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

The 1990 Nigeria Demographic and Health Survey (NDHS) is a nationally representative survey conducted by the Federal Office of Statistics with the aim of gathering reliable information on fertility, family planning, infant and child mortality, maternal care, vaccination status, breastfeeding, and nutrition. Data collection took place two years after implementation of the National Policy on Population and addresses issues raised by that policy. Fieldwork for the NDHS was conducted in two phases: from April to July 1990 in the southern states and from July to October 1990 in the northern states. Interviewers collected information on the reproductive histories of 8,781 women age 15-49 years and on the health of their 8,113 children under the age of five years. OBJECTIVES The Nigeria Demographic and Health Survey (NDHS) is a national sample survey of women of reproductive age designed to collect data on socioeconomic characteristics, marriage patterns, history of child bearing, breastfeeding, use of contraception, immunisation of children, accessibility to health and family planning services, treatment of children during episodes of illness, and the nutritional status of children. The primary objectives of the NDHS are: (i) To collect data for the evaluation of family planning and health programmes; (ii) To assess the demographic situation in Nigeria; and (iii) To support dissemination and utilisation of the results in planning and managing family planning and health programmes. MAIN RESULTS According to the NDHS, fertility remains high in Nigeria; at current fertility levels, Nigerian women will have an average of 6 children by the end of their reproductive years. The total fertility rate may actually be higher than 6.0, due to underestimation of births. In a 1981/82 survey, the total fertility rate was estimated to be 5.9 children per woman. One reason for the high level of fertility is that use of contraception is limited. Only 6 percent of married women currently use a contraceptive method (3.5 percent use a modem method, and 2.5 percent use a traditional method). These levels, while low, reflect an increase over the past decade: ten years ago just 1 percent of Nigerian women were using a modem family planning method. Periodic abstinence (rhythm method), the pill, IUD, and injection are the most popular methods among married couples: each is used by about 1 percent of currently married women. Knowledge of contraception remains low, with less than half of all women age 15-49 knowing of any method. Certain groups of women are far more likely to use contraception than others. For example, urban women are four times more likely to be using a contraceptive method (15 percent) than rural women (4 percent). Women in the Southwest, those with more education, and those with five or more children are also more likely to be using contraception. Levels of fertility and contraceptive use are not likely to change until there is a drop in desired family size and until the idea of reproductive choice is more widely accepted. At present, the average ideal family size is essentially the same as the total fertility rate: six children per woman. Thus, the vast majority of births are wanted. The desire for childbearing is strong: half of women with five children say that they want to have another child. Another factor leading to high fertility is the early age at marriage and childbearing in Nigeria. Half of all women are married by age 17 and half have become mothers by age 20. More than a quarter of teenagers (women age 15-19 years) either are pregnant or already have children. National statistics mask dramatic variations in fertility and family planning between urban and rural areas, among different regions of the country, and by women's educational attainment. Women who are from urban areas or live in the South and those who are better educated want and have fewer children than other women and are more likely to know of and use modem contraception. For example, women in the South are likely to marry and begin childbearing several years later than women in the North. In the North, women continue to follow the traditional pattern and marry early, at a median age of 15, while in the South, women are marrying at a median age of 19 or 20. Teenagers in the North have births at twice the rate of those in the South: 20 births per 1130 women age 15-19 in the North compared to 10 birdas per 100 women in the South. Nearly half of teens in the North have already begun childbearing, versus 14 percent in South. This results in substantially lower total fertility rates in the South: women in the South have, on average, one child less than women in the North (5.5 versus 6.6). The survey also provides information related to maternal and child health. The data indicate that nearly 1 in 5 children dies before their fifth birthday. Of every 1,000 babies born, 87 die during their first year of life (infant mortality rate). There has been little improvement in infant and child mortality during the past 15 years. Mortality is higher in rural than urban areas and higher in the North than in the South. Undemutrition may be a factor contributing to childhood mortality levels: NDHS data show that 43 percent of the children under five are chronically undemourished. These problems are more severe in rural areas and in the North. Preventive and curative health services have yet to reach many women and children. Mothers receive no antenatal care for one-third of births and over 60 percent of all babies arc born at home. Only one-third of births are assisted by doctors, trained nurses or midwives. A third of the infants are never vaccinated, and only 30 percent are fully immunised against childhood diseases. When they are ill, most young children go untreated. For example, only about one-third of children with diarrhoea were given oral rehydration therapy. Women and children living in rural areas and in the North are much less likely than others to benefit from health services. Almost four times as many births in the North are unassisted as in the South, and only one-third as many children complete their polio and DPT vaccinations. Programmes to educate women about the need for antenatal care, immunisation, and proper treatment for sick children should perhaps be aimed at mothers in these areas, Mothers everywhere need to learn about the proper time to introduce various supplementary foods to breastfeeding babies. Nearly all babies are breastfed, however, almost all breastfeeding infants are given water, formula, or other supplements within the first two months of life, which both jeopardises their nutritional status and increases the risk of infection.

