Nigeria - Multiple Indicator Cluster Survey - 2011

Publication date: 2011

        NIGERIA Monitoring the situation of children and women                         Multiple Indicator Cluster Survey 2011 MAIN REPORT             Federal Republic of Nigeria         National Bureau of Statistics   Department For International Development       United Nations Population Fund     United Nations Children’s Fund           UNICEF-MICS CD.5 Errors have been identified in the "Total" row of Table CD.5 (Page 162-163). An updated table is attached to the end of this report. Administrator Sticky Note Accepted set by Administrator Administrator Sticky Note Completed set by Administrator MICS Nigeria, 2011; Main Report   Page  i     Nigeria   Multiple  Indicator  Cluster  Survey   2011                     NBS   National  Bureau  of  Statistics           UNICEF   United  Nations  Children’s  Fund           UNFPA   United  Nations  Population  Fund                 April,  2013   MICS Nigeria, 2011; Main Report   Page  ii                   In  Memory     This  report  is  dedicated  to  the  25  people  killed,  and  those  who  were  injured,  by  the  bomb  attack   on  UN  House   in   Abuja   on   the   26th   August   2011.   Amongst   the   people  who   lost   their   lives  was   Johnson  Awotunde  who  devoted  his   time,  energy  and  personal   resources   to   the   success  of   the   survey  until  his  untimely  departure.             MICS Nigeria, 2011; Main Report   Page  iii               The   Nigeria   Multiple   Indicator   Cluster   Survey   (MICS)   was   carried   out   in   2011   by   the   National   Bureau   of   Statistics.     Financial   and   technical   support   was   provided   by   the   United   Nations   Children’s   Fund   (UNICEF),   United   Nations   Population   Fund   (UNFPA)   and   the   Government   of   Nigeria  through  the  National  Bureau  of  Statistics.     MICS   is  an   international  household  survey  programme  developed  by  UNICEF.    The  Nigeria  MICS   was  conducted  as  part  of  the  fourth  global  round  of  MICS  surveys  (MICS4).    MICS  provides  up-­‐to-­‐ date  information  on  the  situation  of  children  and  women  and  measures  key  indicators  that  allow   countries   to   monitor   progress   towards   the   Millennium   Development   Goals   (MDGs)   and   other   internationally  agreed  upon  commitments.  Additional  information  on  the  global  MICS  project  may   be  obtained  from  www.childinfo.org.                 National  Bureau  of  Statistics  (NBS)  2011,   Nigeria  Multiple  Indicator  Cluster  Survey  2011   Main  Report,  ABUJA  NIGERIA.   MICS Nigeria, 2011; Main Report   Page  iv     Summary  Table  of  Findings   Multiple  Indicator  Cluster  Surveys  (MICS)  and  Millennium  Development  Goals   (MDG)  Indicators,  Nigeria,  2011.     Topic   MICS4   Indicator   Number   MDG   Indicator   Number   Indicator   Value   CHILD MORTALITY Child  mortality   1.1   4.1   Under-­‐five  mortality  rate   158   per  1,000     1.2   4.2   Infant  mortality  rate   97   per  1,000   NUTRITION Nutritional  status   2.1a   1.8   Underweight  prevalence:  Moderate  and  Severe  (-­‐  2  SD)   24.2   percent   2.2a   Stunting  prevalence:  Moderate  and  Severe  (-­‐  2  SD)   34.8   percent   2.3a     Wasting  prevalence:  Moderate  and  Severe  (-­‐  2  SD)   10.2   percent   2.6     Exclusive  breastfeeding  under  6  months   15.1   percent   2.7     Continued  breastfeeding  at  1  year   79.3   percent   2.8     Continued  breastfeeding  at  2  years   34.5   percent   2.12     Introduction  of  solid,  semi-­‐solid  or  soft  foods   32,9   percent   Breastfeeding  and   infant  feeding   2.4     Children  ever  breastfed   95.5   percent   2.5     Early  initiation  of  breastfeeding   22.9   percent   2.6     Exclusive  breastfeeding  under  6  months   15.1   percent   2.7     Continued  breastfeeding  at  1  year   79.3   percent   2.8     Continued  breastfeeding  at  2  years   34.5   percent   2.9     Predominant  breastfeeding  under  6  months   69.9   percent   2.10     Duration  of  breastfeeding   18.3   months   2.11     Bottle  feeding   18.7   percent   2.12     Introduction  of  solid,  semi-­‐solid  or  soft  foods   32.2   percent   2.13     Minimum  meal  frequency   24.1   percent   2.14     Age-­‐appropriate  breastfeeding   34.6   percent   2.15     Milk  feeding  frequency  for  non-­‐breastfed  children   30.1   percent   Salt  iodization   2.16     Iodized  salt  consumption   79.8   percent   Vitamin  A   2.17     Vitamin  A  supplementation  (children  under  age  5)   65.2   percent   Low  birth  weight   2.18     Low-­‐birth  weight  infants   15.2   percent     2.19     Infants  weighed  at  birth   25.7   percent   CHILD HEALTH Vaccinations   3.1     Tuberculosis  immunization  coverage   61.7   percent     3.2     Polio  immunization  coverage   46.1   percent     3.3     Immunization  coverage  for  diphtheria,  pertussis  and  tetanus   (DPT)   42.6   percent     3.4   4.3   Measles  immunization  coverage   49.2   percent     3.5     Hepatitis  B  immunization  coverage   34.0   percent     3.6     Yellow  fever  immunization  coverage   40.4   percent   Tetanus  toxoid   3.7     Neonatal  tetanus  protection   55.2   percent   Care  of  illness   3.8     Oral  rehydration  therapy  with  continued  feeding   27.9   percent     3.9     Care  seeking  for  suspected  pneumonia   39.7   percent     3.10     Antibiotic  treatment  of  suspected  pneumonia   45.4   percent   Solid  fuel  use   3.11     Solid  fuels   74.5   percent   MICS Nigeria, 2011; Main Report   Page  v   Topic   MICS4   Indicator   Number   MDG   Indicator   Number   Indicator   Value   Malaria   3.12     Households  with  at  least  one  ITN   40.1     percent   3.14     Children  under  age  5  sleeping  under  any  mosquito  net   18.6   percent   3.15   6.7   Children  under  5  sleeping  under  insecticide-­‐treated  nets   (ITNs)   16.4   percent   3.16     Malaria  diagnostics  usage   7.9   Percent   3.17     Anti-­‐malarial  treatment  of  children  under  5  the  same  or  next   day   29.4   percent   3.18   6.8   Anti-­‐Malarial  treatment     44.6   percent   3.19     Pregnant  women  sleeping  under  insecticide-­‐treated  nets   (ITNs)   16.9   percent     3.20     Intermittent  preventive  treatment  for  malaria   19.5   percent   WATER AND SANITATION Water  and   sanitation   4.1   7.8   Use  of  improved  drinking  water  sources   58.5   percent   4.2     Water  treatment   4.1   percent   4.3   7.9   Use  of  improved  sanitation     31.0   percent   4.4     Safe  disposal  of  child's  faeces   52.3   percent   4.5     Place  for  hand  washing   48.0   percent   4.6     Availability  of  soap   61.5   percent   REPRODUCTIVE HEALTH Contraception   and  unmet  need   5.1   5.4   Adolescent  birth  rate   89   per  1,000   5.2     Early  childbearing   28.6   per  cent     5.3   5.3   Contraceptive  prevalence  rate   17.5   percent     5.4   5.6   Unmet  need   19.4   percent   Maternal  health   5.5a   5.5   Antenatal  care  coverage  with  at  least  once  by  skilled   personnel   66.2   percent   5.5b   Antenatal   care   coverage   at   least   four   times   by   any   provider   56.6   percent   5.6     Content  of  antenatal  care   51.5   percent   5.7   5.2   Skilled  attendance  at  delivery   48.7   percent     5.8     Institutional  deliveries   45.1   percent     5.9     Caesarean  section   4.7   percent   CHILD DEVELOPMENT Child   development   6.1     Support  for  learning   65.4   percent   6.2     Father's  support  for  learning   37.2   percent     6.3     Learning  materials:  children’s  books   6.0   percent     6.4     Learning  materials:  playthings   38.1   percent     6.5     Inadequate  care   39.9   percent     6.6     Early  child  development  index   60.9   percent     6.7     Attendance  to  early  childhood  education   42.6   percent   EDUCATION Education   7.1   2.3   Literacy  Among  young  women     65.6   percent     7.2     School  readiness   44.8   percent     7.3     Net  intake  rate  in  primary  education   43.8   percent     7.4   2.1   Primary  school  net  attendance  ratio  (adjusted)   70.1   percent     7.5     Secondary  school  net  attendance  ratio  (adjusted)   54.2   percent     7.6   2.2   Children  reaching  last  grade  of  primary   96.5   percent     7.7     Primary  completion  rate   85.4   percent     7.8     Transition  rate  to  secondary  school   74.0   percent     7.9     Gender  parity  index  (primary  school)   0.94   ratio     7.10     Gender  parity  index  (secondary  school)   1.00   ratio   MICS Nigeria, 2011; Main Report   Page  vi   Topic   MICS4   Indicator   Number   MDG   Indicator   Number   Indicator   Value     CHILD PROTECTION Birth  registration   8.1     Birth  registration   41.5   percent   Child  labour   8.2     Child  labour   47.1   percent     8.3     School  attendance  among  child  labourers   76.1   percent     8.4     Child  labour  among  students   47.1   percent   Child  discipline   8.5     Violent  discipline   90.8   percent   Early  marriage     8.6     Marriage  before  age  15   17.6   percent     8.7     Marriage  before  age  18   39.9   percent     8.8     Young  women  age  15-­‐19  currently  married  or  in  union   20.2   percent     8.9     Polygyny   33.6   percent       8.10a   8.10b     Spousal  age  difference       Women  age  15-­‐19     Women  age  20-­‐24     52.2   43.9     percent   percent   Female  genital   mutilation/   cutting   8.11     Approval  for  female  genital  mutilation/cutting  (FGM/C)   21.8   percent   8.12     Prevalence  of  female  genital  mutilation/cutting  (FGM/C)   among  women   27.0   percent   8.13     Prevalence  of  female  genital  mutilation/cutting  (FGM/C)   among  girls   19.2   percent   Domestic  violence   8.14     Attitudes  toward  domestic  violence   45.6   Percent   HIV/AIDS, SEXUAL BEHAVIOUR HIV/AIDS   knowledge  and   attitudes   9.1     Comprehensive  knowledge  about  HIV  prevention   23.1   percent   9.2   6.3   Comprehensive  knowledge  about  HIV  prevention  among  young  people  (women  age  15-­‐24  years)   22.5   percent   9.3     Knowledge  of  mother-­‐  to-­‐child  transmission  of  HIV   49.7   percent   9.4     Accepting  attitudes  towards  people  living  with  HIV   9.0   percent   9.5     Women  who  know  a  place  where  to  be  tested   61.0   percent     9.6     Women  who  have  been  tested  for  HIV  and  know  the   results   11.4   percent   9.7     Sexually  active  young  women  who  have  been  tested  for   HIV  and  know  the  results   9.1   percent   9.8     HIV  counselling  during  antenatal  care   48.4   percent   9.9     HIV  testing  during  antenatal  care   28.5   percent   Sexual   behaviour   9.10     Young  women  who  have  never  had  sex   62.6   percent   9.11     Sex  before  age  15  among  young  women   15.8   percent   9.12     Age-­‐mixing  among  sexual  partners   39.3   percent   9.13     Sex  with  multiple  partners   2.8   percent   9.14     Condom  use  during  sex  with  multiple  partners   34.3   percent   9.15     Sex  with  non  regular  partner  (women  age  15-­‐24  years)   32.4   percent   9.16   6.2   Condom  use  with  non-­‐regular  partners  (women  age  15-­‐24)   years)   47.4   percent   Orphaned   children   9.17     Children’s  living  arrangements   8.8   percent   9.18     Prevalence  of  children  with  at  least  one  parent  dead   6.6   percent   9.19   6.4   School  attendance  of  orphans   79.9   percent   9.20   6.4   School  attendance  of  non-­‐orphans   79.5   percent     MICS Nigeria, 2011; Main Report   Page  vii   Table  of  Contents       Summary  Table  of  Findings  .     iv   Table  of  Contents  .     viii   List  of  Tables  .     x   List  of  Figures  .     xiii   List  of  Abbreviations  .     xiv   Preface    .     xv   Acknowledgements  .     xvi   Executive  Summary  .     xvii     I.  Introduction  -­‐  .            1     Background  .            1     Survey  Objectives  .            2     II.  Sample  and  Survey  Methodology  -­‐  .            3     Sample  Design  .            3     Questionnaires  .            3     Training  and  Fieldwork  .            4     Data  Processing  .            4     III.  Sample  Coverage  and  the  Characteristics  of  Households  and  Respondents  -­‐  .            5     Sample  Coverage  .            5     Characteristics  of  Households  .            6     Characteristics  of  Female  Respondents  15-­‐49  Years  of  Age  and  Children  Under-­‐5    .        10     IV.  Child  Mortality      .        13     V.  Nutrition    .        19     Nutritional  Status  .        19     Breastfeeding  and  Infant  and  Young  Child  Feeding  .        25     Salt  Iodization  .        39     Children’s  Vitamin  A  Supplementation  .        42     Low  Birth  Weight  .        46     VI.  Child  Health    .        50     Vaccinations  .        50     Neonatal  Tetanus  Protection  .        55     Oral  Rehydration  Treatment  .        58     Care  Seeking  and  Antibiotic  Treatment  of  Pneumonia  .        66     Solid  Fuel  Use  .        68     Malaria  .        74     MICS Nigeria, 2011; Main Report   Page  viii   VII.  Water  and  Sanitation  .        90     Use  of  Improved  Water  Sources  .        90     Use  of  Improved  Sanitation  Facilities  .     102     Handwashing  .     114     VIII.  Reproductive  Health  .     121     Fertility  .     121     Contraception  .     127     Unmet  Need  .     131     Antenatal  Care  .     134     Assistance  at  Delivery  .     142     Place  of  Delivery  .     146     IX.  Child  Development  .     149     Early  Childhood  Education  and  Learning  .     149     Early  Childhood  Development  .     161     X.  Literacy  and  Education  .     165     Literacy  among  Young  Women  .     165     School  Readiness  .     168     Primary  and  Secondary  School  Participation  .     174     XI.  Child  Protection  .     186     Birth  Registration  .     186     Child  Labour  .     189     Child  Discipline  .     196     Early  Marriage  and  Polygyny  .     199     Female  Genital  Mutilation/Cutting  .     206     Attitudes  toward  Domestic  Violence  .     213     XII.  HIV/AIDS,  Sexual  Behaviour,  and  Orphans  .     216     Knowledge  about  HIV  Transmission  and  Misconceptions  about  HIV/AIDS  .     216     Attitudes  toward  People  Living  with  HIV/AIDS    .       227     Knowledge  of  a  Place  for  HIV  Testing,  Counselling  and  Testing  during  Antenatal  Care    .       230     Sexual  Behaviour  Related  to  HIV  Transmission    .       238     Orphans  .     249         Appendix  A.  Sample  Design  .     253   Appendix  B.  List  of  Personnel  Involved  in  the  Survey  .     255   Appendix  C.  Estimates  of  Sampling  Errors  .     277   Appendix  D.  Data  Quality  Tables  .     298   Appendix  E.  MICS4  Indicators:  Numerators  and  Denominators  .     321   Appendix  F.  Questionnaires  .     331   MICS Nigeria, 2011; Main Report   Page  ix   List  of  Tables     III.  Sample  Coverage  and  the  Characteristics  of  Households  and  Respondents       Table  HH.1:  Results  of  household,  women's,  and  under-­‐5  interviews  .                5   Table  HH.2:  Household  age  distribution  by  sex  .            6   Table  HH.3:  Household  composition  .            8   Table  HH.4:  Women's  background  characteristics  .        11   Table  HH.5:  Under-­‐5's  background  characteristics    .        13   IV.  Child  Mortality   Table  CM.1:  Children  ever  born,  children  surviving  and  proportion  dead  .        15   Table  CM.2:  Child  mortality  .        17   V.  Nutrition     Table  NU.1:  Nutritional  status  of  children  .        20   Table  NU.2:  Initial  breastfeeding  .        23   Table  NU.3:  Breastfeeding  .        27   Table  NU.4:  Duration  of  breastfeeding  .        30   Table  NU.5:  Age-­‐appropriate  breastfeeding  .        33   Table  NU.6:  Introduction  of  solid,  semi-­‐solid  or  soft  foods  .        35   Table  NU.7:  Minimum  meal  frequency  .        36   Table  NU.8:  Bottle  feeding  .        38   Table  NU.9:  Iodized  salt  consumption  .        40   Table  NU.10:  Children's  vitamin  A  supplementation  .        44   Table  NU.11:  Low  birth  weight  infants  .        47     VI.  Child  Health   Table  CH.1:  Vaccinations  in  first  year  of  life    .        51   Table  CH.2:  Vaccinations  by  background  characteristics  .        53   Table  CH.3:  Neonatal  tetanus  protection  .        56   Table  CH.4:  Oral  rehydration  solutions  and  recommended  homemade  fluids  .        59   Table  CH.5:  Feeding  practices  during  diarrhoea  .        61   Table  CH.6:  Oral  rehydration  therapy  with  continued  feeding  and  other  treatments  .        63   Table  CH.7:  Care  seeking  for  suspected  pneumonia  and  antibiotic  use  during  suspected  pneumonia  .        65   Table  CH.8:  Knowledge  of  the  two  danger  signs  of  pneumonia  .        67   Table  CH.9:  Solid  fuel  use  .        68   Table  CH.10:  Solid  fuel  use  by  place  of  cooking  .        73   Table  CH.11:  Household  availability  of  insecticide  treated  nets  and  protection  by  a  vector  control  method  .        75   Table  CH.12:  Children  sleeping  under  mosquito  nets  .        77   Table  CH.13:  Pregnant  women  sleeping  under  mosquito  nets  .        80   Table  CH.14:  Anti-­‐malarial  treatment  of  children  with  anti-­‐malarial  drugs  .        82   Table  CH.15:  Malaria  diagnostics  usage  .        86   Table  CH.16:  Intermittent  preventive  treatment  for  malaria  .        88   VII.  Water  and  Sanitation   Table  WS.1:  Use  of  improved  water  sources    .        91   Table  WS.2:  Household  water  treatment    .        95   Table  WS.3:  Time  to  source  of  drinking  water    .        98   Table  WS.4:  Person  collecting  water    .     100   Table  WS.5:  Types  of  sanitation  facilities  .     103   MICS Nigeria, 2011; Main Report   Page  x   Table  WS.6:  Use  and  sharing  of  sanitation  facilities  .     107   Table  WS.7:  Disposal  of  child's  faeces  .     109   Table  WS.8:  Drinking  water  and  sanitation  ladders  .     111   Table  WS.9:  Water  and  soap  at  place  for  handwashing  .     115   Table  WS.10:  Availability  of  soap  .     118     VIII.  Reproductive  Health   Table  RH.1:  Adolescent  birth  rate  and  total  fertility  rate  .     122   Table  RH.2:  Early  childbearing  .     125   Table  RH.3:  Trends  in  early  childbearing  .     127   Table  RH.4:  Use  of  contraception  .     128   Table  RH.5:  Unmet  need  for  contraception  .     132   Table  RH.6:  Antenatal  care  coverage  .     136   Table  RH.7:  Number  of  antenatal  care  visits  .     139   Table  RH.8:  Content  of  antenatal  care  .     141   Table  RH.9:  Assistance  during  delivery  .     144   Table  RH.10:  Place  of  delivery  .     147     IX.  Child  Development   Table  CD.1:  Early  childhood  education  .     150   Table  CD.2:  Support  for  learning  .     153   Table  CD.3:  Learning  materials  .     156   Table  CD.4:  Inadequate  care    .     159   Table  CD.5:  Early  child  development  index  .     162     X.  Literacy  and  Education   Table  ED.1:  Literacy  among  young  women  .     166   Table  ED.2:  School  readiness  .     169   Table  ED.3:  Primary  school  entry  .     172   Table  ED.4:  Primary  school  attendance  .     175   Table  ED.5:  Secondary  school  attendance  .     178   Table  ED.6:  Children  reaching  last  grade  of  primary  school    .     180   Table  ED.7:  Primary  school  completion  and  transition  to  secondary  school  .     182   Table  ED.8:  Education  gender  parity  .     184     XI.  Child  Protection   Table  CP.1:  Birth  registration  .     187   Table  CP.2:  Child  labour  .     190   Table  CP.3:  Child  labour  and  school  attendance  .     194   Table  CP.4:  Child  discipline  .     197   Table  CP.5:  Early  marriage  and  polygyny  .     200   Table  CP.6:  Trends  in  early  marriage  .     202   Table  CP.7:  Spousal  age  difference  .     203   Table  CP.8:  Female  genital  mutilation/cutting  (FGM/C)  among  women  .     207   Table  CP.9:  Female  genital  mutilation/cutting  (FGM/C)  among  daughters  .     219   Table  CP.10:  Approval  of  female  genital  mutilation/cutting  (FGM/C)  .     211   Table  CP.11:  Attitudes  toward  domestic  violence  .     214     MICS Nigeria, 2011; Main Report   Page  xi   XII.  HIV/AIDS,  Sexual  Behaviour,  and  Orphans   Table  HA.1:    Knowledge  about  HIV  transmission,  misconceptions  about  HIV/AIDS,  and  comprehensive   knowledge  about  HIV  transmission    .              217   Table  HA.2:    Knowledge  about  HIV  transmission,  misconceptions  about  HIV/AIDS,  and  comprehensive   knowledge  about  HIV  transmission  among  young  women  .      220   Table  HA.3:        Knowledge  of  mother-­‐to-­‐child  HIV  transmission    .      225   Table  HA.4:       Accepting  attitudes  toward  people  living  with  HIV/AIDS  .      228   Table  HA.5:       Knowledge  of  a  place  for  HIV  testing  .      231   Table  HA.6:       Knowledge  of  a  place  for  HIV  testing  among  sexually  active  young  women  .      234   Table  HA.7:       HIV  counselling  and  testing  during  antenatal  care  .      237   Table  HA.8:       Sexual  behaviour  that  increases  the  risk  of  HIV  infection  .      