Data source
Data utilised for this study were sourced from the ninth round of the Nigeria Demographic and Health Survey, NDHS, 2018. The NDHS was conducted between August and December 2018 by the National Population Commission (NPC) with technical support and assistance from the United States Agency for International Development (USAID) with ICF International. The 2018 NDHS was a nationwide survey conducted on women aged 15-49 years, where information about birth history and children under-five were ascertained and gathered. The 2018 NDHS utilized four (4) questionnaires: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, and the Biomarker Questionnaire. The questionnaires, based on the DHS Program’s standard Demographic and Health Survey (DHS-7) questionnaires, were adapted to reflect the population and health issues relevant to Nigeria. In specific terms, the birth recode dataset which focussed on mothers whose children were between the ages 0- 59 months to ascertain the predictive influence of the postnatal care service utilised by mothers during postnatal periods and child morbidity experience in the last five years that preceded the survey was used.
In this study, however, the birth recode dataset were extracted where individual women questionnaire was used. The women’s questionnaire was used to collect information from all eligible women age 15-49. These women were asked questions on the following topics: background characteristics [including age, education, and media exposure]; birth history and child mortality; knowledge, use, and source of family planning methods; antenatal, delivery, and postnatal care; vaccinations and childhood illnesses [child morbidity]; breastfeeding and infant feeding practices; women’s minimum dietary diversity; women’s work and husbands’ background characteristics, etc. However, for this study, only the socio-demographic characteristics of women, birth history, postnatal care information and child illness [child morbidity] that were extracted for the analysis in this study.
Sample and sampling techniques
The total number of women captured in the dataset was 127,545 of the NDHS. Of this number, a total number of 30,713 mothers whose children were under the age of five were selected as the sample size for this study. The sample for the 2018 NDHS was a stratified sample selected in two stages. In the first stage, 1,400 EAs were selected with probability proportional to EA size. In the second stage’s selection, a fixed number of 30 households were selected in every cluster through equal probability systematic sampling, resulting in a total sample size of approximately 42,000 households. The household listing was carried out using tablets, and random selection of households was carried out through computer programming. Details of the sampling techniques can be found in the final report of 2018 NDHS.
Variable Used in the Analysis
The Outcome Variables
The outcome variables of interest in this study were: (i) postnatal care services utilisation, and (ii) child morbidity experienced by mothers. The postnatal care services utilised by the respondents was measured by the place of delivery of their babies. This was captured by the facility where a respondent was delivered of a baby in the last five years that preceded the survey. These facilities were ranged from home, respondent’s home, other homes, other; public sector, government hospitals, government health centre, government post, other public sectors, private sector, private hospitals/clinics to other private sectors. These facilities were further re-categorised into traditional {0} or modern {1}. It is traditional if a respondent indicated that she was delivered of a baby either at home, respondent’s home, other homes or any other place rather than a modern facility. And modern, if a respondent signified that she was delivered of a baby either in the public sector, government health centre, government health post, other public sectors, private sector, private hospitals/clinics, or any other private sector.
Child morbidity, on the other hand, was measured by the experience of any under-five disease diagnosed. These were captured by series of questions which ranged from whether children under the age of five had been diagnosed of diarrhoea recently; have had a fever in the last two weeks; have had a cough in the last two weeks; had short rapid breaths; had a problem in the chest or blocked or running nose and severe; or had mild or moderate anaemia level. The responses were all in either yes (1) or no (0). It is “yes” a respondent had experienced the disease diagnosed during the period indicated and “no” if the respondent did not have the experience of such disease of under-five in the period. Respondents’ responses were further re-grouped as no child morbidity {0} if there was no disease diagnosed with under-five children, and child morbidity {1} if a respondent had ever had the experience of any disease.
The Independent/Explanatory Variables
The selection of the explanatory variables in this study was guided by Anderson-Newman’s [14] Model of healthcare utilisation which proposed that the utilisation of any healthcare facility by an individual is determined by three factors, namely: the predisposing factors, enabling factors, and the need factor. However, only the variables related to the predisposing factors and the enabling factors were included in the analysis of this study. The predisposing factors are the socio-economic cum cultural traits of individuals that precede their health conditions and statuses such as region, age, educational level, and location. This study factored into the analysis the region of the respondent [South-West, South-East, South-South, North-West, North-East, North-Central], age, educational level [nor formal education, primary, secondary, tertiary], residence [rural/urban]. This study also factored in the ethnicity [Yoruba, Igbo, Hausa, The Minority] of the respondent, the number of children-born [0-3, 4-6, 7+] as the enabling factors for PNC services utilization and child morbidity; while the need factor is the most immediate cause of health care service utilisation. Table 1 presents the summary of the measurements and definition of both the dependent and independent variables as used in the study.
