub-group analysis by geo-political regions in Nigeria showed that in all regions there was a higher likelihood of having a next birth following the death of a preceding child. Death of the index child was found to be a major factor that shortens the length of birth intervals in Nigeria. It is therefore important that the Government of Nigeria intensifies efforts aimed at reducing infant mortality and encouraging adequate birth spacing. [ABSTRACT FROM AUTHOR]

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]

Infant mortality and its risk factors in Nigeria was investigated using Bayesian hierarchical modeling. The hierarchical nature of the problem was examined to detect the within and between groups (states and regions) variations in infant deaths. The effect of individual level variables on the risk of a child dying before the age of one was determined using data collected from the fifth round Multiple Indicator Survey (MICS5, 2016-2017). Infants in Northern Nigeria had a higher risk of dying than others, especially in North West, while South West had the lowest risk of infant deaths. Ten percent of the variations in infant deaths was explained by differences between states while differences between regions explained only seven percent of the variations. Also, factors such as urban place of residence, mothers with secondary and tertiary education, first birth and birth interval above 2 years were associated with a decreased risk of infant deaths. Male infants, birth interval of less than 2 years, mothers with primary and no education, teenage mothers and mothers that gave birth at age 35 years and above were associated with a higher risk of infant mortality. [ABSTRACT FROM AUTHOR]

Background: Fertility is high in Nigeria and contraceptive use is low. Little is known about how urban Nigerians perceive the risk of contraceptive use in relation to pregnancy and birth. This study examines and compares the risk perception of family planning methods and pregnancy related scenarios among urban Nigerians.Methods: A total of 26 focus group discussions with 243 participants were conducted in September and October 2010 in Ibadan and Kaduna. The groups were stratified by sex, age, family planning use, and city. Study participants were asked to identify the risk associated with six different family planning methods and four pregnancy related risks. The data were coded in ATLAS.ti 6 and analyzed using the thematic content analysis approach.Results: The ten family planning and pregnancy related items ranked as follows from most to least risky: sterilization, abortion, getting pregnant soon after having a baby (no birth spacing), pill, IUD, injectable, having a birth under 18 years of age (teenage motherhood), condom use, having six children, and fertility awareness methods. Risk of family planning methods was often categorized in terms of side effects and complications. Positive perceptions of teenage motherhood and having many children influenced the low ranking of these items.Conclusion: Inadequate birth spacing was rated as more risky than all contraceptive methods and pregnancy related events except for sterilization and abortion. Some of the participants' risk perceptions of contraceptives and pregnancy related scenarios does not correspond to actual risk of methods and practices. Instead, the items' perceived riskiness largely correspond with prevailing social norms. However, there was a high level of understanding of the risks of inadequate birth spacing.Trial Registration Number: This study is not a randomized control trial so the study has not been registered as such. [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. The prevailing low utilization of modern contraceptives for family planning in developing countries in spite of an almost universal level of awareness by the populace is a cause for concern by relevant stakeholders. Objectives. The aim of this study was to determine the feeling and attitude of women toward family planning and the reasons for such attitude. Material and methods. A 7-item structured, pre-coded questionnaire was used to sample respondents' feelings and attitude toward family planning. Results. All the respondents were aware of family planning, and 412 (90.9%) of them believed in the practice. The majority 269 (59.4%) of the respondents preferred to allow 24 months between their last delivery and the next pregnancy. 306 (74.3%) respondents believed in the use of modern contraceptives for family planning and preferred: the male condom - 160 (52.3%), intrauterine contraceptive device (IUCD) - 27 (8.8%), and hormonal contraceptives - 119 (38.9%). Those who did not believe in modern contraception preferred abstinence - 12 (11.3%), the withdrawal technique - 75, (70.8%) and the rhythm method - 19 (17.9%). The major reasons why some respondents would not use modern contraceptives for child spacing were the feeling that it is not natural - 39 (36.6%), it could fail - 13 (12.2%), fear of side effects - 41 (39.0%), and the fear that it could cause infertility - 13 (12.2%). Conclusions. The willingness to utilize modern contraceptives for family planning in Nigeria remains relatively low despite a universal level of awareness about the practice. This is due to misconceptions about modern contraception. [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: First childbirth in a woman's life is one of the most important events in her life. It marks a turnaround when she might have to drop roles of career building and education, for motherhood and parenthood. The timing of the commencement of these roles affects the child bearing behavior of women as they progress in their reproductive ages. Prevalent early first childbirth in Nigeria has been reported as the main cause of high population growth and high  fertility, mortality and morbidity among women, but little has been documented on the progression into first birth as well as factors affecting it in Nigeria. This paper modelled timing of first birth among women in Nigeria and determined socio-demographic and other factors affecting its timing.Methods: We hypothesized that background characteristics of a woman will influence her progression into having first birth. We developed and fitted a survival analysis model to understand the timing of first birth among women in Nigeria using a national representative 2013 NDHS data. Women with no children were right censored as of the date of the survey. The Kaplan Meier survival function was used to estimate the probabilities of first birth not occurring until certain ages of women while Cox proportional hazard regression was used to model the timing of first births at 5 % significance level.Results: About 75.7 % of the respondents had given birth in the Northern region of Nigerian compared with 63.8 % in the South. Half (50.1 %) of the first childbirth occurred within the 15-19 years age bracket and 38.1 % within 20-29 years. The overall median survival time to first birth was 20 years (North 19, South 22), 27 years among women with higher education and 18 years for those with no formal education. The adjusted hazard of first birth was higher in the Northern region of Nigeria than in the South (aHR = 1.24, 95 % CI: 1.20-1.27), and higher in rural areas than in urban areas (aHR = 1.15, 95 % CI: 1.12-1.19). Also, hazard of earlier first birth tripled among women with no education (aHR = 3.36, 95 % CI: 3.17-3.55) compared to women with higher education. The significant factors affecting age at first birth are education, place and zone of residence, age at first marriage, religion, ethnicity and use of contraceptives.Conclusions: This study showed that progression into early first birth is most affected by the education standing of women as well as age at first marriage. Delay of first childbirths as a strategy for fertility reduction and maternal health improvement can be achieved if women are empowered early in life with quality education. Stakeholders should therefore, give adequate attention to educating the girl child. Adverse socio-cultural norms of betrothing and marrying young girls should be abrogated, while health education and promotion of need to delay child bearing must be intensified especially among rural dwellers and also in Northern Nigeria. [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]