239   Table  HA.9:       Sex  with  multiple  partners  .      242   Table  HA.10:    Sex  with  multiple  partners  among  young  women  .      244   Table  HA.11:    Sex  with  non-­‐regular  partners  .      247   Table  HA.12:    Children's  living  arrangements  and  orphanhood  .      250   Table  HA.13:    School  attendance  of  orphans  and  non-­‐orphans  .      252       Standard  Error  Tables   Table  SE.1:     Indicators  selected  for  sampling  error  calculation    .      278   Table  SE.2:    Sampling  errors:  Total  sample  .      280   Table  SE.3:    Sampling  errors:  Urban  areas  .      282   Table  SE.3:    Sampling  errors:  Rural  areas  .      284   Table  SE.5:    Sampling  errors:  North  Central  .      286   Table  SE.5:    Sampling  errors:  North  East  .      288   Table  SE.5:    Sampling  errors:  North  West  .      290   Table  SE.5:    Sampling  errors:  South  East  .      292   Table  SE.5:    Sampling  errors:  South  South  .      294   Table  SE.5:    Sampling  errors:  South  West  .      296   Data  Quality  Tables   Table  DQ.1:     Age  distribution  of  household  population  .        298   Table  DQ.2:     Age  distribution  of  eligible  and  interviewed  women  .      300   Table  DQ.3:     Age  distribution  of  under-­‐5s  in  household  and  under-­‐5  questionnaires  .      301   Table  DQ.4:     Women's  completion  rates  by  socio-­‐economic  characteristics  of  households  .      302   Table  DQ.5:     Completion  rates  for  under-­‐5  questionnaires  by  socio-­‐economic  characteristics      .      304   Table  DQ.6:     Completeness  of  reporting  .      306   Table  DQ.7:     Completeness  of  information  for  anthropometric  indicators  .      307   Table  DQ.8:     Heaping  in  anthropometric  measurements  .      308   Table  DQ.9:     Observation  of  bednets  and  places  for  hand  washing  .      309   Table  DQ.10:    Observation  of  women's  health  cards  .      311   Table  DQ.11:    Observation  of  under-­‐5s  birth  certificates  .      312   Table  DQ.12:    Observation  of  vaccination  cards  .      313   Table  DQ.13:    Presence  of  mother  in  the  household  and  the  person  interviewed  for  the  under-­‐5    .      314   Table  DQ.14:    Selection  of  children  age  2-­‐14  years  for  the  child  discipline  module  .      315   Table  DQ.15:    School  attendance  by  single  age  .      316   Table  DQ.16:    Sex  ratio  at  birth  among  children  ever  born  and  living  (National)  .      317   MICS Nigeria, 2011; Main Report   Page  xii   List  of  Figures     Figure  HH.1:     Age  and  sex  distribution  of  household  population,  Nigeria,  2011  .          7   Figure  CM.1:     Under  5  Mortality  rates  by  background  characteristics,  Nigeria,  2011  .        18   Figure  NU.1:     Percentage  of  children  under  age  5  who  are  underweight,  stunted  and  wasted,  Nigeria,  2011  .      22   Figure  NU.2:     Percentage  of  mothers  who  started  breastfeeding  within  one  hour  and  within  one  day  of  birth,   Nigeria,  2011  .      26   Figure  NU.3:     Infant  feeding  patterns  by  age,  Nigeria,  2011  .      28   Figure  NU.4:     Percentage  of  households  consuming  adequately  iodized  salt,  Nigeria,  2011  .      42   Figure  NU.5:     Percentage  of  infants  weighing  less  than  2500  grams  at  birth,  Nigeria,  2011  .      49   Figure  CH.1:     Percentage  of  children  aged  12-­‐23  months  who  received  the  recommended  vaccinations  by  12   months,  Nigeria,  2011  .      52   Figure  CH.2:     Percentage  of  women  with  a  live  birth  in  the  last  12  months  who  are  protected  against  neonatal   tetanus  Nigeria,  2011  .      58   Figure  CH.3:     Percentage  of  children  under  age  5  with  diarrhoea  who  received  ORS  or  recommended  home  fluids,   Nigeria,  2011  .      60   Figure  CH.4:     Percentage  of  children  under  age  5  with  diarrhoea  who  received  ORT  or  increased  fluids,  AND   continued  feeding,  Nigeria,  2011  .      62   Figure  WS.1:     Percent  distribution  of  household  members  by  source  of  drinking  water  Nigeria,  2011  .      94   Figure  HA.1:     %  of  women  who  have  comprehensive  knowledge  of  HIV/AIDS  transmission,  Nigeria,  2011    .        223   Figure  HA.2:     Sexual  behaviour  that  increases  risk  of  HIV  infection,  Nigeria,  2011    .  .    241   MICS Nigeria, 2011; Main Report   Page  xiii   List  of  Abbreviations     ACT   Artemisinin  Combination  Therapy   AIDS   Acquired  Immune  Deficiency  Syndrome   AMFm   Affordable  Medicines  Facility  for  Malaria   ANC   Antenatal  Care   BCG   Bacillis-­‐Cereus-­‐Geuerin  (Tuberculosis)   CDC   Centers  for  Disease  Control  and  Prevention       CSPro   Census  and  Survey  Processing  System   DHS   Demographic  and  Health  Survey   DPT   Diphteria  Pertussis  Tetanus   ECCD   Early  Childhood  Care  and  Development   ECDI   Early  Child  Development  Index   eMTCT     elimination  of  mother-­‐to-­‐child  transmission  of  HIV   EPI   Expanded  Programme  on  Immunization   FGM/C       Female  genital  mutilation/cutting   GAR   Gross  Attendance  Ratio       GPI   Gender  Parity  Index   HIV   Human  Immunodeficiency  Virus   ICT   Information  and  Communications  Technology   IDD   Iodine  Deficiency  Disorders   IRS   Indoor  Residual  Spraying   IPTp   Intermittent  Preventative  Treatment  by  women  during  Pregnancy   ITN   Insecticide  Treated  Net   IUD   Intrauterine  Device   JMP   Joint  Monitoring  Programme   LAM   Lactational  Amenorrhea  Method   LLIN   Long-­‐Lasting  Insecticidal  Net   MDG   Millennium  Development  Goals   MICS   Multiple  Indicator  Cluster  Survey   MoH   Ministry  of  Health   NAPEP   National  Programme  on  Eradication  of  Poverty   NAR   Net  Attendance  Rate   NBS     National  Bureau  of  Statistics   ORT   Oral  rehydration  treatment   PNC   Post-­‐natal  Care   PNMR                            Post-­‐neonatal  Mortality  Rate   ppm   Parts  Per  Million   RDT   Rapid  Diagnostic  Test   SPSS   Statistical  Package  for  Social  Sciences   TFR   Total  Fertility  Rate   UNAIDS   United  Nations  Programme  on  HIV/AIDS   UNDP   United  Nations  Development  Programme   UNFPA   United  Nations  Population  Fund   UNGASS   United  Nations  General  Assembly  Special  Session  on  HIV/AIDS   UNICEF   United  Nations  Children’s  Fund   USAID   United  States  Agency  for  International  Development   VIP   Ventilated  Improved  Pit   WFFC   World  Fit  For  Children   WHO   World  Health  Organization   MICS Nigeria, 2011; Main Report   Page  xiv     Preface We  are  pleased  to  present  the  final  findings  of  the  2011  Multiple  Indicator  Cluster  Survey  (MICS4)  on  key  indicators  to   evaluate  and  monitor  the  status  of  children  and  woman  regarding  health,  nutrition,  education,  and  protection.  This   survey   also   contributes   in   measuring   the   progress   attained   in   Nigeria   through   efforts   aimed   at   achieving   the   Millennium  Development  Goals   (MDG)  and   the  objectives  of   a  World  Fit   for  Children   (WFFC).   It   is   also  a  means  of   measuring  the  progress  of  poverty  reduction  strategy  efforts  targeted  specifically  at  women  and  children.     In  order  to  better  understand  the  situation  of  children  and  women,  UNICEF  developed  the  Multiple  Indicator  Cluster   Survey  (MICS)   in  1995.  MICS  produces  a  wide  range  of  scientifically  built  and  tested  indicators  to  provide  a  realistic   and   detailed   picture   of   the   fulfilment   of   critical   children   and   woman   rights   across   the   world.   Acknowledging   the   relevance  of  this  tool,  the  National  Bureau  of  Statistics  (NBS)  conducted  the  first  round  of  the  survey  (MICS1)  in  1995   covering  16,012  households;   the  second  round  was  conducted   in  1999   (MICS2)  with  15,580  households.   In  2007,  a   national  total  sample  of  27,750  households  was  covered  in  the  conduct  of  the  third  round  (MICS3).     In   2011,   the   fourth   round   (MICS4)   was   conducted   by   the   National   Bureau   of   Statistics   (NBS)   with   financial   and   technical   support   from   UNICEF   and   UNFPA.   29,600   households   were   sampled   in   MICS4,   an   increase   of   1,850   households  over  MICS3  conducted  in  2007.     Children  (0-­‐17  years)  constitute  50  percent  of  the  population  of  Nigeria.  Among  this,  children  under  the  age  of  5  years   constitute   17   percent;   hence   investing   efforts   in   their   full   development   guarantees   an   excellent   future   for   the   country.   We   are   cognizant   that   MICS   guided   the   prioritization   of   the   efforts   to   promote   children   and   women’s   wellbeing   in   Nigeria.   MICS4   provides   valuable   and   reliable   information   which   further   support   national   efforts   in   reducing  inequities  of  survival  and  development  opportunities  of  children  and  women.         Dr.    Yemi  Kale     Statistician-­‐General  of  the  Federation   MICS Nigeria, 2011; Main Report   Page  xv   Acknowledgements   The  Multiple  Indicator  Cluster  Survey  (MICS)  is  a  primary  source  of  information  on  women  and  children  as  it  provides   statistical   indicators   that   are   critical   for   the   measurement   of   human   development.   MICS   is   an   indispensable,   reputable  and  high  quality  scientific  mean  for  assessing  the  situation  of  women  and  children,  and  for  monitoring  and   evaluating  efforts  and  progress  towards  the  fulfillment  of  the  Millennium  Development  Goals  and  the  World  Fit   for   Children  framework.     The  first  in  the  series  of  the  Multiple  Indicator  Cluster  Survey  (MICS1)  was  conducted  in  1995  by  the  Federal  Office  of   Statistics   (FOS),   now  National   Bureau  of   Statistics   (NBS),  with   technical   and   funding   assistance   from  UNICEF.   Since   then,  MICS   has   been   institutionalized   within   the   National   Integrated   Survey   of   Households   (NISH)   in   the   National   Bureau  of  Statistics,  as  a  process  of  collecting  regular,  reliable  and  timely  social  statistics.  The  second  and  third  rounds   of   MICS   were   conducted   in   1999   and   2007   respectively.   Expectedly,   the   current   round   of   the   Multiple   Indicator   Cluster   Survey   (MICS4)   was   better   planned   and   executed   than   the   previous   rounds,   and   has   achieved   the   aim   of   providing   reliable   data   for   monitoring   progress   of   the   Nigerian   children   and   women,   and   the   Millennium   Development  Goals.     The   implementation  of  MICS4  has  been  a  success   in  all   its  phase.  The  excellence  achieved   is  confirmed  by  the  high   quality   data,   which   was   confirmed   in   an   international   analysis   and   data   dissemination   workshop   held   in   Dakar,   Senegal  in  July  2011  under  the  guidance  and  expertise  of  the  UNICEF  MICS  Global  Team  from  New  York.     In  presenting   the  Final  Report  of  MICS4,  2011,  we  wish   to  express  our  gratitude  and  appreciation   to  all   those  who   contributed  directly  or   indirectly   in  designing,  conducting  the  survey,  preparing  this  report  and  releasing   its  results;   from  the  staff  of  the  National  Bureau  of  Statistics  (NBS)  to  the  members  of  the  National  Steering  Committee  on  MICS4   which   cut   across   various   MDAs,   which   include   the   National   Planning   Commission,   the   MDG   Office,   the   National   Population   Commission,   the   Federal   Ministries   of   Health,   Education,   Women   Affairs,   Information   and   Communication,  and  various  Non-­‐Government  Organizations.           We   are   thankful   to   the  United  Nations   and   international   organizations   in  Nigeria   for   their   contributions   in   various   stages  of   this  project.  Special   thanks  go  to  UNICEF,  Nigeria   for  spearheading  the  technical  and  financial  support   for   MICS4.  We   are   grateful   to   also   UNFPA   for   their   financial   contribution   to   the   project.   The   contributions   made   by   UNICEF;  West  and  Central  Africa  Regional  Office  (WCARO)  and  UNICEF  Headquarters  cannot  be  overstated.     Special   thanks  go   to  Tunde  Adebisi   (Sampling  Expert)  and  Folorunso  Busari   (Programer/Analyst),  who   joined  me   to   lead  other  staff  in  the  implementation  of  the  project.     Finally,  on  behalf  of  the  National  Bureau  of  Statistics,  I  wish  to  acknowledge  with  gratitude  the  cooperation  of  all  the   heads   and  members   of   sample   households  who  were   respondents   during   the   survey.   Their   participation  was   very   valuable  to  the  conduct  of  the  survey.         Isiaka  Olarewaju   Head;  Household  Surveys  Division       MICS4  Nigeria  Coordinator     MICS Nigeria, 2011; Main Report   Page  xvi   EXECUTIVE  SUMMARY     1. Introduction   This   report   is  based  on   the  Nigeria  Multiple   Indicator  Cluster  Survey,   conducted   in  2011  by   the  National   Bureau  of  Statistics.  The  survey  provides  valuable   information  on  the  situation  of  children  and  women  in   Nigeria,   and  was   based,   to   a   large   extent,   on   the   needs   to  monitor   progress   towards   goals   and   targets   emanating  from  international  agreements  such  as  the  Millennium  Declaration,  adopted  by  all  191  United   Nations  Member  States  in  September  2000,  and  the  Plan  of  Action  of  A  World  Fit  For  Children,  adopted  by   189   Member   States   at   the   United   Nations   Special   Session   on   Children   in   May   2002.     Both   of   these   commitments  build  upon  promises  made  by   the   international   community  at   the  1990  World  Summit   for   Children.   In   signing   these   international   agreements,   governments   committed   themselves   to   improving   conditions  for  their  children  and  to  monitoring  progress  towards  that  end.  UNICEF  was  assigned  to  support   governments  in  achieving  this  task.     The   Federal   Government   of   Nigeria   has   made   several   efforts   directed   towards   the   achievement   of   the   objectives   and   aspirations   expressed   in   the   Millennium   Development   Goals   (MDGs),   the   World   Fit   for   Children  goals,  the  UNICEF  Country  Programme,  the  Convention  on  the  Rights  of  the  Child  (CRC)  and  the   Convention  on  the  Elimination  of  All  Forms  of  Discrimination  against  Women  (CEDAW)  and  Abuja  Targets   for   Malaria   among   others.   The   Government   has   in   recent   times   launched   a   number   of   development   initiatives  to  improve  the  economic  and  social  life  of  its  people.  The  National  Transformation  Agenda  and   Vision   20:2020   are   developed   to   create   employment,   increase   and   stabilize   electricity   power   supply,   improve   social   and   economic   infrastructure   and   provide   enabling   environment   for   local   and   foreign   investments  and  to  become  one  of  the  twenty  leading  economies  in  the  world  by  year  2020.  The  National   Programme   for   the   Eradication   of   Poverty   (NAPEP)   has   been   concerned   with   strategies   for   poverty   reduction   in   the   country   while   National   Agency   for   the   Control   of   HIV/AIDS   (NACA)   has   mandate   for   planning,  implementing  and  monitoring  programmes  for  control  of  HIV/AIDS.       The  Government  has  expressed  strong  commitment  to,  and  declared  as  a  matter  of  high  priority,  efforts  to   monitor   and  evaluate  progress   towards   the   attainment  of   the  benchmarks   established   in   these  national   and  other  global  goals.  The  National  Bureau  of  Statistics  (NBS)  with  strong  financial  and  technical  support   from   international   development   partners   and   donors   like   UNICEF,   UNFPA,   and   DFID   among   others   has   been   involved   in   the  national  efforts   to  achieve   the  goals   through  provision  of   relevant  data   to  monitor,   evaluate   and   advise   necessary   adjustments   in   development   programmes.     The   Nigeria   2011   Multiple   Indicator  Cluster  Survey  has  been  designed  to  measure  progress  towards  achievements  of  MDGs  and  more   specifically  to  assist  UNICEF  in  monitoring  and  evaluation  of  country  programmes  including  those  on  child   survival,   child   development,   child   and  women   rights   and  protection   among  others.    Globally,  MICS4  has   collected  information  on  at  least  100  internationally  agreed  upon  indicators  covering  most  situations  of  the   household,  the  child,  the  mother  and  their  environment.       2. Survey  Objectives   The  2011  Nigeria  Multiple  Indicator  Cluster  Survey  (MICS4)  has  the  following  as  its  primary  objectives:     • To  provide  up-­‐to-­‐date  information  for  assessing  the  situation  of  children  and  women  in  Nigeria;   • To  furnish  data  needed  for  monitoring  progress  toward  goals  established  in  the  Millennium  Declaration   and  other  internationally  agreed  upon  goals,  as  a  basis  for  future  action;   • To  contribute  to  the  improvement  of  data  and  monitoring  systems  in  Nigeria  and  to  strengthen   technical  expertise  in  the  design,  implementation,  and  analysis  of  such  systems.   • To  generate  data  on  the  situation  of  children  and  women,  including  the  identification  of  vulnerable   groups  and  of  disparities,  to  inform  policies  and  interventions.   MICS Nigeria, 2011; Main Report   Page  xvii   3. Sample  and  Survey  Methodology   The   sample   for   the   2011   Nigeria   Multiple   Indicator   Cluster   Survey   (MICS4)   was   designed   to   provide   estimates  for  a  large  number  of  indicators  on  the  situation  of  children  and  women  at  the  national  level,  for   urban  and  rural  areas,  and  for  the  36  states  of  the  Federation  and  the  Federal  Capital  Territory  as  well  as   the  6  geo-­‐political  zones  of  Nigeria  namely  South-­‐West,  South-­‐East,  South-­‐South,  North-­‐West,  North-­‐East   and  North-­‐Central.   The   states  within   each   zone  were   identified   as   the  main   reporting  domain  while   the   Enumeration  Areas   (EAs)  within   each   state  were   identified   as   the  main   sampling   units.   Sample   size  was   29,600  households  and  29,077  were  successfully  interviewed.       4. Questionnaires   Three  sets  of  questionnaires  were  used  in  the  survey;  the  household  questionnaire,  the  individual  women   questionnaire   and   the   under-­‐five   children   questionnaire.   These  were the MICS4 standard questionnaires adapted to Nigeria situation.       5. Training,  Fieldwork  and  Data  Processing   Training   for   the   fieldwork   was   conducted   simultaneously   in   the   six   geo-­‐political   zones   for   15   days   in   February   2011.   In   each   state,   the   data   were   collected   by   two   roving   teams;   each   comprised   of   5   interviewers,  one  driver,  one  editor,  one  measurer  and  a  supervisor.  Fieldwork  lasted  for  about  six  weeks;   it  began  in  February  2011  and  was  concluded  in  March  2011.  A  2-­‐day  training  of  trainers  was  organized  for   data   processing   team   in   Abuja   in   February   2011;   there  was   also   a   subsequent   five-­‐day   training   of   data   processing   personnel   in   February   2011   simultaneously   at   each   of   the   six   zonal   data   processing   centres.   Data  entry  was  done  using  the  CSPro  software  at  each  of  the  six  data  processing  centers.  In  order  to  ensure   data   quality,   all   questionnaires   were   double   entered   and   internal   consistency   checks   were   performed.   Procedures  and  standard  programs  developed  under  the  global  MICS4  project  and  adapted  to  the  Nigeria   questionnaire  were  used   throughout.  Data  processing  began   two  weeks   into  data   collection   in   February   and   was   completed   in   April   2011.     Regular   checks   were   carried   out   for   data   quality   and   to   ensure   compliance  with   global   data   processing   guidelines   by   UNICEF  Nigeria   and  UNICEF  New   York.   Data  were   analyzed   using   the   Statistical   Package   for   Social   Sciences   (SPSS)   software   program,   Version   18,   and   the   model  syntax  and  tabulation  plans  developed  by  UNICEF  for  this  purpose.       6. Characteristics  of  Households   In   the   29,077   households   that   were   successfully   interviewed,   155,553   household  members   were   listed,   77,025  males,   and   78,528   females   translating   to   sex   ratio   (male:   female)   figure   of   98.1   and   an   average   household  size  of  5  members  at  the  national  level.    Sex  ratio  across  age  group  ranges  from  92  percent  for   the  15-­‐64  age-­‐groups  to  165  for  persons  aged  65  years  and  above.  Corresponding   figures   for  age  groups   <5,   <15   and   50-­‐54   are   104,   101   and   95   respectively.   