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Background Despite the relatively high prevalence of Sickle cell trait (SCT) in Nigeria, there has been little research into the correlates of having children with SCT among Nigerian mothers, particularly in terms of socio-demographic differentials. This study aims to investigate the maternal socio-demographic correlates of having under-five children with SCT in Nigeria. Method Data from the 2018 Nigeria Demographic and Health Survey (Household Person Recode and Children Recode) were merged. Mothers with at least one under-five child whose genotype was known ( n  = 7,493) served as the unit of analysis. Three forms of outcome variable were explored. First was the number of children with SCT by each mother. Second, the number of children with SCT was categorized as zero, one, two or more. Lastly, each mother was categorized as either having no child(ren) with SCT or having at least one child with SCT. Subsequently, we assessed multilevel Poisson, ordinal and binary logit models to identify the best fitting model using Akaike and Bayesian Information Criterion. Multilevel binary logistic regression model was identified as best fit used to identify factors associated with having children with SCT. Adjusted Odds Ratio with 95% Confidence Interval (CI) were reported as measures of association. Result Nearly 62% of the mothers lived in rural areas, 38.2% had no formal education and 37.4% had ever given birth to at least five children. About 26.1% (95% CI = 25.2–26.9) of the mothers had children with SCT. By geographical variation, the Northwest region had the highest proportion of mothers of under-five children with SCT. Results from the multilevel binary logistic regression revealed that women who were traditionalists (AOR = 1.77; 95% CI = 1.04–3.02) were more likely of having children with SCT. Conclusion Though SCT is a genetic outcome, findings from this study suggest that important socio-demographic factors such as religion, and region of residence are significantly associated with having children with SCT in Nigeria. Sustained efforts on awareness campaigns on SCT are recommended.

Nigeria's population is projected to increase from 200 million in 2019 to 450 million in 2050 if the fertility level remains at the current level. Thus, we examined the shifts in the age pattern of fertility, timing of childbearing and trend in fertility levels from 2003 and 2018 across six regions of Nigeria. This study utilised the 2003, 2008, 2013, and 2018 Nigeria Demographic and Health Survey datasets. Each survey was a cross-sectional population-based design, and a two-stage cluster sampling technique was used to select women aged 15-49 years. The changes in the timing of childbearing were examined by calculating the corresponding mean ages at the birth of different birth orders for each birth order separately to adjust the Quantum effect for births. The Gompertz Relational Model was used to examine the age pattern of fertility and refined fertility level. In Nigeria, it was observed that there was a minimal decline in mean children ever born (CEB) between 2003 and 2018 across all maternal age groups except aged 20-24 years. The pattern of mean CEB by the age of mothers was the same across the Nigeria regions except in North West. Nigeria's mean number of CEB to women aged 40-49 in 2003, 2008, 2013 and 2018 surveys was 6.7, 6.6, 6.3 and 6.1, respectively. The mean age (years) at first birth marginally increased from 21.3 in 2003 to 22.5 in 2018. In 2003, the mean age at first birth was highest in South East (24.3) and lowest in North East (19.4); while South West had the highest (24.4) and both North East and North West had the lowest (20.2) in 2018. Similar age patterns of fertility existed between 2003 and 2018 across the regions. Nigeria's estimated total fertility level for 2003, 2008, 2013 and 2018 was 6.1, 6.1, 5.9 and 5.7, respectively. The findings showed a reducing but slow fertility declines in Nigeria. The decline varied substantially across the regions. For a downward change in the level of fertility, policies that will constrict the spread of fertility distribution across the region in Nigeria must urgently be put in place.

