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The Worrisome Data From Demographic Health Surveys On Under-5 Mortality


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In this report, ERNEST NZOR writes on findings from the Nigerian Demographic Health Surveys (NDHSs) under-five mortality, conducted by the National Population Commission (NPC) which show that the country needs to do more to reduce under-five mortality to 25 deaths per 1,000 live births by 2030.

The current population of Nigeria is 207,894,460 as of Saturday, November 7, 2020, based on world meter elaboration of the latest United Nations (UN) data, as Nigeria population is equivalent to 2.64 per cent of the total world population. Nigeria ranks number 7 in the list of countries (and dependencies) by population.

However, a situation where the data on population cannot be said to be accurately available in the country makes it difficult to plan for the future. The Nigerian Demographic Health Surveys (NDHSs) are conducted to bridge the gap on the data needed for health planning in the country. One of such data that is needed is on under-five mortality, which was intended to provide policy makers information to address the challenge of high rate of infant mortality.

The Nigerian Demographic Health Surveys (NDHSs) under-five mortality shows that Nigeria has declined from 201 per 1,000 live births in 2003 to 132 per 1000 live births in 2018, a35 per cent decline in 15 years. Most of this decline occurred in children 1 to 59 months of age with a smaller decline in neonatal mortality.

While improving in child mortality shows the impact of improved prevention and care for childhood illnesses, progress has actually been significantly slower than what has been achieved in most other African countries. The decline is also much slower than what is needed to achieve the Sustainable Development Goal (SDG) 3 target of reducing under-five mortality to 25 deaths per 1,000 live births by 2030.

However, it is worth noting that the NDHS found higher death rates in 2018 than in 2013 for both neonates and the 1-59 months age group, suggesting that Nigeria needs to redouble efforts to improve these indicators.

It is on this note that the National Population Commission (NPC) in conjunction with the Federal Ministry of Health and support from USAID and other key stakeholders, carried out 2019 VASA survey to be a veritable tool for planning for infant, children and maternal health in the country.

NPC noted that the VASA survey was a follow up to the 2018 NDHS, where a total of 3,215 under-5 mortality cases were selected out of which 31 percent (974) are Neonates while 69 percent (2,241) are Children.

According to NPC 2019 Verbal and Social Autopsy Survey (VASA) report, “a follow-up to the 2018 Nigeria Demographic and Health Survey (NDHS). The first VASA, conducted in 2014 as a follow-up to the 2013 NDHS, showed the need to better understand how socio-cultural contexts, health beliefs and health-seeking behaviour, household-level factors like decision making on child healthcare, family economy, and factors associated with health systems impact child survival.

“The 2014 VASA also brought the need for stakeholder buy-in to the fore to ensure effective use of study findings for policymaking and for intervention design and implementation. Working with stakeholders in relevant government ministries, departments, and agencies to understand the non-biomedical ‘causes’ of under-five deaths is important for strengthening child health programmes in Nigeria.

“The qualitative component was conducted in a total of 12 states, taking the two states with the highest number of under-five (including neonate) deaths in each of the six geo-political zones of Nigeria, based on reported cases in the 2018 NDHS. Three to four sampling clusters with the highest number of cases of under-five deaths were then selected in each state. Across the selected clusters, data were collected as follows: in-depth interviews with 69 mothers (caregivers) who reported the most recent cases of under-five deaths in the 2018

NDHS, key informant interviews with 24 persons knowledgeable about the local health systems and typical health-seeking behaviour in the study communities, 48 focus group discussions with key community members; and observation of health facilities. By letting study participants speak freely, the study captured issues in depth that cannot be obtained through a quantitative household survey.

“The locations selected in each state were those with the highest reported cases of under-five deaths in the 2018 NDHS, so they can be expected to have somewhat worse contextual problems than other areas of the country. The study itself mostly explored barriers to care, whether they were at the individual, family, community or health systems level. This helped bring out more sharply the many factors that affected health outcomes. The study also explored child health-promoting or enabling factors, and showed that some services such as basic vaccinations were provided widely across the country.”