The   population   is   71   percent   rural   and   29   percent   urban;  eighty-­‐seven  percent  of  the  households  are  headed  by  the  male  and  13  percent  by  the  female.  The   overall  dependency  ratio   is  0.99.  This   figure   indicates  an  economically  active  person  caters  for  one  other   person.  From  the  results  of  MICS4,  children  aged  0-­‐14  years  constitute  47  percent  of  the  population  and   those  aged  0  -­‐17  years  account  for  53  percent  of  the  males,  51  percent  of  the  females  and  52  percent  of   the  combined  population.       MICS Nigeria, 2011; Main Report   Page  xviii   7. Characteristics  of  Women  and  Under  five  Children   The  age  distribution  of  population  of  women  of  reproductive  age  indicates  that  35  percent  are  adolescents   (15-­‐24   years).   Those   in   age   group   25-­‐34   years   constitute   another   35   percent,   while   others   (35-­‐349)   constitute  30  percent.  A   little   above  one  quarter   (28  percent)  of   the  women  of   reproductive   age   report   never   to   have   given   birth;   70   percent   are   currently  married   or   in   union   and   one   quarter   of   the   eligible   women  have  never  married.    Thirty  two  percent  of  the  women  have  no  education,  18  percent  have  primary   while  50  percent  have  secondary  or  higher  education.  About  23  percent  of  women  of  reproductive  age  live   in   richest   households  while   18   percent   live   in   poorest   households.   Nigeria’s  MICS4   shows   that   children   under  five  are  51  percent  male  and  49  percent  female;  the  figures  translate  into  a  sex  ratio  of  104.  Seventy   six  percent  of  the  under  five  children  live  in  rural  areas  while  30  percent  live  in  the  urban.  Fifty  four  percent   of  children  under  five  have  mothers  with  no  education,  20  percent  have  mothers  with  primary  education   while  37  percent  have  mothers  with  at  least  secondary  education.  Twenty  three  percent  of  the  under  five   children  live  in  the  poorest  household  while  18  percent  live  in  richest  households.     8. Child  Mortality   The   infant  mortality   rate   is  estimated  at  97  per   thousand,  while   the  under-­‐five  mortality   rate   is  158  per   thousand   (Rates   refer   to   mid-­‐2005,   North   Model).   The   infant   mortality   rate   for   male   child   is   106   per   thousand  against  86  per  thousand  for  the  female  child.  Similarly,  the  under-­‐five  mortality  rate  was  170  per   thousand  and  144  per  thousand  for  the  male  and  female  child  respectively.    Infant  and  under-­‐5  mortality   rates   are   lowest   in   South-­‐West   zone  with   55   and  83  per   thousand   respectively  while   the   corresponding   figures   for   North-­‐WestNorth-­‐West   are   123   and   208   per   thousand   respectively.   Infant   mortality   rate   is   lower  in  urban  areas  (68  per  thousand)  than  rural  areas  (110  per  thousand)  while  under-­‐5  mortality  rate  is   106  per  thousand  in  urban  against  182  per  thousand  in  rural.  Infant  mortality  rate  for  children  of  mothers   with   no   education   is   121   per   thousand   while   that   of   children   of   mothers   with   secondary   education   or   higher  is  66  per  thousand.  Again,  under-­‐five  mortality  rate  for  children  of  mothers  with  no  education  is  203   per  thousand  while  that  of  children  of  mothers  with  secondary  education  or  higher  was  102  per  thousand.     Considering  the  wealth  index  quintiles,  infant  mortality  rate  is  132  for  the  poorest  quintile  while  the  richest   is   51   per   thousand.   Similarly,   under-­‐five  mortality   rates   are   223   and   76   for   the   poorest   and   the   richest   quintiles  respectively.     9. Nutrition   In  Nigeria,  24  percent  of  children  under  5  are  underweight  (9  percent  severely),  36  percent  are  stunted  (19   percent   severely)   and   10   percent   are   wasted   (3   percent   severely).     Malnutrition   rates   in   the   North-­‐ WestNorth-­‐West  and  North-­‐EastNorth-­‐East   regions  are  higher   than   in   the  South.    Children   in   rural  areas   are   more   likely   to   have   nutritional   deficiencies   than   those   in   urban   areas   with   respectively   19   percent   underweighted  against  31  percent.    Prevalence  of  malnutrition  decreases  with  education  of  mother  and  as   wealth  status  improves  from  poorest  to  richest  quintiles.     10. Breastfeeding  and  Infant  and  Young  Children  Feeding     Overall,  about  95  percent  of  the  children  covered  were  ever  breastfed.    Twenty  three  percent  of  babies  are   breastfed  for  the  first  time  within  one  hour  of  birth,  at  least  two-­‐thirds  start  breastfeeding  within  one  day   of  birth,  while  57  percent  received  a  prelatic  feed.    Ninety-­‐seven  percent  of  children  were  ever  breastfed  in   urban   area   while   it   was   95   percent   in   the   rural   area.     About   15   percent   of   children   0–5   months   are   exclusively  breastfed  while  70  percent  are  predominantly  breastfed.  More  male  children  0-­‐5  months  are   exclusively   breastfed   than   their   female   counterpart   with   16   and   14   percents   respectively.     Higher   percentage  of  children  in  the  urban  areas  (21  percent)  is  exclusively  breastfed  than  children  in  rural  areas   (13  percent).    Percentage  of  children  whose  mothers  have  at  least  secondary  education  and  who  received   exclusive  breastfeeding  is  about  21  percent,  while  those  of  mothers  with  no  education  is  about  8  percent.     In  Nigeria,  19  percent  of  children  below  2  years  are  fed  using  a  bottle  with  a  nipple.       MICS Nigeria, 2011; Main Report   Page  xix   11. Salt  Iodization     Most   of   the   households   (80   percent)   consume   adequately   iodized   salt   (15   parts   per   million)   or   more).   North-­‐WestNorth-­‐West  region  has  the  lower  iodized  salt  consumption  level,  at  63  percent     12. Children’s  Vitamin  A  Supplementation   About  two-­‐thirds  of  children  aged  6-­‐59  months  received  high  dose  of  Vitamin  A  supplement   in  the   last  6   months   preceding   the   survey.   Higher   percentage   of   children   whose   mother   has   secondary   or   higher   education  (79  percent)  received  vitamin  A  supplement  than  those  whose  mothers  have  no  education  (52   percent).    Similarly  Children  from  rich  households  receive  vitamin  A  supplement  (83  percent)  than  children   from  poor  households  (47  percent).       13. Low  Birth  Weight   About  15  percent  of  newborn  babies  were  weighed  at  birth  and  approximately  15  percent  of   infants  are   estimated   to  weigh   less   than  2500  grams  at  birth.    Zonal  variation  of  20  percent   low  birth  weight   in   the   North-­‐WestNorth-­‐West  and  12  percent  in  South-­‐South  was  recorded.  Urban-­‐rural  differentials  for  low  birth   weight   are   13   and   16   respectively.  Many   children   born   into   poorest   quintile   households   have   low   birth   weight  (about  19  percent)  compared  to  12  percent  for  those  in  richest  quintile.  Children  of  mothers  with   secondary  education  or  higher  with  low  birth  weight  is  about  13  percent  and  about  19  percent  among  the   mothers  with  no  education.       14. Immunization     In  Nigeria,  almost  two  third    (62  percent)  of  the  children  aged  12-­‐23  months  have  received  BCG  by  the  age   of  12  months,  but  only  43  percent  have  received  three  doses  of  DPT  and  46  percent  have  received  the  third   dose  of  polio  vaccine.    The  coverage  for  measles  vaccine  is  about  49  percent  and  yellow  fever  is  40  percent.     Twenty  eight  percent  of  children  have  received  all  their  vaccines  by  the  age  of  12  months  and  one  fifth  (20   percent)  have  not  received  any  vaccinations.    Vaccinations  of  children  vary  according  to  the  characteristics   of  the  mother.  Only  10  percent  of  children  of  mothers  with  no  education  have  received  all  their  vaccines   while   it   is   45   percent   when   she   has   secondary   level   and   more.   In   all,   only   a   quarter   of   children   had   vaccination  cards.         15. Neonatal  Tetanus  Protection   Fifty  percent  of  women  received  two  doses  of  tetanus  toxoid  protection  during  the  last  pregnancy  while  55   percent  of  the  women  with  live  birth  in  the  last  two  years  preceding  the  survey  received  neonatal  tetanus   protection.   Seventy   five   percent   of   women   in   urban   area   received   tetanus   toxoid   vaccine   against   46   percent   in   the   rural   area.   The   percentage   is   78   and   31   in   South-­‐West   and   North-­‐WestNorth-­‐West   respectively.       16. Oral  Rehydration  Treatment    Forty-­‐four  percent  of  fewer  than  five  children,  who  had  diarrhoea  in  the  two  weeks  preceding  the  survey,   received   one   or   more   of   the   recommended   home   treatments   (ORS   or   homemade   fluid).   Twenty   eight   percent  of  the  children  received  oral  rehydration  therapy  with  continued  feeding.         17. Care  Seeking  and  Antibiotic  Treatment  of  Pneumonia   In   Nigeria,   45   percent   of   under-­‐five   children   with   suspected   pneumonia   received   antibiotics.   The   percentage  was   considerably   higher   in   the   urban   areas   (53   percent)   than   rural   (43   percent).     About   11   percent   of   women   know   the   two   danger   signs   of   pneumonia.     About   40   percent   of   children   age   0-­‐59   months  with  suspected  pneumonia  were  taken  to  appropriate  health  provider.     MICS Nigeria, 2011; Main Report   Page  xx   18. Use  of  Solid  Fuel     In  Nigeria,  about  three-­‐quarters  of  households  are  using  solid  fuels  for  cooking  out  of  which  68  percent  of   them  are  using  wood.  Eighty-­‐nine  percent  of  households  in  the  poorest  quintile  are  using  wood  while  it  is   only  15  percent   for   those   in   the   richest  quintile.  About  90  percent  of  households   in   rural  area  are  using   solid   fuels   against   45   percent   in   urban   areas.   Differentials   use   of   solid   fuel   with   respect   to   household   wealth  and  educational  level  of  the  household  heads  are  also  significant.         19. Children  Sleeping  Under  Mosquito  Nets   In  Nigeria,  40  percent  of  households  have  at  least  one  insecticide  treated  net.  Only  19  percent  of  children   under   the  age  of   five   slept  under  any  mosquito  net   the  night  prior   to   the   survey.  During   this  period,  16   percent  of  the  under  five  children  slept  under  an  insecticide  treated  net.  The  same  proportion  of  children   (16%)  slept  under  ITN  in  both  rural  and  urban.  However,  a  higher  proportion  of  female  under-­‐five  children   (17%)  than  male  children  (16%)  slept  under  insecticide  treated  net.       20. Malaria  Treatment   In  Nigeria,  20  percent  of  children  under  age  five  had  fever  in  the  two  weeks  preceding  the  survey.    Among   these  children,  45  percent   received  anti-­‐malarial  medicine.     In   rural  areas,  malaria   treatment  of   children   with  fever  was  40  percent  compared  to  58  percent  in  urban  areas.    A  quarter  of  children  with  fever  were   given  Chloroquine,  6  percent  were  given  SP/Fansidar,  and  only  4  percent  received  Artemisinin  Combination   Therapy  (ACT).    In  Nigeria,  19  percent  of  women  age  15-­‐49  years  who  had  a  live  birth  during  the  two  years   preceding  the  survey  took  SP/Fansidar  two  or  more  times.       21. Hand  washing   About   27   percent   of   households   in   Nigeria   have   specific   place   for   hand   washing.    Water   and   soap   are   available   in   48   percent   of   the   households   where   place   for   washing   hand   was   observed.   Rural-­‐urban   differences  in  availability  of  water  and  soap  is  noticeable  from  the  result.     22. Water  and  Sanitation   About  six   in  every  ten  households   in  Nigeria  are  using  an   improved  source  of  drinking  water  with  higher   percentage  of   73  percent   in  urban  areas   against  51  percent   in   rural   areas.    Wealth  quintile   and   level   of   education   have   influence   on   the   household   source   of   drinking   water.       Generally,   the   most   important   source   of   improved   drinking   water   is   the   borehole,   which   contributes   32   out   of   the   59   percent   using   improved  water  source.    Overall,  31  percent  of  household  members  use  an  improved  sanitation  facility  (not   shared).  The  sanitation  indicator  shows  similar  disparities  as  the  improved  source  of  water:  only  26  percent   of   household  members   in   rural   areas   use   improved   sanitation   facility   against   41   percent   in   urban   area.     Still,  29  percent  of  the  population  practices  open  defecation.     23. Reproductive  Health   In  Nigeria,  adolescent  birth  rate  is  89  births  per  1,000  women,  while  total  fertility  rate  is  5.7  per  woman.   The  adolescent  fertility  rate  is  higher  in  rural  (120)  than  urban  (35).  About  27  percent  of  women  had  a  live   birth  before  age  18,  and  about  7  percent  have  had  a  live  birth  before  age  15.     24. Contraception   About  18  percent  of  women  currently  married  or  in  union  reported  current  use  of  contraception.  The  most   popular  method  is  the  injectable  which  is  used  by  4  percent  of  married  women  followed  by  male  condom   with  2  percent.  About  4  percent  of  adolescents  (15-­‐19  years)  currently  use  contraception  compared  to  11   percent  of  20-­‐24  years  and  19  percent  for  older  women.    The  percentage  of  women  using  any  method  of   contraception   rises   from   6   percent   among   those   with   no   education   to   21   percent   among   women  with   primary   education,   and   to   29   percent   among   women   with   secondary   or   higher   education.   About   17   percent  of  women  in  urban  area  use  modern  method  of  contraceptive  against  7  percent  in  rural.     MICS Nigeria, 2011; Main Report   Page  xxi   25. Unmet Need In  Nigeria,  19  percent  of  women  currently  married  or  in  union  reported  unmet  need  for  contraception,  13   percent  in  respect  of  child  spacing  and  6  percent  in  limiting  number  of  children  wanted.  Eighteen  percent   of   women  who   had   demand   for   contraception   are   satisfied.     Place   of   residence,   education   and   wealth   status  respectively  had  an  impact  on  the  extent  to  which  women  demands  for  contraception  is  satisfied.     26. Antenatal  Care   The  proportion  of  women  who  received  antenatal  care  at  least  once  during  pregnancy  from  a  doctor,  nurse   or  midwife  is  66  percent.  Coverage  of  antenatal  care  is  more  in  urban  areas  (88  percent)  than  in  rural  areas   (56  percent).  The  proportions  that  see  skilled  personnel  for  antenatal  care  is  under  39  percent  for  women   with   no   education,   73   percent   for   those   with   primary   education   and   over   89   percent   for   women   with   secondary   or   higher   education.   About   62   percent   of   women   attending   antenatal   care   have   their   blood   pressure   checked,   56   percent   have   blood   sample   taken   and   urine   sample   taken.   In   Nigeria,   about   57   percent  of  women  that  had  live  birth  during  the  two  years  preceding  the  survey  made  4  or  more  antenatal   care  visits;  the  figure  for  rural  is    46  percent  and  urban  is  79  percent.  The  more  educated  the  woman  is  or   the   richer  her  household,   the  more   likely   she   is   to  make  4  or  more  antenatal  visits.  Four   in  every   ten  of   rural  women  did  not  go  for  antenatal  care  against  one  in  ten  for  urban  women.     27. Assistance  during  Delivery   About  49  percent  of  births  occurring  in  the  two  years  preceding  the  MICS4  survey  were  delivered  by  skilled   personnel.    Doctors  assisted  with  the  delivery  of  15  percent  of  births,  Nurses  and  midwives  assisted  in  the   delivery   of   32   percent   of   births.   Educated   women   are   more   likely   to   have   their   babies   delivered   by   assistance  of   a   skilled   attendant.   In  Nigeria,   45  percent  of   births   are  delivered   in   a   health   facility   out   of   which   24   percent   occurred   in   public   sector   facilities   and   21   percent   occurred   in   private   sector   facilities.   About  half  of  the  births  occurred  at  home.       28. Family  Support  for  Learning   About  43  percent  of  Nigeria  children  (aged  36-­‐59  months)  are  attending  pre-­‐school.    About  two-­‐thirds  of   under-­‐five  children  have  opportunity  of  an  adult  household  member  engaged  in  more  than  four  activities   that  promote  learning  and  school  readiness  during  the  3  days  preceding  the  survey.  On  the  average,  adults   engaged  in  about  4  activities  with  children.  About  13  percent  of  children  were  living  in  a  household  without   their  fathers.  The  result  shows  that  6  percent  of  children  ages  0-­‐59  months  are  living  in  households  where   at  least  3  children’s  books  are  present;  38  percent  of  them  had  2  or  more  playthings  to  play  with  in  their   homes  while  about  57  percent  of  children  play  with  toys/objects  found  outside  their  homes.    Two  out  of   every  five  children  aged  0-­‐59  months  were  left  with  inadequate  care  during  the  week  preceding  the  survey   out  of  which  36  percent  were  left  in  the  care  of  other  children.       29. Pre-­‐School  Attendance  and  School  Readiness   Overall,   45   percent of   children  who   are   currently   attending   first   grade   of   primary   school   attended   pre-­‐ school  the  previous  year.  Rural-­‐urban  disparity   is  strong  as  more  than  half  of  children   in  urban  areas  (54   percent)  had  attended  pre-­‐school  the  previous  year  compared  to  about  40  percent  among  children  in  rural   areas.  The  school  readiness  rate  for  children  living  in  poorest  households  is  16  percent  against  62  percent   among  those  in  the  richest  households.  The  pattern  is  the  same  for  children  of  mothers  with  no  education   and   those   whose   mothers   have   secondary   or   higher   education.   Regional   differentials   are   also   very   significant  but  gender  differential  is  not.   30. Primary  and  Secondary  School  Participation   About  44  percent of  children,  who  are  of  primary  school  entry  age  (age  6)  in  Nigeria,  are  attending  the  first   grade  of  primary  school.  The  net  intake  rate  for  male  is  46  percent  and  for  female  is  42  percent.  The  rate  is   57  percent   in  urban  against  38  percent   in  rural  areas.  North-­‐South  disparity   in  primary  school  net   intake   rate   is   noticeable.   About   70   percent   of   children   of   primary   school   age   are   attending   school   while   30   percent  are  out  of  school.  The  proportion  for  male  children  attending  is  72  percent  and  for  female  children   is   68   percent.   The   primary   school   net   attendance   ratio   for   children   in   richest   households   is   about   94   MICS Nigeria, 2011; Main Report   Page  xxii   percent   compared   to   34   percent   on   poorest   households.   Geo-­‐political   zone   is   very   significant   to   school   participation  rate;   it   is  as  high  as  92  percent  in  South-­‐West  and  as  low  as  49  percent  in  North-­‐EastNorth-­‐ East.       The  secondary  school  net  attendance  ratio   is  54  percent.    About  20  percent  of  the  children  of  secondary   school  age  are  attending  primary   school  and  about  a  quarter  of   them  are  not  attending   school  at   all.   In   urban  areas,  72  percent  of  children  of  secondary  school  age  are  in  school  as  against  45  percent  in  the  rural   areas.  At  the  level  of  geo-­‐political  zone,  the  ratio  is  least  in  the  North-­‐East  (32  percent)  and  most  in  South-­‐   South  (76  percent).   The   proportion   of   children   entering   first   grade   who   eventually   reach   grade   6   is   96   percent.     About   85   percent   of   the   children   of   primary   school   completion   age   (11   years)   were   attending   the   last   grade   of   primary   education.   Transition   rate   from   primary   to   secondary   school   is   74   percent  with   no   significance   gender  differential.  