Nigeria - Demographic and Health Survey - 2009

Publication date: 2009

Nigeria 2008Demographic andHealth SurveyDemographic and H ealth Survey N igeria 2008 Nigeria Demographic and Health Survey 2008 National Population Commission Federal Republic of Nigeria Abuja, Nigeria ICF Macro Calverton, Maryland, USA November 2009 The 2008 Nigeria Demographic and Health Survey (2008 NDHS) was implemented by the National Population Commission (NPC) and fielded from June to October 2008. ICF Macro provided technical assistance as well as funding to the survey through MEASURE DHS, a project funded by the United States Agency for International Development (USAID) that provides support and technical assistance for the implementation of population and health surveys in countries worldwide. Funding for the survey was provided by USAID and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Funding for the household listing and additional fieldwork support was provided by the United Nations Population Fund (UNFPA). The views expressed in this publication are those of the authors and do not necessarily reflect the views of the Government of Nigeria, the United States Government, or donor organizations. Additional information about the 2008 NDHS may be obtained from the headquarters of the National Population Commission, Plot 2031, Olusegun Obasanjo Way, Zone 7 Wuse, PMB 0281, Abuja, Nigeria; Telephone: (234) 09 523-9173, Fax: (234) 09 523-1024. Information about the DHS programme may be obtained from the MEASURE DHS Project, ICF Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA; Telephone: 301-572-0200, Fax: 301-572-0999, E- mail: reports@macrointernational.com, Internet: http://www.measuredhs.com. Recommended citation: National Population Commission (NPC) [Nigeria] and ICF Macro. 2009. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro. Contents | iii CONTENTS Page TABLES AND FIGURES .xi PREFACE . xxiii SUMMARY OF FINDINGS . xxv MILLENNIUM DEVELOPMENT GOAL INDICATORS .xxix MAP OF NIGERIA . xxx CHAPTER 1 INTRODUCTION 1.1 History, Geography, and Economy of Nigeria .1 1.1.1 History.1 1.1.2 Geography.1 1.1.3 Economy .2 1.2 Population and Basic Demographic Indicators.2 1.3 Population and Health Policies and Programmes.3 1.3.1 Population Policies and Programmes .3 1.3.2 Health Policies and Programmes.4 1.4 Education.5 1.5 Organisation and Objectives of the 2008 Nigeria Demographic and Health Survey .6 1.5.1 Sample Design.6 1.5.2` Questionnaires .7 1.5.3 Pre-test Activities .8 1.5.4 Training of Field Staff .8 1.5.5 Fieldwork .8 1.5.6 Data Processing .9 1.6 Response Rates .9 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Population by Age and Sex.11 2.2 Household Composition .13 2.3 Education o the Household Population .13 2.3.1 Educational Attainment.14 2.3.2 School Attendance Rates .17 2.3.3 Grade Repetition and Drop-out Rates.19 2.4 Household Environment.20 2.4.1 Drinking Water.20 2.4.2 Household Sanitation Facilities .22 2.4.3 Housing Characteristics.23 iv │ Contents 2.5 Household Possessions.25 2.6 Wealth Index .25 2.7 Birth Registration.26 2.8 Neglected Tropical Diseases (NTDs) .28 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS 3.1 Characteristics of Survey Respondents.31 3.2 Educational Attainment by Background Characteristics.33 3.3 Literacy .34 3.4 Access to Mass Media .36 3.5 Employment .38 3.6 Occupation.41 3.7 Earnings, Employers, and Continuity of Employment .43 3.8 Health Insurance Coverage .44 3.9 Knowledge and Attitudes Regarding Tuberculosis .46 3.10 Tobacco Use.48 CHAPTER 4 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS 4.1 Introduction.51 4.2 Current Fertility.51 4.3 Fertility Differentials .53 4.4 Fertility Trends .55 4.5 Children Ever Born and Living.56 4.6 Birth Intervals.57 4.7 Age at First Birth.59 4.8 Teenage Pregnancy and Motherhood.60 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods.63 5.2 Ever Use of Contraception .65 5.3 Current Use of Contraceptive Methods .68 5.4 Differentials in Contraceptive Use by Background Characteristics.69 5.5 Trends in Contraceptive Use .72 5.6 Number of Children at First Use of Contraception.73 5.7 Brands of Pills, Condoms, and Injectables Used.73 5.8 Knowledge of the Fertile Period .76 5.9 Timing of Sterilisation.77 5.10 Source of Contraception .78 5.11 Cost of Contraception .79 5.12 Informed Choice.80 5.13 Future Use of Contraception .81 5.14 Reasons for Not Intending to Use Contraception in the Future .82 5.15 Preferred Method for Future Use .83 5.16 Exposure to Family Planning Messages in the Media.83 5.16.1 Exposure to Specific Family Planning Messages .85 5.16.2 Exposure to Family Planning Information through Peer Groups, School, or Community Leaders.86 Contents | v 5.17 Contact of Non-users with Family Planning Providers .87 5.18 Husband/Partner’s Knowledge of Women’s Contraceptive Use .89 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Current Marital Status .91 6.2 Polygyny .92 6.3 Age at First Marriage .94 6.4 Median Age at First Marriage.95 6.5 Age at First Sexual Intercourse.96 6.6 Recent Sexual Activity .99 6.7 Postpartum Amenorrhoea, Abstinence, and Insusceptibility. 102 6.8 Menopause. 104 CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for More Children . 105 7.2 Desire to Limit Childbearing. 107 7.3 Need for Family Planning Services. 109 7.4 Ideal Family Size . 113 7.5 Fertility Planning . 115 7.6 Wanted Fertility Rates . 116 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Background and Assessment of Data Quality. 117 8.2 Infant and Child Mortality Levels and Trends. 118 8.3 Socio-Economic Differentials in Infant and Child Mortality . 120 8.4 Demographic Differentials in Childhood Mortality . 121 8.5 Perinatal Mortality. 122 8.6 High-Risk Fertility Behaviour . 124 CHAPTER 9 MATERNAL HEALTH AND OBSTETRIC FISTULA 9.1 Antenatal Care . 125 9.2 Number of ANC Visits and Timing of First Visit. 127 9.3 Components of Antenatal Care . 128 9.4 Tetanus Toxoid Injections . 130 9.5 Place of Delivery. 132 9.6 Assistance during Delivery. 133 9.7 Postnatal Care. 135 9.8 Perceived Problems in Accessing Health Care . 137 9.9 Obstetric Fistula . 139 9.9.1 Knowledge of Obstetric Fistula . 140 9.9.2 Characteristics of Labour Reported as Cause of Fistula Symptoms. 141 CHAPTER 10 CHILD HEALTH 10.1 Child’s Weight at Birth . 143 10.2 Vaccination of Children. 145 vi │ Contents 10.2.1 Trends in Vaccination Coverage. 147 10.2.2 Reasons for Not Receiving Vaccinations . 149 10.3 Acute Respiratory Infection . 151 10.4 Fever. 153 10.5 Prevalence of Diarrhoea. 155 10.6 Diarrhoea Treatment. 157 10.7 Feeding Practices . 158 10.8 Knowledge of ORS Packets . 160 10.9 Stool Disposal . 160 CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS 11.1 Nutritional Status of Children . 163 11.1.1 Measurement of Nutritional Status among Young Children . 163 11.1.2 Results of Data Collection . 164 11.1.3 Trends in Malnutrition . 167 11.2 Initiation of Breastfeeding. 167 11.3 Breastfeeding Status by Age. 170 11.4 Duration and Frequency of Breastfeeding . 172 11.5 Types of Complementary Foods . 173 11.6 Infant and Young Child Feeding (IYCF) Practices . 174 11.7 Micronutrient Intake among Children. 177 11.8 Presence of Iodised Salt in Households . 180 11.9 Nutritional Status of Women. 181 11.10 Foods Consumed by Mothers. 182 11.11 Micronutrient Intake among Mothers . 183 CHAPTER 12 MALARIA 12.1 Introduction. 187 12.2 Mosquito Nets . 187 12.2.1 Ownership of Mosquito Nets . 187 12.2.2 Use of Mosquito Nets by Children under Age Five . 189 12.2.3 Use of Mosquito Nets by All Women and Pregnant Women Age 15-49. 190 12.2.4 Trends in Mosquito Net Ownership and Use . 192 12.3 Prophylactic Use of Anti-malarial Drugs and Use of Intermittent Preventive Treatment in Pregnant Women. 192 12.4 Prevalence and Prompt Treatment of Fever in Children under Age Five . 194 12.5 Availability at Home of Anti-malarial Drugs Taken by Children with Fever. 196 CHAPTER 13 HIV AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR 13.1 Introduction. 197 13.2 HIV and AIDS Knowledge, Transmission and Prevention Methods . 198 13.2.1 Awareness of HIV and AIDS . 198 Contents | vii 13.2.2 Knowledge of HIV Prevention. 199 13.2.3 Rejection of Misconceptions about HIV and AIDS . 200 13.3 Knowledge about Mother-to-Child Transmission . 203 13.4 Attitudes towards People Living with HIV and AIDS . 205 13.5 Attitudes towards Negotiating Safer Sexual Relations with Husbands . 207 13.6 Attitudes towards Condom Education for Youth . 209 13.7 Perceptions and Beliefs about Abstinence and Faithfulness. 210 13.8 Higher-Risk Sex. 210 13.9 Payment for Sex. 213 13.10 Coverage of HIV Testing Services . 215 13.11 Male Circumcision . 218 13.12 Self-Reporting of Sexually Transmitted Infections. 219 13.13 Prevalence of Medical Injections . 221 13.14 HIV and AIDS-Related Knowledge and Behaviour Among Youth. 223 13.14.1 Knowledge about HIV and AIDS and Sources for Condoms . 223 13.14.2 Age at First Sexual Intercourse . 225 13.14.3 Trends in Age at First Sexual Intercourse . 226 13.14.4 Condom Use at First Sex. 227 13.14.5 Premarital Sex . 228 13.14.6 Higher-Risk Sexual Intercourse . 229 13.14.7 Age-mixing in Sexual Relationships . 232 13.14.8 Drunkenness during Sexual Intercourse . 232 13.14.9 HIV Testing. 233 CHAPTER 14 ADULT AND MATERNAL MORTALITY 14.1 Data. 235 14.2 Direct Estimates of Adult Mortality . 236 14.3 Direct Estimates of Maternal Mortality. 237 CHAPTER 15 WOMEN’S EMPOWERMENT AND HEALTH OUTCOMES 15.1 Women’s and Men’s Employment . 239 15.1.1 Employment Status. 240 15.2 Women’s Control over Their Own Earnings and Relative Magnitude of Women’s Earnings . 240 15.3 Women’s Participation in Decision-Making. 243 15.4 Attitudes towards Wife Beating . 247 15.5 Attitudes towards Refusing Sex with Husband . 250 15.6 Women’s Empowerment Indicators . 254 15.7 Current Use of Contraception By Woman’s Empowerment Status . 255 15.8 Ideal Family Size and Unmet Need by Women’s Status. 256 15.9 Women’s Status and Reproductive Health Care . 257 15.10 Women’s Status and Early Childhood Mortality . 258 CHAPTER 16 DOMESTIC VIOLENCE 16.1 Women Experiencing Physical Violence . 262 viii │ Contents 16.2 Perpetrators of Physical Violence. 264 16.3 Experience of Sexual Violence . 264 16.4 Age at First Experience of Sexual Violence. 265 16.5 Persons Committing Sexual Violence. 266 16.6 Experience of Different Forms of Violence . 267 16.7 Violence during Pregnancy. 267 16.8 Marital Control by Husband or Partner. 268 16.9 Forms of Spousal Violence . 271 16.10 Spousal Violence by Background Characteristics . 273 16.11 Violence by Spousal Characteristics and Women’s Indicators . 275 16.12 Frequency of Spousal Violence . 277 16.13 Onset of Spousal Violence . 278 16.14 Types of Injuries to Women because of Spousal Violence . 279 16.15 Violence by Women Against Their Spouse . 279 16.16 Help-seeking Behaviour by Women who Experience Violence. 282 16.17 Sources of Help . 284 CHAPTER 17 ORPHANS AND VULNERABLE CHILDREN 17.1 Orphaned and Vulnerable Children . 285 17.1.1 Children’s Living Arrangements and Orphanhood 17.1.2 Orphaned and Vulnerable Children. 286 17.2 Social and Economic Situation of Orphaned and Vulnerable Children. 288 17.2.1 School Attendance. 288 17.2.2 Basic Material Needs . 289 17.2.3 Orphans Living with Siblings . 290 17.2.4 Nutritional Status . 291 17.3 Care and Support for OVCs . 293 17.3.1 Succession Planning. 293 17.3.2 External Support for Households with OVCs . 296 CHAPTER 18 FEMALE GENITAL CUTTING 18.1 Knowledge and Prevalence of Female Genital Cutting. 299 18.2 Flesh Removal and Infibulation . 301 18.3 Age at Circumcision . 301 18.4 Person Who Performed Circumcision. 302 18.5 Circumcision of Daughters . 304 18.6 Reasons for Supporting Female Circumcision . 305 18.7 Attitudes towards Female Circumcision . 307 APPENDIX A STATE TABLES . 317 APPENDIX B SURVEY DESIGN .457 APPENDIX C ESTIMATES OF SAMPLING ERRORS.463 APPENDIX D DATA QUALITY TABLES. 477 Contents | ix APPENDIX E NUTRITIONAL STATUS OF CHILDREN: 2008 NDHS DATA ACCORDING TO THE NCHS/CDC/WHO INTERNATIONAL REFERENCE POPULATION . 483 APPENDIX F PERSONS INVOLVED IN THE 2008 NIGERIA DEMOGRAPHIC AND HEALTH SURVEY. 485 APPENDIX G QUESTIONNAIRES .497 Tables and Figures | xi TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Basic demographic indicators. 3 Table 1.2 Results of the household and individual interviews. 9 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence.12 Table 2.2 Household composition.13 Table 2.3.1 Educational attainment of the female household population .15 Table 2.3.2 Educational attainment of the male household population .16 Table 2.4 School attendance ratios .18 Table 2.5 Grade repetition and drop-out rates.19 Table 2.6 Household drinking water.21 Table 2.7 Household sanitation facilities.22 Table 2.8 Household characteristics .24 Table 2.9 Household durable goods .25 Table 2.10 Wealth quintiles.26 Table 2.11 Birth registration of children under age five .27 Table 2.12 Birth registration of children under age five by authority .28 Table 2.13 Neglected tropical diseases reported in households.30 Figure 2.1 Population Pyramid .12 Figure 2.2 Percent Distribution of Household Population with No Education by Sex.17 Figure 2.3 Age-Specific Attendance Rates of the De Facto Population Age 5 to 24 by Sex.20 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents .32 Table 3.2.1 Educational attainment: Women.33 Table 3.2.2 Educational attainment: Men .34 Table 3.3.1 Literacy: Women .35 Table 3.3.2 Literacy: Men .36 Table 3.4.1 Exposure to mass media: Women.37 Table 3.4.2 Exposure to mass media: Men .38 Table 3.5.1 Employment status: Women .39 Table 3.5.2 Employment status: Men.40 Table 3.6.1 Occupation: Women.41 Table 3.6.2 Occupation: Men .42 Table 3.7.1 Type of employment: Women.43 Table 3.7.2 Type of employment: Men .44 Table 3.8.1 Health insurance coverage: Women .45 Table 3.8.2 Health insurance coverage: Men.46 xii | Tables and Figures Table 3.9.1 Knowledge and attitudes concerning tuberculosis: Women.47 Table 3.9.2 Knowledge and attitudes concerning tuberculosis: Men .48 Table 3.10.1 Use of tobacco: Women.49 Table 3.10.2 Use of tobacco: Men .50 CHAPTER 4 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS Table 4.1 Current fertility .52 Table 4.2 Fertility by background characteristics .54 Table 4.3 Trends in age-specific fertility rates.55 Table 4.4 Trends in age-specific and total fertility rates, various sources.55 Table 4.5 Children ever born and living.57 Table 4.6 Birth intervals.58 Table 4.7 Age at first birth .59 Table 4.8 Median age at first birth .60 Table 4.9 Teenage pregnancy and motherhood.61 Figure 4.1 Age-Specific Fertility Rates by Urban-Rural Residence.52 Figure 4.2 Total Fertility Rates of Selected West African Countries .53 Figure 4.3 Fertility Differentials by Zone .54 Figure 4.4 Trends in Age-Specific Fertility Rates, 1991-2008.56 Figure 4.5 Percentage of Teenagers Who Have Begun Childbearing and Who Are Pregnant With Their First Child, by Age .61 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods .64 Table 5.2 Knowledge of contraceptive methods by background characteristics .65 Table 5.3.1 Ever use of contraception: Women .66 Table 5.3.2 Ever use of contraception: Men .68 Table 5.4 Current use of contraception by age .70 Table 5.5 Current use of contraception by background characteristics .71 Table 5.6 Trends in current use of contraception.72 Table 5.7 Number of children at first use of contraception .73 Table 5.8 Use of social marketing brand pills and injectables: women .74 Table 5.9 1 Use of social marketing brand condoms: women .75 Table 5.9.2 Use of social marketing brand condoms: men.76 Table 5.10 Knowledge of fertile period.77 Table 5.11 Timing of sterilisation .77 Table 5.12 Source of modern contraception methods .78 Table 5.13 Cost of modern contraceptive methods.80 Table 5.14 Informed choice .81 Table 5.15 Future use of contraception .82 Table 5.16 Reason for not intending to use contraception in the future .82 Table 5.17 Preferred method of contraception for future use.83 Table 5.18 Exposure to family planning messages .84 Table 5.19 Exposure to specific family planning messages.86 Table 5.20 Exposure to family planning messages through peer groups, school, or community leaders .87 Table 5.21 Contact of non-users with family planning providers .88 Table 5.22 Husband/partner's knowledge of women's use of contraception .89 Tables and Figures | xiii Figure 5.1 Trends in Contraceptive Prevalence, NDHS 1990-2008.72 Figure 5.2 Source of Family Planning Methods among Current Users of Modern Methods .79 Figure 5.3 Percentage of Men and Women Exposed to Family Planning Messages.85 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status .91 Table 6.2.1 Number of women's co-wives .92 Table 6.2.2 Number of men's wives.93 Table 6.3 Age at first marriage .94 Table 6.4.1 Median age at first marriage: Women .95 Table 6.4.2 Median age at first marriage: Men.96 Table 6.5 Age at first sexual intercourse .97 Table 6.6.1 Median age at first intercourse: Women .98 Table 6.6.2 Median age at first intercourse: Men.98 Table 6.7.1 Recent sexual activity: Women .99 Table 6.7.2 Recent sexual activity: Men . 101 Table 6.8 Post-partum amenorrhoea, abstinence and insusceptibility . 102 Table 6.9 Median duration of amenorrhoea, post-partum abstinence and Post-partum insusceptibility . 103 Table 6.10 Menopause. 104 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children . 106 Table 7.2.1 Desire to limit childbearing: Women . 108 Table 7.2.2 Desire to limit childbearing: Men. 109 Table 7.3.1 Need and demand for family planning among currently married women . 110 Table 7.3.2 Need and demand for family planning for all women and for women who are not currently married . 112 Table 7.4 Ideal number of children . 114 Table 7.5 Mean ideal number of children. 115 Table 7.6 Fertility planning status. 116 Table 7.7 Wanted fertility rates. 116 Figure 7.1 Percentage of Currently Married Women and Men Who Want No More Children, by Number of Living Children . 107 Figure 7.2 Unmet Need for Family Planning for Currently Married Women by Residence and Zones . 111 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates . 119 Table 8.2 Trends in early childhood mortality. 120 Table 8.3 Childhood mortality rates by socio-economic characteristics . 121 Table 8.4 Early childhood mortality rates by demographic characteristics. 122 Table 8.5 Perinatal mortality. 123 Table 8.6 High-risk fertility behaviour . 124 xiv | Tables and Figures Figure 8.1 Mortality Trends. 119 CHAPTER 9 MATERNAL HEALTH AND OBSTETRIC FISTULA Table 9.1 Antenatal care. 126 Table 9.2 Number of antenatal care visits and timing of first visit . 128 Table 9.3 Components of antenatal care . 129 Table 9.4 Tetanus toxoid injections . 131 Table 9.5 Place of delivery . 132 Table 9.6 Assistance during delivery . 134 Table 9.7 Timing of first postnatal check-up . 136 Table 9.8 Provider of first postnatal check-up . 137 Table 9.9 Problems in accessing health care . 138 Table 9.10 Knowledge of fistula and experience of fistula-like symptoms. 140 Table 9.11 Characteristics of labour reported as cause of fistula symptoms . 141 Figure 9.1 Place of Delivery. 133 Figure 9.2 Problems in Accessing Health Care . 139 CHAPTER 10 CHILD HEALTH Table 10.1 Child's weight and size at birth. 144 Table 10.2 Vaccinations by source of information. 146 Table 10.3 Vaccinations by background characteristics . 147 Table 10.4 Vaccinations in first year of life. 148 Table 10.5 Vaccinations received during national immunisation day campaigns . 149 Table 10.6 Reasons for child not receiving any vaccines . 150 Table 10.7 Reasons for child not receiving any polio vaccine. 151 Table 10.8 Prevalence and treatment of symptoms of ARI . 152 Table 10.9 Prevalence and treatment of fever. 154 Table 10.10 Availability at home of anti-malarial drugs taken by children . 155 Table 10.11 Prevalence of diarrhoea . 156 Table 10.12 Diarrhoeal treatment . 157 Table 10.13 Feeding practices during diarrhoea . 159 Table 10.14 Knowledge of ORS packets or pre-packaged liquids. 160 Table 10.15 Disposal of children's stools. 161 CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS Table 11.1 Nutritional status of children . 165 Table 11.2 Initial breastfeeding. 168 Table 11.3 Breastfeeding status by age . 170 Table 11.4 Median duration and frequency of breastfeeding . 172 Table 11.5 Foods and liquids consumed by children in the day and night preceding the interview . 174 Table 11.6 Infant and young child feeding (IYCF) practices . 176 Table 11.7 Micronutrient intake among children . 179 Table 11.8 Presence of iodised salt in household. 180 Table 11.9 Nutritional status of women . 182 Table 11.10 Foods consumed by mothers in the day and night preceding the interview. 183 Tables and Figures | xv Table 11.11 Micronutrient intake among mothers . 184 Figure 11.1 Nutritional Status of Children by Age . 166 Figure 11.2 Trends in Nutritional Status of Children Under Five, 2003 NDHS and 2008 NDHS. 167 Figure 11.3 Among Last Children Born in the Five Years Preceding the Survey Who Ever Received a Prelacteal Liquid, the Percentage Who Received Specific Liquids. 169 Figure 11.4 Infant Feeding Practices by Age. 171 Figure 11.5 Trends in Infant Feeding Practices for Children 0-5 Months and 6-9 Months, 2003 NDHS and 2008 NDHS. 171 Figure 11.6 Infant and Young Child Feeding (IYCF) Practices . 177 CHAPTER 12 MALARIA Table 12.1 Ownership of mosquito nets . 188 Table 12.2 Use of mosquito nets by children. 189 Table 12.3 Use of mosquito nets by women. 190 Table 12.4 Use of mosquito nets by pregnant women . 191 Table 12.5 Prophylactic use of anti-malarial drugs and use of Intermittent Preventive Treatment (IPT) by women during pregnancy. 193 Table 12.6 Prevalence and prompt treatment of fever . 195 Table 12.7 Type and timing of anti-malarial drugs . 196 Table 12.8 Availability at home of anti-malarial drugs taken by children with fever. 196 Figure 12.1 Trends in Net Ownership and Use, NDHS 2003 AND NDHS 2008. 192 CHAPTER 13 HIV AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR Table 13.1 Knowledge of AIDS. 198 Table 13.2 Knowledge of HIV prevention methods. 200 Table 13.3.1 Comprehensive knowledge about HIV and AIDS: Women . 201 Table 13.3.2 Comprehensive knowledge about HIV and AIDS: Men. 202 Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV. 204 Table 13.5.1 Accepting attitudes towards persons living with HIV or AIDS: Women . 206 Table 13.5.2 Accepting attitudes towards persons living with HIV or AIDS: Men . 207 Table 13.6 Attitudes toward negotiating safer sexual relations with husband . 208 Table 13.7 Adult support of education about condom use to prevent transmission of HIV. 209 Table 13.8.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Women . 211 Table 13.8.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Men. 212 Table 13.9 Payment for sexual intercourse and condom use at last paid sexual intercourse: Men . 214 Table 13.10.1 Coverage of prior HIV testing: Women . 215 Table 13.10.2 Coverage of prior HIV testing: Men. 216 Table 13.11 Pregnant women counselled and tested for HIV. 218 Table 13.12 Male circumcision. 219 xvi | Tables and Figures Table 13.13 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms. 220 Table 13.14 Prevalence of medical injections . 222 Table 13.15 Comprehensive knowledge about HIV and AIDS and of a source of condoms among youth . 224 Table 13.16 Age at first sexual intercourse among youth. 225 Table 13.17 Condom use at first sexual intercourse among youth. 227 Table 13.18 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth. 228 Table 13.19.1 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: Women . 230 Table 13.19.2 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: Men. 231 Table 13.20 Age-mixing in sexual relationships among women age 15-19 . 232 Table 13.21 Drunkenness during sexual intercourse among youth. 233 Table 13.22 Recent HIV tests among youth . 234 Figure 13.1 Perception and Beliefs about Abstinence and Faithfulness . 210 Figure 13.2 Women and Men Seeking Advice or Treatment for STIs. 221 Figure 13.3 Trends in Age at First Sexual Intercourse . 