Abstract

The primary objective of the 2018 NDHS is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the NDHS collected information on fertility, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and children, maternal and child health, adult and childhood mortality, women’s empowerment, domestic violence, female genital cutting, prevalence of malaria, awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs), disability, and other health-related issues such as smoking.

The information collected through the 2018 NDHS is intended to assist policymakers and programme managers in evaluating and designing programmes and strategies for improving the health of the country’s population. The 2018 NDHS also provides indicators relevant to the Sustainable Development Goals (SDGs) for Nigeria.

Geographic coverage

National coverage

Analysis unit

• Household
• Individual
• Children age 0-5
• Woman age 15-49
• Man age 15-49

Universe

The survey covered all de jure household members (usual residents), all women aged 15-49 years resident in the household, and all children aged 0-5 years resident in the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

The sampling frame used for the 2018 NDHS is the Population and Housing Census of the Federal Republic of Nigeria (NPHC), which was conducted in 2006 by the National Population Commission. Administratively, Nigeria is divided into states. Each state is subdivided into local government areas (LGAs), and each LGA is divided into wards. In addition to these administrative units, during the 2006 NPHC each locality was subdivided into convenient areas called census enumeration areas (EAs). The primary sampling unit (PSU), referred to as a cluster for the 2018 NDHS, is defined on the basis of EAs from the 2006 EA census frame. Although the 2006 NPHC did not provide the number of households and population for each EA, population estimates were published for 774 LGAs. A combination of information from cartographic material demarcating each EA and the LGA population estimates from the census was used to identify the list of EAs, estimate the number of households, and distinguish EAs as urban or rural for the survey sample frame. Before sample selection, all localities were classified separately into urban and rural areas based on predetermined minimum sizes of urban areas (cut-off points); consistent with the official definition in 2017, any locality with more than a minimum population size of 20,000 was classified as urban.

The sample for the 2018 NDHS was a stratified sample selected in two stages. Stratification was achieved by separating each of the 36 states and the Federal Capital Territory into urban and rural areas. In total, 74 sampling strata were identified. Samples were selected independently in every stratum via a two-stage selection. Implicit stratifications were achieved at each of the lower administrative levels by sorting the sampling frame before sample selection according to administrative order and by using a probability proportional to size selection during the first sampling stage.

For further details on sample selection, see Appendix A of the final report.

Mode of data collection

Computer Assisted Personal Interview [capi]

Research instrument

Four questionnaires were used for the 2018 NDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, and the Biomarker Questionnaire. The questionnaires, based on The DHS Program’s standard Demographic and Health Survey (DHS-7) questionnaires, were adapted to reflect the population and health issues relevant to Nigeria. Comments were solicited from various stakeholders representing government ministries and agencies, nongovernmental organisations, and international donors. In addition, information about the fieldworkers for the survey was collected through a self-administered Fieldworker Questionnaire.

Cleaning operations

The processing of the 2018 NDHS data began almost immediately after the fieldwork started. As data collection was completed in each cluster, all electronic data files were transferred via the IFSS to the NPC central office in Abuja. These data files were registered and checked for inconsistencies, incompleteness, and outliers. The field teams were alerted to any inconsistencies and errors. Secondary editing, carried out in the central office, involved resolving inconsistencies and coding the open-ended questions. The NPC data processor coordinated the exercise at the central office. The biomarker paper questionnaires were compared with electronic data files to check for any inconsistencies in data entry. Data entry and editing were carried out using the CSPro software package. The concurrent processing of the data offered a distinct advantage because it maximised the likelihood of the data being error-free and accurate. Timely generation of field check tables allowed for effective monitoring. The secondary editing of the data was completed in the second week of April 2019.