There  is  no  significance  difference  in  the  attendance  of  girls  and  boys  in  primary  school   as  indicated  by  gender  parity  index  of  0.94  which  increased  to  1.00  for  secondary  education.       Literacy  rate  among  young  women  in  Nigeria  is  about  66  percent.         31. Birth  Registration   In  Nigeria,  about  41  percent  of  births  for  children  under-­‐five  years  in  Nigeria  are  registered.  There  are  no   significant   variations   in   birth   registration   across   sex   and   age   but   religion   and   education   of  mother   have   correlation  with  birth  registration  of  children.     32. Child  Labour   Forty-­‐seven  percent  of   children  aged  5-­‐14  years  are  engaged   in   child   labour.  More   females   (48  percent)   compared  to  male  (46  percent)  of  the  children  age  5-­‐14  are  involved  in  child  labour.  Area  and  wealth  index   quintiles  have  similar  pattern.  Percentage  of  children  age  12-­‐14  that  are   involved   in  child   labour   is  17  as   compared   to   57   for   children   that   are   age   5-­‐11.     North-­‐WestNorth-­‐West   has   the   highest   percentage   of   children   aged   12-­‐14   that   are   involved   in   child   labour   (21   percent)  while   South-­‐West   has   the   lowest   (10   percent).     About   47   percent   of   children   aged   5-­‐14   years  who   are   attending   school   are   involved   in   child   labour  activities.  About  three-­‐quarters  of  the  children  involved  in  child  labour  are  also  attending  school.       33. Child  Discipline   In  Nigeria,  90  percent  of  children  ages  2-­‐14  years  were  subjected  to  at  least  one  form  of  psychological  or   physical  punishment  by  any  household  members  during  the  month  before  the  survey.  About  34  percent  of   children   were   subjected   to   severe   physical   punishment.   There   are   no   significance   differences   in   the   percentage  for  gender,  area  and  wealth  quintiles.     34. Early  Marriage  and  Polygamy   About   20   percent   of   young   women   age   15-­‐19   years   is   currently   married.   The   proportion   in   urban   is   8   percent  and  rural  is  for  28  percent.  The  proportion  for  those  with  secondary  education  is  6  percent  but  for   none   educated   is   72   percent.  North-­‐WestNorth-­‐West   has   about   52   percent   of   young  women   age   15-­‐19   years  currently  married,  while  it  was  only  3  percent  in  South-­‐East.    Percentage  of  women  age  15-­‐49  years   in  polygamous  marriage/union  in  Nigeria  is  34  percent.       In  Nigeria,  18  percent  of  women  married  before  age  15  while  40  percent  married  before  age  18.  Urban-­‐ rural,   geopolitical   zones   and  wealth   index   quintiles   are   important   factors.     About   44   percent   of  women   aged  20-­‐24  is  currently  married  to  a  man  who  is  ten  years  or  more  older  and  52  percent  of  women  age  15-­‐ 19  are  currently  married  to  men  who  are  older  by  ten  years  or  more.  Significance  differences  are  observed   between  zones  in  the  North  and  South  and  education  of  women.     MICS Nigeria, 2011; Main Report   Page  xxiii     35. Female  Genital  Mutilation/Cutting   In  Nigeria,  27  percent  of  women  aged  15-­‐49  years  had  one  form  of  FGM/C  or  another.    Of  this  number,  13   percent  had  flesh  removed,  2  percent  were  nicked,  and  1  percent  was  sewn  closed  while  about  11  percent   could  not  determine  the   form  of   the  mutilation.  The  percentage  of  women   involved   in  FGM/C   is   least   in   North-­‐EastNorth-­‐East  (3  percent)  and  highest  in  the  South-­‐West  (48  percent).  The  prevalence  of  FGM/C  is   associated  with   age,   education   and  wealth   status.   Twenty   two   percent   of   women   thought   it   should   be   continued  while  66  percent  believed  it  should  be  discontinued.       36. Domestic  Violence   Overall,  46  percent  of  women  in  Nigeria  feel  that  their  husband/partner  has  a  right  to  hit  or  beat  them  for   at   least   one   reason.   Twenty-­‐nine   percent   of   women   believe   that   their   husband/partner   is   justified   in   beating   them   if   they   neglect   their   children,   about   26   percent   said   if   they   go   out   without   telling   their   husbands.  A  larger  proportion  of  women  who  are  currently  married  believe  their  husbands  are    justified  for   beating  them  (48  percent)  compared  with  those  never  married  (37  percent).       37. Knowledge  about  HIV  Transmission  and  Misconceptions  about  HIV/AIDS   The  result  of  MICS4  shows  that  90  percent  of  women  aged  15–49  years  have  heard  of  HIV/AIDS.  Seventy-­‐ two   percent   of   the  women   agreed   that   transmission   could   be   prevented   if   a   person   is   having   only   one   faithful  uninfected  sex  partner,  while  54  percent  agreed  that  using  a  condom  every  time  could  prevent  it.   About  60  percent  said  HIV  cannot  be  transmitted  by  mosquito  bites  and  61  percent  knew  that  HIV  cannot   be  transmitted  by  supernatural  means  and  64  percent  knew  it  cannot  be  transmitted  by  sharing  food.         In  2011,  77  percent  of  women  knew  that  HIV  could  be  transmitted  from  mother  to  child  compared  to  68   percent  recorded  in  2007.     Three  out  of  every  five  of  women  age  15–49  years  have  knowledge  of  a  place  for  HIV  testing  in  the  country;   74  percent  in  urban  and  54  percent  in  the  rural  areas.  About  30  percent  of  the  women  interviewed  were   tested   for  HIV   out   of  which   11   percent   of   the  women  were   told   the   outcome  of   the   test   or   shown   the   result.       38. Sexual  Behaviour  Related  to  HIV  Transmission   Sixty-­‐three  percent  of  the  young  women  age  15–24  had  ever  had  sex  while  59  percent  of  women  had  sex  in   the   last   12   months.   About   38   percent   of   women   who   never   married   reported   they   never   had   sex,   16   percent  of  women  age  15–24  years  had  sex  before  age  15.  About  3  percent  of   the  women  had  sex  with   more  than  one  partner  in  the  last  12  months  and  about  47  percent  used  a  condom  last  time  they  had  sex.   Forty-­‐eight  percent  of  the  women  were  provided  information  about  HIV  prevention  during  antenatal  visit   as  against  37  percent   in  2007.    Also,  37  percent  were  tested  for  HIV  testing  at  the  visit,  while  29  percent   received  the  results  of  the  HIV  test.     In  addition,  29  percent  of  the  women,  who  received  HIV  counseling   with  HIV  test,  accepted  the  results.     39. Orphans   Overall,  9  percent  of  children  0-­‐17  years  were  not   living  with  their  biological  parents.  About  7  percent  of   orphans  have  one  or  both  parents  died.    In  Nigeria,  about  1  percent  of  children  aged  10-­‐14  have  lost  both   parents   and  80  percent  of   them  were  attending   school.   Eighty-­‐one  percent  of   children  aged  10-­‐14  have   both  parents  alive  and  are  living  with  at  least  one  of  them.    In  Nigeria,  percentage  of  children  who  are  non-­‐ orphan  and  are  attending  school  is  also  about  80  percent.     MICS Nigeria, 2011; Main Report   Page  1   I.     Introduction       Background     This   report   is  based  on   the  Nigeria  Multiple   Indicator  Cluster  Survey,   conducted   in  2011  by   the  National   Bureau  of  Statistics.  The  survey  provides  valuable   information  on  the  situation  of  children  and  women  in   Nigeria,   and   was   based,   in   large   part,   on   the   needs   to   monitor   progress   towards   goals   and   targets   emanating  from  recent   international  agreements:   the  Millennium  Declaration,  adopted  by  all  191  United   Nations  Member  States  in  September  2000,  and  the  Plan  of  Action  of  A  World  Fit  For  Children,  adopted  by   189   Member   States   at   the   United   Nations   Special   Session   on   Children   in   May   2002.     Both   of   these   commitments  build  upon  promises  made  by   the   international   community  at   the  1990  World  Summit   for   Children.     In  signing  these  international  agreements,  governments  committed  themselves  to  improving  conditions  for   their  children  and  to  monitoring  progress  towards  that  end.  UNICEF  was  assigned  a  supporting  role  in  this   task  (see  table  below).       A  Commitment  to  Action:  National  and  International  Reporting  Responsibilities     The  governments  that  signed  the  Millennium  Declaration  and  the  World  Fit  for  Children  Declaration  and   Plan  of  Action  also  committed  themselves  to  monitoring  progress  towards  the  goals  and  objectives  they   contained:       “We  will  monitor  regularly  at  the  national  level  and,  where  appropriate,  at  the  regional  level  and  assess  progress   towards  the  goals  and  targets  of  the  present  Plan  of  Action  at  the  national,  regional  and  global  levels.   Accordingly,  we  will  strengthen  our  national  statistical  capacity  to  collect,  analyse  and  disaggregate  data,   including  by  sex,  age  and  other  relevant  factors  that  may  lead  to  disparities,  and  support  a  wide  range  of  child-­‐ focused  research.  We  will  enhance  international  cooperation  to  support  statistical  capacity-­‐building  efforts  and   build  community  capacity  for  monitoring,  assessment  and  planning.”  (A  World  Fit  for  Children,  paragraph  60)     “…We  will  conduct  periodic  reviews  at  the  national  and  subnational  levels  of  progress  in  order  to  address   obstacles  more  effectively  and  accelerate  actions.…”  (A  World  Fit  for  Children,  paragraph  61)     The  Plan  of  Action  (paragraph  61)  also  calls  for  the  specific  involvement  of  UNICEF  in  the  preparation  of   periodic  progress  reports:      “…  As  the  world’s  lead  agency  for  children,  the  United  Nations  Children’s  Fund  is  requested  to  continue  to   prepare  and  disseminate,  in  close  collaboration  with  Governments,  relevant  funds,  programmes  and  the   specialized  agencies  of  the  United  Nations  system,  and  all  other  relevant  actors,  as  appropriate,  information   on  the  progress  made  in  the  implementation  of  the  Declaration  and  the  Plan  of  Action.”     Similarly,  the  Millennium  Declaration  (paragraph  31)  calls  for  periodic  reporting  on  progress:       “…We  request  the  General  Assembly  to  review  on  a  regular  basis  the  progress  made  in  implementing  the   provisions  of  this  Declaration,  and  ask  the  Secretary-­‐General  to  issue  periodic  reports  for  consideration  by   the  General  Assembly  and  as  a  basis  for  further  action.”       There  have  been  several  efforts  by  the  Government  of  Nigeria  directed  towards  objectives  and  aspirations   that   are   similar   in   most   material   respects   to   the   global   commitments   expressed   in   the   Millennium   Development  Goals,   the  World  Fit   for  Children  goals,   the  UNICEF  Country  Programme,  UN  Development   Assistance  Framework  (UNDAF),  the  Convention  on  the  Rights  of  the  Child     (CRC)  and  the  Convention  on   the   Elimination   of   All   Forms   of   Discrimination   against  Women   (CEDAW),   Abuja   Targets   for  Malaria,   and   MICS Nigeria, 2011; Main Report   Page  2   United  Nations  General  Assembly  (UNGA),  among  others.  The  National  Programme  for  the  Eradication  of   Poverty  (NAPEP)  has  been  concerned  with  strategies  for  poverty  reduction    in  the  country;  National  Agency   for  the  Control  of  HIV/AIDS  (NACA)  has  mandate  for  planning,  implementing  and  monitoring  programmes   for  control  of  HIV/AIDS;  National  Economic  Empowerment  Development  Strategy  (NEEDS)  and  its  state  and   local   government   extensions,   SEEDS   and   LEEDS   respectively   are   supposed   to   focus   on   wealth   creation,   employment   generation,   corruption   elimination   and   general   value   orientation.   Recently,   the   National   Planning  Commission,  under  the  National  Transformation  Agenda  introduced  a  monitoring  and  evaluation   a  strategy  for  monitoring  and  evaluating  government  projects  and  programmes.     The  Federal  Government  of  Nigeria  has  expressed  strong  commitment  to,  and  declared  as  a  matter  of  high   priority,  efforts  to  monitor  and  evaluate  progress  towards  the  attainment  of  the  benchmarks  established  in   these   national   and   other   global   goals.   The   National   Bureau   of   Statistics   (NBS)  with   strong   financial   and   technical   support   from   international   development   partners   and   donors   like   UNICEF,   UNFPA,   and   DFID   among  others  has  been  involved  in  the  national  efforts  to  achieve  the  goals  through  provision  of  relevant   data   to  monitor,   evaluate   and   advise   necessary   adjustments   in   development   programmes.     The  NBS,   in   recent   times   had   conducted   a   number   of   national   sample   surveys   most   of   them   within   global   generic   context.    Nigeria  Living  Standard  Survey   (NLSS),  General  Household  Survey   (GHS),  Core  Welfare   Indicator   Questionnaire   (CWIQ)   Survey   and   the   Nigeria   Demographic   and   Health   Survey   (NDHS)   were   examples.   However,  MICS4  Nigeria   like   the   generic  MICS4   has   been   designed  with   the  main   objective   to  measure   progress  towards  achievements  of  Millennium  Development  Goals  (MDGs).       More   specifically,   2011  Multiple   Indicator   Cluster   Survey   should   assist   evaluation   and  monitoring   of   UN   agencies  and  partners’  country  programmes  including  those  on  immunization,  vitamin  A  supplementation,   child  development,  child  and  women  rights  and  protection  among  others.    Globally,  MICS4  would  be  able   to  collect  information  on  at  least  100  internationally  agreed  upon  indicators  covering  most  situations  of  the   household,  the  child,  the  mother  and  their  environment.       This  final  report  presents  the  results  of  the  indicators  and  topics  covered  in  the  survey.       Survey  Objectives     The  2011  Nigeria  Multiple  Indicator  Cluster  Survey  (MICS4)  has  as  its  primary  objectives:     • To  provide  up-­‐to-­‐date  information  for  assessing  the  situation  of  children  and  women  in  Nigeria;     • To  furnish  data  needed  for  monitoring  progress  toward  achievement  of  the  Millennium  Development   Goals,  other  internationally  agreed  upon  goals,  and  the  National  Transformation  Agenda,  as  a  basis  for   future  action;     • To  provide  statistics  to  complement  and  assess  the  quality  of  data  from  recent  national  surveys  like   Harmonized  Nigeria  Living  Standard  Survey  (HNLSS),  Nigeria  Core  Welfare  Indicator  Questionnaires   (CWIQ)  Survey  and  the  National  Demographic  and  Health  Survey  (NDHS);     • To  contribute  to  the  improvement  of  data  and  monitoring  systems  in  Nigeria  and  to  strengthen   technical  expertise  in  the  design,  implementation,  and  analysis  of  such  systems;  and  ;     • To  generate  data  on  the  situation  of  children  and  women,  including  the  identification  of  vulnerable   groups  and  of  disparities,  to  inform  policies  and  interventions.   MICS Nigeria, 2011; Main Report   Page  3   II.     Sample  and  Survey  Methodology       Sample  Design   The  sample  for  the  Nigeria  Multiple  Indicator  Cluster  Survey  (MICS)  was  designed  to  provide  estimates  for   a   large  number  of   indicators  on  the  situation  of  children  and  women  at  the  national   level,   for  urban  and   rural  areas,  and  for  the  36  states  of  the  Federation  and  the  Federal  Capital  Territory  as  well  as  the  6  geo-­‐ political   zones   of   Nigeria   namely   South-­‐West,   South-­‐East,   South-­‐South,   North-­‐WestNorth-­‐West,   North-­‐ EastNorth-­‐East  and  North-­‐CentralNorth-­‐Central.  The  states  within  each  zone  were   identified  as   the  main   sampling  strata  while  the  Enumeration  Areas  (EAs)  within  each  state  were  identified  as  the  main  sampling   units   and   the   sample   was   selected   in   two   stages.   Within   each   state,   40   census   enumeration   areas   (demarcated  by  the  National  Population  Commission  (NPopC)  for  the  2006  housing  and  population  census)   were   selected   systematically   with   equal   probability   within   each   state   reaching   a   total   of   1,480.   After   a   household  listing  was  carried  out  within  the  selected  EAs,  a  systematic  sample  of  20  households  was  drawn   in  each   sample   EA.  All   the  1,480   selected  enumeration  areas  were   covered  during   the   fieldwork  period.   Nationally,  a  total  of  29,349  households  were  selected  as  against  the  expected  29,600  for  the  second  stage   sample  due  to  some  EAs  containing  fewer  than  20  households.  The  sample  was  stratified  by  state  and   is   not   self-­‐weighting.   For   reporting   national   level   results,   sample   weights   are   used.     In   total   29,077   households   were   successfully   interviewed   for   a   response   rate   of   approximately   100   percent.   In   the   interviewed   households,   30,791   of   the   33,699   women   (age   15-­‐49   years)   identified   were   successfully   interviewed,  yielding  a  response  rate  of  91  percent.  Questionnaires  were  completed  for  25,201  (of  a  total   26,018)   children,  yielding  a   response   rate  of  97  percent  within   interviewed  households.  A  more  detailed   description  of  the  sample  design  can  be  found  in  Appendix  A.     Questionnaires   Three   sets  of   questionnaires  were  used   in   the   survey.   The   first  was   the  household  questionnaire,  which   was  used  to  collect  socio-­‐demographic  information  and  other  general  characteristics  on  all  members  of  the   household,  household  and  the  dwelling  units.  The  second  was  the  individual  women  questionnaire  which   was   administered   in   each   household   to   all  women   aged   15-­‐49   years  while   the   third  was   the   under-­‐five   children  questionnaire  which  was  administered  to  mothers  or  caretakers  of  under-­‐five  children  living  in  the   households  interviewed.  The  questionnaires  and  their  corresponding  modules  are  as  listed  below:     Household  Questionnaire:   o Household  Listing  Form   o Education   o Water  and  Sanitation   o Household  Characteristics   o Insecticide  Treated  Nets   o Child  Labour   o Child  Discipline   o Hand  washing   o Salt  Iodization     Questionnaire  for  Individual  Women:   o Women’s  Background   o Child  Mortality   o Desire  for  Last  Birth   o Maternal  and  Newborn  Health   o Illness  Symptoms   o Contraception   o Unmet  Need   o Female  Genital  Mutilation/Cutting   MICS Nigeria, 2011; Main Report   Page  4   o Attitudes  Toward  Domestic  Violence   o Marriage/Union   o Sexual  Behaviour   o HIV/AIDS     Questionnaire  for  Children  Under-­‐Five:   o Age   o Birth  Registration   o Early  Childhood  Development   o Breastfeeding   o Care  of  Illness   o Malaria   o Immunization   o Anthropometry     The   questionnaires   were   developed   by   domesticating   the   English   version   of   the   generic   MICS4   model   questionnaire.  Although  the  questionnaires  were  not  translated   into   local   languages,  during  the  pre-­‐test,   the   field   staff   used   were   those   fluent   and   competent   in   local   languages,   familiar   with   the   culture   and   beliefs  as  well  as  the  peculiarities  of  the  inhabitants  of  the  communities  in  the  selected  states.  For  a  good   representative  of   the  country,   the  pre-­‐test  was  done   in  Osun  and  Akwa-­‐Ibom  states   from  the  South  and   Kano  and  Gombe  from  the  North  in  November  2010.  Based  on  the  results  of  the  pre-­‐test  and  inputs  from   UNICEF  officials,  NBS  Technical  team  and  other  stakeholders,  modifications  were  made  to  the  wording  and   sequencing  of  the  questionnaires.    A  copy  of  the  Nigeria  MICS4  questionnaires  is  provided  in  Appendix  F.     Training  and  Fieldwork   Training   for   the   fieldwork   was   conducted   simultaneously   in   the   six   geo-­‐political   zones   for   15   days   in   February  2011.  Training  programme  included  lectures  on  survey  design,  interview  techniques,  explanation   of   the   contents   and   how   to   complete   the   questionnaires,   mock   interviews   to   gain   practice   in   asking   questions.   Two   rounds   of   field   practice   were   organised   towards   the   end   of   the   training   period   for   the   trainees   to   gain   experience   on   how   to   conduct   interviews   in   purposively   selected   residential   areas   in   2   communities.   