Child Survival in Nigeria: Situation, Response, and Prospects Key Issues

POLICY Project/Nigeria October 2002

POLICY is funded by the U.S. Agency for International Development (USAID) under Contract No. HRN-C-00-00-00006-00, beginning July 7, 2000. The project is implemented by Futures Group International in collaboration with Research Triangle Institute and the Centre for Development and Population Activities (CEDPA). The views expressed in this paper do not necessarily reflect those of USAID.

Child Survival in Nigeria: Situation, Response, and Prospects Key Issues

POLICY Project/Nigeria October 2002

This is a compilation of significant information and data on the current situation of child survival in Nigeria. Facts have been drawn from a wide range of sources including the Nigeria Demographic and Health Survey (1999), Population Bureau, Federal Office of Statistics, National Planning Commission, UNICEF’s Children’s and Women’s Rights in Nigeria: A Wake-up Call—Situation Assessment and Analysis (2001), survey reports, academic articles, policy and programme documents, budget documents, and publications from development partners. This document is intended to serve as a concise public source of data on the major child survival issues in Nigeria and to assist policymakers to “put children first” in national priorities and in the design of public policies.

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A Time for Action The first five years of life are the most crucial to the physical and intellectual development of children and can determine their potential to learn and thrive for a lifetime. For young children, every single day counts. “The name of the child is today, tomorrow may be too late.” The challenges that we face regarding the health of Nigerian children cannot be put off, and they are not insurmountable. We have the tools, resources, and knowledge to address our nation’s most critical child survival problems and build on the considerable achievements that have been made since the World Summit for Children in 1990. What is needed is urgent action and greater national priority placed on children’s issues so that significant gaps and the growing disparity in child health and survival do not reverse the progress already made.

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Table of Contents Acknowledgments ................................................................................................................................. v List of Abbreviations ...........................................................................................................................vi Background ........................................................................................................................................... 1 Child Survival Indicators in Nigeria: Current Situation .................................................................. 2 Infant/Child Mortality and Morbidity................................................................................................ 2 Equality of Child Survival (ECS) ........................................................................................................ 4 Determinants of Childhood Mortality and Morbidity....................................................................... 4 Childhood Illnesses and Child Survival.............................................................................................. 4 Childhood Malnutrition and Child Survival ....................................................................................... 5 VPD and Child Survival...................................................................................................................... 7 Fertility, Family Planning, and Child Survival .................................................................................. 9 Maternal Morbidity/Mortality and Child Survival ........................................................................... 10 HIV/AIDS and Child Survival ........................................................................................................... 11 Availability/Accessibility of Health Services and Child Survival ..................................................... 11 Non-health Factors Influencing Child Survival................................................................................ 12 Responses ............................................................................................................................................. 15 Political Support ............................................................................................................................... 15 Policies and Plans............................................................................................................................. 16 Legislation and Protection of Children’s Rights .............................................................................. 16 Donors/Partners ............................................................................................................................... 17 National NGOs.................................................................................................................................. 18 Intervention Programmes .................................................................................................................. 19 Provision of Child Health Services................................................................................................... 19 Combating Diseases and Malnutrition ............................................................................................. 20 Provision of Adequate Pre- and Postnatal Care for Mothers........................................................... 23 Access to Basic Knowledge of Child Health, Nutrition, and Child Health-related Issues ............... 24 Development of Preventive Health Care Guidance and FP Services for Parents............................ 24 Abolition of Practices Prejudicial to the Health of Children ........................................................... 25 Adequate Housing (Water, Sanitation, and Environmental Conditions) and Household Food Security ............................................................................................................................................. 26 Capacity Building and Constraints................................................................................................... 26 Research and Surveillance ................................................................................................................. 27 OVC...................................................................................................................................................... 28 Coordination........................................................................................................................................ 28 Impact .................................................................................................................................................. 28 Prospects .............................................................................................................................................. 28 Annex 1: Summary Table on Key Actors, Focus Areas, and Estimated Financial Commitments........................................................................... 29 Annex II: Selected Reference Documents ......................................................................................... 35

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Acknowledgments This document was written by Dr. Ochiawunma Ibe, Senior Advisor for Child Survival and Reproductive Health, POLICY/Nigeria. The author acknowledges the contributions of Dr. Jerome Mafeni, Dr. Scott Moreland, and Mr. Charles Wilkinson for comments and support in the production of this document.

