Nigeria - Multiple Indicator Cluster Survey/National Immunization Coverage Survey 2016-17, Fifth round (MICS) and NICS (third Round)

v1.1: Edited, anonymous dataset for public distribution

2018-07-01

Executive Summary

Introduction

This report is based on the Nigeria Multiple Indicator Cluster Survey (MICS 5) 2016-17, conducted between September 2016 and January 2017 by National Bureau of Statistics (NBS), with technical and financial support from UNICEF, WHO, UNFPA, Bill and Melinda Gates Foundation, Save One Million Lives and NACA. The survey provides statistically sound and internationally comparable data essential for developing evidence-based policies and programmes, and for monitoring progress toward national goals and global commitments. Among these global commitments are those emanating from the World Fit for Children Declaration and Plan of Action, the goals of the United Nations General Assembly Special Session on HIV/AIDS, the Education for All Declaration and the Millennium/Sustainable Development Goals (MDGs/SDGs). The Nigeria Multiple Indicator Cluster Survey 2016-17 has been designed to measure achievements of MDGs and provide baseline for SDGs. More specifically, Nigeria MICS 2016-17 will assist UNICEF in monitoring and evaluating its country programmes including those on child survival, development, protection and rights of children, women and men.

The 2016-17 Nigeria National immunisation Coverage Survey (NICS) was embedded within the Nigeria Multiple Indicator Cluster Survey (MICS) 2016-17 and designed to provide routine immunisation vaccination coverage in children aged 12 to 23 months at the national level, 36 States and the Federal Capital Territory (Abuja). MICS is a household survey designed to provide information on indicators related to the situation of children, women and men.

Survey Objectives

The objectives of Nigeria Multiple Indicator Cluster Survey (MICS) 2016-17 and NICS 2016/17 are to:

(1) Provide up-to-date information for assessing the situation of children and women in Nigeria

(2) Generate data for the critical assessment of the progress made in various programme areas, and to identify areas that require more attention

(3) Contribute to the generation of baseline data for the SDG

(4) Provide data needed for monitoring progress toward goals established in the post Millennium Declaration and other internationally agreed goals, as a basis for future action

(5) Provide disaggregated data to identify disparities among various groups to enable evidence based actions aimed at social inclusion of the most vulnerable.

(6) Provide reliable data for: a. Immunisation coverage of children age 12 to 23 months for the basic antigens: BCG, DPT 1-3, OPV 0-3, Measles

b. Immunisation coverage of children age 12 to 23 months for complementary antigens: Yellow fever, Hepatitis B and Vitamin A

(7) Estimate the trend of Immunisation coverage since 2006

(8) Provide a geographical database on Immunisation coverage (for mapping)

(9) Determine the most frequent obstacles to utilization of Immunisation services

(10) Provide information on reasons for utilization or non-utilization of Immunisation services

Sample and Survey Methodology

MICS sample design

The Nigeria MICS 2016-17 was designed to provide estimates for a number of indicators on the situation of children women and men at national, urban/rural, states and for the six geopolitical zones. States in each zone were identified as the main sampling strata and were also the principal units in which Nigeria MICS 2016-17 indicators were reported while enumeration areas (EAs) within each state were used as the primary sampling units (PSUs). The sample size computation of the Nigeria MICS 2016-17 was based on the estimated prevalence of stunting in children aged below five years of age – it was proposed that 60 randomly selected EAs per state would be sufficient for estimating MICS indicators at state level. In Kano and Lagos states the respective state bureaus of statistics requested for larger sample sizes to allow for reporting of indicators by senatorial districts. A senatorial district is an administrative region represented by a senator in Nigeria; there are three (3) senatorial districts in each of the 36 states and one senatorial district in the FCT (Abuja). The sample required to allow for reporting by senatorial district level in both Kano and Lagos was 120 EAs. The combined sample of 60 enumeration areas per state and 120 enumeration areas in Lagos and Kano is referred to as as the “MICS sample”.