Each   round   of   the   field   practice   lasted   for   a   day.     Fieldwork   lasted   for   about   six   weeks;   between  February  2011  and  March  2011.  In  each  state,  the  data  were  collected  by  two  roving  teams;  each   was  comprised  of  5  interviewers,  one  driver,  one  editor,  one  measurer  and  a  supervisor.       Data  Processing   A  2-­‐day  training  of  trainers  was  organized  for  data  processing  team  in  Abuja  in  February  2011;  there  was   also  a  subsequent  five-­‐day  training  of  data  processing  personnel  in  February  2011  simultaneously  at  each   of  the  six  zonal  data  processing  centers.  Data  entry  was  done  using  the  CSPro  software  at  each  of  the  six   data  processing  centers,  each  zone  handling  data  from  the  constituent  states.  The  data  processing  at  each   zone   was   being   monitored   at   regular   intervals   from   the   ICT   department   at   NBS   headquarters   through   phone   communications.   In   order   to   ensure   data   quality,   all   questionnaires   were   double   entered   and   internal   consistency   checks   were   performed.   Procedures   and   standard   programs   developed   under   the   global  MICS4   project   and   adapted   to   the   Nigeria   questionnaire   were   used   throughout.   Data   processing   began  two  weeks  into  data  collection  in  February  and  was  completed  in  April.    Regular  checks  were  carried   out  for  data  quality  and  to  ensure  compliance  with  global  data  processing  guidelines  by  UNICEF  Nigeria  and   UNICEF   New   York.   Data   were   analyzed   using   the   Statistical   Package   for   Social   Sciences   (SPSS)   software   program,  Version  18,   and   the  model   syntax  and   tabulation  plans  developed  by  UNICEF   for   this  purpose.   The   following   provisions   were   made   for   data   processing:   71   desktop   computers   (65   for   data   entry   operators,  6  for  supervisors),  adequate  office  space,  and  effective  and  functional  software  and  hardware.   In   addition,   17   secondary   editors   and  6  data   administrators  were  deployed.   The  procedures   for   primary   and  secondary  data  processing  phases  as  advised  in  global  MICS4  manual  of  instructions  were  adhered  to.   MICS Nigeria, 2011; Main Report   Page  5   III.     Sample  Coverage  and  the  Characteristics  of  Households  and  Respondents     Sample  Coverage   Out  of  a  total  of  29,600  households  planned  for  selected  for  coverage,  29,349  were  actually  canvassed  but   only  29,151  were  found  to  be  occupied.    Of  these,  29,077  were  successfully   interviewed  for  a  household   response  rate  of  approximately  100  percent.       Table  HH.1:  Results  of  household,  women's  and  under-­‐5  interviews   Number  of  households,  women,  and  children  under  5  by  results  of  the  household,  women's  and  under-­‐5's  interviews,  and   household,  women's  and  under-­‐5's  response  rates,  Nigeria,  2011       Households   Women   Children  under  5       Sa m pl ed   O cc up ie d   In te rv ie w ed   Ho us eh ol d   re sp on se  ra te   El ig ib le   In te rv ie w ed   W om en 's   re sp on se  ra te   W om en 's   ov er al l   re sp on se  ra te   El ig ib le   M ot he rs /c ar et ak er s   in te rv ie w ed   U nd er -­‐5 's   re sp on se  ra te   U nd er -­‐5 's   ov er al l   re sp on se  ra te   Area  of  residence                           Urban   7312   7271   7251   99.7   8283   7541   91.0   90.8   5298   5155   97.3   97.0   Rural   22037   21880   21826   99.8   25416   23231   91.4   91.2   20720   20037   96.7   96.5   State                            Abia   797   797   797   100.0   688   664   96.5   96.5   465   463   99.6   99.6   Adamawa   790   790   790   100.0   1076   960   89.2   89.2   875   828   94.6   94.6   Akwa  ibom   798   798   798   100.0   878   792   90.2   90.2   564   559   99.1   99.1   Anambra   800   798   797   99.9   754   714   94.7   94.6   562   561   99.8   99.7   Bauchi   777   774   773   99.9   969   905   93.4   93.3   1001   951   95.0   94.9   Bayelsa   799   795   792   99.6   698   635   91.0   90.6   552   538   97.5   97.1   Benue   800   800   800   100.0   946   891   94.2   94.2   633   621   98.1   98.1   Borno   762   719   703   97.8   835   711   85.1   83.3   796   731   91.8   89.8   Cross  River   788   788   787   99.9   853   785   92.0   91.9   593   586   98.8   98.7   Delta   799   799   798   99.9   800   737   92.1   92.0   552   542   98.2   98.1   Ebonyi   800   800   800   100.0   1117   1001   89.6   89.6   685   661   96.5   96.5   Edo   789   786   786   100.0   796   743   93.3   93.3   519   518   99.8   99.8   Ekiti   785   784   784   100.0   701   621   88.6   88.6   402   397   98.8   98.8   Enugu   799   774   771   99.6   656   625   95.3   94.9   352   349   99.1   98.8   Gombe   774   774   774   100.0   1031   918   89.0   89.0   971   921   94.9   94.9   Imo   799   758   756   99.7   690   659   95.5   95.3   414   411   99.3   99.0   Jigawa   795   777   766   98.6   1023   988   96.6   95.2   1063   1051   98.9   97.5   Kaduna   800   800   800   100.0   1100   1024   93.1   93.1   962   937   97.4   97.4   Kano   798   798   798   100.0   952   880   92.4   92.4   956   913   95.5   95.5   Katsina   800   792   791   99.9   995   982   98.7   98.6   1024   1020   99.6   99.5   Kebbi   800   800   800   100.0   964   892   92.5   92.5   947   905   95.6   95.6   Kogi   781   781   781   100.0   810   770   95.1   95.1   430   426   99.1   99.1   Kwara   800   800   800   100.0   738   676   91.6   91.6   564   547   97.0   97.0   Lagos   796   796   796   100.0   946   892   94.3   94.3   545   529   97.1   97.1   Nasarawa   777   774   763   98.6   1248   968   77.6   76.5   891   802   90.0   88.7   Niger   800   799   799   100.0   1176   1079   91.8   91.8   957   927   96.9   96.9   Ogun   800   800   800   100.0   839   741   88.3   88.3   588   583   99.1   99.1   Ondo   799   799   799   100.0   723   643   88.9   88.9   427   413   96.7   96.7   Osun   765   758   757   99.9   714   682   95.5   95.4   456   454   99.6   99.4   Oyo   800   794   790   99.5   740   655   88.5   88.1   592   586   99.0   98.5   Plateau   791   786   784   99.7   1114   972   87.3   87.0   687   653   95.1   94.8   Rivers   799   799   799   100.0   816   714   87.5   87.5   467   460   98.5   98.5   Sokoto   799   799   799   100.0   1079   1064   98.6   98.6   1020   1014   99.4   99.4   Taraba   800   800   800   100.0   1144   956   83.6   83.6   792   736   92.9   92.9   Yobe   797   797   797   100.0   957   872   91.1   91.1   1015   968   95.4   95.4   Zamfara   800   790   784   99.2   1048   972   92.7   92.0   1053   1013   96.2   95.5   FCT  (Abuja)   796   778   768   98.7   1085   989   91.2   90.0   646   618   95.7   94.4   Total   29349   29151   29077   99.7   33699   30772   91.3   91.1   26018   25192   96.8   96.6     MICS Nigeria, 2011; Main Report   Page  6   In   the   interviewed  households,  33,699  women  (age  15-­‐49  years)  were   identified.    Of   these,  30,772  were   successfully  interviewed,  yielding  a  response  rate  of  91  percent  within  interviewed  households.  In  addition,   26,018  children  under  age  five  were  listed  in  the  household  questionnaire.  Questionnaires  were  completed   for   25,192   of   these   children,   which   corresponds   to   a   response   rate   of   97   percent   within   interviewed   households.  Overall  response  rates  of  91  and  97  are  calculated  for  the  women’s  and  under-­‐5’s  interviews   respectively  (Table  HH.1).     From   the   table,   the   household   response   rates  were   similar   for   urban   and   rural   areas.    Most   states   had   more  than  99  percent  household  response  rate  with  the  exception  of  Borno  state  with  98  percent,  Jigawa   and  Nasarawa  with  99  percent  each  and  FCT  with  99  percent.  The  women  response  rates  were  also  similar   across  the  states  except  Borno,  Nasarawa  and  Taraba  with  85,  78  and  84  percents  respectively.  It  is  advised   that   results   for   these   states   be   interpreted   with   cautions.   The   difference   between   the   sampled   and   occupied  households  was  due  to  households   that  moved  away  or  not  at  home  throughout   the  period  of   the  survey  and  those  that  refused.       Characteristics  of  Households   The  weighted  age  and  sex  distribution  of  survey  population  is  provided  in  Table  HH.2.    The  distribution  is   also   used   to   produce   the   population   pyramid   in   Figure   HH.1.     In   the   29,077   households   successfully   interviewed   in   the   survey,   146,243   household  members   were   listed.   Of   these,   72,124   were  males,   and   74,119  were  females.       Table  HH.2:  Household  age  distribution  by  sex   Percent  and  frequency  distribution  of  the  household  population  by  five-­‐year  age  groups,  dependency  age   groups,  and  by  child  (age  0-­‐17  years)  and  adult  populations  (age  18  or  more),  by  sex,  Nigeria,  2011       Males   Females   Total   Number   Percent   Number   Percent   Number   Percent   Age                           0-­‐4   12757   17.7   12303   16.6   25060   17.1   5-­‐9   11471   15.9   11274   15.2   22746   15.6   10-­‐14   8695   12.1   8981   12.1   17676   12.1   15-­‐19   6645   9.2   6252   8.4   12897   8.8   20-­‐24   4763   6.6   5910   8.0   10672   7.3   25-­‐29   4266   5.9   6330   8.5   10597   7.2   30-­‐34   4372   6.1   5092   6.9   9464   6.5   35-­‐39   3746   5.2   3912   5.3   7658   5.2   40-­‐44   3266   4.5   3230   4.4   6496   4.4   45-­‐49   2574   3.6   2505   3.4   5079   3.5   50-­‐54   2671   3.7   2970   4.0   5641   3.9   55-­‐59   1718   2.4   1613   2.2   3331   2.3   60-­‐64   1740   2.4   1388   1.9   3128   2.1   65-­‐69   1117   1.5   778   1.1   1895   1.3   70-­‐74   1030   1.4   648   .9   1679   1.1   75-­‐79   478   .7   294   .4   772   .5   80-­‐84   405   .6   322   .4   726   .5   85+   297   .4   251   .3   549   .4   Missing/DK   112   .2   66   .1   178   .1   Dependency  age  groups                 0-­‐14   32924   45.6   32558   43.9   65482   44.8   15-­‐64   35761   49.6   39202   52.9   74962   51.3   65+   3327   4.6   2294   3.1   5621   3.8   Missing/DK   112   .2   66   .1   178   .1   Child  and  adult  populations               Children  age  0-­‐17  years   37047   51.4   36142   48.8   73189   50.0   Adults  age  18+  years   34965   48.5   37911   51.1   72876   49.8   Missing/DK   112   .2   66   .1   178   .1   Total   72124   100.0   74119   100.0   146243   100.0   MICS Nigeria, 2011; Main Report   Page  7   The  age  structure  of  Nigeria  shows  a  larger  proportion  of  its  population  in  the  younger  age  groups  than  in   the  older.      About  45  percent  of  the  population  is  under  the  age  of  15  years,  thereby  contributing  to  the   dependency  ratio.      The  population  pyramid  shown  in  Figure  HH.1  indicates  that  there  is  even  distribution   at  the  base  up  to  age  group  19-­‐24.  However,  it  is  clearly  shown  that  age  specific  sex  ratio  is  greater  than   1.0  for  age  groups  25-­‐29  and  50-­‐54.           Tables   HH.3   -­‐   HH.5   provide   basic   information   on   the   households,   female   respondents   age   15-­‐49,   male   respondents  15-­‐49  and  children  under-­‐5  by  presenting  the  unweighted,  as  well  as  the  weighted  numbers.   Information  on  the  basic  characteristics  of  households,  women,  men  and  children  under-­‐5  interviewed  in   the  survey  is  essential  for  the  interpretation  of  findings  presented  later  in  the  report  and  also  can  provide   an   indication  of   the   representativeness  of   the   survey.   The   remaining   tables   in   this   report   are  presented   only  with  weighted  numbers.  See  Appendix  A  for  more  details  about  the  weighting.       Table  HH.3  provides  basic  background  information  on  the  households.    Within  households,  the  sex  of  the   household  head,  region,  area,  and  number  of  household  members,  education  of  household  head  and  geo-­‐ political   zone   of   the   household   are   shown   in   the   table.   These   background   characteristics   are   used   in   subsequent   tables   in   this   report;   the   figures   in   the   table   are   also   intended   to   show   the   numbers   of   observations  by  major  categories  of  analysis  in  the  report.     MICS Nigeria, 2011; Main Report   Page  8     Table  HH.3:  Household  composition   Percent  and  frequency  distribution  of  households  by  selected  characteristics,   Nigeria,  2011       Weighted  percent   Number  of  households   Weighted   Unweighted   Sex  of  household  head             Male   83.9   24389   24502   Female   16.1   4686   4574   Missing   .0   1   1   State         Abia   2.6   755   797   Adamawa   1.9   560   790   Akwa  ibom   3.1   890   798   Anambra   3.5   1023   797   Bauchi   2.8   817   773   Bayelsa   1.5   440   792   Benue   2.8   827   800   Borno   2.9   833   703   Cross  River   2.3   658   787   Delta   3.6   1032   798   Ebonyi   1.3   388   800   Edo   2.6   752   786   Ekiti   2.3   673   784   Enugu   3.2   925   771   Gombe   1.3   378   774   Imo   3.3   952   756   Jigawa   2.3   683   766   Kaduna   3.2   943   800   Kano   5.5   1592   798   Katsina   3.3   955   791   Kebbi   1.8   531   800   Kogi   2.6   762   781   Kwara   1.9   551   800   Lagos   7.6   2196   796   Nasarawa   1.0   291   763   Niger   2.2   626   799   Ogun   3.0   887   800   Ondo   3.2   916   799   Osun   3.0   882   757   Oyo   4.6   1345   790   Plateau   2.0   583   784   Rivers   4.2   1216   799   Sokoto   2.2   634   799   Taraba   1.3   381   800   Yobe   1.3   388   797   Zamfara   1.8   528   784   FCT  (Abuja)   1.0   286   768   MICS Nigeria, 2011; Main Report   Page  9   Table  HH.3:  Household  composition  (continued)   Percent  and  frequency  distribution  of  households  by  selected  characteristics,  Nigeria,   2011       Weighted  percent   Number  of  households   Weighted   Unweighted   Area  of  residence         Urban   36.5   10608   7251   Rural   63.5   18469   21826   Number  of  household  members       1   9.7   2813   2791   2   10.5   3045   2962   3   13.8   4026   3784   4   14.8   4302   4074   5   13.7   3974   3934   6   11.9   3462   3378   7   8.6   2514   2638   8   5.8   1675   1837   9   3.9   1131   1196   10+   7.3   2135   2483   Education  of  household  head         None   35.2   10221   11608   Primary   22.1   6424   6335   Secondary  +   42.7   12424   11127   Missing/DK   .0   8   7   Household  composition         At  least  one  child  age  0-­‐4  years   53.0   29077   29077   At  least  one  child  age  0-­‐17  years   77.7   29077   29077   At  least  one  woman  age  15-­‐49   years   79.6   29077   29077   Mean  household  size   5.0   29077   29077   Geo-­‐political  zone       North-­‐Central   13.5   3925   5495   North-­‐East   11.5   3357   4637   North-­‐West   20.2   5866   5538   South-­‐East   13.9   4043   3921   South  South   17.2   4988   4760   South-­‐West   23.7   6899   4726   Total   100.0   29077   29077         (*)    Less  than  25  cases  unweighted  cases     The  weighted  and  unweighted  numbers  of  households  are  equal,   since  sample  weights  were  normalized   (See  Appendix  A).  The  table  also  shows  the  proportions  of  households  with  at  least  one  child  under  18,  at   least  one  child  under  5,  at  least  one  eligible  woman  age  15-­‐49  and  at  least  one  man  age  15-­‐49.    The  table   also  shows  the  weighted  average  household  size  estimated  by  the  survey.     Sixteen  percent  of  the  households  are  headed  by  women  and  64percent  of  the  households  live  in  the  rural   area.    Table  HH.3  indicates  also  that  35  percent  of  the  household  head  do  not  have  any  formal  education,   MICS Nigeria, 2011; Main Report   Page  10   while   about   22   percent   have   primary   education.     At   least   two   out   of   every   five   household   heads   have   secondary  education  or  above.     Characteristics  of  Female  Respondents  15-­‐49  Years  of  Age  and  Children  Under-­‐5     Tables  HH.4  and  HH.5  provide  information  on  the  background  characteristics  of  female  respondents  15-­‐49   years  of  age  and  of  children  under  age  5.  In  the  two  tables,  the  total  numbers  of  weighted  and  unweighted   observations   are   equal,   since   sample   weights   have   been   normalized   (standardized).   In   addition   to   providing  useful  information  on  the  background  characteristics  of  women  and  children,  the  tables  are  also   intended  to  show  the  numbers  of  observations  in  each  background  category.  These  categories  are  used  in   the  subsequent  tabulations  of  this  report.   Table   HH.4   provides   background   characteristics   of   female   respondents   15-­‐49   years   of   age.     The   table   includes   information   on   the   distribution   of   women   according   to   state,   area,   age,   marital   status   and   motherhood  status;  births   in   last  two  years,  education1,  wealth  index  quintiles2,  and  geo-­‐political  zone  of   the  household.       The  distribution  pattern  of  the  women  population  is  similar  to  that  of  the  households  in  general.    About  63   percent  of  the  sample  women  live  in  the  rural  area  while  on  about  37  live  in  the  urban.    About  70  percent   of   the  eligible  women  are   currently  married  while   about   a  quarter  never  married.    About   2  percent   are   widows  while  2  percent  are  either  divorced  or  separated.    The  women  are  almost  evenly  distributed  among   the  5  wealth  index  quintiles,  with  18  percent  in  the  richest  and  23  percent  in  the  poorest.     1  Unless  otherwise  stated,  “education”  refers  to  educational  level  attended  by  the  respondent  throughout  this  report  when  it  is   used  as  a  background  variable.   2   Principal   components   analysis   was   performed   by   using   information   on   the   ownership   of   consumer   goods,   dwelling   characteristics,  water   and   sanitation,   and   other   characteristics   that   are   related   to   the   household’s  wealth   to   assign  weights   (factor  scores)  to  each  of  the  household  assets.  Each  household  was  then  assigned  a  wealth  score  based  on  these  weights  and   the  assets  owned  by  that  household.  The  survey  household  population  was  then  ranked  according  to  the  wealth  score  of  the   household  they  are  living  in,  and  was  finally  divided  into  5  equal  parts  (quintiles)  from  lowest  (poorest)  to  highest  (richest).  The   assets  used  in  these  calculations  were  as  follows:     Electricity   ,Radio,   Television,   Non-­‐mobile   telephone,   Refrigerator,   VCR/VCD/DVD,   Sewing  machine,   Clock,   Generator,Computer,   Internet  facility,  Fan,  Air  conditioner,  Blender/Mixer/Food  processor,  Water  heater    The  wealth  index  is  assumed  to  capture  the  underlying  long-­‐term  wealth  through  information  on  the  household  assets,  and  is   intended  to  produce  a  ranking  of  households  by  wealth,  from  poorest  to  richest.  The  wealth  index  does  not  provide  information  on   absolute  poverty,  current  income  or  expenditure  levels.  The  wealth  scores  calculated  are  applicable  for  only  the  particular  data  set   they  are  based  on.  Further  information  on  the  construction  of  the  wealth  index  can  be  found  in  Filmer,  D.  and  Pritchett,  L.,  2001.   “Estimating  wealth  effects  without  expenditure  data  –  or  tears:  An  application  to  educational  enrolments  in  states  of  India”.   Demography  38(1):  115-­‐132.  Gwatkin,  D.R.,  Rutstein,  S.,  Johnson,  K.  ,  Pande,  R.  and  Wagstaff.  A.,  2000.  Socio-­‐Economic  Differences   in  Health,  Nutrition,  and  Population.  HNP/Poverty  Thematic  Group,  Washington,  DC:  World  Bank.  Rutstein,  S.O.  and  Johnson,  K.,   2004.  The  DHS  Wealth  Index.  DHS  Comparative  Reports  No.  6.  Calverton,  Maryland:  ORC  Macro.     