Response rate

A total of 41,668 households were selected for the sample, of which 40,666 were occupied. Of the occupied households, 40,427 were successfully interviewed, yielding a response rate of 99%. In the households interviewed, 42,121 women age 15-49 were identified for individual interviews; interviews were completed with 41,821 women, yielding a response rate of 99%. In the subsample of households selected for the male survey, 13,422 men age 15-59 were identified and 13,311 were successfully interviewed, yielding a response rate of 99%.

Sampling error estimates

The estimates from a sample survey are affected by two types of errors: nonsampling errors and sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2018 Nigeria Demographic and Health Survey (NDHS) to minimise this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically.

Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2018 NDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability among all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results.

Sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95% of all possible samples of identical size and design.

If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2018 NDHS sample is the result of a multistage stratified design, and, consequently, it was necessary to use more complex formulas. Sampling errors are computed in SAS, using programs developed by ICF. These programs use the Taylor linearisation method to estimate variances for survey estimates that are means, proportions, or ratios. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.

Note: A more detailed description of estimates of sampling errors are presented in APPENDIX B of the survey report.

Data appraisal

Data Quality Tables - Household age distribution - Age distribution of eligible and interviewed women - Age distribution of eligible and interviewed men - Completeness of reporting - Births by calendar years - Reporting of age at death in days - Reporting of age at death in months - Standardisation exercise results from anthropometry training - Height and weight data completeness and quality for children - Height measurements from random subsample of measured children - Sibship size and sex ratio of siblings - Pregnancy-related mortality trends - Data collection period - Malaria prevalence according to rapid diagnostic test (RDT)

Note: See detailed data quality tables in APPENDIX C of the report.

