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.
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.
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.
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.
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.
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 weight-for-height) and 27 percent are underweight (low weight-for-age).
The 1999 NDHS also collected information on the nutritional status of women who had a birth in the three years prior to the survey. Sixteen percent of these women are considered to be too thin, with a body mass index of less than 18.5. Women of short stature (height less than 145 cm) comprise 7 percent of the women measured.
HIV/AIDS and Other Sexually Transmitted Diseases
Survey data indicate that awareness of HIWAIDS is becoming more widespread. Three-quarters of women and 90 percent of men in Nigeria have heard of AIDS. The radio and relatives and friends are the most commonly cited sources of information about HIV/AIDS among both women and men. However, knowledge of ways to avoid HIV/AIDS is not so widespread. More than a quarter of women and 14 percent of men say they do not know of any way to avoid HIV/AIDS and 6 percent of women and 3 percent of men say there is no way to avoid it. Only 14 percent of women and 29 percent of men say that using condoms is a means of avoiding the disease. On the other hand, three in five men and women who have heard of AIDS know that ahealthy-looking person can be infected with the AIDS virus and over 80 percent know that AIDS is a fatal disease that cannot be cured.
Two-thirds of Nigerian women and men believe that they have no chance of contracting HIV/AIDS, while almost all the rest believe their chances are small. Perhaps one reason is that many Nigerians say they have changed their sexual behavior to avoid getting AIDS. For example, 37 percent of women and 42 percent of men say they restrict themselves to only one pamler; one-fourth of the women say they asked their partners to remain faithful. Condoms are acknowledged by a large majority of respondents to be a way of preventing HIV/AIDS and other sexually-transmitted diseases. Men are almost twice as likely (38 percent) as women (20 percent) to have ever used condoms either for family planning or disease prevention. However, only 7 percent of women and 15 percent of men reported having used a condom the last time they had sexual intercourse. The most widely known sexually transmitted disease apart from AIDS is gonorrhoea.