Essays on Child Health Disparities in Nigeria

Abstract

The United Nations has identified equity in health as a marker of overall development. Disparities abound in almost every facet in Nigeria, but disparities in the health sector, especially child health (i.e. child health care access, provision, and other factors connected with child health such as socio-economic status, maternal education, environmental and cultural factors) are of uttermost concern. Unfortunately, Nigeria is one of the nations with very high rates of child malnutrition and under-five mortality (U5M) in the world. The objectives of this study are to evaluate the relationship between the disparities in under-five child malnutrition and the socio-economic status in Nigeria; analyze the relationship between the disparities in U5M and maternal education in Nigeria; and analyze the profiles of the hotspots of U5M and their relationship to the main factors contributing to the high under-five mortality in the hot spots, such as poverty, religion, selected maternal and environmental variables in Nigeria. The study is divided into three essays, each essay for each objective. The first essay used the concentration index to examine the extent of malnutrition of under-five year children in Nigeria, while Z-scores were used to analyze the occurrence of stunting, wasting and underweight, using data from the LSMS/General Household Survey (GHS) 2015/2016 Nigeria. Essay two and three made use of the 2013 NDHS data, while using the following methodologies: two stage least square with an instrument to take care of the endogeneity; moderation and mediation methodologies to estimate the pathways to which maternal education affects under-five mortality; the concentration index to analyze the magnitude of the U5M in different categories and zones; the Moran’s I to test for autocorrelation and finally the two stage least square to analyze the effects of the factors contributing to the high U5M in the hotspots in Nigeria. The findings revealed that stunted children had the highest percentage, followed by the percentage of underweight children, and lastly, the percentage of children wasted. The percentages of the three malnutrition measures were considerably larger in male children compared to female children. Stunting and underweight were responsive to household socio-economic status. A higher percentage of children under age five who were stunted, wasted and underweight lived in the rural areas of Nigeria compared to those residing in the metropolitan areas. The rate of stunting was highest in the North-West, followed by North-East, and lowest in the South-South. The concentration indices analysis revealed that stunting, wasting and underweight all had negative signs, signifying concentration among the poor household children. Finally, as one moves up the ladder of the socio-economic status, a significant fall in the rate of stunting is witnessed. An inverse relationship was observed between mother’s education and under-five mortality. The levels of maternal education variables (secondary, primary and no education) were highly significant at one percent levels, and all had negative signs, implying an inverse relationship between maternal education and under-five mortality. It was observed that as one moved towards higher education, the impact on under-five mortality was reducing; in other words, the higher the education of the mothers, the lower the under-five mortality. Also, socio-economic status (SES) pathway was the most significant and important mediator/moderator between mother’s education and under-five mortality. Spatial dependence across the study area was confirmed with Moran’s I testing positive (0.4689 and a P-value of 0.01), an indication of the presence of autocorrelation. Six states, namely Zamfara, Bauchi, Jigawa, Sokoto, Kebbi and Katsina were identified as having the highest U5M, ranging from 162-221 deaths per 1000 live births from the spatial analysis. The variables identified as contributing to the high under-five xviii mortalities in these states were maternal education, age of the mother, religion, wealth index, antenatal visits, hospital delivery, post-natal visit, age at first birth, partner’s education, distance to the nearest health care center and sanitation (flush toilet), and piped water. However, the age of the mother and age at first birth were relatively significant and consistent across the six states under examination. The six states were also observed to be part of the poorest states in the country. In conclusion, disparities in child health in Nigeria can be minimized through targeted policies: on poverty alleviation, on good nutrition and under-five healthcare provision, on factors that can improve socio-economic status, on a nationally enforceable minimum age for marriage, and by investing in health education for women and children.