Interrogating our low baseline demographic and health data
Enables preparation for the turbulence ahead
As Nigeria stands at a strategic inflexion point concerning health, demographics and economics, it is critical to take a second look at our baseline indicators. The federal government yesterday decided on the lockdowns in a manner that may have positive or negative consequences for the economy, our health and demographic indicators some months and years down the line. We should know where we stand, where we are coming from and how to go henceforth.
One significant resource is the National Demographic and Health Survey (NDHS). The 2018 survey is the sixth since 1990 and the latest available. The NDHS provides reliable estimates of demographic and health indicators. It covers health as well as socio-economic indicators such as fertility levels, marriage, sexual activity, family planning, breastfeeding practices, nutrition, childhood and maternal mortality, maternal and child health, malaria, domestic violence, disability, and female genital mutilation. The belief is that the information “is essential for programme managers and policymakers to evaluate and design programmes and strategies for improving the health of Nigerians.”
The survey claims “a nationally representative sample of 41,821 women age 15-49 in 40,427 households and 13,311 men of age 15-59 in one-third of the sampled households”. It is a response rate of 99 percent of women and men. “The sample design for the 2018 NDHS provides estimates at the national level, for six zones and 36 states and the Federal Capital Territory (FCT), and urban and rural areas”.
There are vital socio-economic indicators of interest in the survey. Only three percent of Nigerian households have health insurance, a telling sign of the absence in Nigeria of a strategic tool for health funding.
Nigerian families have an average size of 4.7 members, with women heading 18 percent of them. That means women run one in five homes. Forty-six percent of the population is under 15 years.
NDHS 2018 claims that 66 percent of Nigerian households access improved drinking water: 78 percent of urban dwellers and 58 percent of rural dwellers. Sanitation levels are high at 56 percent, but 25 percent engage in open defecation, and another 20 percent utilise low-quality facilities.
The neonatal mortality rate is 39 deaths per 1,000 live births. At these mortality levels, one in every 8 Nigerian children does not survive to their fifth birthday. Childhood mortality rates have declined since 1990. Infant mortality has decreased from 87 deaths per 1,000 live births in 1990 to 67 in 2018. Similarly, under-5 mortality dropped from 193 to 132 deaths per 1,000 live births.
Only 31 percent of children age 12-23 months have received all eight essential vaccinations—one dose each of BCG and measles vaccine and three doses each of DPTHepB-Hib and polio vaccine. Less than half of children have received the third dose of polio. Nearly one in five children have received no necessary vaccinations.
“In the two weeks before the survey, three percent of children under five were ill with symptoms of acute respiratory infection (ARI) such as chest-related short, rapid breathing and difficulty breathing. Parents sought treatment or advice for 75 percent of them. Thirteen percent of children under five had diarrhoea in the two weeks before the survey. Diarrhoea was most common among children in Bauchi (34 percent) and Gombe (35 percent) states and children age 6-11 months and age 12-23 months (both 20 percent). While half of the children under five with diarrhoea received ORT, 17 percent received no treatment. Nearly one-quarter of children under five with diarrhoea received ORS and zinc (23 percent).
Only 59 percent of households in the country can access electricity. Forty-eight percent of men and 40 percent of women have secondary education on a national aggregate. While secondary schooling is common, the next most significant number belong to those who did not go to school. Thirty-five percent of males and 22 percent of females belong here. The other way of looking at it is the survey result of 72 percent male literacy and 53 percent of women.
Internet usage is at 35 percent for men and 16 percent for women. Internet usage is an important indicator currently with its significance set to rise in the post-covid19 era of social distancing and online interaction. The numbers here have to scale up if Nigerians would play well in that dispensation.
Baseline data such as this would be critical parameters for assessment as we struggle to contain and then overcome COVID-19 and commence the management of our social, demographic and health status.