The 2003 Nigeria Demographic and Health Survey (2003 NDHS) is the third national Demographic and Health Survey conducted in Nigeria. The 2003 NDHS is based on a nationally representative sample of over 7,000 households. All women age 15-49 in these households and all men age 15-59 in a subsample of one-third of the households were individually interviewed. The survey provides up-to-date information on the population and health situation in Nigeria. The 2003 NDHS was designed to provide estimates for key indicators such as fertility, contraceptive use, infant and child mortality, immunization levels, use of family planning, maternal and child health, breastfeeding practices, nutritional status of mothers and young children, use of mosquito nets, female genital cutting, marriage, sexual activity, and awareness and behaviour regarding AIDS and other sexually transmitted infections in Nigeria. MAIN RESULTS FERTILITY Fertility Levels, Trends, and Preferences. The total fertility rate (TFR) in Nigeria is 5.7. This means that at current fertility levels, the average Nigerian woman who is at the beginning of her childbearing years will give birth to 5.7 children by the end of her lifetime. Compared with previous national surveys, the 2003 survey shows a modest decline in fertility over the last two decades: from a TFR of 6.3 in the 1981-82 National Fertility Survey (NFS) to 6.0 in the 1990 NDHS to 5.7 in the 2003 NDHS. However, the 2003 NDHS rate of 5.7 is significantly higher than the 1999 NDHS rate of 5.2. Analysis has shown that the 1999 survey underestimated the true levels of fertility in Nigeria. On average, rural women will have one more child than urban women (6.1 and 4.9, respectively). Fertility varies considerably by region of residence, with lower rates in the south and higher rates in the north. Fertility also has a strong negative correlation with a woman's educational attainment. Most Nigerians, irrespective of their number of living children, want large families. The ideal number of children is 6.7 for all women and 7.3 for currently married women. Nigerian men want even more children than women. The ideal number of children for all men is 8.6 and for currently married men is 10.6. Clearly, one reason for the slow decline in Nigerian fertility is the desire for large families. FAMILY PLANNING Knowledge of Family Planning Methods. About eight in ten women and nine in ten men know at least one modern method of family planning. The pill, injectables, and the male condom are the most widely known modern methods among both women and men. Mass media is an important source of information on family planning. Radio is the most frequent source of family planning messages: 40 percent of women and 56 percent of men say they heard a radio message about family planning during the months preceding the survey. However, more than half of women (56 percent) and 41 percent men were not exposed to family planning messages from a mass media source. Current Use. A total of 13 percent of currently married women are using a method of family planning, including 8 percent who are using a modern method. The most common modern methods are the pill, injectables, and the male condom (2 percent each). Urban women are more than twice as likely as rural women to use a method of contraception (20 percent versus 9 percent). Contraceptive use varies significantly by region. For example, one-third of married women in the South West use a method of contraception compared with just 4 percent of women in the North East and 5 percent of women in the North West. CHILD HEALTH Mortality. The 2003 NDHS survey estimates infant mortality to be 100 per 1,000 live births for the 1999-2003 period. This infant mortality rate is significantly higher than the estimates from both the 1990 and 1999 NDHS surveys; the earlier surveys underestimated mortality levels in certain regions of the country, which in turn biased downward the national estimates. Thus, the higher rate from the 2003 NDHS is more likely due to better data quality than an actual increase in mortality risk overall. The rural infant mortality rate (121 per 1,000) is considerably higher than the urban rate (81 per 1,000), due in large part to the difference in neonatal mortality rates. As in other countries, low maternal education, a low position on the household wealth index, and shorter birth intervals are strongly associated with increased mortality risk. The under-five mortality rate for the 1999-2003 period was 201 per 1,000. Vaccinations. Only 13 percent of Nigerian children age 12-23 months can be considered fully vaccinated, that is, have received BCG, measles, and three doses each of DPT and polio vaccine (excluding the polio vaccine given at birth). This is the lowest vaccination rate among African countries in which DHS surveys have been conducted since 1998. Less than half of children have received each of the recommended vaccinations, with the exception of polio 1 (67 percent) and polio 2 (52 percent). More than three times as many urban children as rural children are fully vaccinated (25 percent and 7 percent, respectively). WHO guidelines are that children should complete the schedule of recommended vaccinations by 12 months of age. In Nigeria, however, only 11 percent of children age 12-23 months received all of the recommended vaccinations before their first birthday. WOMEN'S HEALTH Breastfeeding. Breastfeeding is almost universal in Nigeria, with 97 percent of children born in the five years preceding the survey having been breastfed. However, just one-third of children were given breast milk within one hour of birth (32 percent), and less than two-thirds were given breast milk within 24 hours of birth (63 percent). Overall, the median duration of any breastfeeding is 18.6 months, while the median duration of exclusive breastfeeding is only half a month. Complementary Feeding. At age 6-9 months, the recommended age for introducing complementary foods, three-quarters of breast-feeding infants received solid or semisolid foods during the day or night preceding the interview; 56 percent received food made from grains, 25 percent received meat, fish, shellfish, poultry or eggs, and 24 percent received fruits or vegetables. Fruits and vegetables rich in vitamin A were consumed by 20 percent of breastfeeding infants age 6-9 months. Maternal Care. Almost two-thirds of mothers in Nigeria (63 percent) received some antenatal care (ANC) for their most recent live birth in the five years preceding the survey. While one-fifth of mothers (21 percent) received ANC from a doctor, almost four in ten women received care from nurses or midwives (37 percent). Almost half of women (47 percent) made the minimum number of four recommended visits, but most of the women who received antenatal care did not get care within the first three months of pregnancy. In terms of content of care, slightly more than half of women who received antenatal care said that they were informed of potential pregnancy complications (55 percent). Fifty-eight percent of women received iron tablets; almost two-thirds had a urine or blood sample taken; and 81 percent had their blood pressure measured. Almost half (47 percent) received no tetanus toxoid injections during their most recent birth. WOMEN'S CHARACTERISTICS AND STATUS Across all maternal care indicators, rural women are disadvantaged compared with urban women, and there are marked regional differences among women. Overall, women in the south, particularly the South East and South West, received better care than women in the north, especially women in the North East and North West. Female Circumcision. Almost one-fifth of Nigerian women are circumcised, but the data suggest that the practice is declining. The oldest women are more than twice as likely as the youngest women to have been circumcised (28 percent versus 13 percent). Prevalence is highest among the Yoruba (61 percent) and Igbo (45 percent), who traditionally reside in the South West and South East. Half of the circumcised respondents could not identify the type of procedure performed. Among those women who could identify the type of procedure, the most common type of circumcision involved cutting and removal of flesh (44 percent of all circumcised women). Four percent of women reported that their vaginas were sewn closed during circumcision. MALARIA CONTROL PROGRAM INDICATORS Nets. Although malaria is a major public health concern in Nigeria, only 12 percent of households report owning at least one mosquito net. Even fewer, 2 percent of households, own an insecticide treated net (ITN). Rural households are almost three times as likely as urban households to own at least one mosquito net. Overall, 6 percent of children under age five sleep under a mosquito net, including 1 percent of children who sleep under an ITN. Five percent of pregnant women slept under a mosquito net the night before the survey, one-fifth of them under an ITN. Use of Antimalarials. Overall, 20 percent of women reported that they took an antimalarial for prevention of malaria during their last pregnancy in the five years preceding the survey. Another 17 percent reported that they took an unknown drug, and 4 percent took paracetamol or herbs to prevent malaria. Only 1 percent received intermittent preventative treatment (IPT)-or preventive treatment with sulfadoxine-pyrimethamine (Fansidar/SP) during an antenatal care visit. Among pregnant women who took an antimalarial, more than half (58 percent) used Daraprim, which has been found to be ineffective as a chemoprophylaxis during pregnancy. Additionally, 39 percent used chloroquine, which was the chemoprophylactic drug of choice until the introduction of IPT in Nigeria in 2001. Among children who were sick with fever/convulsions, one-third took antimalarial drugs, the majority receiving the drugs