Background Reduction in ideal number of children has been suggested as a necessary precursor for fertility decline especially in high fertility countries of Western and Central Africa. In this study, we explored the social contexts of fertility desires by documenting the effects of individual, household as well as contextual characteristics among young men and women in Nigeria. Methods Data source was the male and female recode file of 2018 Nigeria Demographic and Health Survey. Analytical sample comprised 2674 males and 9637 females aged 15–24 years. The main outcome variable was desire for large family size (DLFS) defined as ideal number of children greater than four. Analysis involved use of descriptive statistics and random-effect logit models fitted in four stages. Results DLFS was 71% among young men and 53% in women. Individual-level factors associated with DLFS among men includes Islam religion (OR = 3.95, CI 2.68–5.83), household size (OR = 1.05) and richer (OR = 0.47, CI 0.29–0.75) or richest wealth index (OR = 0.28, CI 0.16–0.75). Geo-political region and high level of negative attitude to family planning (OR = 1.72, CI 1.23–2.40) were the main contextual factors associated with DLFS. For women, individual-level correlates were education, religion, ethnicity, marital status, household size, and wealth index. Contextual factors include geo-political region, community education (OR = 0.68, CI 0.52–0.89), child mortality experience (OR = 1.29, CI 1.11–1.51) and negative attitude to family planning (OR = 1.36, CI 1.13–1.65). The influence of religion, household wealth and attitude to family planning differ between young men and women. Conclusion Active communication and programmatic interventions are needed so that desire for large family size by young men and women do not become a clog for fertility transition in Nigeria. Plain Language Summary Reduction in ideal number of children has been suggested as a necessary condition for fertility decline especially in high fertility countries of Western and Central Africa. In this study, we explored the effects of individual, household as well as community characteristics on fertility desires among young men and women aged 15–24 years in Nigeria. We analysed data for 2674 males and 9637 females aged 15–24 years extracted from the 2018 Nigeria Demographic and Health Survey. The outcome variable was desire for large family size (DLFS) defined as ideal number of children greater than four. Results showed that DLFS was 71% among men and 53% in women. Individual-level factors associated with DLFS among men include Islam religion, household size and wealth status. Geo-political region and high level of negative attitude to family planning were the main community-level factors associated with DLFS. For women, individual-level positively associated with DLFS were Islam religion, and being currently married. Compared to Yoruba, other ethnic groups were more likely to favour DLFS. The negative factors associated with DLFS among young women include higher education and wealth status. At the community-level, Northern geo-political regions, child mortality experience and negative attitude to family planning were positively associated with DLFS. The influence of religion, household wealth and attitude to family planning differ between young men and women. Multi-dimensional strategies with active communication and programmatic interventions are needed so that desire for large family size by young men and women do not slow down fertility transition in Nigeria.

Background Intra-household dynamics play crucial roles in utilisation of healthcare services for children. We investigated the influence of household relationships on healthcare seeking behaviour for common childhood illnesses in four sub-Sahara African regions. Methods Data on 247,061 under-five children were extracted from recent Demographic and Health Surveys conducted between 2012 and 2016 in 25 countries. Data were combined and analysed per sub-region. Dependent variables (DVs) were uptake of health facility care for diarrhea and Acute Respiratory Tract Infection (ARI) symptoms. The main independent variable (IV) was household relationship which was represented by maternal marital profile (marital status, family type and number of marriages) and maternal relationship to household head. Mixed effects logit models were fitted to assess independent relationship between the IVs and DVs with adjustment for relevant demographic and socio-economic characteristics at 5% significance level. Results The percentage of children who received care for diarrhea and ARI symptoms from health facilities across sub-regions was: Western Africa (WA) 42.4, 44.1%; Central Africa (CA) 32.6, 33.9%; Eastern Africa (EA) 41.5, 48.7% and Southern Africa (SA) 58.9, 62.7%. Maternal marital profile was not associated with healthcare seeking behaviour for diarrhea and ARI symptoms in any of the sub-regions. Children whose mothers were daughter/daughter-in-law to household head were significantly less likely to be taken to health facility for diarrhea treatment in Eastern Africa (AOR = 0.81, CI: 0.51–0.95). Having a mother who is the head of household was significantly associated with higher odds of facility care for ARI symptoms for children from Western (AOR = 1.20, CI: 1.02–1.43) and Southern Africa (AOR = 1.49, CI: 1.20–1.85). Conclusion The type of relationship between mother of under-fives and head of households affect health seeking behaviour for treatment of diarrhea and ARI symptoms in Eastern, Western and Southern Africa. Countries in these regions need to adapt best practices for promoting healthcare utilisation for children such that household relationship does not constitute barriers.