NICS (National Immunisation Coverage Survey) Sample design

The Nigeria NICS 2016-17 sample design based on precise estimation of pentavalent 3 vaccination coverage within ±10% in each state (reporting domain). When the proposed MICS samples were evaluated, it was realised that the “MICS sample” would not have been sufficient to estimate state vaccination coverage for children aged 12 to 23 months in 20 out of the 37 states based on the desired precision parameters. These states were Abia, Akwa Ibom, Anambra, Bayelsa, Benue, Cross River, Delta, Edo, Ekiti, Enugu, Imo, Kogi, Kwara, Ogun, Ondo, Osun, Oyo, Plateau, Rivers and FCT (Abuja). Consequently, to enable precise estimation of vaccination indicators in each state, supplemental sampling was conducted to meet the requirements for vaccine coverage estimation, in the 20 whose MICS 2016-17 was deficient. Immunisation indicators in these 20 states were estimated from analysis of the combined sample (supplemental sample + original MICS sample), while estimation of other MICS indicators these 20 states were done exclusively using the MICS sample.

Questionnaires

Nigeria MICS 2016-17 questionnaires

Questionnaires for the Nigeria, MICS 2016-17 were based on adaptations of standard MICS questionnaires and were used to collect data on household and individual level parameters including information on immunisation status of children aged 12 to 23 months.

A household questionnaire was administered to the household head or their representative to ascertain household level characteristics such as the size of the household, household composition, occupation of household head, household asset ownership and access to water and sanitation. Individual level question o3 months and that only components of the questionnaire collecting age, gender and vaccination status were administered.

The questionnaires used in Nigeria, NICS 2016/17 were based on the MICS5 questionnaire adapted for Nigeria. NICS 2016/17 was based on information collected from a household and an immunisation questionnaire. The household questionnaire was used to collect socio-demographic information and other general characteristics on all members of the household (usual residents), household and the dwelling units. Responses needed for computation of immunisation coverage indicators were contained in the household questionnaire and in the under-five questionnaire from the MICS set of questionnaires

Fieldwork and Data Processing

Training for the fieldwork was conducted in thirty-one (31) days in August 2016. The data were collected by 78 teams; each team comprised of four interviewers, one driver, the measurer and a supervisor. Fieldwork began in September, 2016 and concluded in January 2017. Using Computer Assisted Personal Interviewing (CAPI), the data were electronically captured from the field and transmitted to a central server, using CSPro CAPI application, Version 5.0. Data were analysed using the Statistical Package for Social Scientists (SPSS) software, Version 21. Model syntax and tabulation plans developed by UNICEF MICS team were customized and used for this purpose.

Data management and analysis

Data were simultaneously collected in the core (MICS) and in the supplemental EAs by teams of enumerators who had attended similar training. All data were collected electronically using CAPI program designed using CSPro and running on tablet computers. Collected data were synchronized with a centralized, password protected server managed by NBS. Data processing included identification and resolution of inconsistencies and recoding of variables. Following data cleaning, two datasets were generated:

1) MICS dataset containing data collected only from the core (MICS) EAs

MICS dataset was used for the analysis of all non-immunisation related indicators in the Nigeria MICS 2016-17 report and table CH.1: of the child health chapter while the MICS/NICS dataset was used for generation of tables CH.2A to CH.2F of the same report. In addition, further analysis of the MICS/NICS dataset is presented as a separate report Nigeria, National Immunisation Coverage Survey 2016/17, Final Report.

MICS dataset can be found on the Nigeria Data Archive (NADA) page hosted on the NBS website



2) MICS/NICS dataset which was an aggregation of data collected from the core (MICS) EAs and the supplemental EAs.

Link to MICS/NICS dataset can be found here



A variable labelled source is used to identify whether data for an observation was collected from the core (MICS) EAs or from the supplemental EAs. In the Nigeria MICS 2016-17 report, table CH.1 has been generated from the core MICS sample and includes 5577 children aged between 12 and 23 months. Tables CH2.A to tables CH2.F are computed from the combined sample of core MICS enumeration areas and the supplemental enumeration of 6268 children aged between 12 and 23 months. Given that tables CH.2.1 to CH.2.6 have been produced from a larger sample, their estimates have much narrower confidence bounds especially for state level estimates.

