Nigeria - Demographic and Health Survey 2008

The 2008 Nigeria Demographic Health Sur­vey (NDHS) is a nationally representative survey of 33,385 women age 15-49 and 15,486 men age 15-59. The 2008 NDHS is the fourth comprehen­sive survey conducted in Nigeria as part of the Demographic and Health Surveys (DHS) pro­gramme. The data are intended to furnish pro­gramme managers and policymakers with de­tailed information on levels and trends in fertil­ity; nuptiality; sexual activity; fertility prefer­ences; awareness and use of family planning methods; infants and young children feeding practices; nutritional status of mothers and young children; early childhood mortality and maternal mortality; maternal and child health; and aware­ness and behaviour regarding HIV/AIDS and other sexually transmitted infections. Addition­ally, the 2008 NDHS collected information on malaria prevention and treatment, neglected tropical diseases, domestic violence, fistulae, and female genital cutting (FGC). The 2008 Nigeria Demographic and Health Survey (2008 NDHS) was implemented by the National Population Commission from June to October 2008 on a nationally representative sample of more than 36,000 households. All women age 15-49 in these households and all men age 15-59 in a sub-sample of half of the households were individually interviewed. While significantly expanded in content, the 2008 NDHS is a follow-up to the 1990, 1999, and 2003 NDHS surveys and provides updated estimates of basic demographic and health indicators covered in these earlier surveys. In addition, the 2008 NDHS includes the collection of information on violence against women. Although previous surveys collected data at the national and zonal levels, the 2008 NDHS is the first NDHS survey to collect data on basic demographic and health indicators at the state level. The primary objectives of the 2008 NDHS project were to provide up-to-date information on fertility levels; nuptiality; sexual activity; fertility preferences; awareness and use of family planning methods; breastfeeding practices; nutritional status of mothers and young children; early childhood mortality and maternal mortality; maternal and child health; and awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections. MAIN FINDINGS FERTILITY The survey results show fertility in Nigeria has remained at a high level over the last 17 years from 5.9 births per woman in 1991 to 5.7 births in 2008. On average, rural women are hav­ing two children more than urban women (6.3 and 4.7 children, respectively). Fertility differen­tials by education and wealth are noticeable. Women who have no formal education and women in the lowest wealth quintile on average are having 7 children, while women with higher than a secondary education are having 3 children and women in the highest wealth quintile are having 4 children. FAMILY PLANNING In the 2008 NDHS, 72 percent of all women and 90 percent of all men know at least one con­traceptive method. Male condoms, the pill, and injectables are the most widely known methods. Twenty-nine percent of currently married women have used a family planning method at least once in their lifetime. Fifteen percent of currently married women are using any contra­ceptive method and 10 percent are using a mod­ern method. The most commonly used methods among currently married women are injectables (3 percent), followed by male condoms and the pill (2 percent each). Current use of contraception in Nigeria has increased from 6 percent in 1990 and 13 percent in 2003 to 15 percent in 2008. There has been a corresponding increase in the use of modern con­traceptive methods, from 4 percent in 1990 and 8 percent in 2003 to 10 percent in 2008. CHILD HEALTH Data from the 2008 NDHS indicate that the infant mortality rate is 75 deaths per 1,000 live births, while the under-five mortality rate is 157 per 1,000 live births for the five-year period im­mediately preceding the survey. The neonatal mortality rate is 40 per 1,000 births. Thus, almost half of childhood deaths occurred during infancy, with one-quarter taking place during the first month of life. Child mortality is consistently lower in urban areas than in rural areas. There is also variation in the mortality level across zones. The infant mortality and under-five mortality rates are high­est in the North East, and lowest in the South West. In Nigeria, children are considered fully vac­cinated when they receive one dose of BCG vac­cine, three doses of DPT vaccine, three doses of polio vaccine, and one dose of measles vaccine. Overall, 23 percent of children 12-23 months have received all vaccinations at the time of the survey. Fifty percent of children have received the BCG vaccination, and 41 percent have been vaccinated