Abstract

The 1999 Nigeria Demographic and Health Survey (NDHS) is a nationally representative survey of 8,199 women age 15-49 and 3,082 men age 15-64, designed to provide information on levels and trends of fetility, family planning practice, maternal and child health, infant and child mortality, and maternal mortality, as well as awareness of HIV/AIDS and other sexually transmitted diseases (STDs) and female circumcision. Fieldwork for the survey took place between March and May 1999.

OBJECTIVES

The main objective of the 1999 Nigeria Demographic and Health Survey (NDHS) is to provide up-to-date information on reality and childhood mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; nutrition levels; and maternal and child health. This information is intended to assist policymakers and administrators in evaluating and designing programmes and strategies for improving health and family planning services in Nigeria.

MAIN RESULTS

Fertility

The total fertility rate during the five years before the survey is 5.2 births per woman. This shows a drop from the level of 6.0 births per woman as reported in the 1990 NDHS and 5.4 from the 1994 Sentinel Survey. The total fertility rate may, however be higher due to evidence that some births were probably omitted in the data. Fertility is substantially higher in the Northeast and Northwest regions and lower in the Southeast, Southwest, and Central regions. Fertility rates are also lower for more educated women.

Childbearing begins early in Nigeria, with about half of women 25 years and above becoming mothers before reaching the age of 20. The median age at first birth is 20.

The level of teenage childbearing has declined somewhat, with the proportion of girls age 15-19 who have either given birth or are pregnant with their first child declining from 28 percent in 1990 to 22 percent in 1999.

Teenage childbearing is higher in rural than urban areas and for those with no education than those with education.

The data from the survey indicate that there is a strong desire for children and a preference for large families with 66 percent of married women and 71 percent of married men indicating a desire to have more children. Even among those with six or more children, 30 percent of married women and 55 percent of married men want to have more children. This indicates a decline for women from the 35 percent reported in the 1990 NDHS. Overall, women report a mean ideal number of children of 6.2, compared with 7.8 children for men.

Despite the increasing level of contraceptive use, the 1999 NDHS data show that unplanned pregnancies are common, with almost one in five births reported to be unplanned. Most of these (16 percent of births) are mistimed (wanted later), while 3 percent were unwanted at all.

Family Planning

Knowledge about family planning methods is increasing in Nigeria, with about 65 percent of all women and 82 percent of all men having heard of at least one method of contraception.

Among women, the pill is the best known method (53 percent) while among men, the condom is the best known method (70 percent). Radio is a main source of information about family planning, with 35 percent of women and 61 percent of men reporting that they heard a family planning message on the radio in the few months before interview. The proportions of women and men who have seen a television message are 23 and 40 percent, respectively. Only 17 percent of women had seen a family planning message in the print media.

The contraceptive prevalence rate in Nigeria has also increased, with 15 percent of married women and 32 percent of married men now using some method of family planning. The use of modem methods is lower at 9 percent for married women and 14 percent for men. Although traditional contraceptive methods are not actively promoted, their use is relatively high with about 6 percent of married women and 17 percent of married men reporting that they are using periodic abstinence or withdrawal. In 1990, only 6 percent of married women were using any method, with only 4 percent using a modern method.

There are significant differentials in levels of family planning use. Urban women and men are much more likely to be using a method than rural respondents. Current use among married women is higher in the Southwest regions (26 percent), Southeast (24 percent), and Central (18 percent) regions than in the Northwest and Northeast (3 percent each). The largest differences occur by educational attainment. Only 6 percent of married women with no education are using a method of contraception, compared with 45 percent of those with more than secondary school.

Users of modern contraception are almost as likely to obtain their methods from government as private sources. Forty-three percent of users obtain their methods from the public sector--mostly government hospitals and health centres--while 43 percent use private medical sources such as pharmacies and private hospitals and clinics; 8 percent get their methods from other private sources like friends, relatives, shops and non-governmental organisations.