Table 1: Measurement, definition, variables and codes
Variables
|
Definitions
|
Measurement
|
Code
|
Dependent variable:
|
a) Postnatal care service utilised
|
Measured by the place of delivery of babies –
|
Traditional {home, respondent home, other homes, other}
Modern {public sector, government hospitals, government health centre, government health post, other public sectors, private sector, private hospitals/clinics, other private sectors}
|
0= Traditional
1= Modern
|
b) Child morbidity
|
Children under-five ever-diagnosed of any disease?
|
Not diagnosed of any disease
Diagnosed of any disease {had diarrhoea recently,
had a fever in the last two weeks, had a cough in last
two weeks, short rapid breaths, a problem in the
chest or blocked or running nose and severe,
mild or moderate anaemia level}
|
0 = No child morbidity
1 = Child morbidity
|
Main Independent variables:
|
Region
|
The six geo-political zones in Nigeria represent the regions
|
South West, South-South, South East, North
Central, North East and North West
|
1 = South West
2 = South South
3 = South East
4 = North Central
5 = North East
6 = North West
|
PNC service utilization
|
Place of delivery of respondents’ babies
|
Traditional {home, respondent’s home, other homes, other}
Modern {public sector, government hospital, government health centre, government health post, other public sectors, private sector, private hospital/clinic, other private sectors}
|
0 = Traditional
1 = Modern
|
Socio-demographics variables:
|
Age in the 5-year group
|
Age in years
|
15 – 19; 20 – 24; 25 – 29; 30 – 34; 35 – 39; 40 – 44; 45 – 49
|
1 = 15 – 19; 2 = 20 – 24
3 = 25 – 29; 4 = 30 – 34
5 = 35 – 39; 6 = 40 – 44
7 = 45 – 49
|
Residence
|
Place of residence
|
Urban, rural
|
1 = Urban; 2 = Rural
|
Educational level
|
Highest educational attainment
|
No formal education, Primary, Secondary, Tertiary {any school attended other than primary and secondary}
|
1 = No formal education
2 = Primary;
3 = Secondary
4 = Tertiary
|
Religion
|
Membership of any religious groups
|
Catholic, Other Christians, Islam, Traditionalist
|
1 = Catholic
2 = Other Christians
3 = Islam
4 = Traditionalist
|
Ethnicity
|
Membership of the major and minority ethnic group
|
Yoruba, Igbo, Hausa, The Minority {Ijaw, Kanuri, Tiv, Igala, Kalabari, etc.}
|
1 = Yoruba; 2 = Igbo
3 = Hausa;
4 = The Minority
|
Number of children
|
Number of children ever-born by the respondents
|
Measured at continuous but regroup as 0 – 3 children; 4 – 6 children; 7+ children
|
1 = 0 – 3; 2 = 4 – 6;
3 = 7+
|
Data Management and Analysis
After the extraction of relevant variables suitable for the analysis of this study as described in Table 1, the data were further cleaned and recoded for appropriate statistical analysis. However, both univariate, bivariate and multivariate statistical tools were used. With the aid of the Statistical Package for Social Sciences (SPSS version 21), descriptive and chi-square test were used to analyse the socio-demographic profiles of the respondents as well as the PNC services utilisation. To predict the likelihood of child morbidity, logistic regression was used to analyse and predict the likelihood of the regions and PNC service utilisation [traditional or modern health care facilities] on child morbidity experienced by women immediately after delivery as well as determining the predictive influence of mothers’ socio-demographic variables on child morbidity (whether a child under the age of five developed any health condition or not).
Ethical Considerations
Ethical approval was sought from the DHS Program archivist, and the permission to download the dataset was granted on the 7th November 2019 via https://www.dhsprogram.com/data/dataset_admin/login_main.cfm. All ethical standards prescribed by DHS in the use of the dataset were strictly applied in this study.