against measles. The coverage of the first dose of DPT vaccine and polio 1 is 52 and 68 percent, respectively). However, only 35 per­cent of children have received the third dose of DPT vaccine, and 39 percent have received the third dose of polio vaccine. A comparison of the 2008 NDHS results with those of the earlier sur­veys shows there has been an increase in the overall vaccination coverage in Nigeria from 13 percent in 2003 to the current rate of 23 percent. However, the percentage of children with no vaccinations has not improved for the same pe­riod, 27 percent in 2003 and 29 percent in 2008. MATERNAL HEALTH In Nigeria more than half of women who had a live birth in the five years preceding the survey received antenatal care from a health profes­sional (58 percent); 23 percent from a doctor, 30 percent from a nurse or midwife, and 5 percent from an auxiliary nurse or midwife. Thirty-six percent of mothers did not receive any antenatal care. Tetanus toxoid injections are given during pregnancy to prevent neonatal tetanus. Overall, 48 percent of last births in Nigeria were pro­tected against neonatal tetanus. More than one-third of births in the five years before the survey were delivered in a health facility (35 percent). Twenty percent of births occurred in public health facilities and 15 percent occurred in private health facilities. Al­most two-thirds (62 percent) of births occurred at home. Nine percent of births were assisted by a doctor, 25 percent by a nurse or midwife, 5 per­cent by an auxiliary nurse or midwife, and 22 percent by a traditional birth attendant. Nineteen percent of births were assisted by a relative and 19 percent of births had no assistance at all. Two percent of births were delivered by a caesarean section. Overall, 42 percent of mothers received a postnatal check-up for the most recent birth in the five years preceding the survey, with 38 per­cent having the check-up within the critical 48 hours after delivery. Results from the 2008 NDHS show that the estimated maternal mortality ratio during the seven-year period prior to the survey is 545 ma­ternal deaths per 100,000 live births. BREASTFEEDING AND NUTRITION Ninety-seven percent of Nigerian children under age five were breastfed at some point in their life. The median breastfeeding duration in Nigeria is long (18.1 months). On the other hand, the median duration for exclusive breastfeeding is only for half a month. A small proportion of babies (13 percent) are exclusively breastfed throughout the first six months of life. More than seven in ten (76 percent) children age 6-9 months receive complementary foods. Sixteen percent of babies less than six months of age are fed with a bottle with a nipple, and the proportion bottle-fed peaks at 17 percent among children in the age groups 2-3 months and 4-5 months. Anthropometric measurements carried out at the time of the survey indicate that, overall, 41 percent of Nigerian children are stunted (short for their age), 14 percent are wasted (thin for their height), and 23 percent are underweight. The indices show that malnutrition in young children increases with age, starting with wast­ing, which peaks among children age 6-8 months, underweight peaks among children age 12-17 months, and stunting is highest among children age 18-23 months. Stunting affects half of children in this age group and almost one-third of children age 18-23 months are severely stunted. Overall, 66 percent of women have a body mass index (BMI) in the normal range; 12 per­cent of women are classified as thin and 4 per­cent are severely thin. Twenty-two percent of women are classified as overweight or obese, with 6 percent in the latter category. MALARIA Seventeen percent of all households inter­viewed during the survey had at least one mos­quito net, while 8 percent had more than one. Sixteen percent of households had at least one net that had been treated at some time (ever-treated) with an insecticide. Eight percent of households had at least one insecticide-treated net (ITN). Mosquito net usage is low among young children and pregnant women, groups that are particularly vulnerable to the effects of malaria. Overall, 12 percent of children under five slept under a mosquito net the night before the survey. Twelve percent of children slept under an ever-treated net and 6 percent slept under an ITN. Among pregnant women, 12 percent slept under any mosquito net the night before the interview. Twelve percent slept under an ever-treated net and 5 percent slept under an ITN. Among women who had their last birth in the two years before the survey, 18 percent took an anti-malarial drug during the pregnancy. Eleven percent of all pregnant women took at least one dose of a sulphadoxine-pyrimethamine (SP) drug