Multiple Indicator Cluster Survey (MICS5) 2016

Fifth round

Executive Summary

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

Survey Objectives
The objectives of Nigeria Multiple Indicator Cluster Survey (MICS) 2016-17 are to: (1) provide up-to-date information for assessing the situation of children and women in Nigeria, (2) generate data for the critical assessment of the progress made in various programme areas, and to identify areas that require more attention, (3) contribute to the generation of baseline data for the SDG, (4) provide data needed for monitoring progress toward goals established in the post Millennium Declaration and other internationally agreed goals, as a basis for future action, (5) provide disaggregated data to identify disparities among various groups to enable evidence based actions aimed at social inclusion of the most vulnerable.

Sample and Survey Methodology
The sample for the Nigeria MICS 2016-17 was designed to provide estimates for a large number of indicators on the situation of children and women at the national, rural/urban, states as well as, the 6 geo-political zones of Nigeria. The states within each zone were identified as the main sampling Strata while the Enumeration Areas (EAs) within each state were identified as the Primary Sampling Units (PSUs). The EAs for the survey were selected from the National Integrated Survey of Households round 2 (NISH2) master samples, based on a list of EAs prepared for the 2006 Population Census. Two stage sampling was conducted with the first stage being the selection of EAs within the strata while the second stage was the selection of households within each EAs. Out of 37,440 households sampled, 35,747 households were visited, 34,289 were occupied and 33,901 were successfully interviewed, representing a household response rate of 98.9 percent. Of these, 34,376 women and 15,183 men age 15-49 years were successfully interviewed.

Questionnaires
Four sets of questionnaires were used in the survey; the household questionnaire, the individual women questionnaire, the individual men questionnaire and the under-five children questionnaire. These were the MICS5 standard questionnaires adapted to Nigeria situation.

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

Characteristics of Households
The age structure of Nigeria shows a largely young population. Of the 182,165 household members enumerated, forty-Seven percent of the population are under the age of 15 years, contributing to the high dependency ratio in Nigeria. Households are traditionally headed by men, but a substantial proportion, about fifteen percent, of households were headed by women. Majority of Nigerian, 63.4 percent of households, reside in rural areas, with the North West region accounting for the highest proportion, 26.9 percent, while South East region has the least, 9.2 percent. Twenty-two percent of the household heads had no education, while 19.3 had primary education, 26.7 percent with Secondary / Secondary-technical and 16.3 percent had higher education.

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

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

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

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

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

Nutrition
Three in 10 children under five years have acute, chronic or both malnutrition. Two in 5 children under five years are stunted and 1 in 5 children under 5 years are severely stunted. Fourteen in 36 states in Nigeria have wasting prevalence that are classified as serious for public health significance. Mothers with at least secondary education have higher proportion of obese children than those with lower and non-formal education.
Quite a low proportion of mother, three out of 10, initiated early breastfeeding as recommended by WHO, however, 7 in 10 mothers eventually initiated breastfeeding within 24 hour of birth delivery. The 24 percent exclusive breastfeeding rate is yet to meet the WHO Global nutrition target of 50 percent. One in two infants is predominantly breastfed while just one in five is exclusively breastfed.

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

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

Child health
Vaccination coverage is an important indicator of Immunization, one of the cost-effective means of ending preventable deaths of newborn and under 5 children. Eighteen percent of children age 12-23 months received all recommended vaccination by their first birthday in the survey. Specific vaccine coverage are 35 percent for Tuberculosis; 34 percent coverage for polio, 30 percent coverage for pentavalent vaccine, 39 percent coverage for Measles and 36 percent coverage for yellow fever. The MICS 2016-17 survey also showed that about half of women with a live birth in the last two years prior to the survey received antenatal tetanus toxoid, which protected against neonatal tetanus.

Malaria prevention in pregnancy was adequate in only one out of 6 women age 15-49 years, who received three or more doses of SP/Fansidar during their last pregnancy that led to a live birth in the last 2 years. Reported illnesses in under-five children, two weeks preceding survey, are diarrhoea in 14.3 percent, ARI in 3 percent, and malaria fever in 25.4 percent of children under five.

Water and Sanitation
Access to safe and clean drinking water and sanitation is essential to human health. Sixty-four percent of household members use improved sources of drinking water. Only 2.3 percent of households using unimproved drinking water sources have appropriate water treatment method. About fifty-two percent of household population use improved sanitation facility, mostly using pit latrine with slab and flush or pour flush into septic tank. On shared sanitation facilities, one in 3 household members use improved sanitation facilities that are not shared. Overall, 26.5 percent of households have both improved drinking water source and improved sanitation facility. One in 10 households have a specific place for handwashing where water and soap or other cleansing agents are present. There are differentials across social groups in Nigeria.

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

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

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

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

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

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

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

Primary school completion rate is 63 percent. This implies that six in 10 children of primary completion age of 11 years are in the last grade of primary education. Transition rate to secondary school is 49 percent. Gender parity for primary school is 1.00, indicating no difference in the attendance of girls and boys in primary school. It is however, 0.97 for secondary school.

Child protection
Forty-seven percent of children under age 5 have their birth registered under civil authority. About 50 percent of children are involved in child labour, while 39 percent are working under hazardous condition. In Nigeria, about 85 percent of children age 1-14 years was subjected to at least one form of violent discipline.
Early marriage and domestic violence
The percentage of women who married before age 15 years in Nigeria is 18.5 percent. Forty-four percent of women age 20-49 years married before age 18 years. About 18.4 percent of women had some form of female genital mutilation. One in three women in Nigeria feel that a husband/partner is justified in hitting or beating his wife in at least one of the five situations.

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

Six in 10 men and women age 15-49 know where to do an HIV test. Only one in seven have been tested and know the result of the test in the last 12 months. More men know where to go for test, but more women actually do the test before or in the last 12 months to the survey.

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

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

Access to Mass Media and Use of Information/Communication Technology
Exposure to specific media (newspapers/magazines, radio and television) at least once a week among young people is low - 5.5 percent of young women and 18.5 percent of young men. South west has the highest media exposure: 91.7 percent of males and 80.7 percent of female exposed to at least one of the three media sources in a week. Exposure to computer and the internet is also low- 13.4 percent and 20.6 percent of young women and men had ever used computer respectively. Also, 17.3 percent and 32 percent of young women and men had ever used internet respectively.

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

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

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