226 CHAPTER 14 ADULT AND MATERNAL MORTALITY Table 14.1 Completeness of reporting on siblings . 235 Table 14.2 Adult mortality rates and trends . 236 Table 14.3 Direct estimates of maternal mortality . 237 Figure 14.1 Adult Mortality Rates among Women and Men Age 15-49. 237 CHAPTER 15 WOMEN’S EMPOWERMENT AND HEALTH OUTCOMES Table 15.1 Employment and cash earnings of currently married women and men . 240 Table 15.2.1 Control over women's cash earnings and relative magnitude of women's earnings: Women. 241 Table 15.2.2 Control over men's cash earnings . 242 Table 15.3 Women's control over their own earnings and the earnings of their husband. 243 Table 15.4.1 Women's participation in decision-making . 244 Table 15.4.2 Women's participation in decision-making according to men . 244 Table 15.5.1 Women's participation in decision-making by background characteristics . 245 Table 15.5.2 Men's attitude towards wives' participation in decision-making. 246 Table 15.6.1 Attitudes towards wife beating: Women. 248 Table 15.6.2 Attitudes towards wife beating: Men . 249 Table 15.7.1 Attitudes towards refusing sexual intercourse with husband: Women. 251 Table 15.7.2 Attitudes towards refusing sexual intercourse with husband: Men . 252 Table 15.7.3 Men's attitudes towards a husband's rights when his wife refuses to have sexual intercourse. 253 Table 15.8 Indicators of women's empowerment. 255 Table 15.9 Current use of contraception by women's status. 256 Tables and Figures | xvii Table 15.10 Women's empowerment and ideal number of children and unmet need for family planning . 257 Table 15.11 Reproductive health care by women's empowerment . 258 Table 15.12 Early childhood mortality rates by women's status . 259 CHAPTER 16 DOMESTIC VIOLENCE Table 16.1 Experience of physical violence. 263 Table 16.2 Persons committing physical violence . 264 Table 16.3 Experience of sexual violence . 265 Table 16.4 Age at first experience of sexual violence . 266 Table 16.5 Persons committing sexual violence . 266 Table 16.6 Experience of different forms of violence . 267 Table 16.7 Violence during pregnancy . 268 Table 16.8 Degree of marital control exercised by husbands . 270 Table 16.9 Forms of spousal violence . 272 Table 16.10 Spousal violence by background characteristics. 274 Table 16.11 Spousal violence by husband's characteristics and empowerment indicators. 276 Table 16.12 Frequency of spousal violence among those who report violence. 277 Table 16.13 Onset of marital violence . 278 Table 16.14 Injuries to women due to spousal violence. 279 Table 16.15 Violence by women against their spouse. 280 Table 16.16 Help-seeking to stop violence . 283 Table 16.17 Sources from where help was sought . 284 Figure 16.1 Forms of Spousal Violence . 273 CHAPTER 17 ORPHANS AND VULNERABLE CHILDREN Table 17.1 Children's living arrangements and orphanhood. 286 Table 17.2 Orphans and vulnerable children (OVC) . 287 Table 17.3 School attendance by survivorship of parents and by OVC status . 289 Table 17.4 Possession of basic material needs by orphans and vulnerable children. 290 Table 17.5 Orphan not living with siblings . 291 Table 17.6 Underweight orphans and vulnerable children. 292 Table 17.7 Sexual intercourse before age 15 among orphans and vulnerable children . 293 Table 17.8 Succession planning. 294 Table 17.9 Widows dispossessed of property. 295 Table 17.10 External support for very sick persons. 296 Table 17.11 External support for orphans and vulnerable children. 297 CHAPTER 18 FEMALE GENITAL CUTTING Table 18.1 Knowledge and prevalence of female circumcision . 300 Table 18.2 Age at circumcision. 302 Table 18.3 Person who performed circumcision . 303 Table 18.4 Daughter's circumcision experience and type of circumcision . 304 Table 18.5 Selected characteristics of daughter's circumcision . 305 Table 18.6.1 Perceived benefits of female circumcision: Women . 306 xviii | Tables and Figures Table 18.6.2 Perceived benefits of female circumcision: Men. 307 Table 18.7.1 Attitudes towards continuation of female circumcision: Women . 308 Table 18.7.2 Attitudes towards continuation of female circumcision: Men. 309 APPENDIX A STATE TABLES Table A-2.3.1 Educational attainment of the female household population: States . 317 Table A-2.3.2 Educational attainment of the male household population: States . 318 Table A-2.4 School attendance ratios: States . 319 Table A-2.6.1 Household drinking water: Zones . 321 Table A-2.6.2 Household drinking water: States. 322 Table A-2.7.1 Household sanitation facilities: Zones . 324 Table A-2.7.2 Household sanitation facilities: States. 325 Table A-2.8.1 Household access to electricity: Zones. 327 Table A-2.8.2 Household access to electricity: States . 328 Table A-2.11 Birth registration of children under age five: States. 330 Table A-2.12 Birth registration of children under age five by authority: States . 331 Table A-2.13 Neglected tropical diseases reported in households: States. 332 Table A-3.1 Background characteristics of respondents . 333 Table A-3.2.1 Educational attainment: Women by state. 334 Table A-3.2.2 Educational attainment: Men by state . 335 Table A-3.3.1 Literacy: Women by state . 336 Table A-3.3.2 Literacy: Men by state. 337 Table A-3.4.1 Exposure to mass media: Women by state . 338 Table A-3.4.2 Exposure to mass media: Men by state. 339 Table A-3.5.1 Employment status: Women by state . 340 Table A-3.5.2 Employment status: Men by state. 341 Table A-3.6.1 Occupation: Women by state . 342 Table A-3.6.2 Occupation: Men by state . 343 Table A-3.7.1 Type of earnings: Women by state . 344 Table A-3.7.2 Type of earnings: Men by state . 345 Table A-3.7.3 Type of employer: Women by state . 346 Table A-3.7.4 Type of employer: Men by state . 347 Table A-3.7.5 Continuity of employment: Women by state. 348 Table A-3.7.6 Continuity of employment: Men by state . 349 Table A-3.9.1 Knowledge and attitudes concerning tuberculosis: Women by state . 350 Table A-3.9.2 Knowledge and attitudes concerning tuberculosis: Men by state . 351 Table A-4.2 Fertility by state of residence: States. 352 Table A-4.5 Birth intervals: States. 353 Table A-4.8 Median age at first birth: States . 354 Table A-4.9 Teenage pregnancy and motherhood: States. 355 Table A-5.2 Knowledge of contraceptive methods by state of residence: States. 356 Table A-5.5 Current use of contraception by state of residence: States . 357 Table A-5.18 Exposure to family planning messages: States . 358 Table A-5.21 Contact of non-users with family planning providers: States . 359 Table A-5.22 Husband/partner's knowledge of women's use of contraception: States . 360 Tables and Figures | xix Table A-6.2.1 Number of women's co-wives: States . 361 Table A-6.2.2 Number of men's wives: States. 362 Table A-6.7.1 Recent sexual activity: Women by state . 363 Table A-6.7.2 Recent sexual activity: Men by state. 364 Table A-9.1 Antenatal care: States. 366 Table A-9.3 Components of antenatal care: States . 367 Table A-9.4 Tetanus toxoid injections: States . 368 Table A-9.5 Place of delivery: States . 369 Table A-9.6 Assistance during delivery: States . 370 Table A-9.7 Timing of first postnatal check-up: States . 371 Table A-9.8 Provider of first postnatal check-up: States . 372 Table A-9.9 Problems in accessing health care: States . 373 Table A-10.3 Vaccinations by state of residence: States. 374 Table A-10.5 Vaccinations received during national immunisation day campaigns: States. 375 Table A-10.6 Reasons for child not receiving any vaccines: States . 376 Table A-10.7 Reasons for child not receiving any polio vaccine: States. 377 Table A-10.9 Prevalence and treatment of fever: States. 378 Table A-10.11 Prevalence of diarrhoea: States . 379 Table A-10.14 Knowledge of ORS packets or pre-packaged liquids: States. 380 Table A-10.15 Disposal of children's stools: States. 381 Table A-11.1 Nutritional status of children: States . 382 Table A-11.2 Initial breastfeeding: States. 383 Table A-11.4 Median duration and frequency of breastfeeding: States . 384 Table A-11.6 Infant and young child feeding (IYCF) practices: States . 385 Table A-11.7 Micronutrient intake among children: States . 386 Table A-11.8 Presence of iodised salt in household: States. 387 Table A-11.9 Nutritional status of women: States . 388 Table A-11.10 Foods consumed by mothers in the day and night preceding the interview: States . 389 Table A-11.11 Micronutrient intake among mothers: States . 390 Table A-12.1 Ownership of mosquito nets: States . 392 Table A-12.2 Use of mosquito nets by children: States. 393 Table A-12.3 Use of mosquito nets by women: States. 394 Table A-12.4 Use of mosquito nets by pregnant women: States . 395 Table A-12.5 Prophylactic use of anti-malarial drugs and use of Intermittent Preventive Treatment (IPT) by women during pregnancy: States. 396 Table A-12.6 Prevalence and prompt treatment of fever: States . 397 Table A-12.7 Type and timing of anti-malarial drugs: States . 398 Table A-13.1 Knowledge of AIDS: States. 399 Table A-13.2 Knowledge of HIV prevention methods: States. 400 Table A-13.3.1 Comprehensive knowledge about HIV and AIDS: Women by state. 401 Table A-13.3.2 Comprehensive knowledge about HIV and AIDS: Men by state . 402 Table A-13.4 Knowledge of prevention of mother-to-child transmission of HIV: States. 403 Table A-13.5.1 Accepting attitudes towards persons living with HIV or AIDS: Women by state . 404 xx | Tables and Figures Table A-13.5.2 Accepting attitudes towards persons living with HIV or AIDS: Men by state . 405 Table A-13.6 Attitudes towards negotiating safer sexual relations with husband: States. 406 Table A-13.7 Adult support of education about condom use to prevent transmission of HIV: States. 407 Table A-13.8.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Women by state. 408 Table A-13.8.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Men by state . 410 Table A-13.9 Payment for sexual intercourse and condom use at last paid sexual intercourse: Men by state. 412 Table A-13.10.1 Coverage of prior HIV testing: Women by state . 413 Table A-13.10.2 Coverage of prior HIV testing: Men by state. 414 Table A-13.11 Pregnant women counselled and tested for HIV: States. 415 Table A-13.12 Male circumcision: States. 416 Table A-13.13 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms: States . 417 Table A-13.14 Prevalence of medical injections: States . 418 Table A-13.15 Comprehensive knowledge about HIV and AIDS and of a source of condoms among youth: States . 419 Table A-13.16 Age at first sexual intercourse among youth: States. 420 Table A-13.17 Condom use at first sexual intercourse among youth: States. 421 Table A-13.18 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth: States. 422 Table A-13.19.1 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: Women by state. 423 Table A-13.19.2 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: Men by state . 424 Table A-13.20 Age-mixing in sexual relationships among women age 15-19: States . 425 Table A-13.21 Drunkenness during sexual intercourse among youth: States. 426 Table A-13.22 Recent HIV tests among youth: States . 427 Table A-15.2.1 Control over women's cash earnings and relative magnitude of women's earnings: Women by state . 429 Table A-15.2.2 Control over men's cash earnings: States . 430 Table A-15.5.1 Women's participation in decision-making by state of residence: States . 431 Table A-15.5.2 Men's attitudes towards wives' participation in decision-making: States . 432 Table A-15.6.1 Attitudes towards wife beating: Women by state. 433 Table A-15.6.2 Attitudes towards wife beating: Men by state . 434 Table A-15.7.1 Attitudes towards refusing sexual intercourse with husband: Women by state . 435 Table A-15.7.2 Attitudes towards refusing sexual intercourse with husband: Men by state . 436 Table A-15.7.3 Men's attitudes towards a husband's rights when his wife refuses to have sexual intercourse: States. 437 Table A-17.1 Children's living arrangements and orphanhood: States . 439 Table A-17.2 Orphans and vulnerable children (OVC): States . 440 Table A-17-3.1 School attendance by survivorship of parents: States . 441 Table A-17.3.2 School attendance by OVC status: States . 442 Tables and Figures | xxi Table A-17.4 Possession of basic material needs by orphans and vulnerable children: States. 443 Table A-17.5 Orphan not living with siblings: States. 444 Table A-17.8 Succession planning: States. 445 Table A-17.9 Widows dispossessed of property: States. 446 Table A-17.11 External support for orphans and vulnerable children: States. 447 Table A-18.1 Knowledge and prevalence of female circumcision: States . 448 Table A-18.2 Age at circumcision: States. 449 Table A-18.3 Person who performed circumcision: States . 450 Table A-18.4 Daughter's circumcision experience and type of circumcision: States . 451 Table A-18.6.1 Perceived benefits of female circumcision: Women by state . 452 Table A-18.6.2 Perceived benefits of female circumcision: Men by state. 453 Table A-18.7.1 Attitudes towards continuation of female circumcision: Women by state . 454 Table A-18.7.2 Attitudes towards continuation of female circumcision: Men by state. 455 APPENDIX B SURVEY DESIGN Table B.1 Allocation of completed interviews by region and state . 459 Table B.2 Sample implementation: Women . 461 Table B.3 Sample implementation: Men. 462 APPENDIX C ESTIMATES OF SAMPLING ERRORS Table C.1 List of selected variables for sampling errors, Nigeria 2008 . 466 Table C.2 Sampling errors for national sample, Nigeria 2008 . 467 Table C.3 Sampling errors for urban sample, Nigeria 2008. 468 Table C,4 Sampling errors for rural sample, Nigeria 2008. 469 Table C.5 Sampling errors for Central sample, Nigeria 2008. 470 Table C.6 Sampling errors for North East sample, Nigeria 2008. 471 Table C.7 Sampling errors for North West sample, Nigeria 2008. 472 Table C.8 Sampling errors for South East sample, Nigeria 2008. 473 Table C.9 Sampling errors for South South sample, Nigeria 2008. 474 Table C.10 Sampling errors for South West sample, Nigeria 2008 . 475 APPENDIX D DATA QUALITY TABLES Table D.1 Household age distribution . 477 Table D.2.1 Age distribution of eligible and interviewed women . 478 Table D.2.2 Age distribution of eligible and interviewed men. 478 Table D.3 Completeness of reporting . 479 Table D.4 Births by calendar years . 479 Table D.5 Reporting of age at death in days . 480 Table D.6 Reporting of age at death in months. 481 Table D.7 Data on siblings . 482 Table D.8 Sibship size and sex ratio of siblings . 482 APPENDIX E NUTRITIONAL STATUS OF CHILDREN: 2008 NDHS DATA ACCORDING TO THE NCHS/CDC/WHO INTERNATIONAL REFERENCE POPULATION Table E.1 Nutritional status of children . 483 Preface | xxiii PREFACE The conduct of the 2008 Nigeria Demographic and Health Survey (2008 NDHS) is in furtherance of the National Population Commission’s (NPC) responsibility of collecting, collating, analysing, and disseminating population census and survey data at all levels that contribute to policy formulation and coordination of population activities in the country. I am delighted to present the final report for the 2008 NDHS. The survey is the latest in the periodic Demographic and Health Survey (DHS) series, which started in Nigeria at the national level in 1990. The 2008 NDHS is a national sample survey designed to provide up-to-date information on background characteristics of the respondents; fertility levels; nuptiality; sexual activity; fertility preferences; awareness and the use of family planning methods; breastfeeding practices; nutritional status of mothers and young children; early childhood mortality and maternal mortality; maternal and child health; and awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections. The target groups were women age 15-49 years and men age 15-59 years in randomly selected households across Nigeria. Information about children age 0-5 years was also collected, including weight and height. While the survey is expanded in scope and sample size, the 2008 NDHS is a follow-up to the 1990, 1999, and 2003 NDHS surveys and provides updated estimates of basic demographic and health indicators covered in the earlier surveys. The 2008 NDHS is the first DHS to include the collection of information on violence against women. In addition to presenting national estimates, the report provides estimates of key indicators for rural and urban areas in Nigeria, the six geo-political zones, and for the first time, the thirty-six states and the Federal Capital Territory (FCT). The unprecedented success of the 2008 NDHS was made possible by the contributions from a number of organisations and individuals. I wish to acknowledge the support of the United States Agency for International Development in Nigeria (USAID/Nigeria) and the President’s Emergency Plan for AIDS Relief (PEPFAR) for funding the survey, and to Akintola Williams Deloitte for providing accounting and disbursement services that allowed for the timely and efficient transfer of project funds throughout all components of the survey. Similarly, I wish to acknowledge the United Nations Population Fund (UNFPA) for funding the household listing exercise and additional field support. The support and collaboration witnessed by the 2008 NDHS from government, non- governmental, international development organisations, and other major stakeholders is hereby acknowledged. Special mention is given to the Federal Ministry of Health and its agencies, the National Bureau of Statistics, and the United Nations Children’s Fund (UNICEF) for their support. I would like to thank the NPC Federal Commissioners for their support during the implementation period for providing excellent leadership and advocacy support. The unflinching support and technical assistance provided by Dr. Wokoma D.C. Wokoma (Director-General), Dr. Emmanuel Enu Attah (Director, Planning and Research), and all other Directors are hereby acknowledged. On behalf of the Commission, I gratefully acknowledge the tireless dedication of the core 2008 NDHS team for their outstanding and enthusiastic management of all the technical, administrative, and logistical phases of the survey. The survey could not have been conducted without the leadership of Mr. Sani Ali Gar (Project Director) and Mr. Inuwa Bakari Jalingo (Project Coordinator). Similarly, I wish to express appreciation to ICF Macro for its technical assistance in all stages of the survey. The commitment of the ICF Macro Country Manager, Ms. Adrienne Cox, is greatly appreciated. Ms. Sherrell Goggin and Mr. Noureddine Abderrahim (Data Processing Specialists) handled data processing of the 2008 NDHS with great expertise. I wish to commend the xxiv | Preface efforts of Dr. Alfredo Aliaga (Sampling Specialist), who provided technical support during the sample selection exercise. Dr. Pav Govindasamy (Regional Coordinator) also deserves our deep appreciation for her contributions. Special gratitude goes to the Supervisors, Editors, Interviewers, Quality Control Interviewers, Drivers, and the Data Processing team for their tireless efforts. Finally, a special gratitude goes to all the respondents for their cooperation, patience, and generosity in providing the required information throughout the survey. Without their cooperation, this survey would not have been a success. Chief Samu’ila Danko Makama, CON Chairman National Population Commission Summary of Findings | xxv SUMMARY OF FINDINGS The 2008 Nigeria Demographic Health Sur- vey (NDHS) is a nationally representative survey of 33,385 women age 15-49 and 15,486 men age 15-59. The 2008 NDHS is the fourth comprehen- sive survey conducted in Nigeria as part of the Demographic and Health Surveys (DHS) pro- gramme. The data are intended to furnish pro- gramme managers and policymakers with de- tailed information on levels and trends in fertil- ity; nuptiality; sexual activity; fertility prefer- ences; awareness and use of family planning methods; infants and young children feeding practices; nutritional status of mothers and young children; early childhood mortality and maternal mortality; maternal and child health; and aware- ness and behaviour regarding HIV/AIDS and other sexually transmitted infections. Addition- ally, the 2008 NDHS collected information on malaria prevention and treatment, neglected tropical diseases, domestic violence, fistulae, and female genital cutting (FGC). FERTILITY The survey results show fertility in Nigeria has remained at a high level over the last 17 years from 5.9 births per woman in 1991 to 5.7 births in 2008. On average, rural women are hav- ing two children more than urban women (6.3 and 4.7 children, respectively). Fertility differen- tials by education and wealth are noticeable. Women who have no formal education and women in the lowest wealth quintile on average are having 7 children, while women with higher than a secondary education are having 3 children and women in the highest wealth quintile are having 4 children. Unplanned pregnancies are common in Nige- ria. Overall, 4 percent of births are unwanted, while 7 percent are mistimed (wanted later). If all unwanted births were prevented, women would have an average of 5.3 children, compared with the actual average of 5.7 children. Marriage patterns are an important determi- nant of fertility levels in a population. The me- dian age at first marriage in Nigeria among women age 25-49 is 18.3 years. Urban women marry four years later than rural women (21.1 and 16.9 years, respectively). The median age at first marriage varies substantially by level of education. For women age 25-49 with no educa- tion the median age at marriage is 15.5 years, compared with 22.0 years for women with more than secondary education. Men enter into first union at a later age than women; the median age at first marriage for men age 25-59 is more than 26 years of age. The initiation of sexual activity before mar- riage is not uncommon in Nigeria. Among re- spondents age 25-49, the median age at first sex- ual intercourse is 17.7 years for women and 20.6 years for men. Teenage pregnancy is high in Nigeria. Twenty-three percent of young women age 15-19 have begun childbearing, that is, they have given birth or are currently pregnant with their first child. The 2008 NDHS shows that 33 percent of currently married women are married to men who are in a polygynous union. Older women, women in rural areas, women with less educa- tion, and women in the lowest wealth quintiles are more likely than other women to have co- wives. The prevalence of polygyny varies mark- edly across zones, with South East having the lowest level (13 percent) and North East having the highest (43 percent). FAMILY PLANNING In the 2008 NDHS, 72 percent of all women and 90 percent of all men know at least one con- traceptive method. Male condoms, the pill, and injectables are the most widely known methods. Twenty-nine percent of currently married women have used a family planning method at least once in their lifetime. Fifteen percent of currently married women are using any contra- ceptive method and 10 percent are using a mod- ern method. The most commonly used methods among currently married women are injectables (3 percent), followed by male condoms and the pill (2 percent each). xxvi * Summary of Findings Current use of contraception in Nigeria has increased from 6 percent in 1990 and 13 percent in 2003 to 15 percent in 2008. There has been a corresponding increase in the use of modern con- traceptive methods, from 4 percent in 1990 and 8 percent in 2003 to 10 percent in 2008. Private chemists are the chief provider of contraceptive methods in Nigeria. The distribu- tion of sources of modern method supplies for current users shows that the majority of users (60 percent) obtain their contraceptive methods from the private sector. The participation of the public medical sector in family planning service deliv- ery has decreased steadily during the past 18 years from 37 percent in 1990 to 23 percent in 2008. Overall, 20 percent of currently married women have an unmet need for family