MICS Nigeria, 2011; Main Report   Page  11       Table  HH.4:  Women's  background  characteristics   Percent    and  frequency  distribution  of  women  age  15-­‐49  years  by  selected  background   characteristics,  Nigeria,  2011         Weighted  percent   Number  of  women   Weighted   Unweighted   State               Abia   2.2   662   664   Adamawa   2.3   723   960   Akwa  ibom   3.1   964   792   Anambra   2.9   887   714   Bauchi   3.0   912   905   Bayelsa   1.2   376   635   Benue   2.9   898   891   Borno   2.7   844   711   Cross  River   2.1   650   785   Delta   3.2   976   737   Ebonyi   1.6   493   1001   Edo   2.4   741   743   Ekiti   1.8   542   621   Enugu   2.5   783   625   Gombe   1.5   455   918   Imo   2.8   849   659   Jigawa   2.7   829   988   Kaduna   4.3   1308   1024   Kano   5.9   1822   880   Katsina   3.7   1128   982   Kebbi   1.9   593   892   Kogi   2.4   747   770   Kwara   1.7   510   676   Lagos   7.7   2382   892   Nasarawa   1.5   456   968   Niger   2.8   855   1079   Ogun   2.9   884   741   Ondo   2.6   801   643   Osun   2.5   768   682   Oyo   3.8   1174   655   Plateau   2.5   784   972   Rivers   4.1   1257   714   Sokoto   2.5   776   1064   Taraba   1.7   512   956   Yobe   1.4   427   872   Zamfara   2.1   652   972   FCT  (Abuja)   1.1   354   989     MICS Nigeria, 2011; Main Report   Page  12     Table  HH.4:  Women's  background  characteristics  (continued)   Percent    and  frequency  distribution  of  women  age  15-­‐49  years  by  selected  background   characteristics,  Nigeria,  2011         Weighted  percent   Number  of  women   Weighted   Unweighted   Area  of  residence         Urban   36.8   11330   7541   Rural   63.2   19442   23231   Age              15-­‐19   17.7   5436   5474        20-­‐24   17.2   5278   5389        25-­‐29   19.2   5923   5886        30-­‐34   15.9   4882   4675        35-­‐39   12.2   3756   3755        40-­‐44   10.1   3113   3132        45-­‐49   7.7   2384   2461   Marital/Union  status         Currently  married/in  union   70.7   21740   22141   Widowed   2.2   663   640   Divorced   .7   217   234   Separated   1.5   476   464   Never  married/in  union   24.9   7674   7292   Missing   .0   2   1   Motherhood  status         Ever  gave  birth   71.8   22088   22483   Never  gave  birth   28.2   8684   8289   Births  in  last  two  years         Had  a  birth  in  last  two  years   32.1   9879   10036   Had  no  birth  in  last  two  years   67.9   20893   20736   Education         None   31.8   9771   11437   Primary   17.7   5453   5723   Secondary  +   50.5   15546   13608   Missing/DK   .0   2   4   Wealth  index  quintile         Poorest   17.7   5456   7102   Second   18.7   5742   7112   Middle   19.8   6099   6324   Fourth   21.0   6475   5534   Richest   22.8   7001   4700   Geo-­‐political  zone       North-­‐Central   15.0   4603   6345   North-­‐East   12.6   3873   5322   North-­‐West   23.1   7108   6802   South-­‐East   11.9   3673   3663   South-­‐South   16.1   4964   4406   South-­‐West   21.3   6551   4234             Total   100.0   30772   30772       (*  )  Less  than  25  cases  unweighted  cases     Some   background   characteristics   of   children   under   5   are   presented   in   Table   HH.5.   These   include   the   distribution  of  children  by  several  attributes:  sex,  state  and  area,  age,  mother’s  or  caretaker’s  education,   wealth,  and  geo-­‐political  zone  of  the  household  head.           MICS Nigeria, 2011; Main Report   Page  13   Table  HH.5:  Under-­‐5's  background  characteristics   Percent    and  frequency  distribution  of  children  under  five  years  of  age  by  selected   characteristics,  Nigeria,  2011       Weighted  percent   Number  of  under-­‐5  children   Weighted   Unweighted   Sex               Male   51.0   12851   12865   Female   49.0   12349   12334   State         Abia   1.9   483   463   Adamawa   2.5   631   828   Akwa  ibom   2.6   660   559   Anambra   2.9   737   561   Bauchi   4.3   1072   951   Bayelsa   1.3   335   538   Benue   2.4   617   621   Borno   3.1   776   731   Cross  River   2.0   494   586   Delta   2.8   700   542   Ebonyi   1.3   333   661   Edo   2.1   516   518   Ekiti   1.3   337   397   Enugu   1.9   471   349   Gombe   1.8   462   921   Imo   2.1   539   411   Jigawa   3.7   933   1051   Kaduna   4.9   1240   937   Kano   7.8   1971   913   Katsina   4.9   1242   1020   Kebbi   2.6   644   905   Kogi   1.7   436   426   Kwara   1.7   425   547   Lagos   6.0   1502   529   Nasarawa   1.4   344   802   Niger   3.1   769   927   Ogun   2.5   628   583   Ondo   2.0   500   413   Osun   2.1   538   454   Oyo   4.0   1011   586   Plateau   1.9   480   653   Rivers   3.1   777   460   Sokoto   3.1   783   1014   Taraba   1.6   396   736   Yobe   2.0   504   968   Zamfara   2.7   688   1013   FCT  (Abuja)   .9   214   618   Table  HH.5:  Under-­‐5's  background  characteristics  (continued)   Percent    and  frequency  distribution  of  children  under  five  years  of  age  by  selected   characteristics,  Nigeria,  2011       Weighted   Number  of  under-­‐5  children   MICS Nigeria, 2011; Main Report   Page  14   percent   Weighted   Unweighted   Area  of  residence         Urban   30.4   7664   5155   Rural   69.6   17528   20037   Age  (in  months)           0-­‐5       10.6   2659   2714   6-­‐11       11.0   2773   2582   12-­‐23       19.8   4986   4946   24-­‐35       18.8   4747   4720   36-­‐47       20.5   5170   5237   48-­‐59     19.3   4857   4993   Mother’s  education         None   43.6   10992   12122   Primary   19.8   4989   5244   Secondary  +   36.6   9209   7820   Missing/DK   (*)   (*)   6   Wealth  index  quintile         Poorest   23.0   5797   7033   Second   20.7   5220   6176   Middle   18.7   4711   4836   Fourth   19.1   4801   4083   Richest   18.5   4662   3064   Geo-­‐political  zone           North-­‐Central   13.0   3285   4594   North-­‐East   15.3   3843   5135   North-­‐West   29.8   7501   6853   South-­‐East   10.2   2563   2445   South-­‐South   13.8   3483   3203   South-­‐West   17.9   4516   2962             Total   100.0   25192   25192         (*  )  Less  than  25  cases  unweighted  cases       MICS Nigeria, 2011; Main Report   Page  15   IV.     Child  Mortality       One  of  the  overarching  goals  of  the  Millennium  Development  Goals  (MDGs)  is  the  reduction  of  infant  and   under-­‐five   mortality.   Specifically,   the  MDGs   call   for   the   reduction   in   under-­‐five   mortality   by   two-­‐thirds   between   1990   and   2015.  Monitoring   progress   towards   this   goal   is   an   important   but   difficult   objective.   Measuring  childhood  mortality  may  seem  easy,  but  attempts  using  direct  questions,  such  as  “Has  anyone   in   this  household  died   in   the   last  year?”  give   inaccurate   results.  Using  direct  measures  of  child  mortality   from  birth  histories  generates  detailed  and  recent  data,  but  is  time  consuming,  more  expensive,  and  may   be  subject  to  potential  data  quality  problems  if  excellent  training  and  supervision  has  not  been  undertaken.     Alternatively,   indirect  methods   developed   to  measure   child  mortality   produce   robust   estimates   that   are   comparable  with  the  ones  obtained  from  other  sources.  Indirect  methods  minimize  the  pitfalls  of  memory   lapses,  inexact  or  misinterpreted  definitions,  and  poor  interviewing  technique.       The  infant  mortality  rate  is  the  probability  of  dying  before  the  first  birthday.  The  under-­‐five  mortality  rate  is   the  probability  of  dying  before  the  fifth  birthday.  In  MICS  surveys,  infant  and  under  five  mortality  rates  are   calculated  based  on  an   indirect  estimation   technique  known  as   the  Brass  method3.  The  data  used   in   the   estimation  are:  the  mean  number  of  children  ever  born  for  five  year  age  groups  of  women  from  age  15  to   49,   and   the   proportion   of   these   children  who   are   dead,   also   for   five-­‐year   age   groups   of   women   (Table   CM.1).   The   technique   converts   the   proportions   dead   among   children   of  women   in   each   age   group   into   probabilities  of  dying  by  taking  into  account  the  approximate  length  of  exposure  of  children  to  the  risk  of   dying,  assuming  a  particular  model  age  pattern  of  mortality.  Based  on  previous  information  on  mortality  in   Nigeria,  the  North  model  life  table  was  selected  as  most  appropriate.     Table  CM.1:  Children  ever  born,  children  surviving  and  proportion  dead   Mean  and  total  numbers  of  children  ever  born,  children  surviving  and  proportion  dead  by  age  of  women,   Nigeria,  2011     Age   Children  ever  born   Children  surviving   Proportion   dead   Number  of   women  Mean   Total   Mean   Total                              15-­‐19   .104   565   .086   465   .176   5436        20-­‐24   .653   3445   .539   2844   .174   5278        25-­‐29   1.310   7761   1.100   6513   .161   5923        30-­‐34   2.083   10170   1.725   8419   .172   4882        35-­‐39   2.692   10111   2.213   8312   .178   3756        40-­‐44   3.132   9749   2.479   7716   .208   3113        45-­‐49   3.443   8207   2.644   6302   .232   2384                   Total   1.625   50006   1.318   40571   .189   30772                       3  United  Nations,  1983.  Manual  X:  Indirect  Techniques  for  Demographic  Estimation  (United  Nations  publication,  Sales   No.  E.83.XIII.2).  United  Nations,  1990a.  QFIVE,  United  Nations  Program  for  Child  Mortality  Estimation.  New  York,  UN   Pop  Division.  United  Nations,  1990b.  Step-­‐by-­‐step  Guide  to  the  Estimation  of  Child  Mortality.  New  York,  UN.   MICS Nigeria, 2011; Main Report   Page  16   Table   CM.2   provides   estimates   of   child   mortality.   These   estimates   have   been   calculated   by   averaging   mortality   estimates   obtained   from   women   age   25-­‐29   and   30-­‐34,   and   refer   to   mid-­‐2005.   The   infant   mortality   rate   is   estimated   at   97   per   thousand,   while   the   probability   of   dying   under   age   5   (under   five   mortality  rate)  are  158  per  thousand.  There  are  visible  differences  in  mortality  rate  in  terms  of  sex  of  child,   educational   level   and  wealth   status   of   the   parents,   and   states   or   geopolitical   zones.     The  Nigerian  male   child  has  greater  probability  of  dying  at   infant  or  at  an  age  under  five  years.    The  table  shows  that  infant   mortality  rate   is  106  per  thousand  for  male  child  as  against  86  per  thousand  for  the  female  counterpart.       Similarly,   the  under-­‐five  mortality   rate  was  170  per   thousand  and  144  per   thousand   respectively   for   the   male  and  female  child.         Table  CM.2:  Child  mortality   Infant  and  under-­‐five  mortality  rates,  North  Model,  Nigeria,  2011       Infant  mortality  rate1   Under-­‐five  mortality  rate2   Sex       Male   106   170   Female   86   144   State       Abia   74   116   Adamawa   81   129   Akwa  ibom   72   113   Anambra   71   111   Bauchi   140   236   Bayelsa   107   178   Benue   97   158   Borno   116   192   Cross  River   80   127   Delta   72   112   Ebonyi   77   122   Edo   69   107   Ekiti   48   71   Enugu   81   129   Gombe   117   196   Imo   116   194   Jigawa   163   275   Kaduna   103   169   Kano   111   184   Katsina   133   225   Kebbi   127   212   Kogi   82   132   Kwara   70   110   Lagos   45   65   Nasarawa   109   182   Niger   78   123   Ogun   67   105   Ondo   55   82   Osun   40   56   Oyo   70   110   Plateau   103   171   Rivers   63   97   Sokoto   107   178   Taraba   71   111   Yobe   142   240   Zamfara   150   254   FCT  (Abuja)   92   148   MICS Nigeria, 2011; Main Report   Page  17   Table  CM.2:  Child  mortality  (continued)   Infant  and  under-­‐five  mortality  rates,  North  Model,  Nigeria,  2011       Infant  mortality  rate1   Under-­‐five  mortality  rate2   Area  of    residence       Urban   68   106   Rural   110   182   Mother's  education       None   121   203   Primary   83   134   Secondary  +   66   102   Wealth  index  quintile       Poorest   132   223   Second   121   204   Middle   89   143   Fourth   73   115   Richest   51   76   Geo-­‐political  zone     North-­‐Central   91   147   North-­‐  East   114   190   North-­‐West   123   208   South-­‐East   83   132   South-­‐South   75   118   South-­‐West   55   83           Total   97   158   1  MICS  indicator  1.2;  MDG  indicator  4.2   2  MICS  indicator  1.1;  MDG  indicator  4.1   Rates  refer  to  mid-­‐2005,  North  Model  was  assumed  to  approximate  the  age  pattern   of  mortality  in  Nigeria     Infant  and  under-­‐5  mortality  rates  are  lowest  in  South-­‐West  zone  of  the  country  (55  and  83  per  thousand   respectively)   while   the   figures   for   North-­‐West   are   123   and   208   per   thousand   respectively.     Infant   and   under-­‐5  mortality  rates  are  higher  in  rural  than  urban  sectors  of  the  population;  Infant  mortality  rate  was   110  per  thousand  in  rural  areas,  whereas  it  was  68  per  thousand  in  the  urban.    Also,  under-­‐5  mortality  rate   was  182  in  rural  areas,  while  it  was  106  for  urban  areas.       Infant  and  under  five  mortality  rates  decrease  by  the  level  of  education  of  mother.    Infant  mortality  rate  for   children   of   mothers   with   no   education   is   121   per   thousand   while   that   of   children   of   mothers   with   secondary  education  or  higher  stood  at  66.    Also,  under-­‐five  mortality  rate  for  children  of  mothers  with  no   education  is  203  per  thousand  while  that  of  children  of  mothers  with  secondary  education  or  higher  was   102  per  thousand.    Considering  the  wealth   index  quintiles,   the   infant  mortality  rate  as  well  as  under-­‐five   mortality   rate   decrease   from   poorest   to   richest   quintile.     Infant   mortality   rate   is   132   for   the   poorest   quintile   while   the   richest   is   51   per   thousand.   Similarly,   under-­‐five   mortality   rates   are   223   and   76   per   thousand  respectively,  for  the  poorest  and  the  richest  quintiles.           MICS Nigeria, 2011; Main Report   Page  18     MICS Nigeria, 2011; Main Report   Page  19   V.   Nutrition       Nutritional  Status     Children’s   nutritional   status   is   a   reflection   of   their   overall   health.   When   children   have   access   to   an   adequate  food  supply,  are  not  exposed  to  repeated  illness,  and  are  well  cared  for,  they  reach  their  growth   potential  and  are  considered  well  nourished.     Malnutrition  is  associated  with  more  than  half  of  all  child  deaths  worldwide.    Undernourished  children  are   more  likely  to  die  from  common  childhood  ailments,  and  for  those  who  survive,  have  recurring  sicknesses   and   faltering   growth.     Three-­‐quarters   of   the   children  who  die   from   causes   related   to  malnutrition  were   only  mildly  or  moderately  malnourished  –  showing  no  outward  sign  of  their  vulnerability.  The  Millennium   Development  target   is  to  reduce  by  half  the  proportion  of  people  who  suffer  from  hunger  between  1990   and   2015.     A   reduction   in   the   prevalence   of   malnutrition   will   also   assist   in   the   goal   to   reduce   child   mortality.     In  a  well-­‐nourished  population,   there   is   a   reference  distribution  of  height  and  weight   for   children  under   age   five.   Under-­‐nourishment   in   a   population   can   be   gauged   by   comparing   children   to   a   reference   population.  The  reference  population  used  in  this  report  is  based  on  the  WHO  growth  standards4.  Each  of   the   three   nutritional   status   indicators   can   be   expressed   in   standard   deviation   units   (z-­‐scores)   from   the   median  of  the  reference  population.       Weight-­‐for-­‐age   is   a   measure   of   both   acute   and   chronic   malnutrition.   Children   whose   weight-­‐for-­‐age   is   more   than   two   standard   deviations   below   the   median   of   the   reference   population   are   considered   moderately   or   severely   underweight   while   those   whose   weight-­‐for-­‐age   is   more   than   three   standard   deviations  below  the  median  are  classified  as  severely  underweight.     Height-­‐for-­‐age   is   a  measure   of   linear   growth.   Children  whose   height-­‐for-­‐age   is  more   than   two   standard   deviations   below   the   median   of   the   reference   population   are   considered   short   for   their   age   and   are   classified   as  moderately   or   severely   stunted.   Those   whose   height-­‐for-­‐age   is   more   than   three   standard   deviations   below   the   median   are   classified   as   severely   stunted.   Stunting   is   a   reflection   of   chronic   malnutrition  as  a  result  of  failure  to  receive  adequate  nutrition  over  a  long  period  and  recurrent  or  chronic   illness.       Finally,   children  whose  weight-­‐for-­‐height   is  more   than   two  standard  deviations  below  the  median  of   the   reference  population  are  classified  as  moderately  or  severely  wasted,  while  those  who  fall  more  than  three   standard  deviations  below  the  median  are  classified  as  severely  wasted.  Wasting  is  usually  the  result  of  a   recent  nutritional  deficiency.  The  indicator  may  exhibit  significant  seasonal  shifts  associated  with  changes   in  the  availability  of  food  or  disease  prevalence.       In  MICS  4,  weights  and  heights  of  all  children  under  5  years  of  age  were  measured  using  anthropometric   equipment  recommended  by  UNICEF  (www.childinfo.org).  Findings  in  this  section  are  based  on  the  results   of  these  measurements.       Table  NU.1  shows  percentages  of  children  classified  into  each  of  the  above  described  categories,  based  on   the  anthropometric  measurements  that  were  taken  during   fieldwork.  Additionally,   the  table   includes  the   percentage   of   children   who   are   overweight,   which   takes   into   account   those   children   whose   weight   for   height  is  above  2  standard  deviations  from  the  median  of  the  reference  population,  and  mean  z-­‐scores  for   all  three  anthropometric  indicators.   4 http://www.who.int/childgrowth/standards/second_set/technical_report_2.pdf MICS Nigeria, 2011; Main Report   Page  20   Table  NU.1:  Nutritional  status  of  children   Percentage  of  children  under  age  5  by  nutritional  status  according  to  three  anthropometric  indices:  weight  for  age,  height  for  age,  and  weight  for   height,  Nigeria,  2011       Weight  for  age   Number  of   children   under  age  5   Height  for  age   Number  of   children   under  age  5       Weight  for  height   Underweight   Mean  Z-­‐ Score   (SD)     Stunted   Mean  Z-­‐ Score   (SD)   Wasted           Mean   Z-­‐Score   (SD)   Number   of   children  percent  below     percent  below   percent  below   percent   above   -­‐  2  SD1   -­‐  3  SD2       -­‐  2  SD3   -­‐  3  SD4    -­‐  2  SD5   -­‐  3  SD6   +  2  SD   Sex                             Male   24.4   9.3   -­‐1.1   12327   36.8   19.8   -­‐1.4   12193   11.0   3.6   3.2   -­‐.4   12354   Female   24.0   8.7   -­‐1.1   11843   34.9   18.8   -­‐1.3   11782   9.5   2.7   2.7   -­‐.4   11857   Area  of  residence                                               Urban   16.8   4.9   -­‐.8   7356   23.3   10.9   -­‐.9   7294   9.7   2.6   3.0   -­‐.4   7360   Rural   27.5   10.9   -­‐1.2   16814   41.3   22.9   -­‐1.6   16680   10.5   3.4   3.0   -­‐.4   16850   State                                               Abia   12.9   2.3   -­‐.7   476   14.0   5.3   -­‐.5   475   11.3   2.5   1.7   -­‐.5   476   Adamawa   27.4   10.7   -­‐1.3   591   47.3   24.1   -­‐1.9   588   6.4   1.1   1.4   -­‐.3   590   Akwa  ibom   13.6   3.3   -­‐.7   643   23.3   8.3   -­‐.9   642   4.5   .7   3.4   -­‐.3   642   Anambra   4.5   1.8   -­‐.4   715   11.1   4.3   -­‐.4   716   4.4   .9   .7   -­‐.3   716   Bauchi   35.9   16.3   -­‐1.6   1051   56.4   31.7   -­‐2.2   1047   9.1   2.5   1.7   -­‐.5   1046   Bayelsa   12.9   3.5   -­‐.7   322   15.9   7.4   -­‐.8   322   7.3   .9   1.8   -­‐.4   322   Benue   12.4   4.1   -­‐.5   596   26.0   11.3   -­‐1.0   593   4.9   1.2   4.7   .0   591   Borno   35.5   14.2   -­‐1.5   740   46.9   29.5   -­‐1.6   733   18.7   5.6   3.5   -­‐.8   737   Cross  River   13.0   3.6   -­‐.8   468   28.1   10.1   -­‐1.2   468   5.0   1.3   2.7   -­‐.2   466   Delta   15.7   4.2   -­‐.8   683   21.9   9.4   -­‐.8   681   10.3   2.7   2.3   -­‐.5   677   Ebonyi   16.6   3.8   -­‐.9   322   25.1   11.0   -­‐1.0   322   6.2   1.8   .9   -­‐.5   322   Edo   7.9   1.8   -­‐.5   504   14.6   5.3   -­‐.6   503   4.7   1.4   1.9   -­‐.3   503   Ekiti   8.7   2.9   -­‐.6   320   13.6   6.0   -­‐.8   318   6.1   .5   3.2   -­‐.1   320   Enugu   9.5   .0   -­‐.4   470   10.8   4.0   -­‐.5   461   7.1   2.6   2.7   -­‐.2   463   Gombe   37.1   14.3   -­‐1.6   456   56.3   29.6   -­‐2.1   447   12.3   4.1   2.8   -­‐.5   450   Imo   11.6   1.4   -­‐.6   535   14.6   3.0   -­‐.6   533   5.9   .7   1.3   -­‐.3   535   Jigawa   43.8   18.0   -­‐1.8   882   58.8   39.6   -­‐2.4   867   14.3   6.6   4.7   -­‐.5   874   Kaduna   27.2   11.0   -­‐1.3   1213   43.0   23.5   -­‐1.6   1180   11.9   4.5   2.2   -­‐.5   1212   Kano   37.4   15.1   -­‐1.5   1898   53.6   32.7   -­‐2.1   1883   10.6   2.8   3.5   -­‐.4   1912   Katsina   44.8   20.1   -­‐1.8   1049   61.9   40.1   -­‐2.5   1026   14.7   5.1   4.4   -­‐.5   1157   Kebbi   43.4   20.4   -­‐1.7   621   53.9   33.7   -­‐2.0   608   18.2   5.7   2.3   -­‐.8   613   Kogi   14.7   5.3   -­‐.6   434   26.7   10.3   -­‐1.0   429   6.4   1.3   6.0   .0   434   Kwara   21.5   6.5   -­‐1.1   425   29.5   15.1   -­‐1.1   423   11.5   3.9   .8   -­‐.6   424   Lagos   11.5   .7   -­‐.7   1443   8.9   2.1   -­‐.4   1440   11.6   2.6   1.4   -­‐.6   1444   Nasarawa   16.9   5.1   -­‐.9   326   33.2   15.1   -­‐1.3   325   6.2   1.7   2.3   -­‐.2   325   Niger   