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List of Abbreviations ADB AFP ANC APIN ARCH ARI BASICS BCG BFHI BHSS BI CBR CDD CEDPA CHAN CIDA CMR CPH CRC CS CSM CSO DCD DFID DPT ECS EDR EPI EU FHI FMOH FMWA&YD FOS FP GAVI GNP HIV/AIDS ICC IDA IDD IEC IITA IMCI IMR IP ITNs JHU/CCP

African Development Bank acute flaccid paralysis Antenatal care AIDS Prevention Initiative in Nigeria Applied Research on Child Health acute respiratory infections Basic Support for Institutionalizing Child Survival Bacille Calmette Guerin Baby-Friendly Hospital Initiative Basic Health Services Scheme birth interval crude birth rate control of diarrhoeal diseases Centre for Development and Population Activities Christian Health Association of Nigeria Canadian International Development Agency child mortality rate Community Partnerships for Health Child Rights Convention child survival Cerebro- Spinal Meningitis civil society organisations Department of Child Development Department for International Development Diphtheria Pertussis Tetanus Toxoid Equality of Child Survival End of Decade Review Expanded Programme on Immunisation European Union Family Health International Federal Ministry of Health Federal Ministry of Women Affairs and Youth Development Federal Office of Statistics family planning Global Alliance for Vaccines and Immunisation Gross National Product Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Inter-agency Coordinating Committee Iron Deficiency Anaemia Iodine Deficiency Disorders Information Education and Communication International Institute of Tropical Agriculture Integrated Management of Childhood Illnesses infant mortality rate implementing partner insecticide treated nets Johns Hopkins University/Center for Communication Program

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JICA LGAs MCH MICS MPSI MTCT NACA N-ARCH NCFN NCWC NCRIC NDHS NGOs NHMIS NIDs NIGEP NIMR NPA NPC NPHCDA NPI NPOA OAU OPV ORT OVC PAFA PAN PEI PEP PHC PIC PPFN PMTCT RBM RDA RH RI SCD SNIDs TFR TT UNDP UNDP UNESCO UNFPA UNICEF USAID U5MR VAD

Japanese International Cooperation Agency local government areas maternal and child health Multiple Indicator Cluster Survey Making Pregnancy Safer Initiative mother-to-child transmission National AIDS Control Agency Nigerian Applied Research for Child Health National Committee for Food and Nutrition National Child Welfare Committee National Child Rights Implementation Committee National Demographic and Health Survey Non-governmental organisations National Health Management Information Systems National Immunisation Days Nigeria Guinea Worm Eradication Programme Nigerian Institute of Medical Research National Plan of Action for Children National Planning Commission National Primary Health Care Development Agency National Programme on Immunisation National Programme of Action Organisation of African Unity oral polio vaccines oral rehydration therapy orphans and vulnerable children Population Activities Funds Agency Paediatric Association of Nigeria Polio Eradication Initiative Primary Education Programme primary health care Participatory Information Collection Planned Parenthood Federation of Nigeria Prevention of Mother-to-Child Transmission Roll Back Malaria recommended dietary allowance reproductive health routine immunisation Sickle Cell Disease Subnational Immunisation Days total fertility rate tetanus toxoid United Nation’s Development Project United Nations Development Programme United Nations Educational Scientific and Cultural Organization United Nations Population Funds United Nations Children’s Fund U.S. Agency for International Development under-5 mortality rate vitamin-A deficiency

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VPD WB WHO WSC

vaccine preventable diseases World Bank World Health Organization World Summit for Children

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Child Survival in Nigeria: Situation, Response, and Prospects Key Issues

Background Nigeria’s estimated population of 120 million in 2002 (projected from the 1991 National Population Census) makes it the largest country in sub-Saharan Africa and the tenth most populated country worldwide. Nigeria’s population is largely rural, with 63.7 percent of the population living in rural areas. Currently, about 45 percent of Nigeria’s total population is less than age 15, with about 20 percent (24 million) under age five. The sheer numbers involved, therefore, demand that child survival issues be placed in the forefront of the national agenda. Despite its wealth of human and natural resources, Nigeria is ranked among the 13 poorest countries in the world; two of every three Nigerians (66%) live below the extreme poverty line of US$1 a day (World Bank, 2001). Nigeria’s low gross national product (GNP)—per capita of $310 in 1998—is lower among people living in rural areas, limiting their access to adequate nutrition, quality health care, and other basic social services, especially among vulnerable groups (women and children) (World Bank, 1999; UNICEF, 1999). Less than one-half of the population has access to safe water (40% in rural areas) and only 41 percent have access to adequate sanitation (32% in rural areas). Overall, the adult literacy rate is 56 percent; however, the rate for males (67%) is much higher than for females (47%). These facts adversely affect the survival of children and the reproductive health (RH) status of women in general. Child survival in Nigeria is threatened by nutritional deficiencies and illnesses, particularly malaria, diarrhoeal diseases, acute respiratory infections (ARI), and vaccine preventable diseases (VPD), which account for the majority of morbidity and mortality in childhood. Other threats include high maternal morbidity and mortality. There is the need for an enabling environment through well-articulated policies, projects, and programmes to ensure wholesome development of Nigerian children and enhance the quality of life.

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Child Survival Indicators in Nigeria: Current Situation Total population (millions) Crude birth rate (CBR) (per 1,000)* Total fertility rate (TFR) births per woman**# Unmet need for family planning (FP)(%)** Infant mortality rate (IMR) (per 1,000)** Under-5 mortality rate (U5MR) (per 1,000)** Child mortality rate (CMR) (per 1,000)**a Neonatal mortality rate (per 1,000)** Low birth weight (%)*** Percent of infants