such as Fansidar, Amalar, or Maloxine, while 7 percent reported taking two or more doses of an SP drug. Eight percent of the women who took an SP drug were given the drug during an antena­tal care visit, a practice known as intermittent preventive treatment (IPT). HIV/AIDS KNOWLEDGE AND BEHAVIOUR The majority of women (88 percent) and men (94 percent) age 15-49 have heard of HIV or AIDS. However, only 23 percent of women and 36 percent of men have what can be considered comprehensive knowledge about the modes of HIV transmission and prevention. Comprehen­sive knowledge means knowing that using con­doms and having just one uninfected, faithful partner can reduce the chance of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about HIV transmission or pre­vention, that HIV and AIDS can be transmitted through supernatural means or through mosquito bites. Fifty-two percent of women and 59 percent of men age 15-49 know that HIV can be trans­mitted through breastfeeding. Twenty-eight per­cent of women and 39 percent of men know that the risk of mother-to-child transmission (MTCT) can be reduced by the mother taking special drugs during pregnancy. Given that most HIV cases in Nigeria occur as a result of heterosexual contact, information about the level of higher-risk sexual intercourse (i.e., sexual intercourse with a non-marital, non-cohabiting partner) in the past 12 months is im­portant for planning HIV prevention pro­grammes. The 2008 NDHS findings indicate that 1 percent of women and 10 percent of men had two or more sexual partners during the 12 months preceding the survey. Ten percent of women and 23 percent of men had higher-risk sexual intercourse in this period. Among these respondents, only 33 percent of women and 54 percent of men reported that they used a condom the last time they had sexual intercourse with a higher-risk sexual partner. Among the adult population age 15-49, 17 percent of women and 15 percent of men have been tested for HIV at some time. Seven percent of women and 7 of men received the results from their last HIV test that was taken in the past 12 months. DOMESTIC VIOLENCE One eligible woman in each household was asked questions on domestic violence. In Nige­ria, domestic violence occurs across all socio­economic and cultural backgrounds. Twenty-eight percent of all women reported experiencing physical violence since the age of 15, and 15 percent of women experienced physical violence in the 12 months preceding the survey. Among women who experienced violence since age 15, a total of 45 percent reported that their current husband or partner was the perpetrator and 7 per­cent reported that the perpetrator was a former husband or partner. Overall, 7 percent of women reported that they had experienced sexual violence at some time in their lives. Forty-three percent of women reported that their first experience with sexual intercourse occurred when they were less than 20 years of age. Half of women reported that their current or former husband, partner, or boyfriend committed the act of sexual violence. It is impor­tant to highlight that among women who were younger than age 15 when they first experienced sexual violence, 28 percent reported that the per­petrator was a stranger, 12 percent reported that the person was a friend or acquaintance, 11 per­cent reported that the person was a relative, and 7 percent reported that the person was a family friend. Thirty-four percent of Nigerian women who ever experienced physical or sexual violence sought help to stop the violence. Eight percent of abused women did not seek help but did tell someone about the violence, and 45 percent of the women did not seek help from any source and did not tell anyone about the violence. ORPHANS AND VULNERABLE CHILDREN Twelve percent Nigerian children under age 18 in the households sampled in the 2008 NDHS were not living with a biological parent. Six per­cent of children under age 18 are orphaned, that is, one or both parents are dead. Earlier NDHS surveys obtained information on orphanhood only for children under age 15. A comparison of the results from the 2003 and 2008 surveys for this age group indicates that there has been a slight decrease in orphanhood from 6.2 percent to 5.2 percent. The proportion of children who are not living with either parent decreased from 11 to 9 percent for children under age 15. Overall, 5 percent of children under age 18 are considered vulnerable, i.e., they live in a household in which at least one adult was chronically ill for three months during the past 12 months, or they had a parent living in the household (or elsewhere) who had experienced chronic illness in the past year. Overall, 11 per­cent of children under age 18 are considered or­phans and/or vulnerable.