Maternal Health

The results of the survey show that antenatal care is not uncommon in Nigeria, with mothers receiving antenatal check-ups from either a doctor, nurse or midwife for two out of three births in the three years preceding the survey. However, the content of antenatal care visits appears to be lacking in at least one respect: survey data indicate deficiencies in tetanus toxoid coverage during pregnancy. Mothers reported receiving the recommended two doses of tetanus toxoid for only 44 percent of births and one dose for I 1 percent of births. Almost 40 percent of births occurred without the benefit of a tetanus vaccination.

In Nigeria, home deliveries are still very common, with almost three in five births delivered at home. Compared with 1990, the proportion of home deliveries has declined, with more births now taking place in health facilities. Increasing the proportion of births occurring in facilities is important since they can be attended by medically trained personnel which can result in fewer maternal deaths and delivery complications. Currently, 42 percent of births are attended by doctors, nurses or midwives.

The 1999 NDHS data show that about one in four Nigerian women age 15-49 reported being circumcised. The practice of female genital cutting is more prevalent in the south and central parts of the country and is almost non-existent in the north.

Child Health

The 1999 NDHS data indicate a decline in childhood vaccination coverage, with the proportion of children fully immunised dropping from 30 percent of children age 12-23 months in 1990 to only 17 percent in 1999. Only a little over half of young children receive the BCG vaccine and the first doses of DPT and polio vaccines. Almost 40 percent of children have not received any vaccination.

Diarrhoea and respiratory illness are common causes of childhood death. In the two weeks before the survey, 11 percent of children under three years of age were ill with acute respiratory infections (ARI) and 15 percent had diarrhoea. Half of children with ARI and 37,percent of those with diarrhoea were taken to a health facility for treatment. Of all the children with diarrhoea, 34 percent were given fluid prepared from packets of oral rehydralion salts (ORS) and 38 percent received a home-made sugar-salt solution.

The infant mortality rate for the five-year period before the survey (early 1994 to early 1999) is 75 per thousand live births. The under-five mortality is 140 deaths per 1,000 births, which means that one in seven children born in Nigeria dies before reaching his/her fifth birthday. However, both these figures are probably considerably higher in reality since an in-depth examination of the data from the birth histories reported by women in the NDHS shows evidence of omission of births and deaths. For this reason, the dramatic decline observed in childhood mortality between the 1990 and 1999 NDHS surveys needs to be viewed with considerably skepticism. Based on the reported birth history information, the infant mortality rate fell from 87 to 75 deaths per 1,000 births, while the under-five mortality rate dropped from 192 to 140.

Problems with the overall levels of reported mortality are unlikely to severely affect differentials in childhood mortality. As expected, mother's level of education has a major effect on infant and child mortality. Whereas the lowest infant mortality rate was reported among children of mothers with post- secondary education (41 per thousand live births), the corresponding figure among infants of mothers with no schooling is 77 per thousand live births.

Data were also collected in the NDHS on the availability of various health services. The data indicate that the vast majority of Nigerian households live within five kilometres of a health facility, with health centres being the closest, followed by clinics and hospitals.

Breasffeeding and Nutrition

Breastfeeding is widely practiced in Nigeria, with 96 percent of children being breastfed. The median duration of breastfeeding is 19 months. Although it is recommended that children be exclusively breastfed with no supplements for the first 4 to 6 months, only 20 percent of children 0-3 months are exclusively breasffed, as are 8 percent of children 4-6 months. Two-thirds of children 4-6 months are being given supplements in addition to breast milk.

In the NDHS, interviewers weighed and measured children under three born to women who were interviewed. Unfortunately, data were either missing or implausible for more than half of these children. Of the half with plausible data, 46 percent of children under 3 are classified as stunted (low height-for-age), 12 percent are wasted (low

The 2013 Nigeria Demographic and Health Survey (NDHS) was designed to provide data to monitor the population and health situation in Nigeria with an explicit goal of providing reliable information about maternal and child health and family planning services. The primary objective of the 2013 NDHS was to provide up-to-date information on fertility levels, marriage, fertility preferences, awareness and use of family planning methods, child feeding practices, nutritional status of women and children, adult and childhood mortality, awareness and attitudes regarding HIV/AIDS, and domestic violence. This information is intended to assist policymakers and programme managers in evaluating and designing programmes and strategies for improving health and family planning services in the country.