29.8   12.0   -­‐1.3   745   46.6   28.2   -­‐1.7   739   14.5   4.7   4.5   -­‐.4   740   Ogun   13.8   3.4   -­‐.9   574   19.8   7.1   -­‐.9   571   8.4   3.2   1.5   -­‐.5   571   Ondo   12.2   4.2   -­‐.7   486   43.2   20.5   -­‐1.6   481   5.7   3.1   13.9   .4   484   Osun   11.0   1.6   -­‐.8   529   22.2   6.6   -­‐1.0   529   6.6   .8   .6   -­‐.3   529   Oyo   20.0   4.3   -­‐1.0   944   27.3   9.5   -­‐1.1   936   11.1   3.1   2.8   -­‐.5   934   Plateau   19.6   5.8   -­‐.9   472   33.9   15.6   -­‐1.3   472   6.3   1.4   2.6   -­‐.1   469   Rivers   9.4   3.9   -­‐.4   763   13.5   6.2   -­‐.3   759   6.7   2.6   4.8   -­‐.3   761   Sokoto   31.8   14.2   -­‐1.5   763   47.5   24.9   -­‐1.8   760   16.7   6.4   3.9   -­‐.7   771   Taraba   19.6   5.9   -­‐1.0   363   40.0   20.6   -­‐1.5   358   6.2   2.6   3.7   -­‐.1   359   Yobe   48.0   22.3   -­‐2.0   484   64.8   40.4   -­‐2.5   480   14.9   4.9   2.3   -­‐.7   483   Zamfara   47.5   21.9   -­‐1.9   655   61.7   41.6   -­‐2.4   648   17.5   6.7   2.0   -­‐.7   653   FCT  (Abuja)   11.0   2.5   -­‐.7   210   19.6   7.0   -­‐.8   210   3.4   .6   1.8   -­‐.2   207   MICS Nigeria, 2011; Main Report   Page  21   Table  NU.1:  Nutritional  status  of  children  (continued)   Percentage  of  children  under  age  5  by  nutritional  status  according  to  three  anthropometric  indices:  weight  for  age,  height  for  age,  and  weight  for   height,  Nigeria,  2011       Weight  for  age   Number  of   children   under  age  5   Height  for  age   Number  of   children   under  age  5       Weight  for  height   Underweight   Mean  Z-­‐ Score   (SD)     Stunted   Mean  Z-­‐ Score   (SD)   Wasted           Mean   Z-­‐Score   (SD)   Number   of   children   percent  below     percent  below   percent  below   percent   above   -­‐  2  SD1   -­‐  3  SD2       -­‐  2  SD3   -­‐  3  SD4    -­‐  2  SD5   -­‐  3  SD6   +  2  SD   Age  in  months                             0-­‐5   14.4   5.4   -­‐.5   2540   14.7   6.2   -­‐.2   2501   14.1   4.5   4.6   -­‐.5   2504   6-­‐11   24.3   9.1   -­‐1.1   2701   19.0   8.9   -­‐.6   2665   19.9   6.3   2.3   -­‐.9   2693   12-­‐23   28.7   11.0   -­‐1.2   4860   37.0   19.3   -­‐1.4   4824   15.5   4.2   2.9   -­‐.7   4855   24-­‐35   25.4   11.7   -­‐1.1   4551   43.8   25.0   -­‐1.7   4510   7.3   2.7   3.1   -­‐.2   4573   36-­‐47   24.5   8.7   -­‐1.2   4957   43.9   25.4   -­‐1.8   4923   4.9   1.8   3.0   -­‐.1   4979   48-­‐59   23.5   6.7   -­‐1.2   4560   39.4   20.3   -­‐1.7   4552   5.6   1.3   2.4   -­‐.3   4607   Mother’s  education                                               None   36.3   15.4   -­‐1.5   10426   53.0   31.7   -­‐2.0   10306   12.7   4.4   3.5   -­‐.5   10481   Primary     20.6   6.6   -­‐1.0   4812   31.7   15.1   -­‐1.3   4780   8.9   2.1   2.4   -­‐.4   4817   Secondary  +   12.1   3.0   -­‐.7   8930   18.2   7.1   -­‐.7   8886   8.1   2.2   2.7   -­‐.4   8910   Missing/DK   (*)   (*)   (*)   (*)   (*)   (*)   (*)   (*)   (*)   (*)   (*)   (*)   (*)   Wealth  index  quintile                                               Poorest   38.2   16.8   -­‐1.6   5522   54.0   32.4   -­‐2.1   5442   13.2   4.6   3.3   -­‐.5   5529   Second   30.6   12.1   -­‐1.4   4969   48.5   27.8   -­‐1.9   4931   10.4   3.5   3.4   -­‐.4   4995   Middle   22.4   7.7   -­‐1.1   4528   34.9   16.6   -­‐1.4   4485   9.2   2.8   2.7   -­‐.4   4544   Fourth   16.8   4.8   -­‐.8   4643   23.6   10.6   -­‐1.0   4623   9.9   2.4   2.7   -­‐.4   4641   Richest   9.6   1.8   -­‐.5   4507   13.4   5.7   -­‐.5   4495   7.8   2.1   2.6   -­‐.4   4501   Geo-­‐political  zone                                                 North-­‐Cent   19.4   6.7   -­‐.9   3207   32.8   16.3   -­‐1.2   3191   8.4   2.4   3.6   -­‐.2   3190   North-­‐East   34.6   14.5   -­‐1.5   3686   52.5   29.8   -­‐2.0   3653   11.5   3.4   2.4   -­‐.5   3666   North-­‐West   38.4   16.5   -­‐1.6   7080   53.8   33.2   -­‐2.1   6972   13.9   4.9   3.4   -­‐.5   7191   South-­‐East   10.1   1.7   -­‐.5   2518   14.1   5.0   -­‐.6   2508   6.8   1.6   1.4   -­‐.3   2512   South-­‐South   12.1   3.4   -­‐.7   3383   19.5   7.8   -­‐.7   3375   6.5   1.7   3.0   -­‐.3   3370   South-­‐West   13.5   2.5   -­‐.8   4296   20.3   7.3   -­‐.9   4275   9.4   2.5   3.2   -­‐.4   4281                                 Total   24.2   9.0   -­‐1.1   24170   35.8   19.3   -­‐1.4   23975   10.2   3.1   3.0   -­‐.4   24210                                   1  MICS  indicator  2.1a   2  MICS  indicator  2.1b   3  MICS  indicator  2.2a,   4  MICS  indicator  2.2b   5  MICS  indicator  2.3a,   6  MICS  indicator  2.3b   The  nutritional  status  table  based  on  the  NCHS/CDC/WHO  reference  can  be  produced  if  needed     (*)  less  than  25  unweighted  cases     MICS Nigeria, 2011; Main Report   Page  22   Children  whose  full  birth  date  (month  and  year)  were  not  obtained  and  children  whose  measurements  are   outside  a  plausible   range  are  excluded   from  Table  NU.1.  Children  are  excluded   from  one  or  more  of   the   anthropometric  indicators  when  their  weights  and  heights  have  not  been  measured,  whichever  applicable.   For  example  if  a  child  has  been  weighed  but  his/her  height  has  not  been  measured,  the  child  is  included  in   underweight  calculations,  but  not  in  the  calculations  for  stunting  and  wasting.  Percentages  of  children  by   age  and  reasons  for  exclusion  are  shown  in  the  data  quality  tables  DQ.6  and  DQ.7.  Overall  97  percentage  of   children   had   both   their   weights   and   heights   measured   (Table   DQ.6).   Table   DQ.7   shows   that   due   to   incomplete   dates   of   birth,   implausible   measurements,   and   missing   weight   and/or   height,   4   percent   of   children   have   been   excluded   from   calculations   of   the   weight-­‐for-­‐age   indicator,   while   the   figures   are   5   percent  for  the  height-­‐for-­‐age  indicator,  and  4  percent  for  the  weight-­‐for-­‐height  indicator.       More  than  one  in  five  (15  percent)  of  children  under  age  five  in  Nigeria  are  moderately  underweight  and  9   percent  are  classified  as  severely  underweight  (Table  NU.1).  More  than  one  in  five  children  (17  percent)  are   moderately  stunted  or   too  short   for   their  age  and  7  percent  are  moderately  wasted  or   too  thin   for   their   height.  Severely  stunted  and  severely  wasted  are  19percent  and  about  3  percent  respectively.           Children   in   North   are   more   likely   to   be   underweight   and   stunted   than   other   children.   In   contrast,   the   percentage  (14)  wasted  is  highest  in  North-­‐West  while  the  South-­‐South  has  the  lowest  at  7  percent.     Those  children  whose  mothers  have  secondary  or  higher  education  are   the   less   likely   to  be  underweight   and  stunted  compared  to  children  of  mothers  with  no  education.  Boys  appear  to  be  slightly  more  likely  to   be   underweight,   stunted,   and   wasted   than   girls.   The   age   pattern   shows   that   a   higher   percentage   of   children  aged  12-­‐23  months  are  undernourished  according   to  all   three   indices   in   comparison   to  children   who  are  younger  and  older  (Figure  NU.1).  This  pattern  is  expected  and  is  related  to  the  age  at  which  many   children  cease  to  be  breastfed  and  are  exposed  to  contamination  in  water,  food,  and  environment.         MICS Nigeria, 2011; Main Report   Page  23     Table  NU.2:  Initial  breastfeeding   Percentage  of  last-­‐born  children  in  the  2  years  preceding  the  survey  who  were  ever  breastfed,  percentage  who  were   breastfed  within  one  hour  of  birth  and  within  one  day  of  birth,  and  percentage  who  received  a  prelacteal  feed,  Nigeria,  2011           Percentage  who   were  ever   breastfed1   Percentage  who  were  first   breastfed:   Percentage  who   received  a   prelacteal  feed   Number  of  last-­‐born   children  in  the  two   years  preceding  the   survey   Within  one   hour  of  birth2    Within  one   day  of  birth   State               Abia   96.8   19.1   83.0   55.6   189   Adamawa   97.4   25.0   63.1   49.3   226   Akwa  ibom   96.3   28.6   63.2   36.3   254   Anambra   96.2   26.5   63.2   65.1   270   Bauchi   98.2   6.5   52.3   90.0   455   Bayelsa   97.1   26.3   68.5   53.7   144   Benue   97.6   32.5   74.0   42.9   244   Borno   94.5   26.6   76.1   75.1   270   Cross  River   97.4   32.0   80.4   51.5   203   Delta   98.8   30.1   76.2   54.0   293   Ebonyi   95.7   30.7   79.8   33.4   137   Edo   96.7   41.1   69.0   42.9   204   Ekiti   99.2   15.4   86.5   27.5   152   Enugu   97.1   24.6   58.1   79.8   181   Gombe   97.9   26.4   61.7   62.4   175   Imo   97.3   29.7   71.2   64.5   180   Jigawa   96.6   16.6   50.9   89.0   333   Kaduna   96.6   17.2   77.4   67.3   494   Kano   96.2   23.2   75.8   84.2   725   Katsina   61.8   16.6   33.6   45.6   443   Kebbi   95.7   20.1   55.7   77.8   252   Kogi   99.3   41.9   73.4   50.2   161   Kwara   96.6   29.4   76.0   30.4   168   Lagos   99.1   22.6   62.8   35.6   686   Nasarawa   95.2   28.1   75.2   45.4   157   Niger   99.3   12.8   64.4   76.0   285   Ogun   99.8   18.1   66.7   52.0   272   Ondo   98.9   27.7   88.1   22.8   206   Osun   99.1   7.9   83.6   27.7   215   Oyo   98.4   20.3   81.8   33.0   416   Plateau   97.0   34.2   73.2   44.5   196   Rivers   95.9   26.1   71.4   55.2   318   Sokoto   96.5   39.3   90.6   59.3   273   Taraba   95.7   30.7   75.5   44.4   145   Yobe   96.4   13.7   52.3   80.3   191   Zamfara   89.2   5.9   46.0   73.5   275   FCT  (Abuja)   99.1   26.7   77.8   51.6   90     (*)  less  than  25  unweighted  cases                     MICS Nigeria, 2011; Main Report   Page  24   Table  NU.2:  Initial  breastfeeding  (continued)   Percentage  of  last-­‐born  children  in  the  2  years  preceding  the  survey  who  were  ever  breastfed,  percentage  who  were   breastfed  within  one  hour  of  birth  and  within  one  day  of  birth,  and  percentage  who  received  a  prelacteal  feed,  Nigeria,  2011           Percentage   who  were   ever   breastfed1   Percentage  who  were  first   breastfed:   Percentage  who   received  a   prelacteal  feed   Number  of  last-­‐born   children  in  the  two   years  preceding  the   survey   Within  one   hour  of  birth2    Within  one   day  of  birth   Area  of  residence             Urban   97.2   23.4   71.9   47.3   3122   Rural   94.8   22.7   66.5   62.0   6757   Months  since  birth             0-­‐11  months   94.5   21.9   67.2   56.2   5165   12-­‐23  months   96.6   24.0   69.4   58.9   4616   Assistance  at  delivery           Skilled  attendant   97.7   25.9   72.6   45.8   4814   Traditional  birth  attendant   97.5   18.6   69.1   72.7   1509   Other/Missing   97.8   23.2   69.6   70.1   2312   Place  of  delivery             Public  sector  health  facility   97.8   29.4   76.3   42.2   2369   Private  sector  health   facility   98.0   22.9   69.2   48.1   2088   Home   97.9   21.2   66.7   72.1   4916   Other/Missing   51.7   9.2   41.0   23.0   506   Mother’s  education           None   93.7   19.9   62.4   71.2   3951   Primary   96.5   23.0   72.3   54.4   1852   Secondary  +   96.8   25.8   72.0   45.2   4076   Missing/DK   (*)   (*)   (*)   (*)   (*)   Wealth  index  quintile           Poorest   95.2   18.3   58.7   70.9   2167   Second   92.4   21.3   66.1   63.2   2002   Middle   95.7   23.0   72.2   57.8   1830   Fourth   96.6   27.3   75.9   48.8   1963   Richest   97.8   25.1   69.5   44.1   1917   Geo-­‐political  zone             North-­‐Central   97.8   28.3   72.4   50.6   1301   North-­‐East   96.9   18.8   61.8   71.9   1463   North-­‐West   90.2   19.9   63.1   71.6   2795   South-­‐East   96.6   25.9   70.0   61.4   956   South-­‐South   97.0   30.4   71.6   49.1   1417   South-­‐West   99.0   19.8   74.2   34.5   1948                 Total   95.5   22.9   68.2   57.3   9879   1  MICS  indicator  2.4   2  MICS  indicator  2.5     (*)  less  than  25  unweighted  cases     MICS Nigeria, 2011; Main Report   Page  25   Children  in  the  rural  area  of  the  country  are  more  undernourished  than  their  counterparts  in  urban  area.     The  percentage  of  children,  who  are  moderately  underweighted,  stunted  and  wasted  in  urban  area  are  17,   23  and  10  percent  respectively,  while  those  of  rural  area  are  28,  41  and  11  percent  respectively.  Similarly,   percentage  of  children,  who  are  severely  underweighted,  stunted  and  wasted  in  urban  area  are  5,  11  and  3   percent  respectively.    The  values  for  rural  area  are  11,  23  and  3  percent  respectively.     Level   of   education   of   mother   has   influence   on   the   nutritional   status   of   the   children.   Children   whose   mothers   have   secondary   or   higher   education   have   relatively   lower   rates   of   underweight,   stunting   or   wasting  than  their  counterparts  with  no  formal  education.    Table  NU.1  shows  that  children  whose  mothers   have  no  education  have   rates  of  21,  21  and  8  percent   respectively   for  moderately  underweight,   stunted   and   wasted;     while   the   rates   for   severe   underweight,   stunted   and   wasted   are   15,   32   and   4   percent   respectively.     Prevalence   of   malnourishments   decreases   as   wealth   status   improves   from   poorest   to   richest   quintiles.   Undernourishment  increases  from  about  10  to  38  percent,  for  underweight,  13  to  54  percent  for  stunting   and  about  8  to  13  percent  for  wasting     Breastfeeding  and  Infant  and  Young  Child  Feeding     Breastfeeding   for   the   first   few   years   of   life   protects   children   from   infection,   provides   an   ideal   source  of   nutrients,  and  is  economical  and  safe.  However,  many  mothers  stop  breastfeeding  too  soon  and  there  are   often  pressures   to   switch   to   infant   formula,  which   can   contribute   to   growth   faltering   and  micronutrient   malnutrition  and  is  unsafe  if  clean  water  is  not  readily  available.       WHO/UNICEF  have  the  following  feeding  recommendations:   • Exclusive  breastfeeding  for  first  six  months   • Continued  breastfeeding  for  two  years  or  more                                                             • Safe  and  age-­‐appropriate  complementary  foods  beginning  at  6  months   • Frequency  of  complementary  feeding:  2  times  per  day  for  6-­‐8  month  olds;  3  times  per  day  for    9-­‐11   month  olds     It  is  also  recommended  that  breastfeeding  be  initiated  within  one  hour  of  birth.     The  indicators  related  to  recommended  child  feeding  practices  are  as  follows:   • Early  initiation  of  breastfeeding  (within  1  hour  of  birth)   • Exclusive  breastfeeding  rate  (<  6  months)   • Predominant  breastfeeding  (<  6  months)   • Continued  breastfeeding  rate  (at  1  year  and  at  2  years)   • Duration  of  breastfeeding   • Age-­‐appropriate  breastfeeding  (0-­‐23  months)   • Introduction  of  solid,  semi-­‐solid  and  soft  foods  (6-­‐8  months)   • Minimum  meal  frequency  (6-­‐23  months)   • Milk  feeding  frequency  for  non-­‐breastfeeding  children  (6-­‐23  months)   • Bottle  feeding  (0-­‐23  months)     Table  NU.2  shows  the  proportion  of  children  born   in   the  two  years  preceding  the  survey  who  were  ever   breastfed,  those  who  were  first  breastfed  within  one  hour  and  one  day  of  birth,  and  those  who  received  a   prelacteal   feed.   Although   a   very   important   step   in   management   of   lactation   and   establishment   of   a   physical   and   emotional   relationship   between   the   baby   and   the   mother,   only   23   percent   of   babies   is   breastfed   for   the   first   time   within   one   hour   of   birth,   while   68   percent   of   new-­‐borns   in   Nigeria   start   breastfeeding  within  one  day  of  birth  and  about  57  percent  received  a  prelatic  feed.       MICS Nigeria, 2011; Main Report   Page  26   Ninety-­‐seven  percent  of   children  were  ever  breastfed   in  urban  area  while   it  was  95  percent   in   the   rural   area.     About   23   and   23   percent   were   breastfed   within   one   hour   of   birth   in   urban   and   rural   areas   respectively.   About   72   percent   and   67   percent  were   breastfed  within   one   day   in   urban   and   rural   areas   respectively.         Comparative   analysis   among   the   geopolitical   zones   indicate   that   percentage   of   children  who  were   ever   breastfed  was  between  90  percent  and  99  percent;  the  lowest  was  90  percent   in  North-­‐West  and  South-­‐ West   recorded   the   highest   percentage   of   99   percent.     The   percentage   of   children   that   were   breastfed   within  one  hour  of  birth  was  between  19  and  30  percent  and  those  that  were  breastfed  within  one  day  was   62  and  74  percent  across  the  geopolitical  zones.    Percentage  of  those  who  received  prelatic  feed  was  about   72  percent  in  North-­‐East  and  North-­‐West  zones  while  it  was  about  35  percent  in  South-­‐West.             In   Table   NU.3,   breastfeeding   status   is   based   on   the   reports   of   mothers/caretakers   of   children’s   consumption   of   food   and   fluids   during   the   previous   day   or   night   prior   to   the   interview.   Exclusively   breastfed  refers  to  infants  who  received  only  breast  milk  (and  vitamins,  mineral  supplements,  or  medicine).   The  table  shows  exclusive  breastfeeding  of  infants  during  the  first  six  months  of  life,  as  well  as  continued   breastfeeding  of  children  at  12-­‐15  and  20-­‐23  months  of  age.       MICS Nigeria, 2011; Main Report   Page  27     Table  NU.3:  Breastfeeding     Percentage  of  living  children  according  to  breastfeeding  status  at  selected  age  groups,  Nigeria,  2011       Children  age  0-­‐5  months   Children  age  12-­‐15  months     Children  age  20-­‐23  months       Percent   exclusively   breastfed1   Percent   predominantly   breastfed2   Number   of   children   Percent   breastfed   (Continued   breastfeeding   at  1  year)3   Number  of   children   Percent   breastfed   (Continued   breastfeeding   at  2  years)4   Number   of   children   Sex                 Male   15.9   70.1   1376   78.5   986   32.6   825   Female   14.1   69.6   1283   80.1   935   36.6   742   Area  of  residence                 Urban   20.6   69.7   716   76.5   566   23.2   558   Rural   13.0   70.0   1943   80.4   1355   40.7   1009   Mother’s  education               None   8.4   77.4   1162   88.3   857   58.2   635   Primary     18.5   69.3   522   79.6   342   31.6   293   Secondary  +   21.2   61.2   975   68.4   723   12.3   640   Wealth  index  quintile               Poorest   10.3   77.7   656   86.9   474   55.0   318   Second   11.9   74.1   571   87.6   429   52.7   310   Middle   12.5   64.2   485   72.0   357   29.3   287   Fourth   21.5   65.1   493   74.1   348   25.8   344   Richest   21.6   64.4   454   70.4   313   9.5   309   Geo-­‐political  zone                 North-­‐  Central   23.8   72.0   341   83.5   227   30.4   217   North-­‐East   12.8   77.5   402   88.1   348   55.0   228   North-­‐West   6.2   78.0   864   89.6   580   66.7   408   South-­‐East   13.5   49.5   281   59.7   198   8.5   145   South-­‐South   16.8   50.6   310   62.5   254   14.0   240   South-­‐West   27.0   71.9   461   73.3   314   9.4   329                     Total   15.1   69.9   2659   79.3   1921   34.5   1567   1  MICS  indicator  2.6   2  MICS  indicator  2.9   3  MICS  indicator  2.7   4  MICS  indicator  2.8       MICS Nigeria, 2011; Main Report   Page  28   About  15  percent  of  children  aged  less  than  six  months  are  exclusively  breastfed,  a  level  considerably  lower   than  recommended.  By  age  12-­‐15  months,  79  percent  of  children  are  still  being  breastfed  and  by  age  20-­‐23   months,  35  percent  are  still  breastfed.  Boys  (16  percent)  were  more  likely  to  be  exclusively  breastfed  than   girls  (14  percent).     There  is  no  significant  difference  in  the  pattern  of  continued  breastfeeding  for  male  and  female  children  at   age   one   or   age   two.     For   female   children,   about   80   percent   continued   receiving   breast  milk   at   age   one   while   the   percentage  was   reduced   to   37   at   age   two.   Similar   pattern   is   also   observed   for  male   children.   About  78  percent   continued   receiving  breast  milk   at   age  one  but   the  percentage  was  33  percent  at   age   two.    More  children  in  the  urban  areas  are  exclusively  breastfed  in  the  first  five  months  of  life  than  children   in  rural  areas  (21  percent  versus  13  percent).    Conversely,  percentage  of  children  that  were  predominantly   being   breastfed   was   higher   in   rural   area   than   in   urban.   In   urban   area,   about   77   percent   of   children   continued  receiving  breast  milk  at  age  one  while  only  23  percent  continued  at  age  two  years.    Similarly  in   the   rural  area,  80  percent  continued  receiving  breast  milk  at  age  one  while  41  percent  continued  at  age   two.     