Background Nigeria continues to have one of the highest rates of neonatal deaths in Africa. This study aimed to identify risk factors associated with neonatal death in Nigeria using the 2008 Nigeria Demographic and Health Survey (NDHS). Methods Neonatal deaths of all singleton live-born infants between 2003 and 2008 were extracted from the 2008 NDHS. The 2008 NDHS was a multi-stage cluster sample survey of 36,298 households. Of these households, survival information of 27,147 singleton live-borns was obtained, including 996 cases of neonatal mortality. The risk of death was adjusted for confounders relating to individual, household, and community level factors using Cox regression. Results Multivariable analyses indicated that a higher birth order of newborns with a short birth interval ≤ 2 years (hazard ratio [HR] = 2.19, confidence interval [CI] : 1.68-2.84) and newborns with a higher birth order with a longer birth interval > 2 years (HR = 1.36, CI : 1.05-1.78) were significantly associated with neonatal mortality. Other significant factors that affected neonatal deaths included neonates born to mothers younger than 20 years (HR = 4.07, CI : 2.83-5.86), neonates born to mothers residing in rural areas compared with urban residents (HR = 1.26, CI : 1.03-1.55), male neonates (HR = 1.30, CI : 1.12-1.53), mothers who perceived their neonate's body size to be smaller than the average size (HR = 2.10, CI : 1.77-2.50), and mothers who delivered their neonates by caesarean section (HR = 2.80, CI : 1.84-4.25). Conclusions Our study suggests that the Nigerian government needs to invest more in the healthcare system to ensure quality care for women and newborns. Community-based intervention is also required and should focus on child spacing, childbearing at a younger age, and poverty eradication programs, particularly in rural areas, to reduce avoidable neonatal deaths in Nigeria. [ABSTRACT FROM AUTHOR]

Results are presented from an analysis of the intervals between births from Imesi, Western Nigeria. The mean interval following births of children who survived to 1 year was 35·03 months, but nearly half this value at 18·8 months following stillbirths or deaths under 1 year. Both these results confirm an early study done in the village (Martin, Morley & Woodland, 1964), and the role of post-partum sexual abstention as an explanation for these results is discussed. Attempts were made to look for effects of birth interval variation on the survival of the following child, but no strong trends emerged. Similarly, analyses of many growth variables by preceding and following birth intervals gave very little evidence of real effects. There were, however, hints of trends which were possibly caused by birth order biases; higher birth orders had been found to have correspondingly higher birth intervals. An intriguing result was that those children who had ever suffered from kwashiorkor showed a significantly higher preceding mean birth interval, and also a higher mean interval to the next birth. [ABSTRACT FROM PUBLISHER]