Steps for combining data from core (MICS) EAs and data from supplemental (NICS) EAs to

1) Filter CH dataset from core EAs and extract data for children aged between 12 and 23 months and keeping only variables related to child demographic characteristics and immunisation.

2) Combine data from core EAs and data from supplemental EAs

Characteristics of Households

The age structure of Nigeria shows a largely young population. Of the 182,165 household members enumerated, forty-Seven percent of the population are under the age of 15 years, contributing to the high dependency ratio in Nigeria. Households are traditionally headed by men, but a substantial proportion, about fifteen percent, of households were headed by women. Majority of Nigerian, 63.4 percent of households, reside in rural areas. Twenty-two percent of the household heads had no education, while 19.3 had primary education, 26.7 percent with Secondary / Secondary-technical and 16.3 percent had higher education.

Characteristics of Women, Men and Under five Children

Women: Majority of the woman are married, with 7 in 10 women age 15-49 years being currently married. About 23 percent of them had no education, 14.4 percent with primary education, while 36.3 had secondary education and 10.2 percent had higher education. Sixty-four percent of women resides in the rural areas.

Men: In contrast to the women, about half of eligible men were never married. Among the eligible men, 10.3 percent of them had no education, 13.2 percent with primary education, while 45.2 had secondary education and 17.3 percent had higher education. Similar to the women, most men, sixty-three percent, resides in the rural areas.

Children: There is a somewhat higher proportion of children in the rural areas, 69.5 percent, compared to the adult population. Likewise, a higher proportion of children under 5 years old were in the poorest households, 23 percent, compared to 17.8 percent in the richest households.

Child Mortality

MICS 5 estimate of neonatal mortality rate is 39 per 1,000 live births, while Infant mortality rate is 70 per 1,000 live births. This implies that 1 in 15 livebirths in Nigeria die before their first birthday according to the MICS5 2016-17 survey. Also, under-five mortality rate is estimated to be 120 per 1,000 live births – 1 in 9 live births die before their fifth birthday.

Urban-rural mortality differential is pronounced across early childhood age groups. As expected, mortality rates in urban areas are lower than rural areas in Nigeria. Also, mortality is higher in the poorer households, as one out of 6 children who lives in the poorest household in Nigeria die before their fifth birthday. Nine states in the northern region have higher U5 mortality rates than the national average: Nasarawa, Niger, Bauchi, Gombe, Jigawa, Kano, Katsina, Kebbi, and Zamfara. To achieve SDG 3.2, there must be at least 50 percent reduction in early childhood mortality rates before 2030 across all groups.

Nutrition

Three in ten children under 5 years have acute or chronic malnutrition. Two in 5 children under five years are stunted and 1 in 5 children under 5 years are severely stunted. Fourteen in 36 states in Nigeria have wasting prevalence that are classified as serious for public health significance. Mothers with at least secondary education have higher proportion of obese children than those with lower and non-formal education.

Quite a low proportion of mothers, three out of 10, initiated early breastfeeding as recommended by WHO, however, 7 in 10 mothers eventually initiated breastfeeding within 24 hour of birth delivery. The 24 percent exclusive breastfeeding rate is yet to meet the WHO Global nutrition target of 50 percent. One in two infants is predominantly breastfed while just one in five is exclusively breastfed.

Salt Iodization

Iodized salt containing 15 ppm or more are consumed in 69 percent of sampled household with higher prevalence in South South and South East. There was slight variation in households using adequately iodized salt in urban and rural areas. Richer households consume adequately iodized salt more than others in poorer wealth quintile.

Low Birth Weight

Only one in 4 live births were weighed at birth, and fifteen percent of these births are classified as low weight because they are less than 2,500 grams at birth. Although more babies are weighed at birth in the southern part of the country, the proportion of low birth weights babies is less than 20 percent across all the geopolitical zones in Nigeria.

Child health

Vaccination coverage is an important indicator of Immunization, one of the cost-effective means of ending preventable deaths of newborn and under 5 children. Eighteen percent of children age 12-23 months received all recommended vaccination by their first birthday in the survey. Specific vaccine coverage for children age 12-23 months at any time before the survey are 53.1 percent for Tuberculosis; 34 percent coverage for polio, 34.4 percent coverage for pentavalent vaccine, 41.8 percent coverage for Measles and 39 percent coverage for yellow fever. The MICS 2016-17 survey also showed that about half of women with a live birth in the last two years prior to the survey received antenatal tetanus toxoid, which protected against neonatal tetanus.