The  table  shows  that  both  education  and  wealth  status  of  mothers  are  influential  to  the  feeding  pattern  of   children.   Children   of   mothers   with   secondary   or   higher   education   fare   best   with   respect   to   exclusive   breastfeeding  in  early  life.    Percentage  of  children  whose  mothers  have  at  least  secondary  education  and   who   received   exclusive   breastfeeding   is   about   21   percent,  while   those   of  mothers  with   no   education   is   about  8  percent.    Percentage  of  children  (0  –  5  months)  who  were  exclusively  breastfed  increase  as  wealth   status  improves.    It  was  22  percent  for  richest  quintile  and  about  10  percent  for  the  poorest.    Percentage  of   predominantly  breastfed  decreases  as  the  wealth  status  improves,  about  78  to  64  percent  from  poorest  to   richest.     Also   the   percentage   of   children  who   continue   receiving   breast  milk   at   age   one   or   two   years   is   decreasing  as  the  wealth  status  of  mother  improves.     Figure  NU.3  shows  the  detailed  pattern  of  breastfeeding  by  the  child’s  age  in  months.  Even  at  the  earliest   ages,  the  majority  of  children  are  receiving  liquids  or  foods  other  than  breast  milk.  By  the  end  of  the  sixth   month,  the  percentage  of  children  exclusively  breastfed  is  3  percent.  Only  about  22  percent  of  children  are   receiving  breast  milk  after  2  years.           MICS Nigeria, 2011; Main Report   Page  29   Table  NU.4   shows   the  median   duration   of   breastfeeding   by   selected   background   characteristics.   Among   children  under  age  3,   the  median  duration   is  about  18  months   for  any  breastfeeding,  about  a  month  for   exclusive  breastfeeding,  and  about  6  months  for  predominant  breastfeeding.    For  male  and  female  under   age   3,   the  median   duration   is   over   18  months   for   any   breastfeeding,   about   half   a  month   for   exclusive   breastfeeding  for  both  sexes  and  about  5  months  for  predominant  breastfeeding  for  male  and  female.  The   median  duration  for  any  breastfeeding  among  children  under  age  3  in  the  urban  area  is  16  months  which  is   lower  than  the  median  duration  in  rural  area  which  is  about  20  months.  The  median  duration  is  about  half   a   month   for   exclusive   breastfeeding   in   both   urban   and   rural   area   and   about   4   and   5months   for   predominant  breastfeeding   in  urban  and  rural  areas.  Among  the  mothers  who  have  secondary  education   or  more,  the  median  duration  of  children  under  age  3  who  received  any  breastfeeding  is  about  15  months   while   it  was   about   22  months   for  mothers  with   no   education.   Gender   of   child,   education   of  mother   or   wealth  status  has  little  or  no  influence  in  the  median  duration  of  exclusive  breastfeeding  of  children.    For   any  breastfeeding,  the  median  duration  is  higher  for  the  poorest  quintile  (about  22  months)  and  lowest  for   the  richest  (15  months).    Median  duration  for  predominant  breastfeeding  is  about  4  months  for  the  richest   quintile  and  7  months  for  the  poorest  quintile.       In  the  Northern  zones,  the  median  duration  of  any  breastfeeding  is  between  18  and  22  months,  while  it  is   between  14  to  16  months  in  the  southern  zones.    Median  duration  for  exclusive  breastfeeding  is  less  than   one   month   in   all   the   zones.   For   predominant   breastfeeding,   North-­‐West   zone   has   the   highest   median   duration  of  about  7  months  while  South-­‐East  and  South-­‐South  zones    have   the   lowest  of  about   two  and   half  months.   MICS Nigeria, 2011; Main Report   Page  30       Table  NU.4:  Duration  of  breastfeeding   Median  duration  of  any  breastfeeding,  exclusive  breastfeeding,  and  predominant  breastfeeding  among   children  age  0-­‐35  months,  Nigeria,  2011       Median  duration  (in  months)  of   Number  of  children   age  0-­‐35  months  Any   breastfeeding1   Exclusive   breastfeeding   Predominant   breastfeeding   Sex             Male   17.9   .5   4.9   7727   Female   18.9   .5   4.6   7437   State           Abia   13.2   .5   4.1   304   Adamawa   20.8   .5   8.5   370   Akwa  ibom   14.0   1.5   2.2   375   Anambra   13.4   .5   2.0   462   Bauchi   20.9   .4   6.5   666   Bayelsa   14.7   .6   2.3   204   Benue   16.9   1.0   5.4   373   Borno   22.2   .4   3.3   440   Cross  River   15.6   .6   3.4   302   Delta   17.8   .4   3.1   416   Ebonyi   16.9   .7   5.1   207   Edo   18.1   .6   4.0   322   Ekiti   15.9   1.0   7.1   195   Enugu   15.6   .5   3.0   291   Gombe   19.5   .5   8.2   262   Imo   13.9   .5   1.4   336   Jigawa   21.7   .4   9.0   516   Kaduna   21.2   .4   4.1   743   Kano   22.1   .4   5.8   1168   Katsina   22.4   .4   8.1   721   Kebbi   22.3   .4   6.5   385   Kogi   20.5   .6   5.6   263   Kwara   17.2   .6   4.0   267   Lagos   15.6   1.6   3.4   980   Nasarawa   19.0   .7   5.3   209   Niger   21.6   .5   4.0   433   Ogun   14.0   .4   3.8   399   Ondo   16.3   .5   5.6   310   Osun   16.2   2.1   5.6   336   Oyo   16.7   .7   4.8   633   Plateau   19.1   .9   5.8   286   Rivers   12.0   .4   1.7   484   Sokoto   22.5   .4   10.3   449   Taraba   21.3   .4   6.0   240   Yobe   23.0   .5   8.9   296   Zamfara   23.9   .4   5.9   383   FCT  (Abuja)   16.3   .4   3.4   135   MICS Nigeria, 2011; Main Report   Page  31   Table  NU.4:  Duration  of  breastfeeding    (continued)   Median  duration  of  any  breastfeeding,  exclusive  breastfeeding,  and  predominant  breastfeeding  among  children  age   0-­‐35  months,  Nigeria,  2011       Median  duration  (in  months)  of   Number  of  children   age  0-­‐35  months  Any   breastfeeding1   Exclusive   breastfeeding   Predominant   breastfeeding   Area  of  residence           Urban   16.0   .5   4.0   4752   Rural   20.1   .5   5.3   10413   Mother’s  education           None   21.7   .4   6.3   6302   Primary   18.4   .5   4.8   2906   Secondary  +   15.4   .6   3.6   5956   Wealth  index  quintile           Poorest   21.6   .4   7.1   3395   Second   21.3   .5   5.5   3071   Middle   17.0   .5   4.2   2793   Fourth   16.0   .6   3.8   2925   Richest   15.3   .6   3.7   2981   Geo-­‐political  zone             North-­‐Central   18.6   .6   4.9   1966   North-­‐East   21.4   .4   6.5   2274   North-­‐West   22.1   .4   6.6   4366   South-­‐East   14.5   .5   2.5   1600   South-­‐South   15.1   .5   2.6   2104   South-­‐West   15.7   .7   4.2   2854                 Median   19.5   .5   5.2   14964               Mean  for  all  children  (0-­‐35  months)   18.3   1.0   6.3   15165   1  MICS  indicator  2.10     The  adequacy  of  infant  feeding  in  children  less  than  24  months  is  provided  in  Table  NU.5.    Different  criteria   of  feeding  are  used  depending  on  the  age  of  the  child.  For  infants  aged  0-­‐5  months,  exclusive  breastfeeding   is   considered   as   age-­‐appropriate   feeding,   while   infants   aged   6-­‐23   months   are   considered   to   be   appropriately  fed  if  they  are  receiving  breast  milk  and  solid,  semi-­‐solid  or  soft  food.  Percentage  of  children   aged  0   -­‐  5  months  who  were  exclusively  breastfed  during   the  previous  24  hours   is  15.  About  21  percent   and  13  percent  are  exclusively  breastfed  in  urban  and  rural  area  respectively.    Children  whose  mother  has   secondary   education   or  more   have   higher   percentage   of   exclusive   breastfeeding   than  mothers   with   no   education  (21  percent  versus  8  percent).    As  wealth  status  of  mother  improves,  the  percentage  of  children   (age  0  –  5  months)  receiving  exclusive  breastfeeding  increases,  the  richest  quintile  is  22  percent  while  the   poorest  is  about  10  percent.    Percentage  of  children  age  0  –  5  months  who  receive  exclusive  breastfeeding   was  about  27  percent  in  South-­‐west  which  is  the  highest  and  the  lowest  is  from  North-­‐west  (6  percent).  As   a  result  of  these  feeding  patterns,  only  35  percent  of  children  aged  6-­‐23  months  are  being  appropriately   fed.  Age-­‐appropriate  feeding  among  all  infants  age  0-­‐5  months  drops  to  15  percent.       Percentage  of  children  age  6  –  23  months  who  were  currently  being  breastfed  and  receiving  solid,   semi-­‐ solid  or  soft  food  is  41  percent.    The  percentage  is  about  42  and  40  for  female  and  male  respectively.     In   urban  and  rural  areas,  about  35  and  44  percent  of  children  age  6  –  23  months  are  currently  being  breastfed   and  receiving  solid,  semi-­‐solid  or  soft  food.       MICS Nigeria, 2011; Main Report   Page  32    It  is  about  54  percent  in  NorthEast  and  29  percent  in  South-­‐West.    Education  of  mothers  also  show  some   differences,     the   percentage   of   the   children   age   6   –   23  months  who   are   currently   being   breastfed   and   receiving  solid,  semi-­‐solid  or  soft  food  whose  their  mothers  have  secondary  education  is  about  32  percent   while  mothers  with  no  education  is  51  percent.    The  percentage  decreases  as  the  wealth  status  of  mother   improves,  about  52  percent  for  poorest  and  2  7percent  for  richest  quintiles.    Considering  children  age  0  –   23  months  about  35  percent  received  appropriate  breastfeed,  the  percentage  for  male  and  female  is  about   35  percent.     It   is  about  32  and  36  percent   for  urban  rural  areas  respectively.    About  38  to  44  percent  of   children  age  0  –  23  months  are  appropriately  breastfed  in  Northern  zones  while  the  percentage  is  between   27  and  29  percent  in  Southern  zones.                   MICS Nigeria, 2011; Main Report   Page  33       Table  NU.5:  Age-­‐appropriate  breastfeeding   Percentage  of  children  age  0-­‐23  months  who  were  appropriately  breastfed  during  the  previous  day,  Nigeria,  2011       Children  age  0-­‐5   months   Children  age  6-­‐23  months   Children  age  0-­‐23  months   Percent   exclusively   breastfed1   Number   of   children   Percent  currently   breastfeeding  and   receiving  solid,  semi-­‐ solid  or  soft  foods   Number   of   children   Percent   appropriately   breastfed2   Number  of   children   Sex               Male   15.9   1376   40.3   3948   34.0   5325   Female   14.1   1283   42.3   3810   35.2   5093   State               Abia   11.9   55   23.5   150   20.4   205   Adamawa   18.1   68   44.6   176   37.2   243   Akwa  ibom   24.7   46   29.4   206   28.6   252   Anambra   9.9   83   35.0   208   27.9   291   Bauchi   6.0   123   66.9   361   51.5   484   Bayelsa   19.3   33   25.8   111   24.3   144   Benue   28.2   65   43.3   191   39.4   257   Borno   10.5   82   58.7   237   46.3   320   Cross  River   18.5   50   40.0   160   34.9   210   Delta   9.3   75   34.3   231   28.2   305   Ebonyi   30.0   41   36.4   111   34.7   152   Edo   24.8   60   25.8   154   25.5   214   Ekiti   47.2   30   30.2   121   33.6   152   Enugu   12.4   50   32.3   155   27.5   204   Gombe   15.2   37   45.5   139   39.0   176   Imo   8.9   53   30.7   146   24.9   199   Jigawa   6.4   110   54.0   228   38.5   339   Kaduna   8.4   158   52.4   358   39.0   516   Kano   6.5   221   50.0   576   38.0   797   Katsina   6.3   156   52.5   343   38.1   499   Kebbi   6.6   77   58.9   190   43.8   266   Kogi   20.4   40   30.6   133   28.2   173   Kwara   28.2   40   33.0   143   31.9   182   Lagos   28.1   123   25.4   586   25.9   708   Nasarawa   34.4   36   45.9   106   42.9   143   Niger   13.9   90   52.7   209   41.1   299   Ogun   13.6   78   15.9   197   15.2   275   Ondo   8.6   51   27.7   157   23.1   207   Osun   40.7   61   31.3   167   33.8   228   Oyo   30.4   119   43.4   321   39.9   439   Plateau   33.5   49   54.8   145   49.4   194   Rivers   7.5   47   29.9   266   26.5   314   Sokoto   1.2   75   32.7   223   24.7   299   Taraba   30.0   38   43.9   114   40.4   153   Yobe   11.3   54   44.4   151   35.7   204   Zamfara   4.5   67   56.4   212   43.9   279   FCT  (Abuja)   10.4   21   30.5   75   26.1   96   MICS Nigeria, 2011; Main Report   Page  34   Table  NU.5:  Age-­‐appropriate  breastfeeding  (continued)   Percentage  of  children  age  0-­‐23  months  who  were  appropriately  breastfed  during  the  previous  day,  Nigeria,  2011       Children  age  0-­‐5   months   Children  age  6-­‐23  months   Children  age  0-­‐23  months   Percent   exclusively   breastfed1   Number   of   children   Percent  currently   breastfeeding  and   receiving  solid,  semi-­‐ solid  or  soft  foods   Number   of   children   Percent   appropriately   breastfed2   Number  of   children   Area  of  residence               Urban   20.6   716   35.0   2560   31.8   3276   Rural   13.0   1943   44.4   5199   35.8   7142   Mother’s  education               None   8.4   1162   51.0   3149   39.5   4311   Primary   18.5   522   39.9   1420   34.1   1942   Secondary  +   21.2   975   32.3   3190   29.7   4165   Wealth  index  quintile               Poorest   10.3   656   52.4   1677   40.5   2333   Second   11.9   571   50.7   1565   40.3   2136   Middle   12.5   485   39.2   1424   32.4   1909   Fourth   21.5   493   35.9   1540   32.4   2033   Richest   21.6   454   27.0   1553   25.8   2007   Geo-­‐political  zone                 North-­‐Central   23.8   341   43.1   1002   38.2   1343   North-­‐East   12.8   402   54.3   1178   43.7   1580   North-­‐West   6.2   864   50.9   2131   38.0   2995   South-­‐East   13.5   281   31.6   770   26.7   1052   South-­‐South   16.8   310   31.2   1128   28.1   1439   South-­‐West   27.0   461   29.2   1549   28.7   2010                   Total   15.1   2659   41.3   7759   34.6   10418   1  MICS  indicator  2.6   2  MICS  indicator  2.14     Appropriate   complementary   feeding   of   children   from   6   months   to   two   years   of   age   is   particularly   important   for   growth   and   development   and   the   prevention   of   undernutrition.   Continued   breastfeeding   beyond  six  months  should  be  accompanied  by  consumption  of  nutritionally  adequate,  safe  and  appropriate   complementary  foods  that  help  meet  nutritional  requirements  when  breastmilk  is  no  longer  sufficient.  This   requires  that  for  breastfed  children,  two  or  more  meals  of  solid,  semi-­‐solid  or  soft  foods  are  needed  if  they   are   six   to   eight  months  old,   and   three  or  more  meals   if   they   are   9-­‐23  months  of   age.   For   children  6-­‐23   months  and  older  who  are  not  breastfed,  four  or  more  meals  of  solid,  semi-­‐solid  or  soft  foods  or  milk  feeds   are  needed.     Overall,   33   percent   of   infants   age   6-­‐8   received   solid,   semi-­‐solid,   or   soft   foods   (Table   NU.6).   Among   currently  breastfeeding  infants  this  percentage  is  32  percent  while  it  is  50  percent  among  infants  currently   not  breastfeeding.     Infant  age  6  –  8  months  who  are  currently  being  breastfed  and  receiving  solid,  semi-­‐solid  or  soft   food   in   rural  area  is  about  31  percent  and  35  percent  in  urban  area.    Those  who  are  not  currently  being  fed  with   breast   milk   but   receiving   solid,   semi-­‐solid   or   soft   food   is   about   41   and   62   percent   in   rural   and   urban   respectively.    There  are  differences  in  proportion  for  the  geopolitical  zones  of  the  country.    For  infant  6  –  8   months  who  are  currently  being  breastfed  and  receiving  solid,  semi-­‐solid  or  soft  food,  the  percentage  was   48  percent   in  South-­‐east  which   is   the  highest  while   it   is  28  percent   in  South-­‐west  which   is   the   lowest.   In   MICS Nigeria, 2011; Main Report   Page  35   South-­‐west,  about  76  percent  of  infant  (6  –  8  months)  are  currently  not  being  breastfed  but  receiving  solid,   semi-­‐solid  or  soft  food  which  is  highest.    South-­‐south  recorded  the  lowest  percentage  of  about  21  percent.     Table  NU.6:  Introduction  of  solid,  semi-­‐solid  or  soft  foods   Percentage  of  infants  age  6-­‐8  months  who  received  solid,  semi-­‐solid  or  soft  foods  during  the  previous  day,  Nigeria,  2011       Currently  breastfeeding     Currently  not   breastfeeding   All     Percent   receiving   solid,  semi-­‐ solid  or  soft   foods   Number   of   children   age  6-­‐8   months   Percent   receiving   solid,  semi-­‐ solid  or   soft  foods   Number   of  children   age  6-­‐8   months   Percent   receiving   solid,  semi-­‐ solid  or   soft  foods1   Number  of   children  age  6-­‐8   months   Sex               Male   31.1   687   64.9   30   32.5   717   Female   33.2   690   35.0   32   33.3   722   Residence               Urban   34.7   449   62.1   25   36.2   474   Rural   30.9   929   40.9   37   31.3   966   Geo-­‐political  zone                 North-­‐Central   37.0   171   19.8   4   36.6   175   North-­‐East   30.3   209   48.6   7   30.9   217   North-­‐West   29.0   448   58.9   18   30.1   466   South-­‐East   48.3   127   27.6   9   46.8   136   South-­‐South   31.8   165   21.2   8   31.4   173   South-­‐West   28.3   257   75.5   15   30.9   272                   Total   32.2   1377   49.5   62   32.9   1440   1  MICS  indicator  2.12       Table  NU.7  presents  the  proportion  of  children  age  6-­‐23  months  who  received  semi-­‐solid  or  soft  foods  the   minimum   number   of   times   or   more   during   the   day   or   night   preceding   the   interview by breastfeeding   status.  Overall,  about  one  quarter  of  the  children  age  6-­‐23  months  were  receiving  solid,  semi-­‐solid  and  soft   foods  the  minimum  number  of  times.       About  26  and  23  percent  are  for  urban  and  rural  areas  receive  minimum  meal   frequency.    Twenty-­‐seven   (27)  percent  of  children  aged  6–23  months  whose  mothers  are  educated  received  minimum  meal  while  it  is   about   21   percent   for  whose  mothers   have   no   education.     South-­‐East   and   South-­‐South   have   33   percent   while   it   is   19   percent   in   South-­‐West,   North-­‐Central   and   North-­‐West   is   about   23   percent   while   it   is   21   percent  for  North-­‐East.    Effect  of  mother  wealth  status  is  also  noticeable,  among  the  richest  wealth  quintile   it  is  about  28  percent  while  in  the  poorest  wealth  quintile  it  is  18  percent.       MICS Nigeria, 2011; Main Report   Page  36     Table  NU.7:  Minimum  meal  frequency   Percentage  of  children  age  6-­‐23  months  who  received  solid,  semi-­‐solid,  or  soft  foods  (and  milk  feeds  for  non-­‐breastfeeding  children)   the  minimum  number  of  times  or  more  during  the  previous  day,  according  to  breastfeeding  status,  Nigeria,  2011       Currently  breastfeeding     Currently  not  breastfeeding     All         Percent  receiving  solid,   semi-­‐solid  and  soft   foods  the  minimum   number  of  times   Number  of   children  age   6-­‐23  months   Percent   receiving  at   least  2  milk   feeds1   Percent    receiving  solid,   semi-­‐solid  and  soft   foods  or  milk  feeds  4   times  or  more   Number  of   children   age  6-­‐23   months   Percent  with   minimum   meal   frequency2   Number  of   children  age   6-­‐23  months   Sex                 Male   18.5   2729   31.5   34.6   1220   23.5   3948   Female   21.7   2735   28.5   32.5   1075   24.8   3810   Age                 6-­‐8  months   20.1   1377   35.4   29.1   62   20.5   1440   9-­‐11  months   11.2   1200   57.7   53.3   133   15.4   1333   12-­‐17  months   21.5   1996   32.7   37.2   708   25.6   2704   18-­‐23  months   29.0   891   26.0   30.1   1391   29.7   2282   State                 Abia   16.2   70   50.2   44.0   80   31.0   150   Adamawa   24.6   138   19.4   27.8   38   25.3   176   Akwa  ibom   24.7   93   18.0   29.6   113   27.4   206   Anambra   27.6   103   34.1   50.2   105   39.0   208   Bauchi   15.7   295   2.4   7.0   67   14.1   361   Bayelsa   9.4   61   20.2   26.0   50   16.9   111   Benue   31.8   118   16.1   32.3   73   32.0   191   Borno   21.0   206   8.9   23.8   31   21.4   237   Cross  River   46.9   95   26.2   37.5   65   43.1   160   Delta   21.3   146   31.6   35.9   85   26.7   231   Ebonyi   34.0   68   19.5   28.3   43   31.8   111   Edo   9.6   118   41.2   41.2   37   17.1   154   Ekiti   11.5   76   15.3   17.9   45   13.9   121   Enugu   37.5   76   41.9   48.2   78   43.0   155   Gombe   28.9   101   23.7   24.3   38   27.7   139   Imo   6.9   79   26.5   24.4   67   14.9   146   Jigawa   21.7   207   18.5   17.4   21   21.3   228   Kaduna   30.4   310   23.6   42.5   48   32.0   358   Kano   24.4   487   15.8   32.5   89   25.6   576   Katsina   17.0   293   25.0   36.0   50   19.8   343   Kebbi   20.6   160   16.7   31.3   30   22.3   190   Kogi   11.3   102   24.2   18.2   32   13.0   133   Kwara   4.6   96   53.1   36.6   47   15.1   143   Lagos   13.4   332   43.6   30.0   254   20.6   586

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