plan- ning—15 percent for spacing and 5 percent for limiting. If all married women with an unmet need for family planning were to use a contra- ceptive method, the contraceptive prevalence rate for any method would increase from 15 to 35 percent. CHILD HEALTH Data from the 2008 NDHS indicate that the infant mortality rate is 75 deaths per 1,000 live births, while the under-five mortality rate is 157 per 1,000 live births for the five-year period im- mediately preceding the survey. The neonatal mortality rate is 40 per 1,000 births. Thus, almost half of childhood deaths occurred during infancy, with one-quarter taking place during the first month of life. Child mortality is consistently lower in urban areas than in rural areas. There is also variation in the mortality level across zones. The infant mortality and under-five mortality rates are high- est in the North East, and lowest in the South West. In Nigeria, children are considered fully vac- cinated when they receive one dose of BCG vac- cine, three doses of DPT vaccine, three doses of polio vaccine, and one dose of measles vaccine. Overall, 23 percent of children 12-23 months have received all vaccinations at the time of the survey. Fifty percent of children have received the BCG vaccination, and 41 percent have been vaccinated against measles. The coverage of the first dose of DPT vaccine and polio 1 is 52 and 68 percent, respectively). However, only 35 per- cent of children have received the third dose of DPT vaccine, and 39 percent have received the third dose of polio vaccine. A comparison of the 2008 NDHS results with those of the earlier sur- veys shows there has been an increase in the overall vaccination coverage in Nigeria from 13 percent in 2003 to the current rate of 23 percent. However, the percentage of children with no vaccinations has not improved for the same pe- riod, 27 percent in 2003 and 29 percent in 2008. Three percent of children under five years showed symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey. Treatment from a health facility or provider was sought for 45 percent of children with ARI symptoms. Twenty-three percent of children re- ceived antibiotics. Sixteen percent of children under five were reported to have had fever, a major manifestation of malaria, within the two weeks prior to the sur- vey. More than half of children (54 percent) were taken to a health facility or provider for treat- ment. A third of children with fever (33 percent) received anti-malarial drugs and 18 percent re- ceived antibiotics. At the time of the survey, 10 percent of chil- dren under age five had diarrhoea at some time within the two weeks before the survey. For 42 percent of children, advice or treatment was sought from a health facility or a health provider. More than a third of children (37 percent) were treated with some type of oral rehydration ther- apy (ORT) or increased fluids: 26 percent were treated with solution prepared from an oral rehy- dration salt (ORS) packet; 8 percent were given recommended home fluids (RHF) prepared at home; and 9 percent were given increased fluids. Twenty-nine percent of children with diarrhoea did not receive any type of treatment at all. MATERNAL HEALTH In Nigeria more than half of women who had a live birth in the five years preceding the survey received antenatal care from a health profes- sional (58 percent); 23 percent from a doctor, 30 percent from a nurse or midwife, and 5 percent from an auxiliary nurse or midwife. Thirty-six percent of mothers did not receive any antenatal care. Summary of Findings | xxvii Tetanus toxoid injections are given during pregnancy to prevent neonatal tetanus. Overall, 48 percent of last births in Nigeria were pro- tected against neonatal tetanus. More than one-third of births in the five years before the survey were delivered in a health facility (35 percent). Twenty percent of births occurred in public health facilities and 15 percent occurred in private health facilities. Al- most two-thirds (62 percent) of births occurred at home. Nine percent of births were assisted by a doctor, 25 percent by a nurse or midwife, 5 per- cent by an auxiliary nurse or midwife, and 22 percent by a traditional birth attendant. Nineteen percent of births were assisted by a relative and 19 percent of births had no assistance at all. Two percent of births were delivered by a caesarean section. Overall, 42 percent of mothers received a postnatal check-up for the most recent birth in the five years preceding the survey, with 38 per- cent having the check-up within the critical 48 hours after delivery. Results from the 2008 NDHS show that the estimated maternal mortality ratio during the seven-year period prior to the survey is 545 ma- ternal deaths per 100,000 live births. BREASTFEEDING AND NUTRITION Ninety-seven percent of Nigerian children under age five were breastfed at some point in their life. The median breastfeeding duration in Nigeria is long (18.1 months). On the other hand, the median duration for exclusive breastfeeding is only for half a month. A small proportion of babies (13 percent) are exclusively breastfed throughout the first six months of life. More than seven in ten (76 percent) children age 6-9 months receive complementary foods. Sixteen percent of babies less than six months of age are fed with a bottle with a nipple, and the proportion bottle-fed peaks at 17 percent among children in the age groups 2-3 months and 4-5 months. Anthropometric measurements carried out at the time of the survey indicate that, overall, 41 percent of Nigerian children are stunted (short for their age), 14 percent are wasted (thin for their height), and 23 percent are underweight. The indices show that malnutrition in young children increases with age, starting with wast- ing, which peaks among children age 6-8 months, underweight peaks among children age 12-17 months, and stunting is highest among children age 18-23 months. Stunting affects half of children in this age group and almost one-third of children age 18-23 months are severely stunted. Overall, 66 percent of women have a body mass index (BMI) in the normal range; 12 per- cent of women are classified as thin and 4 per- cent are severely thin. Twenty-two percent of women are classified as overweight or obese, with 6 percent in the latter category. MALARIA Seventeen percent of all households inter- viewed during the survey had at least one mos- quito net, while 8 percent had more than one. Sixteen percent of households had at least one net that had been treated at some time (ever- treated) with an insecticide. Eight percent of households had at least one insecticide-treated net (ITN). Mosquito net usage is low among young children and pregnant women, groups that are particularly vulnerable to the effects of malaria. Overall, 12 percent of children under five slept under a mosquito net the night before the survey. Twelve percent of children slept under an ever- treated net and 6 percent slept under an ITN. Among pregnant women, 12 percent slept under any mosquito net the night before the interview. Twelve percent slept under an ever-treated net and 5 percent slept under an ITN. Among women who had their last birth in the two years before the survey, 18 percent took an anti-malarial drug during the pregnancy. Eleven percent of all pregnant women took at least one dose of a sulphadoxine-pyrimethamine (SP) drug such as Fansidar, Amalar, or Maloxine, while 7 percent reported taking two or more doses of an SP drug. Eight percent of the women who took an SP drug were given the drug during an antena- tal care visit, a practice known as intermittent preventive treatment (IPT). HIV/AIDS KNOWLEDGE AND BEHAVIOUR The majority of women (88 percent) and men (94 percent) age 15-49 have heard of HIV or AIDS. However, only 23 percent of women and 36 percent of men have what can be considered xxviii * Summary of Findings comprehensive knowledge about the modes of HIV transmission and prevention. Comprehen- sive knowledge means knowing that using con- doms and having just one uninfected, faithful partner can reduce the chance of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about HIV transmission or pre- vention, that HIV and AIDS can be transmitted through supernatural means or through mosquito bites. Fifty-two percent of women and 59 percent of men age 15-49 know that HIV can be trans- mitted through breastfeeding. Twenty-eight per- cent of women and 39 percent of men know that the risk of mother-to-child transmission (MTCT) can be reduced by the mother taking special drugs during pregnancy. Given that most HIV cases in Nigeria occur as a result of heterosexual contact, information about the level of higher-risk sexual intercourse (i.e., sexual intercourse with a non-marital, non- cohabiting partner) in the past 12 months is im- portant for planning HIV prevention pro- grammes. The 2008 NDHS findings indicate that 1 percent of women and 10 percent of men had two or more sexual partners during the 12 months preceding the survey. Ten percent of women and 23 percent of men had higher-risk sexual intercourse in this period. Among these respondents, only 33 percent of women and 54 percent of men reported that they used a condom the last time they had sexual intercourse with a higher-risk sexual partner. Among the adult population age 15-49, 17 percent of women and 15 percent of men have been tested for HIV at some time. Seven percent of women and 7 of men received the results from their last HIV test that was taken in the past 12 months. DOMESTIC VIOLENCE One eligible woman in each household was asked questions on domestic violence. In Nige- ria, domestic violence occurs across all socio- economic and cultural backgrounds. Twenty- eight percent of all women reported experiencing physical violence since the age of 15, and 15 percent of women experienced physical violence in the 12 months preceding the survey. Among women who experienced violence since age 15, a total of 45 percent reported that their current husband or partner was the perpetrator and 7 per- cent reported that the perpetrator was a former husband or partner. Overall, 7 percent of women reported that they had experienced sexual violence at some time in their lives. Forty-three percent of women reported that their first experience with sexual intercourse occurred when they were less than 20 years of age. Half of women reported that their current or former husband, partner, or boyfriend committed the act of sexual violence. It is impor- tant to highlight that among women who were younger than age 15 when they first experienced sexual violence, 28 percent reported that the per- petrator was a stranger, 12 percent reported that the person was a friend or acquaintance, 11 per- cent reported that the person was a relative, and 7 percent reported that the person was a family friend. Thirty-four percent of Nigerian women who ever experienced physical or sexual violence sought help to stop the violence. Eight percent of abused women did not seek help but did tell someone about the violence, and 45 percent of the women did not seek help from any source and did not tell anyone about the violence. ORPHANS AND VULNERABLE CHILDREN Twelve percent Nigerian children under age 18 in the households sampled in the 2008 NDHS were not living with a biological parent. Six per- cent of children under age 18 are orphaned, that is, one or both parents are dead. Earlier NDHS surveys obtained information on orphanhood only for children under age 15. A comparison of the results from the 2003 and 2008 surveys for this age group indicates that there has been a slight decrease in orphanhood from 6.2 percent to 5.2 percent. The proportion of children who are not living with either parent decreased from 11 to 9 percent for children under age 15. Overall, 5 percent of children under age 18 are considered vulnerable, i.e., they live in a household in which at least one adult was chronically ill for three months during the past 12 months, or they had a parent living in the household (or elsewhere) who had experienced chronic illness in the past year. Overall, 11 per- cent of children under age 18 are considered or- phans and/or vulnerable. Millennium Development Goal Indicators | xxix MILLENNIUM DEVELOPMENT GOAL INDICATORS Value Goal Indicator Female Male Total 1. Eradicate extreme poverty and hunger 1.8-Prevalence of underweight children under five years of age1 21.7 24.5 23.1 2. Achieve universal primary education 2.1-Net attendance ratio in primary school2 2.2-Percentage of pupils starting grade 1 who reach grade 53 59.1 98.5 64.9 98.5 62.1 98.5 2.3-Literacy rate of 15-24 year-olds4 64.3 82.5 69.4 3. Promote gender equality and empower women 3.1-Ratio of girls to boys in primary, secondary and tertiary education na na 83.9 4. Reduce child mortality 4.1-Under-five mortality rate (per 1,000 live births) 166 175 157 4.2-Infant mortality rate (per 1,000 live births) 81 93 75 4.3-Percentage of 1 year-old children immunised against measles 41.4 41.5 41.4 5. Improve maternal health 5.1-Maternal mortality ratio (0-6 year period before survey) na na 545 5.2-Percentage of births attended by skilled health personnel5 39.3 38.6 38.9 5.3-Contraceptive prevalence rate (any contraceptive method, currently married women and men age 15-49) 14.6 na na 6. Combat HIV/AIDS, malaria and other diseases 6.2-Condom use at last higher-risk sex: youth 15-24 years6 35.5 49.4 40.8 6.3-Percentage of population 15-24 years with comprehensive knowledge of HIV/AIDS7 22.2 32.6 23.9 6.4-Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years 1.3 1.1 1.2 6.7-Percentage of children under five sleeping under ITN 5.6 5.3 5.5 6.8-Percentage of children under five with fever who are appropriately treated with anti-malarial drugs8 31.8 34.4 33.2 Value Urban Rural Total 7. Ensure environmental sustainability 7.8-Percentage of population using improved drinking water source, urban and rural (de jure population)9 79.7 43.8 55.8 7.9-Percentage of population using improved sanitation facility, urban and rural (de jure population)10 37.5 28.1 31.2 na = Not applicable 1 Proportion of children age 0-59 months who are below -2 standard deviations (SD) from the median of the WHO Child Growth Standards in weight-for-age 2 2008 NDHS data are based on reported attendance, not enrolment. 3 The cohort of people enrolled in grade 1 who are expected to reach grade 5. 4 Refers to respondents who attended secondary school or higher or who can read a whole sentence 5 Among births in the past 5 years 6 Higher-risk refers to sexual intercourse with a non-marital, non-cohabiting partner; time frame is 12 months preceding the survey. 7 A person is considered to have comprehensive knowledge about HIV/AIDS when s/he knows that consistent use of a condom during sexual intercourse and having just one HIV-negative and faithful partner can reduce the chances of getting HIV, knows that a healthy-looking person can have HIV, and rejects the two most common misconceptions about HIV, i.e., that HIV can be transmitted by mosquito bites and that a person can get HIV by eating from the same plate as someone who has HIV. 8 Malaria treatment is measured as the percentage of children age 0-59 months who were ill with a fever in the two weeks preceding the interview and received an anti-malarial drug. 9 Proportion whose main source of drinking water is a household connection (piped), public standpipe, borehole, protected dug well or spring, or rainwater collection. 10 Improved sanitation technologies are: flush toilet, ventilated improved pit latrine, traditional pit latrine with a slab, or composting toilet. xxx | Map of Nigeria Introduction | 1 INTRODUCTION 1 1.1 HISTORY, GEOGRAPHY, AND ECONOMY OF NIGERIA 1.1.1 History Nigeria came into existence as a nation-state in 1914 through the amalgamation of the Northern and Southern protectorates. Prior to that time, there were various separate cultural, ethnic, and linguistic groups, such as the Oyo, Benin, Nupe, Jukun, Kanem-Bornu, and Hausa-Fulani empires. These peoples lived in kingdoms and emirates with traditional but sophisticated systems of government. There were also other relatively small but strong—and indeed resistant—ethnic groups (e.g., Igbo, Ibibio, and Tiv). The British established a crown colony type of government after the amalgamation. The affairs of the colonial administration were conducted by the British until 1942, when a few Nigerians became involved in the administration of the country. In the early 1950s, Nigeria achieved partial self- government with a legislature in which the majority of the members were elected into an executive council of which most were Nigerians. Nigeria became fully independent in October 1960 as a federation of three regions (Northern, Western, and Eastern) under a constitution that provided for a parliamentary system of governance. The Lagos area became the Federal Capital Territory. On October 1, 1963, Nigeria became a republic with different administrative structures, social groups, and distinct cultural traits. There are about 374 identifiable ethnic groups, with the Igbo, Hausa, and Yoruba as major groups. Presently, Nigeria is made up of 36 states and a Federal Capital Territory (FCT), grouped into six geopolitical zones: North Central, North East, North West, South East, South South, and South West. There are also 774 constitutionally recognized local government areas (LGAs) in the country. 1.1.2 Geography Nigeria is in the West African sub-region, lying between latitudes 4º16' and 13º53' north and longitudes 2º40' and 14º41' east. It is bordered by Niger in the north, Chad in the northeast, Cameroon in the east, and Benin in the west. To the south, Nigeria is bordered by approximately 850 kilometres of the Atlantic Ocean, stretching from Badagry in the west to the Rio del Rey in the east. With a total land area of 923,768 square kilometres, Nigeria is the fourteenth largest country in Africa. Nigeria is diverse in climate and topography, encompassing uplands of 600 to 1,300 metres in the North Central and the east highlands, and lowlands of less than 20 metres in the coastal areas. The lowlands extend from the Sokoto plains to the Borno plains in the North, the coastal lowlands of Western Nigeria, and the Cross River basin in the east. The highland areas include the Jos Plateau and the Adamawa Highlands in the North, extending to the Obudu Plateau and Oban Hills in the South East. Other topographic features include the Niger-Benue Trough and Chad Basin. Nigeria has a tropical climate with distinct wet and dry seasons associated with the movement of the two dominant winds—the rain-bearing south westerly winds and the cold, dry, and dusty north easterly winds commonly referred to as the Harmattan. The dry season occurs from October to March with a spell of cool, dry, and dusty Harmattan wind felt mostly in the north in December and January. The wet season occurs from April to September. The temperature in Nigeria oscillates between 25° and 40°C, and rainfall ranges from 2,650 millimetres in the southeast to less than 600 millimetres in some parts of the north, mainly on the fringes of the Sahara Desert. The vegetation that results from 2 | Introduction these climatic differences consists of mangrove swamp forest in the Niger Delta and Sahel grassland in the north. Within a wide range of climatic, vegetation, and soil conditions, Nigeria possesses potential for growing a wide range of agricultural crops. 1.1.3 Economy Agriculture has been the mainstay of Nigeria’s economy. Before the discovery of oil, the country depended almost entirely on agricultural production for food and agro-industrial raw materials for foreign exchange earnings through the commodity trade. At the time of independence, over 75 percent of the country’s labour force was engaged in agriculture, which also provided gainful employment and a satisfactory livelihood to over 90 percent of the population. Over the years, the dominant role of agriculture in the economy, especially in terms of the country’s foreign exchange earnings, gave way to petroleum exports. The country’s economic strength is derived largely from its oil and gas reserves, which make up 99 percent of export revenues, 78 percent of government revenues, and 38.8 percent of the GDP (2006). The contributions of other sectors to the GDP in 2006 were as follows: agriculture (32.5 percent), wholesale and retail (13.5 percent), industry, excluding petroleum (2.9 percent) and other sectors (1.5 percent). Since 1980, oil production has accounted for more than two-thirds of the GDP and more than 80 percent of the total government revenues (FRN, 2008). Since the onset of the new democratic administration in 1999, economic policies have become more favourable to investment. Progress has been made toward establishing a market-based economy. Consequently, there has been an improvement in the performance of the domestic economy. Nigeria’s GDP growth rate was estimated at 2.7 percent in 1999, 2.8 percent in 2000, and 3.8 percent in 2001. By 2006, the real GDP growth rate was estimated at 6.0 percent (Central Bank of Nigeria, 2002). Before the advent of the civilian administration in 1999, Nigeria had a large public sector, comprising over 550 public enterprises in most sectors of the economy and dominating activities in the electric power, telecommunications, petroleum, and steel sectors. The public enterprise sector accounts for an estimated 50 percent of the total GDP, 57 percent of investments, and 33 percent of formal sector employment (Central Bank of Nigeria, 2002). Like other emerging democracies, the civilian administration in Nigeria has recognised the importance of privatisation in the restructuring of its economy. A number of policies were put in place to liberalise, deregulate, and privatise key sectors of the economy such as electric power, telecommunications, and downstream petroleum sectors. In recent years, Nigeria privatised the only government-owned petrochemical company and sold its interest in eight oil service companies. While it may be too early to determine the impact of privatization and liberalisation on the Nigerian economy, it is believed that these economic policy reforms, combined with investments in human capital and physical infrastructure, as well as the establishment of macroeconomic stability and good governance, are essential to achieve a high rate of self-sustaining, long-term economic growth. 