Demographic and Health Survey 2003

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 the same day as the onset of the fever/convulsions or the following day.

HIV/AIDS AND OTHER STIS

Knowledge. Almost all men (97 percent) and a majority of women (86 percent) reported that they had heard of AIDS. Considerably fewer know how to prevent transmission of the AIDS virus; men are better informed than women. Sixty-three percent of men and 45 per­cent of women reported knowing that condom use protects against HIV/AIDS. More respon-dents (six in ten women and eight in ten men) reported knowing that limiting the number of sexual partners is a way to avoid HIV/AIDS. Less than half of the population knows that mother to child trans­mission of HIV is possible through breastfeeding. Few people (less than one in ten) know that a woman living with HIV can take drugs during preg­nancy to reduce the risk of transmission.

HIV Testing and Counselling. Six percent of women and 14 percent of men have been tested for HIV and received the results of their test. During the 12 months preceding the survey, only 3 percent of women and 6 percent of men were tested and re­ceived their test results. About one-quarter of women received counselling or information about HIV/AIDS during an antenatal care visit.

High-risk Sex. A much higher percentage of men than women report having had sex with a non-marital, noncohabiting partner at some time during the year preceding the survey (39 percent of men versus 14 percent of women). Less than half of men (47 percent) and less than one-quarter of women (23 percent) reported using a condom the last time they had sex with a nonmarital, noncohabiting partner. Fifteen percent of men who are currently married or cohabiting reported having high-risk sex in the past 12 months.

Sexually Transmitted Infections. Five percent of both women and men reported having a sexually transmitted infection (STI) or an associated symp­tom during the 12 months preceding the survey. The never-married population of both women and men are most at risk. Eight percent of never-married women and 7 percent of never-married men reported having an STI or STI symptom. Of these, 68 percent of women and 83 percent of men sought treatment for their STI or STI symptom; however, not every­one went to a health professional.

Orphanhood. Nationwide, fewer than 1 per­cent of children have lost both parents; 6 percent of children under age 15 have lost at least one parent.