In terms of malaria prevention during pregnancy, only one out of six women received adequate doses (three or more) of SP/Fansidar during their last pregnancy that led to live birth in the last two years. Reported illnesses in under-five children, two weeks preceding survey, are diarrhoea in 14.3 percent, ARI in 3 percent, and malaria fever in 25.4 percent of children under five.

Water and Sanitation

Access to safe and clean drinking water and sanitation is essential to human health. Sixty-four percent of household members use improved sources of drinking water. Only 2.3 percent of households using unimproved drinking water sources have appropriate water treatment method. About fifty-two percent of household population use improved sanitation facility, mostly using pit latrine with slab and flush or pour flush into septic tank. 2 in 3 household members use shared improved sanitation facilities. Overall, 26.5 percent of households have both improved drinking water source and improved sanitation facility. One in 10 households have a specific place for handwashing where water and soap or other cleansing agents are present. There are differentials across social groups in Nigeria.

E.Coli contaminated drinking water is high and of public health concern as 90.8 percent of household members in Nigeria drink faecal contaminated water. Percentage of Household with improved drinking water sources accessible on the premises, available when needed, and free from faecal contamination is remarkably low 3.7 percent.

Reproductive Health

Fertility is high in the Nigerian population, as a woman will have about 6 children over her childbearing years. Adolescent birth rate is 120 per 1,000 women in the 15-19 age group. Adolescent fertility differentials per 1,000 women age 15-19 are: 59 in urban; 154 in rural; 35 in the richest quantile; 199 in the poorest quantile; 9 in women with higher education; 232 in women with non-formal education. Also, three in 10 women age 20-24 have had a live birth before age 18.

One out of 8 women currently married or in union are using contraception (13.4 percent). Unmet need for family planning in Nigeria is 27.6 percent. The most commonly used contraceptive methodis injectable (4.3% percent). Contraceptive prevalence ranges from 7.6 percent in North-East to 25.8 percent in South-West. About 21 percent of married women in urban areas and 10 percent in rural areas use a method of contraception. Adolescents are far less likely to use contraception than older women.

About 65.8 percent received antenatal care from a skilled provider and 49.1 percent of women with a live birth in the last two years had adequate antenatal visit (four or more antenatal visits). Two out of 5 of births were delivered by skilled personnel- doctor, nurse, midwife or auxiliary midwife. Assistance by skilled birth attendant is as low as 23.6 percent in North-West and as high as 90.7 percent in the South-East. 37.5 percent of women age 15-49 used health facility for their last delivery;24.4 percent in public health facilities and 13.1 percent in private health facilities.

Early childhood development

One out of 3 children attends organized early childhood education programme in Nigeria, with more children in Southern regions than Northern part. About two-thirds (62.8 percent) of the children have an adult household member engage them on four or more activities that promote learning and school readiness. Involvement of biological father and mother in activities that support early learning is as low as 10.8 percent and 28.1 percent respectively. Only 5.6 percent of the children live in households where there are at least 3 children’s books accessible to the child. Three in 5 children age 36-59 months are developmentally on track in at least three of the four early childhood development domains. One third of children were left with inadequate care either by being left alone or in the care of another child.

Literacy and Education

The percentage of young people age 15-24 years who can read a short simple statement about everyday life or who attended secondary or higher education was used in the survey to estimate literacy rate. Literacy rate is 59.3 percent for women and 79.9 percent for men age 15-24. The rate is very low among young women and men in Niger, Bauchi, Gombe, Yobe, Jigawa, Katsina, Kebbi, Sokoto and Zamfara, which are all in the Northern region of Nigeria. School readiness is also low as 39 percent of children in the first grade of primary school attended pre-school the previous year.

Net intake rate in primary education is 39.4 percent. One third of children of school-entry age were enrolled in first grade of primary school. Three in 5 of primary school age children and two in 5 secondary school age children are currently attending school. 94 percent of children reach final grade (primary 6) in government-owned primary school.