1.2 POPULATION AND BASIC DEMOGRAPHIC INDICATORS Nigeria has, since the 19th century collected demographic statistics through censuses, vital registration systems and sample surveys. However, until the 1950s these were limited to certain parts of the country. Since then, there have been considerable improvements in the data collection process. The first attempt at a population census in Nigeria was in 1866. Subsequent censuses before 1952, such as the 1911 and 1922 censuses, were restricted to specific sections of the country. The 1952-1953 enumeration was the first nationwide census. The first post-independence census, conducted in 1962, was cancelled because of alleged irregularities in its conduct. Another census, conducted in 1963, was officially accepted (Table 1.1). The Population Census of 1973 was not acceptable and was therefore cancelled. The next census took place in 1991. The 2006 Population and Introduction | 3 Housing Census puts Nigeria’s population at 140,431,790, with a national growth rate estimated at 3.2 percent per annum. With this population, Nigeria is the most populous nation in Africa. Nigeria’s population is unevenly distributed across the country. Large areas in the Chad Basin, the middle Niger Valley, the grassland plains, among others, are sparsely populated. The average population density for the country in 2006 was estimated at 150 people per square kilometre. The most densely populated states are Lagos, Anambra, Imo, Abia, and Akwa Ibom. Most of the densely populated states are found in the South East, Kano state, with an average density of 442 persons per square kilometre, is the most densely populated state in the north. Table 1.1 Basic demographic indicators Demographic indicators from various sources, Nigeria 1963-2006 Indicators Census 1963 NFS 1981-1982 Census 1991 NDHS 20031 Census 2006 Population (millions) 55.7 84.7 88.9 u 140.4 Density (pop./sq.km) 60 92 96 u 150 Percent urban 19 23 36.3 u u Crude birth rate (CBR) 66 46 44.6 41.7 u Crude death rate (CDR) 27 16 14 u u Total fertility rate (TFR) u 6.3 5.9 5.7 u Infant mortality rate (IMR) u 85 93 100 u Life expectancy at birth 36 48 53.2 u u u = Unknown (not available) 1 Reported rates. See 2003 NDHS final report for information on data quality. Sources: National Population Commission; Federal Office of Statistics Numerous sample surveys have been conducted in an effort to generate reliable demographic data. These include the 1965-1966 Rural Demographic Sample Survey and the 1980 National Demographic Sample Survey (NDSS) conducted by the Federal Office of Statistics and the National Population Bureau, respectively. The 1981-1982 Nigeria Fertility Survey (NFS) was the first nationally representative survey on fertility, family planning, contraceptive use, and related topics. This was followed by the first Nigeria Demographic and Health Survey (NDHS) in 1990. In 1994, the first sentinel survey was conducted to serve as a baseline study to monitor the various projects designed to achieve the objectives of the National Population Policy. In 1999, another NDHS was conducted. This was followed by a sentinel survey conducted in 2000. Another sentinel survey was conducted in 2007 to further assess the implementation of the objectives of the population policy. 1.3 POPULATION AND HEALTH POLICIES AND PROGRAMMES 1.3.1 Population Policies and Programmes In response to the pattern of the population growth rate and its adverse effect on national development, the Federal Government of Nigeria approved the National Policy on Population for Development on February 4, 1988. Over the years, emerging issues such as HIV/AIDS, poverty, gender inequality, among others, gained wider recognition. This necessitated a review of the 1988 National Population Policy, giving way to the National Policy on Population for Sustainable Development launched in February 2005 by the then President and Commander-in-Chief of the armed forces of the Federal Republic of Nigeria, Chief Olusegun Obasanjo. The policy recognises that population factors, social and economic development, and environmental issues are irrevocably interconnected and are critical to the achievement of sustainable development in Nigeria. 4 | Introduction The overall goal of the National Policy on Population for Sustainable Development is to improve the quality of life and standard of living for the Nigerian population (NPC, 2004). This is to be achieved through the attainment of a number of specific goals that include: • Achievement of sustainable economic growth, protection and preservation of the environment, poverty eradication, and provision of quality social services, • Achievement of a balance between the rate of population growth, available resources, and social and economic development of the country, • Progress towards a complete demographic transition to a reasonable growth in birth rates and a low death rate, • Improvement in the reproductive health of all Nigerians at every stage of the life circle, • Acceleration of a strong and immediate response to the HIV/AIDS pandemic and other related infectious diseases, • Progress in achieving balance and integrated urban and rural development. The National Policy on Population for Sustainable Development operates on the principle that achieving a higher quality of life for people today should not jeopardise the ability of future generations to meet their own needs (NPC, 2004). To guide policy, programme planning, and implementation, the following targets were set: • Reduce the national population growth rate to 2 percent or lower by 2015. • Reduce the total fertility rate by at least 0.6 children every five years by encouraging child spacing through the use of family planning. • Increase the contraceptive prevalence rate for modern methods by at least two percentage points per year through the use of family planning. • Reduce the infant mortality rate to 35 per 1,000 live births by 2015. • Reduce the child mortality rate to 45 per 1,000 live births by 2010. • Reduce the maternal mortality ratio to 125 per 100,000 live births by 2010 and to 75 by 2015. • Achieve sustainable universal basic education as soon as possible before 2015. • Eliminate the gap between males and females in school enrolment at all levels and in vocational and technical education by 2015. • Eliminate illiteracy by 2020. • Achieve at least a 25 percent reduction in HIV/AIDS adult prevalence every five years. 1.3.2 Health Policies and Programmes A national health policy targeted at achieving health for all Nigerians was promulgated in 1988. In view of emerging issues and the need to focus on realities and trends, a review of the policy became necessary. The new policy, referred to as the Revised National Health Policy, launched in September 2004, describes the goals, structure, strategy, and policy direction of the health care delivery system in Nigeria (NPC, 2004a). Roles and responsibilities of different tiers of government, including non-governmental organisations are outlined. The policy’s long-term goal is to provide adequate access to primary, secondary, and tertiary health care services for the entire Nigerian population through a functional referral system. Introduction | 5 The following principles and values underpin the Revised National Health Policy: • Social justice, equity, and the ideals of freedom and opportunity affirmed in the 1999 Constitution of the Federal Republic of Nigeria are a basic right. • Health and access to quality and affordable health care is a human right. • Equity in health care for all Nigerians will be pursued as a goal. • Primary health care (PHC) shall remain the basic philosophy and strategy for national health development. • Good quality health care shall be assured through cost-effective interventions that are targeted at priority health problems. • A high level of efficiency and accountability shall be maintained in the development and management of the national health system. • Effective partnership and collaboration between various health sectors shall be pursued while safeguarding the identity of each. Because health is an integral part of overall development, inter-sectoral cooperation and collaboration between the different health-related ministries, development agencies and other relevant institutions shall be strengthened; and a gender-sensitive and responsive national health system shall be achieved by mainstreaming gender considerations in all health programmes. The overall objective of the Revised National Health Policy is to strengthen the national health system such that it will be able to provide effective, efficient, quality, accessible and affordable health services that will improve the health status of Nigerians through the achievement of the health- related Millennium Development Goals (MDGs). The main health policy targets are the following: • Reduce the under-five mortality rate by two-thirds between 1990 and 2015, • Reduce the maternal mortality rate by three-quarters between 1990 and 2015, • Reduce the spread of HIV/AIDS by 2015, • Reduce the burden of malaria and other major diseases by 2015. The national health policy regards primary health care as the framework to achieve improved health for the population. Primary health care services include health education; adequate nutrition; safe water and sanitation; reproductive health, including family planning; immunisation against five major infectious diseases; the provision of essential drugs; and disease control. The policy document requires that a comprehensive health care system delivered through the primary health centres should include maternal and child health care, including family planning services. The health sector is characterised by wide regional disparities in status, service delivery, and resource availability. More health services are located in the southern states than in the northern states. The current priorities in the health sector are in the area of childhood immunisation and HIV/AIDS prevention. 1.4 EDUCATION Education in Nigeria has been through a series of policy changes over time. The overall responsibility establishing national policies and guidelines for uniform standards throughout all levels of education is vested in the Federal Ministry of Education. These policies and guidelines are protected by various statutory instruments such as the National Policy on Education, the Education Decree No. 16 of 1985 and the 1999 Constitution of the Federal Republic of Nigeria. Accordingly, the Federal Ministry of Education focuses on six spheres of education—Early Childhood Education, 6 | Introduction Basic Education, Secondary Education, Tertiary Education, Adult and Non-formal Education, and Special Needs Education (Federal Ministry of Education, 2009). The National Policy on Education provides every child the right to tuition-free primary education. This has resulted in an increase in the school enrolment and in the number of educational institutions, particularly in the public sector. The 6-3-3-4 system introduced in 1981 provides six years of primary education, followed by three years of junior secondary education, and three years of senior secondary education. The last segment of four years is for university or polytechnic education. Subsequently, the National Literacy Programme for Adults was launched, followed by the establishment of Nomadic Education to address the needs of children of migrant cattle herders and fishermen in the riverine areas. The Universal Basic Education (UBE) system, launched in October 1999, made it compulsory for every child to be educated free of tuition up to the junior secondary school level in an effort to meet Nigeria’s manpower requirements for national development (Osuji, 2004). 1.5 ORGANISATION AND OBJECTIVES OF THE 2008 NIGERIA DEMOGRAPHIC AND HEALTH SURVEY The 2008 Nigeria Demographic and Health Survey (2008 NDHS) was implemented by the National Population Commission from June to October 2008 on a nationally representative sample of more than 36,000 households. All women age 15-49 in these households and all men age 15-59 in a sub-sample of half of the households were individually interviewed. While significantly expanded in content, the 2008 NDHS is a follow-up to the 1990, 1999, and 2003 NDHS surveys and provides updated estimates of basic demographic and health indicators covered in these earlier surveys. In addition, the 2008 NDHS includes the collection of information on violence against women. Although previous surveys collected data at the national and zonal levels, the 2008 NDHS is the first NDHS survey to collect data on basic demographic and health indicators at the state level. The primary objectives of the 2008 NDHS project were to provide up-to-date information on fertility levels; nuptiality; sexual activity; fertility preferences; awareness and use of family planning methods; breastfeeding practices; nutritional status of mothers and young children; early childhood mortality and maternal mortality; maternal and child health; and awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections. 1.5.1 Sample Design The sample for the 2008 NDHS was designed to provide population and health indicators at the national, zonal, and state levels. The sample design allowed for specific indicators, such as contraceptive use, to be calculated for each of the 6 zones and 37 states (36 states plus the Federal Capital Territory, Abuja). The sampling frame used for the 2008 NDHS was the 2006 Population and Housing Census of the Federal Republic of Nigeria conducted in 2006, provided by the National Population Commission (NPC). Administratively, Nigeria is divided into states. Each state is subdivided into local government areas (LGAs), and each LGA is divided into localities. In addition to these administrative units, during the 2006 Population Census, each locality was subdivided into convenient areas called census enumeration areas (EAs). The primary sampling unit (PSU), referred to as a cluster for the 2008 NDHS, is defined on the basis of EAs from the 2006 EA census frame. The 2008 NDHS sample was selected using a stratified two-stage cluster design consisting of 888 clusters, 286 in the urban and 602 in the rural areas1. A representative sample of 36,800 households was selected for the 2008 1 The final survey sample included 886 instead of 888 clusters. During fieldwork, access was not obtained in one cluster due to flooding, and in another cluster due to inter-communal disturbances. Introduction | 7 NDHS survey, with a minimum target of 950 completed interviews per state. In each state, the number of households was distributed proportionately among its urban and rural areas. A complete listing of households and a mapping exercise were carried out for each cluster from April to May 2008, with the resulting lists of households serving as the sampling frame for the selection of households in the second stage. All private households were listed. The NPC listing enumerators were trained to use Global Positioning System (GPS) receivers to take the coordinates of the 2008 NDHS sample clusters. In the second stage of selection, an average of 41 households was selected in each cluster, by equal probability systematic sampling. All women age 15-49 who were either permanent residents of the households in the 2008 NDHS sample or visitors present in the households on the night before the survey were eligible to be interviewed. In a sub-sample of half of the households, all men age 15-59 who were either permanent residents of the households in the 2008 NDHS sample or visitors present in the households on the night before the survey were eligible to be interviewed. In addition, a sub- sample of one eligible woman in each household was randomly selected to be asked additional questions about domestic violence. 1.5.2 Questionnaires Three questionnaires were used for the 2008 NDHS. They are the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. These questionnaires were adapted to reflect the population and health issues relevant to Nigeria at a series of meetings with various stakeholders from government ministries and agencies, non-governmental organisations, and international donors. In addition to English, the questionnaires were translated into three major Nigerian languages: Hausa, Igbo, and Yoruba. The Household Questionnaire was used to list all the usual members and visitors of selected households. Some basic information was collected on the characteristics of each person listed, including his or her age, sex, education, and relationship to the head of the household. For children under age 18, survival status of the parents was determined. If a child in the household had a parent who was sick for more than three consecutive months in the 12 months preceding the survey or a parent who had died, additional questions related to support for orphans and vulnerable children were asked. Additionally, if an adult in the household was sick for more than three consecutive months in the 12 months preceding the survey or an adult in the household died, questions were asked related to support for sick people or people in households where a household member has died. The data on the age and sex of household members obtained in the Household Questionnaire was used to identify women and men who were eligible for the individual interview. Additionally, the Household Questionnaire collected information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the house, ownership of various durable goods, and ownership and use of mosquito nets (to assess the coverage of malaria prevention programmes). The Household Questionnaire was also used to record height and weight measurements for children age 0-59 months and women age 15-49. The Women’s Questionnaire was used to collect information on all women age 15-49. These women were asked questions on the following main topics: • Background characteristics (education, residential history, media exposure, etc.) • Birth history and childhood mortality • Knowledge and use of family planning methods • Fertility preferences • Antenatal, delivery, and postnatal care • Breastfeeding and infant and young child feeding practices • Vaccinations and childhood illnesses • Marriage and sexual activity 8 | Introduction • Women’s work and husband’s background characteristics • Women’s and children’s nutritional status • Malaria prevention and treatment • Awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs) • Adult mortality including maternal mortality • Women’s status and health outcomes • Fistulae • Domestic violence • Female genital cutting The Men’s Questionnaire was administered to all men age 15-59 in every second household in the 2008 NDHS sample. The Men’s Questionnaire collected much of the same information found in the Women’s Questionnaire, but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health or nutrition. 1.5.3 Pre-test Activities The training for the pre-test took place March 3-12, 2008. Thirty-two interviewers (15 females and 17 males) were trained to administer the questionnaires and take anthropometric measurements. The pre-test training for the interviewers and supervisors consisted of a project overview and survey objectives, techniques of interviewing, field procedures, a detailed description of all sections of the household and individual questionnaires, and two days of field practice. The trainers/resource people included professionals from NPC and ICF Macro. The pre-test was conducted in 6 states by 6 teams March 15-22, 2008. The teams were divided according to languages. There were 2 Hausa teams in the North East and North West zones, 2 English teams in the South South and North Central zones, 1 Yoruba team in the South West, and 1 Igbo team in the South East. The supervisors and editors were drawn from the NPC core technical team. The teams covered 6 zones (one state in each zone) and aimed at completing 25 urban and 25 rural households per state. At the end of fieldwork, a debriefing session was held March 24-25, 2008 in Kaduna with all staff involved in the pre-test, and the questionnaires were amended based on the pre-test findings. 1.5.4 Training of Field Staff NPC recruited and trained 368 people for the fieldwork to serve as zonal coordinators, supervisors, field editors, female and male interviewers, reserve interviewers, and quality control interviewers. Training of field staff for the main survey was conducted during a three-week period in May-June 2008. The training course consisted of instruction regarding interviewing techniques and field procedures, a detailed review of items on the questionnaires, instruction and practice in weighing and measuring children, mock interviews between participants in the classroom, and practice interviews with real respondents in areas outside the 2008 NDHS sample points. During this period, field editors, team supervisors, and quality control interviewers were provided with additional training in methods of field editing, data quality control procedures, and fieldwork coordination. Thirty-seven supervisors, 37 editors, 152 female interviewers, and 74 male interviewers were selected to make up 37 data collection teams for the 2008 NDHS. Thirty-seven people were selected to be quality control interviewers. 1.5.5 Fieldwork Thirty-seven interviewing teams carried out data collection for the 2008 NDHS. Each team consisted of 1 supervisor (team leader), 1 field editor, 4 female interviewers, 2 male interviewers, and 2 drivers. Nineteen senior staff members from NPC, designated as zonal coordinators, coordinated Introduction | 9 and supervised fieldwork activities. Data collection took place over a four-month period from June to October 2008. 1.5.6 Data Processing All questionnaires for the 2008 NDHS were returned to the NPC headquarters office in Abuja for data processing, which consisted of office editing, coding of open-ended questions, data entry, and editing computer-identified errors. The data were processed by a team of 30 data entry operators, 3 data coders, 4 data entry supervisors, and 8 secondary editors. Data entry and editing were accomplished using the CSPro software. The processing of data was initiated in July 2008 and completed in February 2009. 1.6 RESPONSE RATES The household and individual response rates for the 2008 NDHS are shown in Table 1.2. A total of 36,298 households were selected and of these 34,644 were occupied. Of the 34,644 households found, 34,070 were successfully interviewed, yielding a response rate of 98 percent. There is no significant difference between rural and urban areas in terms of response rates. In the interviewed households, a total of 34,596 women were identified to be eligible for the individual interview, and 97 percent of them were successfully interviewed. For men, 16,722 were identified as eligible in half the households, and 93 percent of them were successfully interviewed. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Nigeria 2008 Residence Result Urban Rural Total Household interviews Households selected 11,418 24,880 36,298 Households occupied 10,958 23,686 34,644 Households interviewed 10,724 23,346 34,070 Household response rate1 97.9 98.6 98.3 Interviews with women age 15-49 Number of eligible women 10,868 23,728 34,596 Number of eligible women interviewed 10,489 22,896 33,385 Eligible women response rate2 96.5 96.5 96.5 Interviews with men age 15-59 Number of eligible men 5,597 11,125 16,722 Number of eligible men interviewed 5,133 10,353 15,486 Eligible men response rate 91.7 93.1 92.6 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Household Population and Housing Characteristics | 11 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 The purpose of this chapter is to provide a summary of some demographic and socio- economic characteristics of the population in the households sampled in the 2008 NDHS. For the purpose of the 2008 NDHS, a household was defined as a person or a group of persons, related or unrelated, who live together and share common cooking and eating arrangements. The Household Questionnaire (see Appendix G) included a schedule for collecting basic demographic and socio- economic information (e.g., age, sex, educational attainment, and current school attendance) for all usual residents and visitors who slept in the household the night preceding the interview. This method of data collection allows the analysis of the results for either the de jure population (usual residents) or the de facto population (i.e., persons in the household at the time of the survey). The Household Questionnaire also obtained information on housing facilities, e.g., dwelling characteristics, source of water supply, and sanitation facilities and household possessions, and some neglected tropical diseases that affect the population of Nigeria.1 The information in this chapter is intended to facilitate interpretation of the key demographic, socio-economic, and health indices presented later in the report. It is also intended to assist in the assessment of the representativeness of the survey sample. 