However, the main focus was on letting the participants explain factors that led to the death of the specific children in the study and for children in general in their communities. While the results show many difficulties, health systems can respond in ways to prevent most of the deaths.

Speaking recently during the launch and national dissemination of the 2019 Verbal and Social Autopsy  Survey (VASA) report, the chairman of NPC, Alhaji Nasir Isa Kwarra, said that the data from the 2019 VASA survey will ensure that planning in the health sector is evidence-based and will ensure maximum utilization of resources in that sector.

He explained that the VASA survey report would provide policy makers with accurate and timely data to formulate courses of action designed to help guide the government in proper stakeholder engagement, policy and programme implementation so as to reduce under-five deaths to the barest minimum in Nigeria.

“The report provide a substantial amount of household-based data needed in Nigeria and the outcome of the Survey will inform programming that would improve levels of health care delivery as well as facilitate equitable access to quality care for all children in Nigeria.

“From the study, the government and stakeholders will understand that beyond the medical causes of under-five deaths, there are socio-cultural factors that also affect neonatal, infant and child mortality in Nigeria.

“The menace of under-five mortality cannot be wished away; indeed, there has to be purposeful interventions and programmes from all concerned to reduce under-five mortality in Nigeria. But first, appropriate data on causes and factors that lead to under-five deaths is first required to properly implement meaningful programmes and interventions.

“The conduct of the 2019 VASA Survey marks another major step by the National Population Commission in collaboration with Federal Ministry of Health and other Agencies to respond to the national imperative of providing adequate and relevant data for national planning, particularly in the health sector.

“As you are aware, the primary responsibility of the Commission as contained in the third schedule of the 1999 Constitution is to provide demographic data for planning purposes through the conduct of periodic censuses and surveys,” he said.

While the Commission conducts and disseminates demographic data collected from censuses, it believes that effective planning requires more specialized and regular data in order to achieve concrete improvements in the living standards of the people.

He said that the 2019 VASA meets its lofty objective of providing the much needed data for planning in the health sector, adding that the commission adopted a meticulous and scientific approach at every stage of the survey. Majority of the staff deployed for the 2019 VASA survey participated in the conduct of the 2018 NDHS and gained practical experience in fieldwork and techniques of interviewing.

NPC boss appeal to all Nigerians, particularly stakeholders in the health sector, to avail themselves of the huge data generated by the 2019 VASA survey in the planning, for execution and evaluation of health programmes for infants and children in the country.

In his reaction, the minister of Health, Dr Osagie Ehanire, noted that the 2019 VASA study was thus a vital tool in the critical initiative to improve the health of infants, children and for maternal health.

He said: “VASA provides up-to-date health and social indicators on under-five deaths in Nigeria and the distribution along geopolitical zones and individual states, among the nine priority health areas of the current administration. It is an indication of the President’s vision and commitment to promote health and well-being of all Nigerians.

“This report is the product of the sound collaboration of several organisations. It is gratifying to note that the indicators from the report represent key areas of maternal healthcare (Women aged 15 – 49), Child Health, Nutrition and Child Mortality.

“Data generated in the survey will provide the information needed to identify key deficits and channel resources to address development needs, it will also be used to monitor and evaluate progress toward meeting the goals of our Universal Health Coverage agenda and of the Sustainable Development Goal three, with regards to maternal and child health.

“I look forward to further deepening our relationship, I call on Federal Ministries, Departments and Agencies, state governments, local governments, organised private sector and civil society organisations to feel free to make use of the 2019 VASA data for planning and development purposes.”

The minister commended all the stakeholders for providing the technical support to conduct the survey and appreciated all the other invaluable contributions that supported the development of the report.

He assured that the Federal Ministry of Health would continue to collaborate with NPC in its efforts to achieve its constitutional mandate of providing accurate, credible, verifiable and acceptable demographic and health data for national planning.



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