title: Inequality in Maternal and Child Health and Healthcare in Nigeria: An Econometric Analysis
Creators: name: Okoli, Chijioke
Publisher: name: University of Southern Queensland
Year: 2022
Subjects: subject: Maternal and child mortality
subject: inequality
subject: socioeconomic status
subject: concentration index
subject: decomposition analysis
classificationCode: 380108
subject: Health economics
valueUri: https://www.abs.gov.au/statistics/classifications/australian-and-new-zealand-standard-research-classification-anzsrc/latest-release
classificationCode: 420602
subject: Health equity
valueUri: https://www.abs.gov.au/statistics/classifications/australian-and-new-zealand-standard-research-classification-anzsrc/latest-release

description: Globally, thousands of women die annually from complications during pregnancy, childbirth, or the postpartum period. Most of these deaths occur in developing countries, especially in sub-Saharan Africa. The situation is critical in Nigeria, with a maternal mortality ratio of 512 deaths per 100,000 live births. For neonates, infants and children under five, their mortalities are 39, 67, and 132 deaths per 1,000 live births, respectively. Evidently, the maternal mortality ratio in Nigeria is the highest in Africa and much higher than the global average of 290 per 100,000 live births. Improving maternal and child health is an important global health priority. This study seeks to investigate the inequality in maternal and child health and healthcare, particularly geographic and socioeconomic inequality, in the six geopolitical zones of Nigeria using decomposition and survival analyses. This is a PhD thesis by publication. It includes four cross-sectional studies and one scoping review study. The cross-sectional studies used 2003, 2008, 2013 and 2018 datasets from the Nigeria Demographic Health Survey (NDHS). The NDHS is a nationally representative dataset with similar variables that are comparable over time. A specific method for a specific objective approach was deployed in each of the research papers. Research paper 1 examines the geographic and socioeconomic inequalities in maternal healthcare utilisation in Nigeria between 2003 and 2017. The finding from the rate difference shows that the gap in the utilisation of facility-based delivery between urban and rural areas increased significantly by 0.3% per year over the study period. The Theil index suggests a decline in relative inequalities in antenatal care and facility-based delivery across the six geopolitical zones by 7% and 1.8% per year, respectively. Further, the results indicate a persistently higher concentration of maternal healthcare use among well-educated and wealthier mothers in Nigeria over the study period. Research paper 2 measures and identifies factors explaining socioeconomic inequality in the uptake of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). The study showed a higher concentration of the adequate uptake of IPTp-SP among socioeconomically advantaged women in Nigeria. The result of the decomposition analysis ii indicates that geographic zones of residence and antenatal visits were the two main drivers for the concentration of the uptake of IPTp-SP among wealthier pregnant women in Nigeria. Research paper 3 focuses on measuring inequality and identifying factors explaining socioeconomic inequality in teenage pregnancy in Nigeria. The results suggest that pregnancy is concentrated among poor teenagers. The decomposition analysis identifies that the marital status, wealth index of households, exposure to information and communication technology, and religion were the most important predictors contributing to the observed concentration of teenage pregnancy in Nigeria. Research paper 4 investigates inequalities in geographic and socioeconomic factors influencing the survival time of children under five in Nigeria. The Kaplan-Meier survival estimates show that most under-five mortality occurs within 12 months after birth, with the poorest households most at risk of under-five mortality. The richest households are the least affected across the geographic zones and household wealth index quintiles. Of the six geopolitical zones, children born to mothers living in the North-West region of Nigeria had a 63.4% higher risk of under-five mortality compared to children born to mothers in the South-West. Research paper 5 conducts a scoping review to ascertain the implications of outbound medical tourism on maternal and child mortality in Nigeria. The 32 articles included out of 2,957; 23 (74.2%) indicate that a lack of confidence and/or trust in the nation’s health sector motivates Nigerians to embark on medical tourism. Outbound medical tourism affects the development of the health system and, by implication, contributes to increases in maternal and child mortality rates in the country. The review, therefore, calls for the regulation of sponsored medical treatment for government officials abroad to strengthen the public healthcare system. Strong political will, accountability, transparency and leadership by example are required to revamp the Nigerian health system.