2.1 POPULATION BY AGE AND SEX Age and sex are important demographic variables and are the primary basis of demographic classification. They are also important variables in the study of mortality, fertility, and nuptiality. The distribution of the de facto household population in the 2008 NDHS is shown in Table 2.1 by five- year age groups, according to sex and residence. About 50 percent of the population is female, and 50 percent is male. The sex ratio (the number of men per 100 women) is 99. The ratio in rural areas is lower than that of urban areas (97 compared with 101). The results show that the household population has a greater number of younger people than older people. Forty-five percent of the total population is under 15 years of age while 4 percent is 65 or older. The proportion of the population in each age group declines as age increases; the lowest age group (0-4) has the largest proportion of the population (17 percent), while the highest five-year age group (75-79) has the smallest proportion (less than 1 percent). Figure 2.1 illustrates the age structure of the household population in a population pyramid. Another feature of population pyramids is their strength in illustrating whether a population is “young” or “old.” The broad base of the pyramid indicates that Nigeria’s population is young. This scenario is typical of countries with higher fertility rates. 1 The survey results in this chapter are presented for the country as a whole, by urban-rural residence, and by zone. State-level results are available in Appendix A. 12 | Household Population and Housing Characteristics Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Nigeria 2008 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 15.9 15.7 15.8 18.2 17.2 17.7 17.5 16.7 17.1 5-9 13.7 13.8 13.7 16.7 15.7 16.2 15.7 15.1 15.4 10-14 11.4 11.2 11.3 12.9 11.8 12.3 12.4 11.6 12.0 15-19 8.8 9.2 9.0 8.6 8.5 8.5 8.7 8.7 8.7 20-24 8.5 9.2 8.8 6.4 7.8 7.1 7.1 8.2 7.7 25-29 8.4 10.1 9.3 6.5 8.0 7.2 7.1 8.7 7.9 30-34 7.2 6.9 7.0 5.4 6.0 5.7 6.0 6.3 6.1 35-39 6.4 5.5 5.9 4.7 5.0 4.9 5.3 5.2 5.2 40-44 4.7 4.3 4.5 4.0 4.0 4.0 4.2 4.1 4.1 45-49 3.9 3.4 3.6 3.5 3.5 3.5 3.7 3.5 3.6 50-54 3.0 3.2 3.1 2.9 3.8 3.3 2.9 3.6 3.2 55-59 2.1 2.1 2.1 2.2 2.7 2.4 2.2 2.5 2.3 60-64 2.2 1.8 2.0 2.6 2.2 2.4 2.5 2.1 2.3 65-69 1.4 1.2 1.3 1.8 1.5 1.7 1.7 1.4 1.6 70-74 1.0 0.9 1.0 1.6 1.1 1.3 1.4 1.0 1.2 75-79 0.5 0.4 0.5 0.8 0.5 0.6 0.7 0.5 0.6 80 + 0.8 1.0 0.9 1.1 0.9 1.0 1.0 0.9 1.0 Don’t know/missing 0.0 0.1 0.1 0.1 0.0 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 25,069 24,846 49,915 49,499 50,781 100,284 74,568 75,627 150,199 Note: Total includes 4 persons whose sex was not stated. Figure 2.1 Population Pyramid 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 0246810 0 2 4 6 8 10 NDHS 2008 Male Percent Female Age Household Population and Housing Characteristics | 13 2.2 HOUSEHOLD COMPOSITION Information on key aspects of the household composition, including the sex of the household head and the size of the household, is presented in Table 2.2. These characteristics are important because they are associated with household welfare. Female-headed households are, for example, typically poorer than male- headed households. Economic resources are often more limited in larger households. Moreover, where the size of the household is large, crowding also can lead to health problems. Table 2.2 shows that households in Nigeria are predominantly headed by men (81 percent) and less than one in five (19 percent) are headed by women. Female-headed house- holds are more common in urban areas (21 percent) than in rural areas (19 percent). There has been a slight increase in the proportion of female-headed households from 17 percent in the 2003 NDHS to 19 percent in the 2008 NDHS. The 2008 NDHS indicates that the average household size is 4.4 persons, compared with 5.0 persons in the 2003 NDHS. This shows a modest decline over the past five years. The table further shows that the average household size is slightly lower in urban areas (4.1 persons) and in rural areas (4.6 persons). The proportion of households with nine or more members is higher in rural areas (10 percent) than in urban areas (7 percent). Table 2.2 provides information on the proportion of households with foster children (that is, children who live in households with neither biological parent present), double orphans (children with both parents dead), and single orphans (children with one parent dead). Overall, one in five households contain foster children or orphans. The proportion of households with foster children (17 percent) is higher than the proportion with double orphans (1 percent) or single orphans (7 percent). Rural areas have a higher proportion of households with foster children and orphans than urban areas (21 percent compared with 19 percent). 2.3 EDUCATION O THE HOUSEHOLD POPULATION Education is a key determinant of the lifestyle and societal status an individual enjoys. Studies have consistently shown that educational attainment has a strong effect on health behaviours and attitudes. Results from the 2008 NDHS can be used to look at educational attainment among household members and school attendance, repetition, and drop-out rates among youth. For the purposes of the analysis presented below, the official age for entry into the primary level is six years old. Formal education in Nigeria is based on a three-tier system: primary education Table 2.2 Household composition Percent distribution of households by sex of head of household and by household size; mean size of household, and percentage of households with orphans and foster children under 18, according to residence, Nigeria 2008 Residence Characteristic Urban Rural Total Household headship Male 79.3 81.4 80.7 Female 20.7 18.6 19.3 Missing 0.0 0.0 0.0 Total 100.0 100.0 100.0 Number of usual members 0 0.2 0.3 0.3 1 20.2 16.4 17.8 2 12.4 12.8 12.6 3 14.1 13.2 13.5 4 14.2 12.8 13.3 5 12.4 12.1 12.2 6 9.4 9.7 9.6 7 6.7 7.6 7.3 8 3.9 5.0 4.6 9+ 6.5 10.2 8.9 Total 100.0 100.0 100.0 Mean size of households 4.1 4.6 4.4 Percentage of households with orphans and foster children under 18 Foster children1 15.5 17.5 16.8 Double orphans 0.8 0.7 0.7 Single orphans 6.5 7.4 7.1 Foster and/or orphan children 18.7 21.3 20.4 Number of households 12,100 21,970 34,070 Note: Table is based on de jure household members, i.e., usual residents. 1 Foster children are those under age 18 living in households with neither their mother nor their father present. 14 | Household Population and Housing Characteristics consisting of six years, junior secondary school consisting of three years, and senior secondary school consisting of three years. Upon completion of secondary school one may choose to further his or her education by either going to university or polytechnic or colleges of education for four to seven years, depending on the field of study, and obtain a degree or higher national diploma or certificate, or by attending a vocational or technical institute for a two- to three-year certificate or diploma course (Osuji, 2004). 2.3.1 Educational Attainment Tables 2.3.1 and 2.3.2 show data on educational attainment for female and male household members age six and older. Results from both tables indicate that, overall, more females than males have never attended school (40 percent compared with 28 percent). Figure 2.2 shows the percentage of males and females who have never attended school by age group. The proportion who have never attended school is higher for females than for males in all age groups. More than two in ten males (21 percent) and about two in ten females (19 percent) have some primary education. The proportion of males completing the primary level of education is 12 percent, compared with 11 percent of women. Fifteen percent of men have completed the secondary level of education, compared with 10 percent of women. There are urban-rural differences in educational attainment. Twenty-two percent of males in urban areas and 11 percent in rural areas have completed the secondary level, compared with 18 percent of females in urban areas and 7 percent in rural areas. Forty-nine percent of females and 35 percent of males in rural areas have no education. In urban areas, 22 percent of females and 14 percent of males have no education. With the exception of the youngest age group, some of whom will begin to attend school in the future, the proportion with no education increases with age. For example, the proportion of women who have never attended any formal schooling increases from 26 percent among those age 10- 14 to 78 percent among those age 65 and above. For men, the proportion increases from 20 percent of those age 10-14 to 62 percent of those age 65 and older. The proportion of the population that has attained any education varies among Nigeria’s geopolitical regions. The North West and North East have the highest proportion of persons with no education—roughly seven in ten women and half of men—while the South South has the lowest percentage who have never been to school, 15 percent among females and 8 percent among males. South West has the highest proportion of females and males who completed more than a secondary education (10 percent and 13 percent, respectively). As expected, educational attainment is positively related to household wealth status. Females and males in the highest wealth quintiles are more likely to be educated than those in the lowest wealth quintiles. Household Population and Housing Characteristics | 15 Table 2.3.1 Educational attainment of the female household population Percent distribution of the de facto female household populations age six and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Nigeria 2008 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Median years completed Age 6-9 43.9 52.8 0.3 0.6 0.0 0.0 2.4 100.0 9,292 0.0 10-14 25.8 45.3 7.7 19.9 0.3 0.0 1.0 100.0 8,775 3.1 15-19 24.1 7.5 8.9 46.4 11.1 1.3 0.7 100.0 6,587 7.0 20-24 29.8 3.9 11.4 16.6 27.0 10.5 0.8 100.0 6,235 8.0 25-29 33.1 4.8 15.8 11.0 21.7 12.6 1.1 100.0 6,567 5.7 30-34 37.3 5.4 16.8 9.2 17.8 12.1 1.5 100.0 4,733 5.4 35-39 37.2 6.5 20.3 8.6 15.6 10.6 1.2 100.0 3,899 5.3 40-44 46.0 5.8 17.2 7.4 12.6 9.6 1.3 100.0 3,071 3.2 45-49 54.9 7.0 16.5 4.3 8.1 7.9 1.1 100.0 2,616 0.0 50-54 62.1 7.8 15.0 2.4 5.0 4.3 3.4 100.0 2,700 0.0 55-59 64.1 9.9 15.4 1.4 3.2 3.0 3.1 100.0 1,876 0.0 60-64 69.5 8.3 10.2 1.7 2.9 2.3 5.2 100.0 1,574 0.0 65+ 77.9 5.7 6.5 0.7 0.9 1.3 7.1 100.0 2,915 0.0 Residence Urban 22.0 19.2 11.3 17.2 17.5 11.4 1.5 100.0 20,294 5.7 Rural 48.9 18.7 10.6 10.8 6.5 2.5 2.0 100.0 40,585 0.0 Zone North Central 39.3 23.8 10.9 12.4 7.1 4.8 1.7 100.0 8,861 1.7 North East 65.5 15.9 5.9 6.5 2.8 1.3 2.1 100.0 7,743 0.0 North West 67.5 13.1 6.8 4.6 3.1 1.5 3.4 100.0 14,977 0.0 South East 20.8 23.2 13.8 17.4 15.9 7.6 1.4 100.0 7,936 5.4 South South 14.9 22.0 15.7 22.3 16.2 7.9 0.9 100.0 9,255 5.7 South West 21.5 19.2 13.5 17.6 17.4 9.9 0.8 100.0 12,107 5.6 Wealth quintile Lowest 74.4 12.3 6.1 3.8 0.9 0.1 2.4 100.0 11,724 0.0 Second 58.6 19.2 9.7 7.5 2.4 0.3 2.4 100.0 12,188 0.0 Middle 39.0 23.4 13.0 14.1 7.1 1.4 2.0 100.0 12,575 1.9 Fourth 20.9 21.6 15.1 19.1 16.0 5.8 1.4 100.0 12,238 5.4 Highest 8.0 17.6 10.1 19.8 24.1 19.4 1.0 100.0 12,155 9.2 Total 39.9 18.9 10.9 12.9 10.2 5.4 1.8 100.0 60,879 2.1 Note: Total includes 37 unweighted cases with information missing on educational attainment. 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level 16 | Household Population and Housing Characteristics Table 2.3.2 Educational attainment of the male household population Percent distribution of the de facto male household populations age six and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Nigeria 2008 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Median years completed Age 6-9 39.7 57.3 0.4 0.5 0.0 0.0 2.1 100.0 9,459 0.0 10-14 19.6 52.2 7.3 19.8 0.2 0.1 0.8 100.0 9,251 3.2 15-19 15.0 9.7 8.5 54.6 10.5 1.2 0.5 100.0 6,465 7.4 20-24 14.8 3.1 8.7 24.9 34.9 13.0 0.6 100.0 5,300 10.8 25-29 18.6 3.2 13.5 12.5 32.7 18.7 0.7 100.0 5,330 11.1 30-34 21.1 3.6 16.4 10.6 29.0 18.8 0.5 100.0 4,457 9.8 35-39 21.3 4.2 19.9 9.6 26.6 17.6 0.8 100.0 3,941 8.4 40-44 25.2 5.0 20.3 8.1 23.5 17.1 0.9 100.0 3,149 6.0 45-49 28.9 4.4 20.7 7.6 19.2 18.2 1.0 100.0 2,724 5.8 50-54 39.6 6.1 23.6 3.8 12.1 13.7 1.1 100.0 2,173 5.2 55-59 44.3 7.0 23.4 3.8 9.0 11.4 1.3 100.0 1,605 3.6 60-64 51.6 6.9 21.0 3.1 7.7 6.6 3.0 100.0 1,851 0.0 65+ 61.5 7.6 16.4 2.0 4.8 4.0 3.7 100.0 3,567 0.0 Residence Urban 13.8 19.3 11.0 17.2 22.2 15.3 1.2 100.0 20,418 7.4 Rural 35.0 21.9 12.3 14.1 10.5 5.0 1.3 100.0 38,918 2.8 Zone North Central 25.3 24.5 10.4 17.2 12.6 8.8 1.2 100.0 8,746 4.9 North East 53.1 19.8 6.3 9.7 6.0 3.9 1.2 100.0 7,667 0.0 North West 48.8 18.4 9.4 9.1 6.6 5.5 2.3 100.0 14,590 0.0 South East 11.1 24.0 19.5 19.2 16.4 9.0 0.8 100.0 6,758 5.7 South South 7.5 22.2 14.2 21.9 22.0 11.4 0.7 100.0 9,367 7.3 South West 12.8 19.8 13.2 16.8 24.0 12.7 0.7 100.0 12,208 6.9 Wealth quintile Lowest 62.4 16.7 8.8 7.1 2.9 0.5 1.5 100.0 11,458 0.0 Second 41.6 23.5 12.4 12.3 6.9 1.7 1.6 100.0 11,088 1.0 Middle 23.0 26.9 14.2 18.1 12.2 4.4 1.3 100.0 11,786 4.9 Fourth 11.2 21.9 14.4 19.9 21.2 10.3 1.0 100.0 12,393 6.3 Highest 4.4 16.3 9.4 17.4 27.5 24.1 0.9 100.0 12,611 11.1 Total 27.7 21.0 11.8 15.1 14.5 8.6 1.2 100.0 59,336 5.1 Note: Total includes 68 unweighted cases with information missing on educational attainment 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level Household Population and Housing Characteristics | 17 2.3.2 School Attendance Rates Table 2.4 shows primary school and secondary school net and gross attendance ratios (NAR and GAR) for the 2007/2008 school year by household residence and zones. The NAR for primary school is the percentage of the primary-school-age (6-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school-age (13-17 years) population that is attending secondary school. By definition, the NAR cannot exceed 100 percent. The GAR for primary school is the total number of primary school students, of any age, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, of any age, expressed as a percentage of the official secondary- school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. Youth are considered to be attending school currently if they attended formal academic school at any point during the given school year. The gender parity index (GPI) assesses sex-related differences in school attendance rates and is calculated by dividing the GAR for females by the GAR for males. A GPI less than one indicates a gender disparity in favour of males (i.e., a higher proportion of males than females attends that level of schooling). A GPI greater than one indicates a gender disparity in favour of females. A GPI of one indicates parity or equality between the rates of participation for males and females. Table 2.4 shows the NARs and GARs for the de facto household population by sex, level of schooling, and GPI, according to background characteristics. Results show that the overall NAR for primary schools is 62, while the GAR is 84. Analysis by urban and rural residence shows that the NAR is much higher in urban areas (74 percent) than in rural areas (57 percent). The GAR is also higher in urban areas than in rural areas (98 and 79 percent, respectively). There is a slight difference in the NAR between males and females at the primary school level (65 and 59 percent, respectively). Males also show a higher GAR at the primary school level (89 percent) than females (80 percent). There is significant variation at the zonal level; the primary NAR and GAR are highest in the South East (83 and 110 percent, respectively). North West has the lowest NAR and GAR, with 43 and 59 percent, respectively. According to wealth status, the NAR is 79 percent for the fourth quintile and 33 percent for the lowest quintile. The same trend applies to the GAR at the primary level (105 percent for the fourth quintile and 48 percent for the lowest quintile, respectively). Figure 2.2 Percent Distribution of Household Population with No Education by Sex 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Age 0 20 40 60 80 Percent Female Male NDHS 2008 18 | Household Population and Housing Characteristics Table 2.4 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling; and the gender parity index (GPI), according to background characteristics, Nigeria 2008 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Urban 75.9 72.2 74.1 0.95 99.5 95.5 97.5 0.96 Rural 60.3 53.5 57.0 0.89 84.4 72.7 78.7 0.86 Zone North Central 71.7 69.2 70.5 0.97 104.4 97.8 101.2 0.94 North East 46.8 40.3 43.7 0.86 66.4 55.8 61.3 0.84 North West 49.8 37.1 43.4 0.75 68.4 49.2 58.7 0.72 South East 82.4 83.2 82.8 1.01 109.5 110.7 110.1 1.01 South South 80.1 80.1 80.1 1.00 109.1 105.6 107.4 0.97 South West 77.8 75.2 76.6 0.97 101.0 98.9 99.9 0.98 Wealth quintile Lowest 37.1 29.0 33.2 0.78 54.7 41.2 48.2 0.75 Second 59.1 49.3 54.2 0.83 84.8 68.3 76.5 0.81 Middle 76.2 70.5 73.5 0.93 105.0 95.7 100.5 0.91 Fourth 80.5 78.2 79.4 0.97 106.3 102.8 104.6 0.97 Highest 78.4 76.7 77.5 0.98 100.4 99.1 99.8 0.99 Total 64.9 59.1 62.1 0.91 88.9 79.5 84.3 0.89 SECONDARY SCHOOL Residence Urban 66.2 62.5 64.3 0.94 99.2 88.0 93.5 0.89 Rural 44.7 38.0 41.4 0.85 70.4 54.6 62.6 0.77 Zone North Central 50.1 41.6 46.0 0.83 84.9 62.2 73.9 0.73 North East 29.4 22.1 25.7 0.75 47.2 30.3 38.6 0.64 North West 33.8 19.3 26.7 0.57 54.6 28.7 42.0 0.52 South East 68.7 68.7 68.7 1.00 98.0 91.5 94.6 0.93 South South 66.7 65.5 66.1 0.98 100.6 93.6 97.2 0.93 South West 68.5 68.9 68.7 1.01 101.7 98.6 100.1 0.97 Wealth quintile Lowest 19.1 10.6 15.0 0.56 32.2 16.4 24.5 0.51 Second 37.4 27.3 32.3 0.73 61.7 38.3 49.9 0.62 Middle 56.7 50.8 53.8 0.90 90.4 70.3 80.4 0.78 Fourth 66.9 63.9 65.4 0.96 102.0 91.3 96.8 0.89 Highest 75.3 73.0 74.1 0.97 108.2 104.7 106.4 0.97 Total 51.8 46.4 49.1 0.89 80.0 65.9 73.0 0.82 1 The NAR for primary school is the percentage of the primary-school-age (1-6 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school-age (1-6 years) population that is attending secondary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of over-age and under-age students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index for primary school is the ratio of the primary school NAR(GAR) for females to the NAR(GAR) for males. The Gender Parity Index for secondary school is the ratio of the secondary school NAR (GAR) for females to the NAR(GAR) for males. The NAR at the secondary school level is 49 percent, while the GAR is 73 percent. This is an indication that fewer people attend secondary school than primary school. Both ratios are much higher in urban areas than in rural areas. The NAR and GAR at the secondary school level for males and females follow a similar pattern as the primary school level with males recording a higher proportion in both cases (52 versus 46 for the NAR and 80 versus 66 for the GAR). South East and South west have the highest NAR (69 percent each) for the secondary school level while North East has the lowest (26 percent). South West also has the highest GAR (100 percent) while North East has the lowest GAR (39 percent). The NAR and GAR are highest in the highest (wealthiest quintile) (74 and 106 percent, respectively) and lowest in the lowest (poorest) wealth quintile (15 and 25 percent, respectively). Household Population and Housing Characteristics | 19 2.3.3 Grade Repetition and Drop-out Rates Repetition rates and drop-out rates shown in Table 2.5 describe the flow of pupils through the educational system in Nigeria at the primary level. The repetition rates indicate the percentage of pupils who attended a particular grade during the 2006/2007 school year who again attended that same class during the following school year. The drop-out rates show the percentage of pupils in a grade during the 2006/2007 school year who no longer attended school the following school year. Table 2.5 shows that, overall, repetition in Nigeria is highest at grade six (5 percent). There are no significant differences in repetition rates between rural and urban areas at the sixth grade level. However, by sex, repetition rates are higher among males (6 percent) than among females (4 percent). Zonal differentials indicate that repetition rates are generally higher in North Central for primary school grades 1-6. The patterns for drop-out rates are similar to those for repetition rates. Drop-out rates are highest in the sixth grade (12 percent) and lowest in the second grade (less than 1 percent). Drop-out rates at grade 6 are higher among females (13 percent) than among males (10 percent). There is great variation by residence and zone. For example, rural children are twice as likely as urban children to drop out of school at grade 6. The drop-out rate in grade 6 is highest in the North East (18 percent) and lowest in the South West (5 percent). The table also shows that drop-out rates at grade 6 are highest among respondents in the lowest wealth quintile (25 percent) and lowest among children in the highest wealth quintile (5 percent). Figure 2.3 shows the age-specific attendance rates for the male and female de facto population age 5-24. The figure shows that there are no marked differences in the attendance rates between males and females age 5 to 15; however, after age 15 attendance rates for males are much higher than those for females. Table 2.5 Grade repetition and drop-out rates Repetition and drop-out rates for the de facto household population age 5-24 who attended primary school in the previous school year by school grade, according to background characteristics, Nigeria 2008 School grade Background characteristic 1 2 3 4 5 6 REPETITION RATE1 Sex Male 2.6 2.3 1.7 1.3 1.1 5.6 Female 2.5 2.1 2.3 2.1 1.4 3.5 Residence Urban 2.3 2.1 2.5 1.8 0.8 4.4 Rural 2.7 2.3 1.7 1.7 1.5 4.7 Zone North Central 4.0 3.4 4.7 2.4 2.2 11.1 North East 1.0 1.4 1.9 0.9 0.7 5.5 North West 2.9 3.1 2.0 2.5 1.2 3.0 South East 2.0 1.3 1.5 1.6 0.8 2.4 South South 2.6 1.9 0.5 1.0 1.4 1.4 South West 2.0 1.6 1.5 1.4 0.9 5.2 Wealth quintile Lowest 2.8 1.4 1.5 1.4 1.0 4.1 Second 2.7 2.9 2.7 1.3 1.2 4.9 Middle 2.8 2.2 1.8 1.4 1.2 5.4 Fourth 2.6 2.3 2.3 2.5 2.0 3.3 Highest 1.8 2.0 1.5 1.7 0.4 5.2 Total 2.6 2.2 2.0 1.7 1.2 4.6 DROP-OUT RATE2 Sex Male 0.4 0.2 0.3 0.4 0.4 10.3 Female 0.5 0.2 0.3 0.4 0.6 12.9 Residence Urban 0.7 0.5 0.1 0.1 0.4 7.5 Rural 0.3 0.0 0.4 0.6 0.5 14.1 Zone North Central 0.3 0.1 0.0 0.1 0.3 15.0 North East 1.2 0.2 0.5 0.4 0.5 17.9 North West 0.4 0.1 0.2 0.4 0.4 17.2 South East 0.1 0.5 0.0 0.1 0.6 9.9 South South 0.3 0.0 0.6 0.8 0.8 12.7 South West 0.3 0.4 0.4 0.4 0.2 4.7 Wealth quintile Lowest 0.6 0.2 1.0 1.4 0.3 24.8 Second 0.5 0.1 0.8 0.4 0.8 19.5 Middle 0.5 0.3 0.0 0.6 0.3 11.2 Fourth 0.4 0.1 0.0 0.0 0.3 8.3 Highest 0.2 0.3 0.2 0.0 0.5 5.0 Total 0.4 0.2 0.3 0.4 0.5 11.6 1 The repetition rate is the percentage of students in a given grade in the previous school year who are repeating that grade in the current school year. 2 The drop-out rate is the percentage of students in a given grade in the previous school year who are not attending school. 20 | Household Population and Housing Characteristics 2.4 HOUSEHOLD ENVIRONMENT The physical characteristics of household dwellings are important indicators of the socio- economic and health status of households. The 2008 NDHS asked a number of questions about the household environment, including the following: source of drinking water; type of sanitation facility; type of flooring, walls, and roof; and number of rooms in the dwelling. The results are presented both for households and for the de jure population. 