Multilevel analysis showing determinants of health facility delivery among women of reproductive age in Nigeria (NDHS 2018).

Prevalence of undernutrition among children 0–59 months by wealth index, NDHS 2003 and 2013.

Concentration indices (CI) of undernutrition among children 0–59 months, NDHS 2003 and 2013.

Adjusted estimates for percentage contribution of socioeconomic factors to child undernutrition in 2003 and 2013.

The data is an extract from the 2018 Nigerian Demographic and Health Survey (NDHS). The NDHS allows researchers to use the data for reseach work.

Descriptive statistics of the sample, Nigeria 2018 DHS.

Adjusted odds ratio and 95% confidence interval for predictors of LBW and HBW in urban Nigeria.

Final multiple logistics regression model for study variables and pregnancy outcome in Nigerian adolescents aged 15–19 years between 2013 and 2018.

Abstract

The 2010 NEDS is similar to the 2004 Nigeria DHS EdData Survey (NDES) in that it was designed to provide information on education for children age 4–16, focusing on factors influencing household decisions about children’s schooling. The survey gathers information on adult educational attainment, children’s characteristics and rates of school attendance, absenteeism among primary school pupils and secondary school students, household expenditures on schooling and other contributions to schooling, and parents’/guardians’ perceptions of schooling, among other topics.The 2010 NEDS was linked to the 2008 Nigeria Demographic and Health Survey (NDHS) in order to collect additional education data on a subset of the households (those with children age 2–14) surveyed in the 2008 Nigeria DHS survey. The 2008 NDHS, for which data collection was carried out from June to October 2008, was the fourth DHS conducted in Nigeria (previous surveys were implemented in 1990, 1999, and 2003).

The goal of the 2010 NEDS was to follow up with a subset of approximately 30,000 households from the 2008 NDHS survey. However, the 2008 NDHS sample shows that of the 34,070 households interviewed, only 20,823 had eligible children age 2–14. To make statistically significant observations at the State level, 1,700 children per State and the Federal Capital Territory (FCT) were needed. It was estimated that an additional 7,300 households would be required to meet the total number of eligible children needed. To bring the sample size up to the required target, additional households were screened and added to the overall sample. However, these households did not have the NDHS questionnaire administered. Thus, the two surveys were statistically linked to create some data used to produce the results presented in this report, but for some households, data were imputed or not included.

Geographic coverage

National

Analysis unit

Households Individuals

Kind of data

Sample survey data [ssd]

Sampling procedure

The eligible households for the 2010 NEDS are the same as those households in the 2008 NDHS sample for which interviews were completed and in which there is at least one child age 2-14, inclusive. In the 2008 NDHS, 34,070 households were successfully interviewed, and the goal here was to perform a follow-up NEDS on a subset of approximately 30,000 households. However, records from the 2008 NDHS sample showed that only 20,823 had children age 4-16. Therefore, to bring the sample size up to the required number of children, additional households were screened from the NDHS clusters.

The first step was to use the NDHS data to determine eligibility based on the presence of a child age 2-14. Second, based on a series of precision and power calculations, RTI determined that the final sample size should yield approximately 790 households per State to allow statistical significance for reporting at the State level, resulting in a total completed sample size of 790 × 37 = 29,230. This calculation was driven by desired estimates of precision, analytic goals, and available resources. To achieve the target number of households with completed interviews, we increased the final number of desired interviews to accommodate expected attrition factors such as unlocatable addresses, eligibility issues, and non-response or refusal. Third, to reach the target sample size, we selected additional samples from households that had been listed by NDHS but had not been sampled and visited for interviews. The final number of households with completed interviews was 26,934 slightly lower than the original target, but sufficient to yield interview data for 71,567 children, well above the targeted number of 1,700 children per State.

Mode of data collection

Face-to-face [f2f]

Research instrument

The four questionnaires used in the 2004 Nigeria DHS EdData Survey (NDES)— 1. Household Questionnaire 2. Parent/Guardian Questionnaire 3. Eligible Child Questionnaire 4. Independent Child Questionnaire—formed the basis for the 2010 NEDS questionnaires. These are all available in Appendix D of the survey report available under External Resources.