Background Childbearing is a major concern for women living with HIV especially in low-middle income countries. There are fears about access to care, risk of vertical transmission, health challenges, maternal and child morbidity/mortality. Investigation of childbearing progression and its associated factors among these women will be useful for design of reproductive healthcare services of these women and ultimately address their multifaceted concerns. This study examined childbearing progression and its correlates another among women living with HIV in Ibadan. Method The study used a dataset from a cross-sectional study on childbearing progression among 933 respondents aged (18–49) receiving HIV care at the University College Hospital, Ibadan. Synthetic Relational Gompertz method was used to estimate fertility rate in the study population while a multistate model was developed to identify the factors associated with progression from one birth to the next. Results The average age of participants was 38 years, with majority being Yoruba tribe (80.5%). Nearly all had at least basic education (93%), and about half had 1–2 children at the time of their HIV diagnosis (47.6%). The likelihood of progressing from the first to a second birth was 77%, though no specific factors were statistically significant. However, progression to a third birth was significantly less likely (86% lower), and associated with factors such as: Having 1–2 children at HIV diagnosis (59% less likely to progress). Having more than 2 children at HIV diagnosis (94% more likely to progress), marital status (widowed women were 36% more likely to progress), partner’s education (secondary education increased the likelihood by 23%), partner’s employment status (unemployed partners increased the likelihood by 40%), desire for more children, partner’s HIV-negative status. Progression to fourth and subsequent births showed a continued decline, with the likelihood of a fourth birth being 82% lower and a fifth or sixth birth 85% lower. Women with secondary education were significantly less likely to progress to fifth births. Conclusion Overall, the corrected total fertility rate is 3.54, it’s below the national estimates and Southwest region which implies fertility is declining among women living with HIV in Ibadan. The findings revealed the relevance of socio-economic and demographic factors in childbearing progression among women living with HIV. Focused interventions should aim to provide better family planning support and integrate reproductive health counseling into HIV care programs.

Diagnosed hypertension stands out as a prominent global cause of mortality, prompting recent efforts to understand not only treatment options but also determinants across diverse age and occupational groups. However, the literature on the impact of environmental factors on diagnosed hypertension is limited, especially in rural areas with restricted access to health infrastructure. Geographical determinants research has often focused on spatial variations across different units, potentially masking individual environmental contributions. Data on diagnosed hypertension patients and their behaviours were gathered during the ARISE project, complemented by geographical data (elevation, vegetation, road network, population density, and nighttime light exposure) from secondary sources. Spatial patterns were analyzed using the Nearest Neighbour Statistic, Ripley K Function, and Kernel Density Estimation, while Binomial logistic regression identified predictors. Diagnosed hypertension patients exhibit spatial clustering, and are mainly comprised of elderly individuals, residing closer to roads, at higher elevations, in areas with higher population distribution, and with little or no green vegetation. Socio-economic, health-related, behavioural, and environmental factors collectively drive diagnosed hypertension. Spatial clustering of diagnosed hypertension in the Igbo Ora community is localized, indicating potential spatial factors influencing its prevalence. Beyond identified behavioural and medical history factors, geographical elements like nighttime light exposure and normalized vegetation index contribute to the observed clustering. Understanding these dynamics is crucial for targeted interventions in the community.

Background Stigma and discrimination remains a barrier to uptake of HIV/AIDS counselling and treatment as well as effective HIV reduction programmes. Despite ethnic diversity of Nigeria, studies on determinants of HIV stigma incorporating the ethnic dimension are very few. This paper provides empirical explanation of the ethnic dimension of determinant of HIV stigma and discrimination in Nigeria. Methods Nationally representative data from Nigerian Demographic and Health Survey 2013 (Individual recode) was analysed to explore ethnic differentials and homogeneity in the determinants of HIV/AIDS stigma and discrimination among women in multi-ethnic Nigeria. Results Result shows that determinants of HIV stigma and discrimination varies by ethnicity in Nigeria. Significant ethnic differentials in HIV/AIDS stigma and discrimination by Secondary school education exist among Hausa and Igbo respectively (OR = 0.79; CI: 1.49-2.28 and OR=1.62; CI: 1.18-2.23, p <0.05). Wealth status significantly influenced HIIV/AIDS stigma and discrimination among Hausa, Igbo and Yoruba ethnic groups ( p <0.05). Knowledge of HIV/AIDS was significantly associated with lower odds of discriminating attitudes among the Hausa and Fulani ethnic groups (OR = 0.45; CI: 0.30-0.67 and OR=0.36; CI: 0.16-0.83, p <0.05). Conclusions Identifying ethnic differential and homogeneity in predictors of HIV/AIDS stigma is key to reducing HIV/AIDS prevalence in Nigeria and countries with similar settings.