Primary school completion rate is 63 percent. This implies that six in 10 children of primary completion age of 11 years are in the last grade of primary education. Transition rate to secondary school is 49 percent. Gender parity for primary school is 0.95, and 0.97 for secondary school.

Child protection

Forty-seven percent of children under age 5 have their birth registered under civil authority. About 50 percent of children are involved in child labour, while 39 percent are working under hazardous condition. In Nigeria, about 85 percent of children age 1-14 years were subjected to at least one form of violent discipline.

Early marriage and domestic violence

The percentage of women who married before age 15 years in Nigeria is 18.5 percent. Forty-four percent of women age 20-49 years married before age 18 years. About 18.4 percent of women had some form of female genital mutilation. One in three women in Nigeria feel that a husband/partner is justified in hitting or beating his wife in at least one of the five situations.

HIV/AIDS and Sexual Behaviour

Majority of young people have heard of HIV/AIDS but few have correct and comprehensive knowledge of the disease. Twenty-nine percent of women and thirty-four percent of men have knowledge of the two main ways of HIV prevention. About half of the women can identify the 3 ways of HIV transmission from mother to child. Stigma and discrimination is still high in Nigeria because only one in ten persons in Nigeria have accepting attitude towards people living with HIV.

Seven out of ten men and six out of ten women know where to do HIV test. In addition, only 1 in 7 have been tested and know the result of test in the last 12 months. More men know where to go for test, but more women actually do the test before or in the last 12 months to the survey.

Early sexual debut is higher in the Northern Nigeria, among female age 15-24 who do not have formal education, married, live in poorest wealth quintile household and in rural areas. Other risk factors for HIV/AIDS are having multiple sexual partner and sex with a non-marital, non-cohabiting partner, as well as age-mixing among sexual partner; very few women age 15-49 (2 percent) had sex with more than one partner in the last 12 months. Percentage of men (11 percent) who were engaged in the same risky sexual behaviour is higher than female. Age mixing is a common practice as 2 in 5 young women (41 percent) age 15-24 reported that they had sex with a man 10 or more years older. Age mixing is notably high in North West, rural areas, among ever married women, no education women and poor households.

Sixty-one percent of young men and 47 percent of young women who had sex with non-marital and non-cohabiting partners reported use of condom during the last sex in the last 12 months preceding the survey. Condom use among different social groups who are involved in non-regular sex is specifically higher in South East, urban areas, age group 23-24 year, never married, higher education and richest wealth index quintile household.

Access to Mass Media and Use of Information/Communication Technology

Exposure to specific media (newspapers/magazines, radio and television) at least once a week among young people is low - 5.5 percent of young women and 18.5 percent of young men. South west has the highest media exposure: 91.7 percent of males and 80.7 percent of female exposed to at least one of the three media sources in a week. Exposure to computer and the internet is also low.

13.4 percent of young women and 20.6 percent of young men had used computer during the last 12 months. Also, 17.3 percent of young women and 32 percent of young men had used the internet during the last 12 months.

Subjective well-being

At least nine in 10 young women and men age 15-24 years are very or somewhat happy. Young people who are happy are more than those who are satisfied with life, and those who are satisfied with life are more than those who perceived a better life. Zamfara (97.8 percent) and Akwa-Ibom (99.6 percent) have the highest percentage of young women and men who have overall life satisfaction respectively. Seven in 10 young women and men perceived that their lives improved during the last one year and expect that it will get better after one year.

Tobacco and Alcohol Use

Use of tobacco products is higher among men than women in the last one month: 6.9 percent of men and 0.3 percent of women use Tobacco products. Proportion of people age 15-49 who smoked a whole cigarette before age 15 years is 1.6 percent of men and 0.2 percent of women.

Use of alcohol is also higher among men than women in the last one month as 19.4 percent of men use alcohol while 6.4 percent of women use alcohol. Percentage of people age 15-49 who had at least one alcoholic drink whole before age 15 years is 5.5 percent of men and 3.3 percent of women.

Kind of Data

Sample survey data [ssd]

Units of Analysis

Individuals and Households.