2.4.1 Drinking Water Increasing access to improved drinking water is one of the Millennium Development Goals that Nigeria and other nations worldwide have adopted. Table 2.6 includes a number of indicators that are useful in monitoring household access to improved drinking water. The source of drinking water is an indicator of whether it is suitable for drinking. Sources that are likely to provide water suitable for drinking are identified as improved sources in Table 2.6; they include, piped source within the dwelling or plot, public tap, tube well or borehole, and protected well or spring. Lack of ready access to water may limit the quantity of suitable drinking water that is available to a household, even if the water is obtained from an improved source. Water that must be fetched from a source that is not immediately accessible to the household may be contaminated during transport or storage. Another factor in considering the accessibility of water sources is that the burden of fetching water often falls disproportionately on female members of the household. Finally, home water treatment can be effective in improving the quality of household drinking water. Figure 2.3 Age-Specific Attendance Rates of the De Facto Population Age 5 to 24 by Sex 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age 0 20 40 60 80 100 Percent Female Male NDHS 2008 Household Population and Housing Characteristics | 21 Table 2.6 Household drinking water Percent distribution of households and de jure population by source, time to collect, and person who usually collects drinking water; and percentage of households and the de jure population by treatment of drinking water, according to residence, Nigeria 2008 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 75.1 45.3 55.9 75.4 43.6 54.2 Piped water into dwelling/ yard/plot 7.2 1.4 3.4 7.9 1.5 3.6 Public tap/standpipe 12.7 4.1 7.2 12.2 3.6 6.5 Tube well or borehole 38.2 22.4 28.0 37.8 21.0 26.6 Protected dug well 14.5 13.2 13.6 14.9 13.7 14.1 Protected spring 0.5 0.7 0.6 0.6 0.6 0.6 Rainwater 1.9 3.6 3.0 1.9 3.1 2.7 Non-improved source 14.6 53.4 39.6 16.9 55.5 42.6 Unprotected dug well 6.1 21.7 16.2 7.6 24.5 18.9 Unprotected spring 1.1 4.7 3.4 1.1 4.8 3.6 Tanker truck/cart with small tank 2.8 1.0 1.7 3.3 1.0 1.8 Surface water 4.6 26.0 18.4 4.8 25.2 18.4 Bottled water, improved source for cooking/washing1 6.0 0.4 2.4 4.4 0.3 1.6 Bottled water, non-improved source for cooking/washing 0.9 0.2 0.5 0.7 0.1 0.3 Other sources 3.3 0.7 1.7 2.7 0.5 1.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 81.1 45.6 58.2 79.7 43.8 55.8 Time to obtain drinking water (round trip) Water on premises 30.0 21.5 24.5 31.4 23.0 25.8 Less than 30 minutes 52.9 50.4 51.3 50.3 48.0 48.8 30 minutes or longer 14.6 26.8 22.5 15.3 27.8 23.7 Don't know/missing 2.6 1.2 1.7 3.0 1.2 1.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Person who usually collects drinking water Adult female 15+ 23.6 26.7 25.6 20.8 24.5 23.3 Adult male 15+ 18.6 22.3 21.0 14.0 17.1 16.1 Female child under age 15 4.7 4.0 4.2 5.7 4.5 4.9 Male child under age 15 3.5 3.8 3.7 4.2 4.2 4.2 Adult woman with child 3.9 6.4 5.5 5.0 8.1 7.1 Other 4.2 1.9 2.7 4.3 1.6 2.5 Water on premises 32.6 24.6 27.4 35.3 27.4 30.0 Missing 0.2 0.2 0.2 0.3 0.2 0.2 Total 91.2 89.9 90.4 89.5 87.6 88.2 Water treatment prior to drinking2 Boiled 6.6 2.4 3.9 6.2 2.2 3.6 Bleach/chlorine 3.9 1.6 2.4 4.0 1.7 2.5 Strained through cloth 2.2 4.5 3.7 2.6 5.3 4.4 Ceramic, sand or other filter 1.3 0.7 0.9 1.4 0.8 1.0 Solar disinfection 0.1 0.1 0.1 0.1 0.1 0.1 Alum 3.1 4.3 3.9 3.3 4.0 3.8 Other 2.0 1.4 1.6 2.0 1.5 1.7 No treatment 82.7 85.8 84.7 82.1 85.3 84.3 Percentage using an appropriate treatment method3 12.9 8.9 10.3 13.2 9.6 10.8 Number 12,100 21,970 34,070 50,147 100,442 150,589 1 Because the quality of bottled water is not known, households using bottled water for drinking are classified as using an improved or non-improved source according to their water source for cooking and washing. 2 Respondents may report multiple treatment methods so the sum of treatment may exceed 100 percent. 3 Appropriate water treatment methods include boiling, bleaching, straining, filtering, and solar disinfecting. 22 | Household Population and Housing Characteristics The table shows that only 56 percent of the households have access to improved sources of water. Households in urban areas are more likely to have access to improved sources of water than those in rural areas (75 percent compared with 45 percent). About two-fifths of households draw their water from an unimproved source. Thirty percent of urban households have water on their premises, compared with about one in five households (22 percent) in rural areas. Overall, 23 percent of the households take 30 or more minutes to obtain water: 15 percent of households in urban areas compared with 27 percent of households in the rural areas. Adult females collect drinking water more often than adult males (26 and 21 percent, respectively). Results also show that both male and female children below age 15 are involved in collecting drinking water. Most households (85 percent) do not treat their water; about 10 percent of households use an appropriate method to treat their drinking water. Alum, boiling, straining through cloth, and bleach or chlorine are the most common methods used by households for water treatment. 2.4.2 Household Sanitation Facilities Ensuring adequate sanitation facilities is another of the Millennium Development Goals that Nigeria shares with other countries. A household is classified as having an improved toilet if the toilet is used only by members of one household (i.e., it is not shared with other households) and if the facility used by the household separates the waste from human contact (WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, 2004). Table 2.7 shows that almost three in ten households in Nigeria (27 percent) use an improved toilet facility (31 percent in urban areas and 25 percent in rural areas), while seven in ten households (73 percent) use non-improved facilities (69 percent in urban areas and 75 percent in rural areas). Among households with improved toilet facilities, flush toilets (to pipe sewer system, to septic tank, or to pit latrine) are mainly found in urban areas and are used by 18 percent of households (4 percent in rural areas). Table 2.7 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Nigeria 2008 Households Population Type of toilet/latrine facility Urban Rural Total Urban Rural Total Improved, not shared facility Total 31.4 24.6 27.0 37.5 28.1 31.2 Flush/pour flush to piped sewer system 5.3 1.0 2.5 5.9 1.0 2.6 Flush/pour flush to septic tank 10.9 2.3 5.3 11.1 1.9 5.0 Flush/pour flush to pit latrine 1.5 0.6 0.9 2.0 0.6 1.1 Ventilated improved pit (VIP) latrine 9.0 14.4 12.5 11.6 17.2 15.3 Pit latrine with slab 4.6 6.4 5.7 6.8 7.2 7.1 Composting toilet 0.0 0.0 0.0 0.0 0.0 0.0 Non-improved facility Total 68.6 75.4 73.0 62.5 71.9 68.8 Any facility shared with other households 44.2 15.7 25.8 38.8 13.0 21.6 Flush/pour flush not to sewer/septic tank/pit latrine 0.4 0.1 0.2 0.4 0.1 0.2 Pit latrine without slab/open pit 7.8 14.2 11.9 9.2 15.7 13.5 Bucket 0.1 0.1 0.1 0.1 0.0 0.1 Hanging toilet/hanging latrine 1.7 1.7 1.7 1.2 1.4 1.4 No facility/bush/field 13.6 42.2 32.1 11.8 40.2 30.8 Other 0.5 0.8 0.7 0.4 0.8 0.7 Missing 0.6 0.6 0.6 0.6 0.6 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 12,100 21,970 34,070 50,147 100,442 150,589 Household Population and Housing Characteristics | 23 Ventilated improved pit (VIP) latrines are more common in the rural areas (14 percent) than in urban areas (9 percent). Overall, 13 percent of households use VIP latrines. Six percent of households use a pit latrine with a slab (6 percent rural and 5 percent urban). Among households with a non-improved toilet facility, 26 percent use facilities that are shared with other households (44 percent urban and 16 percent rural). Less than 1 percent use a flush toilet (not to sewer/septic tank/pit latrine). Overall, 32 percent of households in Nigeria have no toilet facilities. This problem is more common in rural areas (42 percent) than in urban areas (14 percent). 2.4.3 Housing Characteristics Table 2.8 presents information on a number of household dwelling characteristics, the proportion of households using various types of fuel for cooking. These characteristics reflect the household’s socio-economic situation. They also may influence environmental conditions—for example, in the case of the use of biomass fuels, exposure to indoor pollution—that have a direct bearing on household members’ health and welfare. The proportion of households with electricity in Nigeria is 50 percent. There are more households with electricity in urban areas (85 percent) than in rural areas (31 percent). Cement is the most common material used for floors, with 42 percent of households having floors made of cement (49 percent urban and 39 percent rural). In rural areas, 46 percent of households have floors made out of earth/sand, compared with 9 percent in urban areas. About 43 percent of the households in Nigeria live in housing units with only one bedroom, while about three in ten households (29 percent) live in housing units with three or more bedrooms. About 40 percent of households cook inside the house, while about one-quarter (25 percent) cook outdoors. The percentage of households that cook in their dwelling is higher in urban areas (43 percent) than in rural areas (38 percent). Wood is the most common fuel used for cooking, reported by 66 percent of households. Wood is more commonly used in rural areas (83 percent) than in urban areas (37 percent). Twenty-six percent of all households use kerosene for cooking. More households in the urban areas (52 percent) use kerosene for cooking than those in rural areas (11 percent). The percentage of households using solid fuel is high (70 percent), including 86 percent of households in rural areas and 42 percent of households in urban areas. Among the households that reported use of solid fuel for cooking, the majority (94 percent) were using an open fire/stove without a chimney or hood—92 percent of urban households and 95 percent of rural households. 24 | Household Population and Housing Characteristics Table 2.8 Household characteristics Percent distribution of households and de jure population by housing characteristics and percentage using solid fuel for cooking; and among those using solid fuels, percent distribution by type of fire/stove, according to residence, Nigeria 2008 Households Population Housing characteristic Urban Rural Total Urban Rural Total Electricity Yes 84.8 31.4 50.3 84.3 29.7 47.9 No 15.0 68.3 49.4 15.5 70.0 51.8 Missing 0.2 0.3 0.3 0.2 0.3 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Earth, sand 8.7 45.5 32.4 10.5 48.6 35.9 Dung 0.4 2.3 1.6 0.4 2.5 1.8 Wood/planks 0.1 0.6 0.5 0.1 0.7 0.5 Palm/bamboo 0.0 0.6 0.4 0.0 0.7 0.5 Parquet or polished wood 0.2 0.3 0.3 0.1 0.3 0.3 Vinyl or asphalt strips 0.0 0.0 0.0 0.1 0.0 0.0 Ceramic tiles 3.1 0.7 1.5 3.4 0.6 1.5 Cement 48.7 38.5 42.1 50.9 37.5 42.0 Carpet 38.0 11.1 20.6 33.7 8.7 17.0 Other 0.5 0.3 0.4 0.6 0.2 0.4 Missing 0.1 0.2 0.2 0.2 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 51.6 38.8 43.3 35.9 23.3 27.5 Two 24.0 28.8 27.1 27.8 29.9 29.2 Three or more 23.9 32.1 29.2 35.9 46.6 43.0 Missing 0.5 0.3 0.3 0.4 0.3 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Place for cooking In the house 43.3 37.7 39.7 46.1 41.2 42.8 In a separate building 29.5 34.1 32.4 31.2 35.2 33.9 Outdoors 23.8 25.1 24.7 21.1 22.4 21.9 Other 0.6 0.4 0.5 0.6 0.3 0.4 Missing 2.8 2.8 2.8 1.0 1.0 1.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 0.7 0.1 0.3 0.7 0.1 0.3 LPG/natural gas/biogas 3.0 0.4 1.3 2.6 0.3 1.1 Kerosene 51.6 11.3 25.6 44.1 7.3 19.5 Coal/lignite 0.6 0.2 0.4 0.7 0.2 0.4 Charcoal 4.1 1.8 2.6 4.3 1.7 2.6 Wood 36.6 82.5 66.2 45.8 88.3 74.1 Straw/shrubs/grass 0.7 0.9 0.9 0.8 1.1 1.0 Agricultural crop 0.0 0.2 0.1 0.0 0.2 0.2 Animal dung 0.0 0.0 0.0 0.0 0.1 0.0 No food cooked in household 2.5 2.4 2.4 0.7 0.7 0.7 Other 0.1 0.0 0.1 0.1 0.0 0.1 Missing 0.1 0.1 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using solid fuel for cooking1 42.1 85.6 70.1 51.7 91.5 78.3 Number of households 12,100 21,970 34,070 50,147 100,442 150,589 Type of fire/stove among households using solid fuel Closed stove with chimney 0.7 0.2 0.3 0.6 0.2 0.3 Open fire/stove with chimney 3.0 1.9 2.2 3.2 2.1 2.3 Open fire/stove with hood 3.6 2.4 2.7 4.3 2.8 3.2 Open fire/stove without chimney or hood 92.0 95.0 94.3 91.3 94.4 93.7 Other 0.2 0.0 0.1 0.2 0.0 0.0 Missing 0.5 0.4 0.4 0.4 0.5 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population using solid fuel 5,092 18,803 23,894 25,933 91,943 117,875 1 Includes coal/lignite, charcoal, wood/straw/shrubs/grass, agricultural crops, and animal dung LPG = Liquid petroleum gas Household Population and Housing Characteristics | 25 2.5 HOUSEHOLD POSSESSIONS The availability of durable consumer goods is a good indicator of a household’s socio- economic status. Moreover, particular goods have specific benefits. For instance, having access to a radio or a television exposes household members to innovative ideas; a refrigerator prolongs food storage; and a means of transport allows greater access to many services away from the local area. Table 2.9 shows the presence of selected consumer goods by residence; 74 percent of households own a radio (84 percent in urban areas and 69 percent in rural areas), and 39 percent own a television (69 percent in urban areas and 23 percent in rural areas). A mobile telephone is owned by 50 percent of households (76 percent in urban areas and 35 percent in rural areas), while 16 percent of households own a refrigerator. Table 2.9 also shows the proportion of households owning various means of transport. Twenty-three percent of the households own a bicycle (11 percent in urban areas and 29 percent in rural areas), while only 8 percent own a car, and 24 percent own a motorcycle. Only 3 percent own a canoe (1 percent urban and 4 percent rural), and 3 percent own an animal-drawn cart (1 percent urban and 4 percent rural). Less than 1 percent owns a boat with a motor. Among the means of transport listed , the bicycle, motorcycle/scooter, canoe, and animal drawn cart are more common in rural areas than in urban areas. Table 2.9 Household durable goods Percentage of households and de jure population possessing various household effects, means of transportation, agricultural land and livestock/farm animals by residence, Nigeria 2008 Households Population Possession Urban Rural Total Urban Rural Total Household effects Radio 83.5 69.4 74.4 85.5 72.6 76.9 Television 69.0 22.9 39.3 71.7 23.1 39.3 Mobile telephone 76.1 35.1 49.7 77.5 35.1 49.2 Non-mobile telephone 3.7 0.7 1.8 4.1 0.8 1.9 Refrigerator 32.4 6.7 15.9 36.0 6.9 16.6 Means of transport Canoe 1.0 3.8 2.8 1.1 3.7 2.8 Bicycle 11.3 29.3 22.9 15.8 35.2 28.7 Animal drawn cart 0.9 3.7 2.7 1.5 5.3 4.0 Motorcycle/scooter 23.5 24.9 24.4 29.5 30.0 29.8 Car/truck 14.9 4.5 8.2 18.2 5.2 9.5 Boat with a motor 0.4 0.5 0.4 0.5 0.5 0.5 Ownership of agricultural land 33.0 76.7 61.2 38.9 83.0 68.3 Ownership of farm animals1 29.0 62.9 50.8 36.1 72.5 60.4 Ownership of bank/savings account2 52.7 16.6 29.4 53.0 16.1 28.4 Number 12,100 21,970 34,070 50,147 100,442 150,589 1 Includes livestock and poultry. 2 At least one household member has an account. Agricultural land is owned by 61 percent of households (77 percent in rural areas and 33 percent in urban areas,), whereas farm animals are owned by 51 percent of households (63 percent in rural areas and 29 percent in urban areas). 2.6 WEALTH INDEX The wealth index is used throughout the report as a background characteristic. It serves as a proxy for measuring the long-term standard of living. It is based on data from the household’s ownership of consumer goods; dwelling characteristics; type of drinking water source; toilet facilities; and other characteristics that are related to a household’s socio-economic status. To construct the index, each of these assets was assigned a weight (factor score) generated through principal 26 | Household Population and Housing Characteristics component analysis, and the resulting asset scores were standardised in relation to a standard normal distribution with a mean of zero and standard deviation of one (Gwatkin et al., 2000). Each household was then assigned a score for each asset, and the scores were summed for each household. Individuals were ranked according to the total score of the household in which they resided. The sample was then divided into quintiles from one (lowest) to five (highest). A single asset index was developed on the basis of data from the entire country sample and this index is used in all the tabulations presented. Table 2.10 shows the percent distribution of the de jure household population by wealth quintile according to residence and region. The distributions indicate the degree to which wealth is evenly (or unevenly) distributed geographically. The table shows that urban areas have higher proportions of people in the fourth and highest quintiles (30 and 47 percent, respectively) compared with rural areas (15 and 7 percent, respectively). On the other hand, rural areas have higher proportions of the population in the lowest and second quintiles (29 and 27 percent, respectively) than urban areas (3 and 5 percent, respectively). Table 2.10 Wealth quintiles Percent distribution of the jure population by wealth quintiles, according to residence and region, Nigeria 2008 Wealth quintile Residence/zone Lowest Second Middle Fourth Highest Total Number of population Residence Urban 2.5 5.4 15.3 29.9 46.9 100.0 50,147 Rural 28.7 27.3 22.3 15.1 6.6 100.0 100,442 Zone North Central 20.6 23.2 25.3 17.1 13.8 100.0 21,971 North East 47.4 22.7 16.4 10.3 3.2 100.0 20,353 North West 31.9 30.9 17.2 12.5 7.6 100.0 38,913 South East 4.6 9.9 28.1 31.6 25.8 100.0 17,430 South South 6.7 14.4 22.9 30.1 26.0 100.0 22,329 South West 4.2 11.6 15.3 24.3 44.6 100.0 29,594 Total 20.0 20.0 20.0 20.0 20.0 100.0 150,589 Considering these findings, it is not surprising that the three southern zones, which are more urbanised, have greater proportions of their populations in the higher wealth quintiles than the northern zones. Forty-five percent of the population in South West is concentrated in the highest wealth quintile. The percentage of the population in the highest wealth quintile is 26 percent in South South and South East. By contrast the proportion of the population in the highest wealth quintile in North East is only 3 percent. Eight percent of the population in North West and 14 percent of the population in North Central are in the highest wealth quintile. On the other hand, the proportion of the population in the lowest wealth quintile in North East is 47 percent, followed by 32 percent in North West and 21 percent in North Central. The proportion of the population in the lowest wealth quintile in South South, South East and South West zones is 6 percent, 5 percent, and 4 percent, respectively. 2.7 BIRTH REGISTRATION Birth registration is the formal inscription of the facts of a birth into an official log kept at the registrar’s office. A birth certificate is issued at the time of registration or later as proof of the registration of the birth. Birth registration is basic to ensuring a child’s legal status and, thus, basic rights and services (UNICEF, 2006; United Nations General Assembly, 2002). Over time, various forms of registrations of births and deaths have been implemented across Nigeria from the colonial period onward. The most recent being the “Births, Deaths, ETC (Compulsory) Registration” Decree (now Act) No. 69 of 1992 which went into effect 1st December 1992. The law gave the sole authority to register these events nationwide to the National Population Commission. The provisions were further reinforced by section 24 of the Third schedule of the 1999 Constitution of the Federal Republic of Nigeria. Household Population and Housing Characteristics | 27 Table 2.11 shows the percentage of children less than five years of age whose births were officially registered and the percentage who had a birth certificate seen at the time of the survey. Thirty percent of children under five were reported to have had their births registered and, of those, 38 percent had a birth certificate. More births are registered in urban areas (49 percent) than in rural areas (22 percent). At the zonal level, South East zone has the highest proportion of births being registered (54 percent) while North East zone has the lowest (14 percent). Children in wealthier households are more likely to be registered than those in poorer households; 62 percent of children in households in the highest wealth quintile are registered compared with 9 percent in households in the lowest wealth quintile. Table 2.12 shows the percent distribution of de jure children less than five years of age who are registered, according to the authority with which the birth is registered. Thirty-six percent of the children were registered at private clinics or hospitals, 36 percent were registered at the National Population Commission (NPC), and 17 percent were registered at the Local Government Area (LGA). The proportion of births registered with the NPC is higher in urban than rural areas (39 percent, compared with 33 percent). The same pattern is seen for births registered at private hospitals and clinics. In contrast, the proportion of births registered at the LGA is higher in rural (18 percent) than urban areas (14 percent). The North West zone has the highest percentage of births registered with the NPC (49 percent) and the LGA (30 percent), while the South East zone has the lowest percentage (19 and 8 percent, respectively). Birth registration at private clinics or hospitals was highest in the South East zone (63 percent) and lowest at the North West zone (17 percent). Birth registration at the LGA was highest for children in households in the lowest wealth quintile (36 percent) and lowest for children in the highest wealth quintile (12 percent). On the other hand, children in the fourth and highest wealth quintiles were more likely to be registered with the NPC or private hospitals or clinics than those in the lower wealth quintiles. Table 2.11 Birth registration of children under age five Percentage of de jure children under five years of age whose births are registered, and among children whose births are registered, percentage with a birth certificate seen, by background characteristics, Nigeria 2008 All children under age five Children under age five whose births were registered Background characteristic Percentage registered Number of children Percentage with birth certificate seen Number of children Age <2 28.8 10,434 39.9 3,010 2-4 30.8 15,292 36.1 4,717 Sex Male 29.6 13,067 38.3 3,867 Female 30.5 12,660 36.9 3,860 Residence Urban 48.8 7,949 45.1 3,878 Rural 21.7 17,777 30.0 3,850 Zone North Central 26.6 3,609 41.6 960 North East 13.9 4,141 47.3 575 North West 22.3 7,764 28.6 1,730 South East 54.4 2,468 28.0 1,342 South South 29.9 3,354 35.5 1,005 South West 48.2 4,391 47.7 2,116 Wealth quintile Lowest 8.9 5,794 20.1 513 Second 17.6 5,773 26.6 1,017 Middle 26.8 4,938 31.9 1,321 Fourth 44.0 4,670 38.3 2,056 Highest 61.9 4,552 46.9 2,820 Total 30.0 25,726 37.6 7,727 28 | Household Population and Housing Characteristics Table 2.12 Birth registration of children under age five by authority Among de jure children under five years of age whose births are registered with the civil authorities, percent distribution of children by the authority with which the birth is registered, according to background characteristics, Nigeria 2008 Authority where birth is registered Background characteristic National Population Commission Local Government Administration Private clinic/ hospital Other Missing Total registered Number of children Age <2 36.8 15.7 36.7 9.2 1.7 100.0 3,010 2-4 35.4 17.7 36.2 9.2 1.6 100.0 4,717 Sex Male 36.7 16.7 35.2 9.6 1.8 100.0 3,867 Female 35.1 17.1 37.5 8.7 1.5 100.0 3,860 Residence Urban 38.8 14.1 37.7 8.2 1.1 100.0 3,878 Rural 33.0 19.7 35.0 10.2 2.2 100.0 3,850 Zone North Central 30.5 15.7 42.7 9.5 1.4 100.0 960 North East 39.7 20.4 26.6 7.3 5.9 100.0 575 North West 48.6 30.0 17.3 2.0 2.2 100.0 1,730 South East 19.0 7.9 63.4 9.4 0.4 100.0 1,342 South South 31.0 8.5 46.0 12.9 1.7 100.0 1,005 South West 40.1 15.5 29.9 13.5 0.9 100.0 2,116 Wealth quintile Lowest 29.3 36.3 20.7 9.3 4.4 100.0 513 Second 33.9 27.9 25.7 8.8 3.9 100.0 1,017 Middle 34.0 16.2 38.3 10.3 1.2 100.0 1,321 Fourth 35.1 13.5 41.5 8.5 1.4 100.0 2,056 Highest 39.3 12.2 38.4 9.3 0.7 100.0 2,820 Total 35.9 16.9 36.4 9.2 1.6 100.0 7,727 2.8 NEGLECTED TROPICAL DISEASES (NTDS) Neglected Tropical Diseases (NTDs) are a group of communicable diseases of public health importance that cause severe pain, irreversible disability and even disfigurement. These