Although Nigeria has made some progress in malaria control, there are variations across States. We investigated the factors associated with utilisation of long-lasting insecticide-treated net (LLIN) and parasitaemia among under-five children in 13 States with high malaria burden. Data from the 2015 Nigeria Malaria Indicator Survey and 2018 Demographic and Health Survey were obtained and analysed. The 2015 and 2018 data were compared to identify States with increase or reduction in parasitaemia. Analysis was done for all the 13 study States; four States with increased parasitaemia and nine States with reduction. Random-effects logit models were fitted to identify independent predictors of LLIN utilisation and parasitaemia. LLIN was used by 53.4% of 2844 children, while parasitaemia prevalence was 26.4% in 2018. Grandchildren (AOR = 5.35, CI: 1.09-26.19) were more likely to use LLIN while other relatives (AOR = 0.33, CI: 0.11-0.94) were less likely compared to children of household-heads. LLIN use was more common in children whose mother opined that only weak children could die from malaria (AOR = 1.83, CI: 1.10-3.10). Children whose mothers obtained net from antenatal or immunisation clinics (AOR = 5.30, CI: 2.32-12.14) and campaigns (AOR = 1.77, CI: 1.03-3.04) were also more likely to use LLIN. In contrast, LLIN utilisation was less likely among children in female-headed households (AOR = 0.51, CI: 0.27-0.99) and those in poor-quality houses (AOR = 0.25, CI: 0.09-0.72). Children aged 24-59 months compared to 0-11 months (AOR = 1.78, CI: 1.28-2.48), those in whom fever was reported (AOR = 1.31, CI: 1.06-1.63) and children of uneducated women (AOR = 1.89, CI: 1.32-2.70) were more likely to have parasitaemia. The likelihood of parasitaemia was higher among children from poor households compared to the rich (AOR = 2.06, CI: 1.24-3.42). The odds of parasitaemia were 98% higher among rural children (AOR = 1.98, CI: 1.37-2.87). The key drivers of LLIN utilisation were source of net and socioeconomic characteristics. The latter was also a key factor associated with parasitaemia. These should be targeted as part of integrated malaria elimination efforts.

One of the targets for the third and fifth Sustainable Development Goals (SDGs) borders on children survival and women economic empowerment, respectively. A robust investigation of the relationship between maternal employment and childhood mortality will provide information useful for programs aimed at ensuring the complementarity of SDG 3 (healthy life for all) and SDG 5 (gender equality, girls and women empowerment). We addressed the following questions: (1) What is the independent relationship between maternal employment and infant (0-11 months) and child (12-59 months) mortality in Nigeria? (2) How does father's occupation, type of residence, and geopolitical region modify the relationship? We retrospectively analysed cross-sectional data on weighted sample of 31,828 under-five children extracted from the birth history in the 2013 round of Nigeria Demographic and Health Survey, using Cox proportional hazards models. The outcomes of interest were infant (0-11 months) and child (12-59 months) mortality, and the main explanatory variables include maternal employment, involvement in decision making on work earnings, and father's occupation. Other confounding variables were also controlled. Results showed that about two-third (68.7%) of under-five children had mothers who were working, with the majority engaged in self-employed occupations such as sales or small businesses, agriculture, and other manual labour. Infant mortality rate amongst children of employed mothers (65 per 1000 live births) was slightly less than the unemployed (70 per 1000 live births). A similar pattern was observed for child mortality. Hazards regression models revealed that the risk of both infant and child mortality was higher amongst unemployed women. Sales and agriculture/manual occupation constituted a higher risk for infant and child mortality. Analysis of interaction effects also revealed variations by father's occupation, type of residence, and geopolitical region. The role of maternal employment in child survival is dynamic and depends on the type of occupation, family, and residential and regional context.

Background Rapid urbanization in Nigerian cities may lead to localized variations in malaria transmission, particularly with a higher burden in informal settlements and slums. However, there is a lack of available data to quantify the variations in transmission risk at the city level and inform the selection of appropriate interventions. To bridge this gap, field studies will be undertaken in Ibadan and Kano, two major Nigerian cities. These studies will involve a blend of cross-sectional and longitudinal epidemiological research, coupled with longitudinal entomological studies. The primary objective is to gain insights into the variation of malaria risk at the smallest administrative units, known as wards, within these cities. Methods/results The findings will contribute to the tailoring of interventions as part of Nigeria’s National Malaria Strategic Plan. The study design incorporates a combination of model-based clustering and on-site visits for ground-truthing, enabling the identification of environmental archetypes at the ward-level to establish the study’s framework. Furthermore, community participatory approaches will be utilized to refine study instruments and sampling strategies. The data gathered through cross-sectional and longitudinal studies will contribute to an enhanced understanding of malaria risk in the metropolises of Kano and Ibadan. Conclusions This paper outlines pioneering field study methods aimed at collecting data to inform the tailoring of malaria interventions in urban settings. The integration of multiple study types will provide valuable data for mapping malaria risk and comprehending the underlying determinants. Given the importance of location-specific data for microstratification, this study presents a systematic process and provides adaptable tools that can be employed in cities with limited data availability .