More than 90 percent of the questionnaires remained the same; for cases where there was a clear justification or a need for a change in item formulation or a specific requirement for additional items, these were updated accordingly. A one day workshop was convened with the NEDS Implementation Team and the NDES Advisory Committee to review the instruments and identify any needed revisions, additions, or deletions. Efforts were made to collect data to ease integration of the 2010 NEDS data into the FMOE’s national education management information system. Instrument issues that were identified as being problematic in the 2004 NDES as well as items identified as potentially confusing or difficult were proposed for revision. Issues that USAID, DFID, FMOE, and other stakeholders identified as being essential but not included in the 2004 NDES questionnaires were proposed for incorporation into the 2010 NEDS instruments, with USAID serving as the final arbiter regarding questionnaire revisions and content.

General revisions accepted into the questionnaires included the following: - A separation of all questions related to secondary education into junior secondary and senior secondary to reflect the UBE policy - Administration of school-based questions for children identified as attending pre-school - Inclusion of questions on disabilities of children and parents - Additional questions on Islamic schooling - Revision to the literacy question administration to assess English literacy for children attending school - Some additional questions on delivery of UBE under the financial questions section

Upon completion of revisions to the English-language questionnaires, the instruments were translated and adapted by local translators into three languages—Hausa, Igbo, and Yoruba—and then back-translated into English to ensure accuracy of the translation. After the questionnaires were finalized, training materials used in the 2004 NDES and developed by Macro International, which included training guides, data collection manuals, and field observation materials, were reviewed. The materials were updated to reflect changes in the questionnaires. In addition, the procedures as described in the manuals and guides were carefully reviewed. Adjustments were made, where needed, based on experience on large-scale survey and lessons learned from the 2004 NDES and the 2008 NDHS, to ensure the highest quality data capture.

Cleaning operations

Data processing for the 2010 NEDS occurred concurrently with data collection. Completed questionnaires were retrieved by the field coordinators/trainers and delivered to NPC in standard envelops, labeled with the sample identification, team, and State name. The shipment also contained a written summary of any issues detected during the data collection process. The questionnaire administrators logged the receipt of the questionnaires, acknowledged the list of issues, and acted upon them if required. The editors performed an initial check on the questionnaires, performed any coding of open-ended questions (with possible assistance from the data entry operators), and left them available to be assigned to the data entry operators. The data entry operators entered the data into the system, with the support of the editors for erroneous or unclear data.

Experienced data entry personnel were recruited from those who have performed data entry activities for NPC on previous studies. The data entry teams composed a data entry coordinator, supervisor and operators. Data entry coordinators oversaw the entire data entry process from programming and training to final data cleaning, made assignments, tracked progress, and ensured the quality and timeliness of the data entry process. Data entry supervisors were on hand at all times to ensure that proper procedures were followed and to help editors resolve any uncovered inconsistencies. The supervisors controlled incoming questionnaires, assigned batches of questionnaires to the data entry operators, and managed their progress. Approximately 30 clerks were recruited and trained as data entry operators to enter all completed questionnaires and to perform the secondary entry for data verification. Editors worked with the data entry operators to review information flagged as “erroneous” or “dubious” in the data entry process and provided follow up and resolution for those anomalies.

The data entry program developed for the 2004 NDES was revised to reflect the revisions in the 2010 NEDS questionnaire. The electronic data entry and reporting system ensured internal consistency and inconsistency checks.

Response rate

A very high overall response rate of 97.9 percent was achieved with interviews completed in 26,934 households out of a total of 27,512 occupied households from the original sample of 28,624 households. The response rates did not vary significantly by urban–rural (98.5 percent versus 97.6 percent, respectively). The response rates for parent/guardians and children were even higher, and the rate for independent children was slightly lower than the overall sample rate, 97.4 percent. In all these cases, the urban/rural differences were negligible.

Sampling error estimates

Estimates derived from a sample survey are affected by two types of errors: (1) non-sampling errors and (2) sampling errors. Non-sampling errors are the results of mistakes made in implementing data collection and data processing, such as

BA  =  Birth attendant; Prob.  =  Probability; CI  =  Confidence interval; NDHS  = 2008 Nigeria Demographic and Health Survey.The average birth interval for all reported deliveries was 2.9 years, and it varied between 3.3 years for deliveries that occurred before year 2001, and 2.5 years for births that occurred from 2001.

The data from the 2013 NDHS underlying aggregates used in building the model are freely available at https://dhsprogram.com. (XLSX)

Relationship between culture and parental sex preferences among men and women in Nigeria.

MSS, Midwives Service Scheme; NDHS, Nigeria Demographic and Health Survey.

Relationship between family structure and parental sex preferences among men and women in Nigeria.