diseases predominantly occur among populations that have little or no access to good housing, safe water supply and sanitation, formal health systems and other modern amenities. The 2008 NDHS included questions about four of these diseases—dracunculiasis (Guinea worm disease - GWD), onchocerciasis (river blindness), schistosomiasis (bilharziasis), and lymphatic filariasis (LF) (elephantiasis). More than 32 million Nigerians in 32 states and the Federal Capital Territory (FCT) are estimated to be at risk for onchoceriasis. Nigeria accounts for 40 percent of the 40 million people infected with onchoceriasis worldwide. LF is endemic in 28 states and the FCT out of the 32 states so far mapped with an estimated 80-100 million Nigerians needing treatment. Nigeria is third in the world’s burden for LF. The mean national prevalence for infections with schistosomiasis and soil transmitted helminthiasis ranges from 13 percent to 100 percent across the country. Seventy-three cases of GWD were reported in Nigeria in 2007. In 2008, there were 38 cases of GWD reported in five villages in Nigeria, a significant drop from over the 653,000 cases reported when the first case search was conducted in 1987/88 (Nigeria Guinea Worm Eradication Programme, 2007). Together, the NTDs constitute a tremendous disease burden in Nigeria, but can be treated collectively through large-scale integrated programmes that use safe and effective drugs and/or management and containment methods. Safe and cost-effective interventions for the prevention and control of these diseases are available. As a result, Mass Drug Administration (MDA) was initiated in Household Population and Housing Characteristics | 29 Nigeria in 1991 for these diseases. Ivermectin is used for onchocerciasis, and the current initiative uses Community Directed Treatment with Ivermectin (CDTI or ComDT).2 Ivermectin and albendazole are used for lymphatic filariasis, and praziquantel and albendazole are used for schistosomiasis and soil- transmitted helminthiasis. The national control programmes have also initiated Triple Drug Administration for co-endemic diseases (schistosomiasis, onchocerciasis and lymphatic filariasis). There are no vaccines or medications effective in preventing or treating GWD. Current eradication efforts for GWD are aimed at improving routine and active GWD surveillance with nationwide and local case searches and promotion of activities and practices that will ensure the zero GWD case status is maintained in Nigeria for a minimum of three consecutive years. All suspected cases are reported to health facilities and health workers, and investigated within 24 hours. Other eradication strategies taken include creating adequate public awareness to promote enhanced early case detection and reporting, provision of adequate safe water sources in the previously endemic villages and villages at risk, containment of cases, treatment of unsafe water sources with the chemical larvicide Abate (temephos), and distribution of water filters (cloth and pipe) to endemic communities. In the 2008 NDHS, information was collected for each household member on whether they had taken a drug for river blindness, elephantiasis, or bilharziasis, and whether they had seen a worm emerging from a skin lesion (blister or boil) in the 12 months preceding the survey. In addition, information was collected for children age 5-17 years on whether they had blood in their urine (haematuria) in the 30 days prior to the survey. The results are shown in Table 2.13. According to the 2008 NDHS, 4 percent of the household population received drugs for river blindness, 1 percent each received drugs for elephantiasis, and nilharziasis. Drug consumption for these diseases was almost equal among males and females but was more common in rural than urban areas. The Northern zones (North Central, North East, and North West) generally recorded higher percentages of the household population receiving drugs for these three diseases in the 12 months prior to the survey compared with the Southern zones. About one percent of children age 5-17 were reported to have had blood in their urine in the 30 days prior to the survey. The prevalence was higher in males (2 percent) than females (1 percent) and was more common in the Northern zones than in the Southern zones. Generally, people in the lower wealth quintiles were more likely to have received the drugs or to have had blood in their urine than those in the higher wealth quintiles. Less than 1 percent of the household populations were reported to have had a worm emerging from a skin lesion (blister or boil) in the 12 months prior to the survey. It is important to note that this figure represents information provided by household respondents, and not confirmed cases. Equal proportions of males and females were reported to have experienced worms emerging from skin lesions; however, this occurrence was more common in rural areas than urban areas. Generally, a higher proportion of the population in the Northern zones was reported to have seen a worm emerging from a skin lesion, with the highest proportion observed in the North Central (2 percent). As with the other NTDs, sighting the emergence of a worm from a blister decreases as wealth quintile increases. 2 CDTI is a programme for prevention and treatment of onchocerciasis and LF based on the concept of Community Directed Interventions. For more information, see Boatin, 2008. 30 | Household Population and Housing Characteristics Table 2.13 Neglected tropical diseases reported in households Percentage of de jure women, men, and children who reported taking drugs for onchoceriasis, lymphatic filariasis, and schistosomiasis, and the percentage who saw a worm emerging from a skin lesion (blister or boil) in the 12 months prior to the survey, by background characteristics, Nigeria 2008 Guinea worm disease Mass drug administration for onchoceriasis, lymphatic filariasis, and schistosomiasis Schistosomiasis in children ages 5-17 Background characteristic Percentage who took any drug for onchoceriasis (river blindness)1 Percentage who took any drug for lymphatic filariasis (elephantitis)2 Percentage who took any drug for schistosomiasis (bilharazia)3 Percentage who saw a worm emerging from a skin lesion (blister or boil) in the past 12 months Number Percentage of children age 5-17 who had blood in their urine in the past 30 days Number of children Age 0-4 2.2 0.6 0.5 0.4 25,726 na na 5-9 4.0 1.1 0.9 0.5 23,118 1.0 23,118 10-14 4.1 1.1 1.1 0.5 18,042 1.5 18,042 15-19 4.2 1.1 0.8 0.5 13,047 na na 15-17 4.2 1.1 0.8 0.5 7,901 1.4 7,901 18-19 4.2 1.0 0.7 0.5 5,146 na na 20-24 3.6 1.1 0.8 0.5 11,481 na na 25-29 3.8 1.1 0.8 0.5 11,940 na na 30-34 3.7 1.1 0.9 0.6 9,208 na na 35-39 4.4 1.2 0.9 0.6 7,905 na na 40-44 4.6 1.4 1.0 0.6 6,272 na na 45-49 4.8 1.2 0.8 0.5 5,402 na na 50-54 4.7 1.0 0.9 0.6 4,895 na na 55-59 4.6 1.2 0.8 0.8 3,488 na na 60+ 5.9 1.2 0.7 0.4 9,927 na na Don't know/missing 3.0 0.0 0.0 0.0 137 na na Sex Male 4.0 1.1 0.9 0.5 74,953 1.7 25,005 Female 3.8 1.0 0.7 0.5 75,635 0.8 24,056 Residence Urban 1.9 0.6 0.4 0.3 50,147 1.0 15,257 Rural 4.9 1.2 1.0 0.6 100,442 1.4 33,805 Zone North Central 9.3 4.0 2.3 1.8 21,971 2.1 7,670 North East 8.0 1.5 1.3 0.4 20,353 3.3 7,266 North West 3.0 0.7 0.9 0.4 38,913 1.2 13,610 South East 1.4 0.2 0.2 0.1 17,430 0.4 5,061 South South 1.3 0.2 0.1 0.1 22,329 0.2 6,705 South West 1.8 0.2 0.1 0.1 29,594 0.2 8,751 Wealth quintile Lowest 4.9 1.4 1.4 0.7 30,113 2.6 10,473 Second 5.0 1.6 1.2 0.7 30,120 1.6 10,408 Middle 5.2 1.2 0.8 0.5 30,127 0.9 10,116 Fourth 3.0 0.6 0.4 0.4 30,122 0.7 9,345 Highest 1.4 0.4 0.2 0.2 30,106 0.3 8,720 Total 3.9 1.0 0.8 0.5 150,589 1.3 49,062 na = Not applicable 1 River blindness is a disease that causes itchy skin, lumps in the skin, and blindness. 2 Elephantitis is a disease that causes swelling in the arms and legs. 3 Bilharazia is a disease that causes blood in the urine. Characteristics of Respondents | 31 CHARACTERISTICS OF RESPONDENTS 3 The purpose of this chapter is to provide a demographic and socio-economic profile of individual female and male respondents. This information is essential for interpretation of the findings presented later in the report and provides an indication of the representativeness of the survey. The chapter begins by describing basic background characteristics, including age, marital status, residence, education, religion, ethnicity, and economic status of respondents’ households. The chapter also includes more detailed information on education, employment, and indictors of women’s status. Information on health insurance coverage and knowledge and attitudes concerning tuberculosis is presented, and findings on the use of tobacco are provided as a lifestyle measure.1 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS Table 3.1 shows the distribution of women and men age 15-49 by background characteristics. The proportions of women and men decline with increasing age. More than two-thirds (69 percent) of all women are currently married, and an additional 2 percent are in informal unions (living together). One-quarter of women age 15-49 have never been married, while 2 percent of women are divorced or separated, and 2 percent are widowed. Fifty-one percent of men are currently married or in informal unions (living together), 47 percent have never been married and 2 percent are divorced, separated, or widowed. The majority of women and men live in rural areas (64 percent of women and 62 percent of men). For both women and men, half live in the northern zones (North Central, North East, and North West) and half live in the southern zones (South East, South South, and South West). The majority of respondents have had some education; however, 36 percent of women and 19 percent of men have never attended school. One-fifth of both women and men have attained primary education only, while 45 percent of women and 61 percent of men have attended secondary school or higher. Table 3.1 shows that about 45 percent of all respondents are Muslim; 54 percent of respondents are Christian (12 percent Catholic); and 1 percent of respondents are Traditionalist. The ethnic composition of the sample indicates that Hausa (22 percent), Yoruba (18 percent), and Igbo (16 percent) are the major ethnic groups in Nigeria. Other ethnic groups constitute about 44 percent of the total sample, underscoring the multiplicity of ethnic groups in Nigeria. 1 The survey results in this chapter are presented for the country as a whole, by urban-rural residence, and by zone. State-level results are available in Appendix A. 32 | Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Nigeria 2008 Women Men Background characteristic Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Age 15-19 19.4 6,493 6,591 18.3 2,532 2,571 20-24 18.4 6,133 6,103 17.2 2,378 2,399 25-29 18.9 6,309 6,303 17.8 2,459 2,446 30-34 13.9 4,634 4,557 14.9 2,058 2,051 35-39 11.7 3,912 3,883 13.0 1,794 1,773 40-44 9.1 3,032 3,043 10.2 1,413 1,417 45-49 8.6 2,872 2,905 8.5 1,174 1,181 Marital status Never married 25.2 8,397 8,021 47.4 6,548 6,418 Married 69.1 23,062 23,479 49.0 6,765 6,922 Living together 1.5 516 475 1.8 253 264 Divorced/separated 1.9 651 646 1.3 184 176 Widowed 2.3 759 763 0.4 54 55 Missing 0.0 1 1 0.0 3 3 Residence Urban 35.7 11,934 10,489 37.8 5,215 4,643 Rural 64.3 21,451 22,896 62.2 8,593 9,195 Zone North Central 14.2 4,748 6,366 15.0 2,065 2,773 North East 12.8 4,262 6,217 11.9 1,645 2,444 North West 24.0 8,022 7,297 23.4 3,237 2,930 South East 12.3 4,091 3,667 10.5 1,448 1,237 South South 16.4 5,473 4,813 17.7 2,437 2,167 South West 20.3 6,789 5,025 21.6 2,977 2,287 Religion Catholic 11.5 3,848 3,583 11.6 1,597 1,490 Other Christian 42.1 14,060 13,588 42.1 5,806 5,694 Islam 44.4 14,826 15,449 44.7 6,173 6,406 Traditionalist 1.3 429 535 1.0 138 150 Other 0.2 53 53 0.4 60 61 Missing 0.5 171 177 0.2 34 37 Ethnicity Ekoi 1.7 555 583 1.5 205 208 Fulani 6.1 2,020 2,460 5.4 744 949 Hausa 22.3 7,431 7,086 22.5 3,107 2,956 Ibibio 2.5 819 693 2.5 340 290 Igala 1.4 476 529 1.7 230 256 Igbo 15.9 5,295 4,583 14.5 1,999 1,692 Ijaw/Izon 3.5 1,169 1,184 4.5 621 615 Kanuri/Beriberi 2.0 674 836 1.7 241 307 Tiv 2.4 801 896 2.6 362 397 Yoruba 17.7 5,924 4,861 18.5 2,555 2,168 Others 24.2 8,083 9,522 24.5 3,381 3,974 Missing 0.4 139 152 0.2 24 26 Education No education 35.8 11,942 13,242 18.8 2,597 2,907 Primary 19.7 6,566 6,591 20.0 2,761 2,769 Secondary 35.7 11,904 10,905 46.9 6,470 6,287 More than secondary 8.9 2,974 2,647 14.3 1,979 1,875 Total 15-49 100.0 33,385 33,385 100.0 13,808 13,838 50-59 na na na na 1,678 1,648 Total men 15-59 na na na na 15,486 15,486 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable Characteristics of Respondents | 33 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Table 3.2.1 provides an overview of the relationship between women’s level of education and other background characteristics. The results show that younger women are more likely than older women to have some education. For example, more than twice as many women age 45-49 as women age 15-24 reported that they have no education (59 versus 27 percent, respectively). Women’s level of education varies by residence; women in rural areas are far less likely to be educated than their urban counterparts. For example, 47 percent of rural women have not attended school, compared with just 17 percent of their urban counterparts. Overall, the median years of school completed for women age 15-49 is 6 years. Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Nigeria 2008 Highest level of schooling Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Median years completed Number of women Age 15-24 27.3 5.3 9.3 31.8 20.4 5.8 100.0 7.5 12,626 15-19 24.7 6.4 8.2 45.6 13.9 1.2 100.0 7.4 6,493 20-24 30.0 4.1 10.5 17.2 27.4 10.8 100.0 8.0 6,133 25-29 34.1 5.3 14.6 12.5 21.1 12.4 100.0 5.7 6,309 30-34 37.6 6.7 15.9 9.8 17.8 12.2 100.0 5.4 4,634 35-39 38.3 7.2 19.4 10.1 14.4 10.6 100.0 5.2 3,912 40-44 46.3 7.2 17.1 8.6 11.7 9.1 100.0 3.0 3,032 45-49 59.1 7.6 14.8 4.9 6.8 6.8 100.0 a 2,872 Residence Urban 16.5 4.0 12.8 20.9 28.3 17.5 100.0 10.1 11,934 Rural 46.5 7.3 14.0 16.6 11.5 4.1 100.0 3.1 21,451 Zone North Central 35.5 8.3 16.8 18.5 12.9 8.0 100.0 5.4 4,748 North East 68.1 6.9 8.5 9.3 5.0 2.2 100.0 a 4,262 North West 74.2 3.8 8.1 6.1 5.3 2.5 100.0 a 8,022 South East 6.3 8.1 15.3 28.8 28.6 13.0 100.0 9.6 4,091 South South 6.0 7.6 17.7 30.4 26.1 12.2 100.0 8.7 5,473 South West 12.0 4.3 16.7 21.3 29.6 16.2 100.0 10.0 6,789 Wealth quintile Lowest 75.9 6.9 8.8 6.5 1.8 0.1 100.0 a 6,194 Second 59.5 9.0 14.1 12.1 4.7 0.7 100.0 a 6,234 Middle 34.8 8.8 17.5 23.1 13.2 2.6 100.0 5.4 6,341 Fourth 14.4 5.1 17.9 26.6 26.4 9.6 100.0 8.4 6,938 Highest 4.2 1.7 9.9 20.7 36.2 27.3 100.0 11.4 7,678 Total 35.8 6.1 13.6 18.1 17.5 8.9 100.0 5.6 33,385 a = Omitted because more than 50 percent of women had no formal schooling 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level The urban-rural difference is more pronounced at the level of secondary school or higher. For example, the percentage of women in urban areas who have completed secondary school or gone on to the post-secondary level is almost three times that of their rural counterparts (46 and 16 percent, respectively). In Table 3.2.2, the relationship between men’s level of education and other background characteristics also shows that men in urban areas have higher levels of educational attainment than their rural counterparts. Only 8 percent of urban males compared with 26 percent of their rural counterparts have no formal education. While 57 percent of urban males have completed secondary or higher education, only 29 percent of their rural counterparts have done so. Overall, the median years of school completed for men age 15-49 is 9 years. 34 | Characteristics of Respondents The level of educational attainment varies by zone, but it is higher for both women and men in the southern zones compared with the northern zones. Educational attainment also increases as household economic status increases. For example, 76 percent of the women in the poorest households have no formal education compared with just 4 percent of women in the most advantaged households. Almost two-thirds of women in the highest wealth quintile have completed secondary or higher education, compared with 2 percent of women in the lowest wealth quintile. A similar pattern is observed for men. Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Nigeria 2008 Highest level of schooling Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Median years completed Number of men Age 15-24 13.3 5.3 8.8 39.8 25.8 7.0 100.0 8.9 4,910 15-19 13.0 7.2 9.4 54.9 14.5 1.0 100.0 8.0 2,532 20-24 13.7 3.1 8.2 23.7 37.9 13.3 100.0 11.0 2,378 25-29 17.8 3.3 13.9 13.9 30.7 20.3 100.0 11.0 2,459 30-34 20.3 4.3 17.9 12.3 26.1 19.1 100.0 8.8 2,058 35-39 21.6 4.9 21.8 11.0 23.8 16.9 100.0 7.1 1,794 40-44 25.2 6.3 21.3 7.6 22.7 16.9 100.0 5.9 1,413 45-49 29.2 5.7 21.8 7.7 18.3 17.3 100.0 5.7 1,174 Residence Urban 7.5 2.9 11.3 21.0 33.8 23.4 100.0 11.2 5,215 Rural 25.7 6.1 17.4 21.5 20.5 8.8 100.0 6.1 8,593 Zone North Central 15.4 5.4 15.0 26.6 23.4 14.3 100.0 8.8 2,065 North East 45.0 8.2 11.1 16.9 11.3 7.5 100.0 3.4 1,645 North West 40.7 4.3 17.4 13.9 13.6 10.0 100.0 5.3 3,237 South East 0.9 6.0 23.0 25.9 30.1 14.1 100.0 9.5 1,448 South South 2.3 4.1 13.4 29.1 34.5 16.5 100.0 11.0 2,437 South West 5.2 3.3 12.5 19.6 38.3 21.2 100.0 11.2 2,977 Wealth quintile Lowest 55.2 8.3 16.0 13.4 6.0 1.3 100.0 a 2,275 Second 32.5 7.8 20.5 20.7 15.1 3.3 100.0 5.5 2,332 Middle 15.6 6.2 18.6 27.5 23.5 8.6 100.0 8.0 2,570 Fourth 4.2 3.2 15.7 27.2 34.4 15.3 100.0 11.0 3,163 Highest 1.4 1.2 7.9 17.0 38.8 33.7 100.0 11.6 3,468 Total 15-49 18.8 4.9 15.1 21.3 25.5 14.3 100.0 8.7 13,808 50-59 41.3 8.6 23.1 4.7 9.3 13.1 100.0 5.0 1,678 Total men 15-59 21.2 5.3 16.0 19.5 23.8 14.2 100.0 8.2 15,486 a = Omitted because more than 50 percent of men had no formal schooling 1 Completed 6th grade at the primary level 2 Completed 6th grade at the secondary level 3.3 LITERACY The literacy status of respondents in the 2008 NDHS was determined by assessing their ability to read all or part of a simple sentence in any of the major language groups of Nigeria. The ability to read is crucial for exploring social and economic opportunities during a person’s lifetime. For programme planners, literacy statistics are critical for determining the best ways to get health and other messages to women and men in different subgroups. The literacy test was administered only to Characteristics of Respondents | 35 respondents who had less than a secondary education because those with some secondary education or higher were assumed to be literate. Tables 3.3.1 and 3.3.2 show the percent distribution of women and men by level of schooling attended, level of literacy, and percentage literate according to background characteristics. More than half (54 percent) of women are literate. The level of literacy is much higher for younger women than older women, ranging from a high of 67 percent for women age 15-19 to a low of 32 percent for women age 45-49. Urban women are nearly twice as likely to be literate as rural women (77 and 41 percent, respectively). Literacy levels also vary widely by zone, with the northern zones lagging behind the southern zones. The patterns of men’s literacy are similar to those of women. However, the disparity between women and men according to household economic status is marked; in the poorest households 40 percent of men are literate compared with 13 percent of women Table 3.3.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Nigeria 2008 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Total Percentage literate1 Number of women Age 15-19 60.7 2.1 4.6 31.9 0.2 0.0 0.5 100.0 67.3 6,493 20-24 55.3 1.6 4.2 38.3 0.2 0.0 0.5 100.0 61.1 6,133 25-29 46.0 2.2 6.4 44.4 0.4 0.0 0.4 100.0 54.7 6,309 30-34 39.8 2.8 7.2 49.0 0.4 0.1 0.6 100.0 49.9 4,634 35-39 35.1 3.8 8.7 51.2 0.2 0.2 0.7 100.0 47.7 3,912 40-44 29.4 4.3 8.2 57.1 0.4 0.2 0.4 100.0 41.9 3,032 45-49 18.5 4.9 8.3 66.5 0.5 0.4 0.8 100.0 31.7 2,872 Residence Urban 66.7 3.4 6.5 22.3 0.4 0.1 0.6 100.0 76.6 11,934 Rural 32.3 2.4 6.3 58.2 0.2 0.1 0.5 100.0 40.9 21,451 Zone North Central 39.3 2.1 6.3 51.2 0.5 0.1 0.6 100.0 47.6 4,748 North East 16.5 1.7 4.6 76.7 0.1 0.0 0.3 100.0 22.8 4,262 North West 14.0 2.5 4.6 78.1 0.1 0.2 0.6 100.0 21.1 8,022 South East 70.3 3.3 7.7 17.8 0.0 0.1 0.7 100.0 81.3 4,091 South South 68.6 2.1 7.0 21.3 0.1 0.2 0.5 100.0 77.8 5,473 South West 67.1 4.5 8.1 18.8 0.9 0.0 0.5 100.0 79.8 6,789 Wealth quintile Lowest 8.4 0.9 3.4 86.6 0.2 0.2 0.4 100.0 12.7 6,194 Second 17.4 2.0 6.5 73.3 0.3 0.1 0.5 100.0 25.8 6,234 Middle 38.9 3.4 8.2 48.3 0.3 0.2 0.7 100.0 50.5 6,341 Fourth 62.6 4.5 8.8 23.1 0.4 0.0 0.6 100.0 75.9 6,938 Highest 84.2 2.8 4.9 7.1 0.3 0.0 0.6 100.0 92.0 7,678 Total 44.6 2.8 6.4 45.3 0.3 0.1 0.6 100.0 53.7 33,385 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence 36 | Characteristics of Respondents Table 3.3.2 Literacy: Men Percent distribution of men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Nigeria 2008 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Total Percentage literate1 Number of men Age 15-19 70.4 4.3 7.0 17.5 0.3 0.0 0.5 100.0 81.7 2,532 20-24 74.9 2.7 5.7 15.8 0.6 0.1 0.3 100.0 83.3 2,378 25-29 65.0 4.8 8.6 20.9 0.6 0.0 0.1 100.0 78.3 2,459 30-34 57.5 6.3 11.5 23.3 1.0 0.0 0.4 100.0 75.3 2,058 35-39 51.7 7.9 12.1 27.2 0.7 0.0 0.4 100.0 71.7 1,794 40-44 47.2 9.3 13.3 28.6 1.0 0.1 0.5 100.0 69.9 1,413 45-49 43.3 10.9 14.7 30.2 0.4 0.3 0.3 100.0 68.9 1,174 Residence Urban 78.3 5.2 7.3 8.5 0.3 0.0 0.3 100.0 90.9 5,215 Rural 50.8 6.4 11.1 30.4 0.9 0.1 0.4 100.0 68.3 8,593 Zone North Central 64.3 4.5 6.8 23.3 0.7 0.1 0.3 100.0 75.6 2,065 North East 35.7 7.4 10.7 45.7 0.2 0.1 0.3 100.0 53.8 1,645 North West 37.6 8.3 14.7 36.9 1.7 0.0 0.7 100.0 60.6 3,237 South East 70.0 10.7 12.9 6.0 0.0 0.0 0.4 100.0 93.7 1,448 South South 80.2 3.0 6.2 10.5 0.0 0.0 0.1 100.0 89.3 2,437 South West 79.0 3.6 6.9 9.6 0.6 0.0 0.2 100.0 89.6 2,977 Wealth quintile Lowest 20.6 6.3 13.3 59.0 0.4 0.0 0.4 100.0 40.2 2,275 Second 39.2 7.5 14.1 37.9 0.9 0.0 0.4 100.0 60.7 2,332 Middle 59.6 6.4 12.0 19.8 1.5 0.1 0.6 100.0 78.1 2,570 Fourth 76.9 5.9 8.7 7.6 0.6 0.1 0.2 100.0 91.5 3,163 Highest 89.5 4.3 3.5 2.4 0.1 0.0 0.2 100.0 97.3 3,468 Total 15-49 61.2 5.9 9.7 22.1 0.7 0.0 0.3 100.0 76.8 13,808 50-59 27.0 14.5 13.1 42.6 0.9 0.3 1.5 100.0 54.6 1,678 Total men 15-59 57.5 6.9 10.0 24.4 0.7 0.1 0.5 100.0 74.4 15,486 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence 3.4 ACCESS TO MASS MEDIA Information on the respondents’ exposure to common print and electronic media was collected in the 2008 NDHS. Respondents were asked how often they read a newspaper, listen to the radio, or watch television. This information is important because it provides an indication of the extent to which Nigerians are regularly exposed to mass media that are often used to convey messages on family planning and other health topics. Data on exposure to mass media for both women and men age 15-49 are presented in Tables 3.4.1 and 3.4.2. About one in ten women read a newspaper weekly compared with three in ten men. While half of male respondents watch television at least once a week, only about two-fifths of women do so. Women and men living in urban areas are much more likely to be exposed to mass media. The proportion of non-exposure to any media at least once a week increases with age for both women and men. The findings show that women are less likely than men to have had no exposure to any form of media at least once a week (39 versus 14 percent, respectively). Urban respondents are more likely than rural respondents to be exposed to all three types of media. By zone, exposure to all three types of media is highest for respondents in the southern zones compared with those in the northern zones. Higher levels of educational attainment are associated with increased exposure to mass media. Characteristics of Respondents | 37 Similarly, wealth status is positively related to exposure to mass media. For instance, 71 percent of women in the lowest quintile have no weekly exposure to any media source, while only 8 percent of those in the highest quintile have no exposure. For men, 38 percent in the lowest wealth quintile have no weekly exposure to any media source, compared with 2 percent of men in the highest wealth quintiles. Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Nigeria 2008 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to radio at least once a week All three media at least once a week No media at least once a week Number of women Age 15-19 11.9 43.5 53.5 9.0 36.2 6,493 20-24 15.0 43.5 55.4 11.9 35.8 6,133 30-34 12.0 39.6 54.5 9.9 38.5 4,634 35-39 10.8 37.7 53.5 8.8 39.4 3,912 40-44 9.1 33.0 52.5 7.7 42.1 3,032 45-49 6.9 27.2 47.2 5.3 47.6 2,872 Residence Urban 21.8 68.8 68.5 18.5 18.9 11,934 Rural 6.3 23.3 45.5 4.3 49.4 21,451 Zone North Central 9.9 32.1 47.5 8.2 47.0 4,748 North East 3.1 14.4 35.0 1.9 61.4 4,262 North West 3.8 17.8 47.9 2.7 49.9 8,022 South East 17.9 44.5 53.8 12.8 34.0 4,091 South South 19.6 58.3 53.6 15.5 30.1 5,473 South West 18.2 68.3 76.6 15.9 13.9 6,789 Education No education 0.2 9.6 36.0 0.1 61.9 11,942 Primary 3.1 32.7 50.4 1.8 41.6 6,566 Secondary 18.3 62.5 65.8 14.1 21.2 11,904 More than secondary 52.0 83.5 83.4 44.8 6.5 2,974 Wealth quintile Lowest 0.4 2.9 27.4 0.1 71.4 6,194 Second 2.0 7.6 39.5 0.8 58.0 6,234 Middle 6.1 23.8 50.7 3.1 43.2 6,341 Fourth 14.5 63.1 66.6 11.1 21.0 6,938 Highest 31.3 86.9 77.3 27.5 7.9 7,678 Total 11.8 39.6 53.7 9.4 38.5 33,385 38 | Characteristics of Respondents Table 3.4.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Nigeria 2008 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to radio at least once a week All three media at least once a week No media at least once a week Number of men Age 15-19 20.7 52.0 74.1 15.9 18.4 2,532 20-24 32.8 58.5 82.5 26.4 11.8 2,378 25-29 33.8 55.1 83.1 27.6 12.2 2,459 30-34 33.4 52.9 83.2 27.4 13.3 2,058 35-39 30.3 48.0 82.6 24.1 13.5 1,794 40-44 29.0 45.9 82.9 24.1 14.6 1,413 45-49 29.3 43.9 82.2 23.9 15.9 1,174 Residence Urban 47.5 77.6 87.7 40.9 5.8 5,215 Rural 19.1 36.4 77.2 13.9 19.2 8,593 Zone North Central 26.2 44.3 79.2 18.7 15.8 2,065 North East 13.4 23.0 61.8 8.0 34.1 1,645 North West 16.4 31.5 80.0 12.2 17.4 3,237 South East 39.7 65.5 88.5 34.1 7.5 1,448 South South 36.0 71.1 80.9 30.2 10.7 2,437 South West 46.3 73.3 91.2 39.8 4.4 2,977 Education No education 0.9 11.5 61.2 0.4 37.3 2,597 Primary 10.2 38.1 77.9 7.2 18.0 2,761 Secondary 35.8 64.4 86.4 28.0 7.2 6,470 More than secondary 75.7 83.8 94.9 66.1 1.0 1,979 Wealth quintile Lowest 5.3 10.7 60.3 2.3 38.0 2,275 Second 10.5 19.9 75.1 5.4 22.3 2,332 Middle 20.2 38.7 82.2 13.1 13.2 2,570 Fourth 36.7 72.5 87.8 29.3 5.5 3,163 Highest 59.9 91.7 92.2 54.3 1.6 3,468 Total 15-49 29.8 52.0 81.2 24.1 14.1 13,808 50-59 24.1 37.0 77.3 19.8 20.8 1,678 Total men 15-59 29.2 50.4 80.8 23.6 14.9 15,486 3.5 EMPLOYMENT Employment is one source of empowerment for women, given that they exercise control over their own income. It is difficult to measure employment status because some work, especially work on family farms, in family businesses, or in the informal sector, is often not perceived as employment by women and men themselves, and hence not reported as such. The 2008 NDHS asked women and men detailed questions about their employment status in order to ensure complete coverage of employment in any sector, formal or informal. Women and men who reported that they were currently working and those who reported that they worked at sometime during the 12 months preceding the survey are considered to have been employed. Additional information was collected on the type of work women and men were doing, whether they worked continuously throughout the year or not, for whom they worked, and the form in which they received their earnings. Tables 3.5.1 and 3.5.2 show the percent distribution of women and men age 15-49 by employment status, according to background characteristics. Fifty-nine percent of women are currently employed. Four percent reported that they worked at some point during the past 12 months but were not working at the time of the survey. Thirty-seven percent did not work at all in the 12 months preceding the survey. Eighty percent of men are currently employed. Two percent of men reported that they worked during the past 12 months but were not working at the time of the survey. Eighteen percent of men did not work at all in the 12 months preceding the survey. Characteristics of Respondents | 39 Table 3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Nigeria 2008 Employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of women Age 15-19 26.1 2.2 71.6 0.1 100.0 6,493 20-24 48.3 3.4 48.1 0.2 100.0 6,133 25-29 65.0 3.4 31.5 0.1 100.0 6,309 30-34 73.1 4.0 22.7 0.2 100.0 4,634 35-39 77.6 3.4 18.8 0.2 100.0 3,912 40-44 77.2 4.2 18.4 0.2 100.0 3,032 45-49 77.4 5.8 16.7 0.1 100.0 2,872 Marital status Never married 33.8 1.7 64.5 0.1 100.0 8,397 Married or living together 66.9 4.2 28.7 0.2 100.0 23,578 Divorced/separated/widowed 80.5 3.7 15.6 0.1 100.0 1,409 Missing 100.0 0.0 0.0 0.0 100.0 1 Number of living children 0 37.1 2.2 60.5 0.1 100.0 10,392 1-2 62.3 3.7 34.0 0.1 100.0 8,352 3-4 71.8 3.9 24.1 0.2 100.0 7,591 5+ 74.2 4.9 20.6 0.3 100.0 7,049 Residence Urban 59.7 2.4 37.7 0.2 100.0 11,934 Rural 58.8 4.2 36.8 0.2 100.0 21,451 Zone North Central 62.8 3.2 33.9 0.2 100.0 4,748 North East 57.1 4.1 38.6 0.2 100.0 4,262 North West 46.0 7.2 46.6 0.2 100.0 8,022 South East 58.7 1.0 40.0 0.3 100.0 4,091 South South 63.9 2.4 33.5 0.2 100.0 5,473 South West 69.9 1.4 28.7 0.0 100.0 6,789 Education No education 56.8 5.4 37.5 0.3 100.0 11,942 Primary 73.1 3.4 23.3 0.2 100.0 6,566 Secondary 52.9 2.2 44.8 0.1 100.0 11,904 More than secondary 62.5 1.9 35.6 0.0 100.0 2,974 Wealth quintile Lowest 55.8 5.0 39.0 0.2 100.0 6,194 Second 59.6 5.9 34.3 0.2 100.0 6,234 Middle 59.2 3.4 37.2 0.2 100.0 6,341 Fourth 59.3 2.2 38.3 0.2 100.0 6,938 Highest 61.2 1.8 36.9 0.1 100.0 7,678 Total 59.1 3.5 37.2 0.2 100.0 33,385 Note: Total includes 1 woman with information missing on marital status who is not shown separately. 1 Currently employed is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Tables 3.5.1 and 3.5.2 also show that current employment increases with age for both women and men. Women who are divorced, separated, or widowed (81 percent) are most likely to be employed, followed by those who are married or living together (67 percent), while never-married women are the least likely to be employed (34 percent). Men who are currently married or living together are most likely to be employed (98 percent), followed by those who are divorced, separated, or widowed (96 percent). Sixty percent of never-married men are currently employed. 40 | Characteristics of Respondents Table 3.5.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Nigeria 2008 Employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of men Age 15-19 44.8 3.7 51.6 0.0 100.0 2,532 20-24 65.4 2.9 31.6 0.0 100.0 2,378 25-29 85.7 2.1 12.1 0.1 100.0 2,459 30-34 94.9 1.2 3.8 0.1 100.0 2,058 35-39 98.0 0.8 1.2 0.0 100.0 1,794 40-44 98.1 0.8 1.1 0.1 100.0 1,413 45-49 98.4 0.3 1.4 0.0 100.0 1,174 Marital status Never married 60.3 3.1 36.6 0.0 100.0 6,548 Married or living together 97.9 0.8 1.2 0.1 100.0 7,018 Divorced/separated/widowed 95.9 2.0 2.1 0.0 100.0 238 Missing 100.0 0.0 0.0 0.0 100.0 3 Number of living children 0 64.2 2.8 32.9 0.0 100.0 7,272 1-2 96.5 1.2 2.3 0.0 100.0 2,505 3-4 98.0 1.0 1.0 0.0 100.0 2,043 5+ 98.8 0.5 0.6 0.1 100.0 1,989 Residence Urban 75.4 2.0 22.5 0.0 100.0 5,215 Rural 82.8 1.9 15.3 0.0 100.0 8,593 Zone North Central 84.9 2.6 12.5 0.0 100.0 2,065 North East 90.8 1.6 7.6 0.0 100.0 1,645 North West 86.4 1.7 11.8 0.1 100.0 3,237 South East 72.9 1.1 26.0 0.0 100.0 1,448 South South 69.4 3.5 27.0 0.0 100.0 2,437 South West 75.9 1.0 23.1 0.0 100.0 2,977 Education No education 97.3 0.9 1.9 0.0 100.0 2,597 Primary 90.9 1.3 7.7 0.1 100.0 2,761 Secondary 70.1 2.5 27.4 0.0 100.0 6,470 More than secondary 74.6 2.4 23.0 0.1 100.0 1,979 Wealth quintile Lowest 93.7 1.3 4.9 0.1 100.0 2,275 Second 87.3 1.9 10.8 0.0 100.0 2,332 Middle 77.7 2.4 19.9 0.0 100.0 2,570 Fourth 72.4 2.1 25.5 0.0 100.0 3,163 Highest 74.9 1.8 23.2 0.1 100.0 3,468 Total 15-49 80.0 1.9 18.0 0.0 100.0 13,808 50-59 96.6 1.0 2.2 0.2 100.0 1,678 Total men 15-59 81.8 1.8 16.3 0.1 100.0 15,486 Note: Total includes 3 men with information missing on marital status who are not shown separately. 1 Currently employed is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. There is no significant difference by urban-rural residence in the proportion of women currently employed (60 and 59 percent, respectively). However, the percentage of men currently employed is higher in rural areas than in urban areas (83 and 75 percent, respectively). Levels of employment vary by zone; for example, among women, current employment ranges from a low of 46 percent in the North West to a high of 70 percent in the South West. Among men, employment is lowest in the South South (69 percent) and highest in the North East (91 percent). Characteristics of Respondents | 41 3.6 OCCUPATION Respondents who reported being currently employed or who worked in the 12 months preceding the survey were asked what type of work they normally do. Tables 3.6.1 and 3.6.2 show the distribution of women and men by occupation according to background characteristics. Table 3.6.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Nigeria 2008 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of women Age 15-19 1.8 2.0 46.5 17.3 1.3 30.3 0.8 100.0 1,839 20-24 4.3 2.7 49.9 18.3 1.1 22.9 0.8 100.0 3,172 25-29 6.2 2.5 51.9 17.3 0.4 20.8 0.7 100.0 4,315 30-34 8.8 1.8 54.8 12.9 0.2 20.7 0.7 100.0 3,573 35-39 7.9 1.6 54.4 11.7 0.2 23.6 0.7 100.0 3,166 40-44 8.1 1.7 53.3 8.9 0.2 27.5 0.4 100.0 2,469 45-49 7.1 0.6 52.0 8.6 0.1 30.7 0.9 100.0 2,387 Marital status Never married 10.4 6.2 47.6 14.1 1.9 19.1 0.7 100.0 2,975 Married or living together 5.9 1.2 53.1 14.2 0.2 24.7 0.7 100.0 16,758 Divorced/separated/widowed 7.0 1.6 50.3 8.4 0.1 32.1 0.4 100.0 1,187 Missing 0.0 0.0 100.0 0.0 0.0 0.0 0.0 100.0 1 Number of living children 0 9.8 4.9 47.4 16.2 1.5 19.4 0.8 100.0 4,089 1-2 7.2 1.9 51.7 16.0 0.3 22.1 0.7 100.0 5,508 3-4 6.3 1.1 54.1 13.4 0.2 24.2 0.7 100.0 5,749 5+ 3.9 0.6 54.2 10.5 0.1 30.0 0.7 100.0 5,574 Residence Urban 12.1 4.3 61.1 14.5 0.7 6.5 0.8 100.0 7,411 Rural 3.6 0.6 47.3 13.5 0.3 34.0 0.6 100.0 13,511 Zone North Central 5.7 1.3 37.4 7.5 0.4 47.2 0.5 100.0 3,132 North East 1.8 0.6 42.9 16.6 0.4 36.6 1.1 100.0 2,608 North West 2.6 0.2 62.1 25.4 0.3 8.7 0.7 100.0 4,268 South East 10.3 2.2 51.8 8.9 0.7 25.5 0.5 100.0 2,444 South South 7.0 2.8 49.8 9.3 0.6 29.9 0.6 100.0 3,628 South West 11.0 3.7 60.0 12.2 0.4 11.7 0.9 100.0 4,841 Education No education 0.5 0.0 51.9 16.7 0.3 29.8 0.8 100.0 7,426 Primary 0.6 0.2 51.3 13.6 0.2 33.7 0.5 100.0 5,026 Secondary 5.3 3.8 58.7 13.8 0.6 17.2 0.6 100.0 6,554 More than secondary 50.2 7.5 33.4 3.9 1.7 2.1 1.3 100.0 1,916 Wealth quintile Lowest 0.1 0.0 41.3 13.0 0.2 44.6 0.8 100.0 3,765 Second 0.7 0.0 45.6 15.4 0.3 37.4 0.6 100.0 4,081 Middle 3.0 0.7 50.2 12.8 0.3 32.2 0.8 100.0 3,970 Fourth 8.6 2.2 60.7 15.1 0.5 12.4 0.6 100.0 4,269 Highest 17.7 5.8 60.3 13.0 0.9 1.5 0.8 100.0 4,836 Total 6.6 1.9 52.2 13.9 0.5 24.3 0.7 100.0 20,921 42 | Characteristics of Respondents Among occupational categories, sales and services and agriculture are the most common for both women and men. Among women, the sales and services sector employs half (52 percent) of employed women and the agriculture sector employs 24 percent of women. Another 14 percent of women are engaged in skilled manual jobs. Table 3.6.2 shows that the highest proportion of men work in agriculture (40 percent), followed by sales and services (27 percent). Table 3.6.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Nigeria 2008 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of men Age 15-19 1.7 0.7 14.9 18.6 13.2 50.1 0.7 100.0 1,227 20-24 5.3 1.9 23.2 22.8 6.9 39.0 0.9 100.0 1,626 25-29 7.9 1.9 31.7 20.5 2.3 35.1 0.7 100.0 2,160 30-34 9.3 1.7 32.9 18.8 0.7 35.7 0.8 100.0 1,978 35-39 11.4 1.9 29.6 16.9 0.1 39.4 0.7 100.0 1,772 40-44 12.6 1.5 25.8 16.9 0.2 42.3 0.6 100.0 1,397 45-49 15.1 2.2 24.7 16.0 0.0 41.4 0.6 100.0 1,158 Marital status Never married 7.6 2.1 25.9 22.8 7.7 33.1 0.9 100.0 4,150 Married or living together 9.8 1.5 27.9 16.6 0.3 43.2 0.7 100.0 6,931 Divorced/separated/widowed 8.1 1.6 26.5 15.8 0.8 47.1 0.0 100.0 233 Missing 0.0 0.0 0.0 0.0 0.0 100.0 0.0 100.0 3 Number of living children 0 7.5 2.0 26.4 21.8 6.6 34.9 0.9 100.0 4,874 1-2 10.7 2.0 30.8 17.3 0.4 38.1 0.7 100.0 2,447 3-4 9.5 1.2 27.6 19.3 0.2 41.4 0.7 100.0 2,023 5+ 10.0 1.3 23.8 13.2 0.1 51.2 0.4 100.0 1,974 Residence Urban 14.2 2.9 40.6 27.5 3.1 11.0 0.8 100.0 4,041 Rural 6.1 1.0 19.6 14.1 3.0 55.5 0.7 100.0 7,277 Zone North Central 8.1 1.3 15.9 11.8 7.3 55.0 0.6 100.0 1,806 North East 3.8 0.9 20.1 8.7 3.7 61.9 0.8 100.0 1,520 North West 6.3 1.4 23.2 11.7 3.3 53.3 0.7 100.0 2,852 South East 10.2 2.0 37.7 29.9 1.4 18.0 0.8 100.0 1,072 South South 10.9 2.3 35.8 28.1 1.2 21.2 0.5 100.0 1,778 South West 14.3 2.3 33.6 27.8 1.0 20.0 0.9 100.0 2,290 Education No education 1.0 0.7 16.3 7.5 0.6 73.3 0.7 100.0 2,548 Primary 2.2 0.6 26.0 21.3 1.5 47.8 0.7 100.0 2,547 Secondary 6.3 1.9 32.9 26.2 4.9 26.9 0.7 100.0 4,700 More than secondary 41.8 4.6 29.3 11.2 3.7 8.6 0.8 100.0 1,522 Wealth quintile Lowest 1.0 0.4 10.2 5.7 2.6 79.4 0.7 100.0 2,161 Second 3.1 0.4 13.8 10.5 2.8 68.4 1.0 100.0 2,080 Middle 6.0 1.3 25.9 18.1 4.0 44.3 0.4 100.0 2,059 Fourth 11.9 2.0 37.9 28.1 3.6 15.7 0.7 100.0 2,356 Highest 19.7 3.8 42.7 28.5 2.2 2.4 0.8 100.0 2,661 Total 15-49 9.0 1.7 27.1 18.9 3.0 39.6 0.7 100.0 11,317 50-59 11.1 1.8 24.8 13.0 0.5 48.3 0.5 100.0 1,638 Total men 15-59 9.2 1.7 26.8 18.1 2.7 40.7 0.7 100.0 12,955 Characteristics of Respondents | 43 Regardless of marital status, urban-rural residence, or number of living children, sales and services and agriculture are the most common occupations among both women and men. However, respondents with more than a secondary education (among both women and men) are more likely to be engaged in professional/technical/managerial jobs than in other occupations: 50 percent for women and 42 percent for men. There is considerable variation by zone; for example, men in the northern zones are more likely to be in agriculture compared with those in the southern zones. Generally, women in the southern zones are more likely to be in professional/technical/managerial occupations than their northern counterparts. Engaging in professional/technical/managerial occupations is positively related to household economic status; for example, in households in the lowest wealth quintile 1 percent or less of women and men are engaged in professional/technical/managerial occupations, compared with 18 and 20 percent, respectively, in households in the highest wealth quintile. 3.7 EARNINGS, EMPLOYERS, AND CONTINUITY OF EMPLOYMENT Tables 3.7.1 and 3.7.2 show the distribution of women and men by type of earnings, type of employer, and the continuity of employment. Table 3.7.1 presents information separately on women engaged in agricultural work or non-agricultural work. The two sectors influence the type of earnings women receive, the type of employer, and the continuity of employment. Forty-six percent of women employed in agricultural work are not paid. Almost two-thirds of women in this sector are self- employed (63 percent) and 56 percent work seasonally. Among women employed in the non- agricultural sector, 83 percent earn cash only, 75 percent are self-employed, and 82 percent work all year. Table 3.7.1 Type of employment: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or non-agricultural), Nigeria 2008 Employment characteristic Agricultural work Non-agricultural work Missing Total Type of earnings Cash only 23.4 82.8 71.0 68.3 Cash and in-kind 24.6 6.2 8.2 10.7 In-kind only 6.4 1.0 1.4 2.3 Not paid 45.5 9.6 10.1 18.3 Missing 0.1 0.4 9.3 0.4 Total 100.0 100.0 100.0 100.0 Type of employer Employed by family member 33.6 9.0 8.6 15.0 Employed by non-family member 3.5 15.5 16.4 12.6 Self-employed 62.9 75.2 66.7 72.2 Missing 0.1 0.3 8.3 0.3 Total 100.0 100.0 100.0 100.0 Continuity of employment All year 40.9 82.0 68.7 71.9 Seasonal 56.0 13.7 16.2 24.0 Occasional 2.8 3.9 4.6 3.6 Missing 0.3 0.5 10.5 0.5 Total 100.0 100.0 100.0 100.0 Number of women employed during the past 12 months 5,081 15,692 149 20,921 Note: Total includes women with information missing on type of employment who are not shown separately. 44 | Characteristics of Respondents Table 3.7.2 shows that 58 percent of men employed in agricultural work are not paid. Sixty- five percent of men in agricultural work are self-employed and 53 percent work seasonally. Among men employed in the non-agricultural sector, 78 percent are paid in cash only, 55 percent are self- employed, and 85 percent work all year. Table 3.7.2 Type of employment: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or non-agricultural), Nigeria 2008 Employment characteristic Agricultural work Non- agricultural work Missing Total Type of earnings Cash only 20.8 77.8 49.2 54.4 Cash and in-kind 15.5 9.3 10.2 11.8 In-kind only 5.9 1.2 2.4 3.1 Not paid 57.7 11.6 27.8 30.5 Missing 0.1 0.1 10.5 0.2 Total 100.0 100.0 100.0 100.0 Type of employer Employed by family member 30.6 8.0 15.9 17.3 Employed by non-family member 3.9 37.0 28.1 23.4 Self-employed 65.4 54.9 46.7 59.1 Missing 0.1 0.1 9.4 0.2 Total 100.0 100.0 100.0 100.0 Continuity of employment All year 43.3 84.9 59.0 67.8 Seasonal 53.4 10.0 27.9 27.8 Occasional 2.7 4.9 2.3 4.0 Missing 0.6 0.3 10.7 0.5 Total 100.0 100.0 100.0 100.0 Number of men employed during the past 12 months 5,274 7,591 90 12,955 Note: Total includes men with information missing on type of employment who are not shown separately. 3.8 HEALTH INSURANCE COVERAGE Health insurance improves access to health care, thus promoting good health. Reasonable access to health care encourages individuals to seek health maintenance services more regularly than they otherwise would, thereby preventing potentially serious illnesses. Additionally, health insurance protects individuals from financial hardship that may result from large or unexpected medical bills. In Nigeria, health insurance can be obtained from private organisations or from government agencies. Nigeria’s National Health Insurance Scheme (NHIS) was established by Decree Number 35 of 1999. The scheme, identified as a tool for achieving health-related Millennium Development Goals (MDGs), currently enrols only persons who are employees in the formal employment sector. However, as the scheme is mandated to offer universal coverage to all Nigerians by 2015, there are plans to extend health insurance schemes to the informal sector in the future. Characteristics of Respondents | 45 Tables 3.8.1 and 3.8.2 present information about specific types of insurance coverage for women and men by background characteristics. The tables show that the majority of women and men have no health insurance coverage (98 and 97 percent, respectively). Among all categories of insurance, employer-based insurance is used most commonly. However, only 2 percent of men and 1 percent of women are covered by this type of insurance. Women and men in urban areas (4 and 5 percent, respectively) and those in the highest wealth quintile (6 and 8 percent, respectively) are the most likely to have health insurance coverage. Level of education is also strongly associated with health care coverage. Table 3.8.1 Health insurance coverage: Women Percent distribution of women age 15-49 by type of health insurance coverage, according to background characteristics, Nigeria 2008 Background characteristic Employer- based insurance Mutual health organization/ community- based insurance Privately purchased commercial insurance Other No health insurance Number of women Age 15-19 0.5 0.1 0.1 0.2 99.0 6,493 20-24 0.7 0.1 0.3 0.2 98.8 6,133 25-29 1.4 0.1 0.3 0.2 98.0 6,309 30-34 1.7 0.2 0.2 0.1 97.9 4,634 35-39 2.1 0.3 0.2 0.2 97.3 3,912 40-44 2.6 0.1 0.1 0.1 97.1 3,032 45-49 1.0 0.1 0.1 0.1 98.7 2,872 Residence Urban 2.8 0.2 0.4 0.2 96.4 11,934 Rural 0.5 0.1 0.1 0.1 99.2 21,451 Zone North Central 2.0 0.2 0.2 0.2 97.4 4,748 North East 0.3 0.1 0.0 0.0 99.5 4,262 North West 0.4 0.2 0.0 0.0 99.3 8,022 South East 0.4 0.1 0.1 0.0 99.3 4,091 South South 2.0 0.2 0.5 0.7 96.6 5,473 South West 2.3 0.1 0.3 0.0 97.3 6,789 Education No education 0.1 0.0 0.0 0.0 99.9 11,942 Primary 0.4 0.1 0.1 0.0 99.3 6,566 Secondary 1.3 0.1 0.3 0.3 98.0 11,904 More than secondary 8.1 0.6 0.9 0.6 89.8 2,974 Wealth quintile Lowest 0.0 0.0 0.0 0.0 99.9 6,194 Second 0.0 0.0 0.0 0.0 99.9 6,234 Middle 0.2 0.1 0.1 0.1 99.5 6,341 Fourth 0.9 0.2 0.2 0.1 98.6 6,938 Highest 4.5 0.3 0.6 0.5 94.0 7,678 Total 1.3 0.1 0.2 0.2 98.2 33,385 46 | Characteristics of Respondents Table 3.8.2 Health insurance coverage: Men Percent distribution of men age 15-49 by type of health insurance coverage, according to background characteristics, Nigeria 2008 Background characteristic Employer- based insurance Mutual health organization/ community- based insurance Privately purchased commercial insurance Other No health insurance Number of men Age 15-19 0.2 0.0 0.3 0.3 99.1 2,532 20-24 1.1 0.1 0.3 0.4 98.2 2,378 25-29 1.8 0.4 0.3 0.4 97.2 2,459 30-34 2.3 0.3 0.4 0.1 96.8 2,058 35-39 3.8 0.0 0.2 0.5 95.4 1,794 40-44 2.9 0.7 0.6 0.5 95.4 1,413 45-49 2.6 0.0 0.5 0.8 96.2 1,174 Residence Urban 3.4 0.3 0.4 0.8 95.0 5,215 Rural 1.0 0.1 0.3 0.2 98.5 8,593 Zone North Central 2.1 0.1 0.3 0.2 97.2 2,065 North East 0.9 0.0 0.0 0.0 99.0 1,645 North West 1.2 0.4 0.2 0.2 97.9 3,237 South East 1.6 0.4 0.7 0.0 97.6 1,448 South South 3.3 0.1 0.7 0.8 95.2 2,437 South West 2.1 0.1 0.3 0.8 96.7 2,977 Education No education 0.1 0.0 0.2 0.0 99.8 2,597 Primary 0.6 0.0 0.2 0.0 99.3 2,761 Secondary 1.4 0.3 0.3 0.4 97.7 6,470 More than secondary 7.9 0.7 1.1 1.5 89.0 1,979 Wealth quintile Lowest 0.1 0.0 0.1 0.1 99.8 2,275 Second 0.3 0.0 0.1 0.0 99.6 2,332 Middle 0.6 0.2 0.3 0.0 98.8 2,570 Fourth 2.0 0.2 0.4 0.3 97.2 3,163 Highest 5.1 0.5 0.7 1.2 92.5 3,468 Total 15-49 1.9 0.2 0.4 0.4 97.2 13,808 50-59 2.2 0.4 0.3 0.5 96.7 1,678 Total men 15-59 1.9 0.2 0.4 0.4 97.1 15,486 3.9 KNOWLEDGE AND ATTITUDES REGARDING TUBERCULOSIS During the 2008 NDHS, respondents were asked if they had ever heard of tuberculosis (TB), a major public health concern worldwide. Women and men were also asked about how TB is spread, whether the disease is curable and through what methods, and several other TB-related questions. Additionally, respondents were asked whether or not they would want other people to know if a family member had TB. Tables 3.9.1 and 3.9.2 present information on knowledge and attitudes concerning TB for women and men age 15-49, by background characteristics. Although knowledge of TB is high among both women and men, it is substantially higher among men (84 percent) than women (71 percent). Among all respondents who report having heard of TB, 59 percent of women and 72 percent of men reported that TB is spread through the air by coughing. Knowledge of TB transmission increases with level of education and wealth quintile among both women and men. Characteristics of Respondents | 47 Among women and men who have heard of TB, 72 percent of women and 87 percent of men believe that it can be cured. Women are more likely than men to want to conceal the fact that a family member has TB (21 and 18 percent, respectively). Table 3.9.1 Knowledge and attitudes concerning tuberculosis: Women Percentage of women age 15-49 who have heard of tuberculosis (TB), and among women who have heard of TB, the percentages who know that TB is spread through the air by coughing, the percentage who believe that TB can be cured, and the percen

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