Healthy people are the foundation of healthy economies, the United Nations states. And former US first lady Michelle Obama noted that a country is only as strong as the health of its women.
As Africa’s most populous country and one of its biggest economies, Nigeria’s health indicators are of national concern. What does the latest data tell about the country’s well-being?
The UN’s child agency Unicef does major surveys tracking the health of women, men and children globally. Known as Multiple Indicator Cluster Surveys (MICS), the latest one for Nigeria was released in late 2017.
It covered 33,901 households across Nigeria between 2016 and 2017, with 15,183 men and 34,376 women aged between 15 to 49 interviewed. The results were then weighted to ensure it is nationally representative.
To track progress - or the lack thereof - we compared eight key indicators measured by the survey in 2007, 2011 and 2017. Comparing different rounds of MICS is statistically sound as its methods have remained the same with only a few tweaks, Dr Isiaka Olarewaju, the survey’s project director for Nigeria, told Africa Check.
Infant and child health
Because most children die from preventable causes, the UN regards child mortality, along with that of women, as key indicators of a country’s healthcare system.
1. Infant mortality rate
- Reduced to 70 deaths per 1,000 live births
The infant mortality rate measures the probability that a child will die between birth and their first birthday. It is given as the number of deaths per 1,000 live births.
In 2007, Nigeria’s infant mortality rate was 86 deaths/1,000 live births, according to the survey. It then increased to 97 deaths/1,000 live births in 2011, before dropping to 70 deaths/1,000 live births in the 2016/17 survey.
2. Under-5 mortality rate
- Reduced to about 120 deaths per 1,000 live births
This indicator measures the likelihood of a child dying between birth and their fifth birthday. In 2007, the survey estimated it at 138 deaths/1,000 live births. In 2011, it significantly rose to 158 deaths/1,000 live births before falling to 120/1,000 live births in 2016/17.
Nigeria remains off-pace in reducing this rate to 12 deaths per 1,000 live births by 2030, the target set by the UN’s sustainable development goals.
READ: Is it so bad in Nigeria’s north-east that almost all children under 5 have died?
Chronic and acute malnutrition in Nigerian children has worsened in the past decade, despite falling between 2007 and 2011. (Note: This is determined by comparing a child’s weight-for-age against acceptable nutritional benchmarks.)
TABLE: Malnutrition in Nigerian children aged under 5
These nutritional indicators particularly worsened in the northern parts of the country - where an insurgency by Islamist terror group Boko Haram left thousands dead and displaced millions since 2009.
4. Maternal mortality rate
- No data
A maternal death is defined as the death of a woman during pregnancy, childbirth or within 6 weeks after birth, but not from accidental or incidental (such as self-harm) causes.
The maternal mortality rate is given as the number of maternal deaths per 100,000 live births in a specified period. The UN views a rate of fewer than 100 deaths per 100,000 live births as low. Once the rate crosses the 300 barrier, it is considered high and above 500 very high.
However, problems with sampling have stymied an accurate estimate of Nigeria’s maternal mortality rate over the past three MICS rounds.
“The reason is that in the [2007 MICS], we discovered that the responding sample was too small to get a good and robust estimate for maternal mortality ratio,” Olarewaju, the survey’s project director for Nigeria, said.
Olarewaju added there were also problems with the sample size for the 2011 round making the estimate unreliable. It was not measured in the 2016/17 round for this same reason.
Previous Demographic and Health Surveys estimated the rate at 545 per 100,000 live births for the period 2002-2007 and 576 per 100,000 live births for the period 2007-2013.
Nigeria’s aim was to reduce the rate to 125 deaths/100,000 live births by 2010.
5. Adolescent birth rate
The adolescent birth rate is defined as the fertility rate among girls between ages 15 and 19.
The 2007 survey didn’t measure this indicator, but the 2011 survey estimated it at 89 births/1,000 women. In the last round, it rose to 120 births. (Note: The latest estimate is in line with findings by Nigeria’s Demographic and Health Surveys which put it at 123 births per 1,000 women in 2008 and 122 births in 2013.)
Births by teenagers are higher in rural areas, where the average rate was 154 births/1,000 women. Northern Nigeria also struggles - the north-west region had a birth rate of 176 births/1,000 women. In contrast, south-east Nigeria had the lowest adolescent birth rate of 38 births/1,000 women.
Girls with little or no education, from the poorest homes and from the Hausa ethnic group are more likely to have a child between ages 15 and 19, according to the survey.
Prof Tanimola Akande, a public health expert, says there is a direct correlation between adolescent birth rate, child marriage and maternal mortality, especially in northern Nigeria.
“I practise in the north and I have once done a caesarean section on a 13 year-old. That's miserable. That’s a child having a child,” he said.
6. Contraceptive prevalence rate
- Reduced slightly to 13.4%
This is the proportion of women of reproductive age who are using (or whose partner is using) a contraceptive method at a given point in time. In 2007, the rate was 14.7%. It increased to 18% in 2011 before dropping to 13.4% in 2016/17.
The drop is attributed to the low availability of birth control options to Nigerian women who want to use them. The 2016 National Health Facility Survey found that only a third (33.1%) of primary healthcare facilities had male condoms while just 26% had birth control pills. Implants were available in 12% of the facilities.
7. Marriage before age 18
- No marked change
In 2016/17, nearly one in every five women (18.5%) between 15 and 49 reported that they had been married or were in a union by the age of 15. Of women aged 20 to 49, some 44% were first married or in a union before they turned 18.
This indicator shows no marked changes from previous health surveys done between 2007 and 2011. Nigeria’s northern regions has the highest percentage of women who were married as adolescents.
Education and household wealth also strongly influence the prevalence of early marriage, the survey noted.
READ: Do 45% of Nigerian women get married before their 18th birthday?
8.Condom use and HIV/AIDS
In 2007, only 13% of Nigerian women had been tested for HIV and knew their status. This fell to 11% in 2012, but jumped to 34.8% in the 2016/7 survey after HIV screening was implemented in antenatal routines in 2010 and implemented in some states.
The number of women who knew how to avoid HIV infection increased from 23.1% to 29.3% between 2007 and 2016/17. The share of women and men using a condom during sex with multiple partners has remained around 34% over the years, however.
Need to reduce reliance on donors
Health experts told Africa Check that Nigeria needs to reduce its reliance on donors, which have funded many health programmes, such as HIV prevention.
“There is a current fear that these donors cannot be here forever and most of them are rounding up. We just hope that the federal government can take up the challenge to sustain these interventions,” Akande said.
Dr Fadahunsi Fajuyitan, a Lagos based physician and health policy analyst, urged a revamp of the struggling primary healthcare system.
“Apart from the present national health strategy