2005年-世界发展银行全球_Nigeria___Health_Nutrition_and_Population_Country_Status_Report_Volume_1_Executive_Summary_54页_4mb

Nigeria Health, Nutrition, and Population Country Status Report Summary

Core Content

This report, titled Nigeria Health, Nutrition, and Population Country Status Report (CSR), provides an analysis of the health situation in Nigeria, focusing on the poor and how the health system is performing in meeting their needs. It is a joint effort between the Federal Ministry of Health (FMOH) and the World Bank Group, and it includes insights from various stakeholders, including donor agencies and international organizations. The report aims to support Nigeria's poverty reduction strategy and health system reform, while also informing the World Bank's policy dialogue with the Nigerian government.

Main Chapters and Key Findings

1. Health Outcomes

• Child Mortality: Nigeria has a high under-five mortality rate, with approximately 1 million children dying annually. In 2003, the rate was 201 per 1,000 live births, and infant mortality was 100 per 1,000.
• Malnutrition: Chronic malnutrition (stunting) affects 38% of under-five children, and acute malnutrition (wasting) affects 9%. These rates are similar to other Sub-Saharan African countries.
• Regional Disparities: The North-West and North-East regions have the highest under-five mortality rates (over 260 per 1,000), while the rest of the country has lower rates (under 180 per 1,000).
• Main Causes of Child Mortality: Communicable diseases such as malaria, diarrhea, and pneumonia are the leading causes, often linked to malnutrition. Malaria alone accounts for about 300,000 deaths annually.
• Fertility Rate: The Total Fertility Rate (TFR) in 2003 was 5.7, down from 6 in 1990, but still higher than the Sub-Saharan African average.
• Maternal Mortality: Nigeria has a maternal mortality ratio of 800 per 100,000 live births, resulting in an estimated 37,000 maternal deaths annually.
• Nutritional Status of Women: 15% of adult Nigerian women have a low BMI, indicating malnutrition. 10% of pregnant women are deficient in vitamin A, 20% in iron, and 4% in iodine.
• HIV/AIDS: The adult HIV prevalence rate is 5%, with 3.5 million people infected. While there has been a slight decrease from 5.8% in 2001, the data are insufficient to confirm stabilization.
• Tuberculosis (TB): Nigeria has the fourth highest TB cases globally, with an estimated 293 new cases per 100,000 and 546 prevalent cases per 100,000.
• Non-Communicable Diseases (NCDs): There is an increasing burden of NCDs such as hypertension, diabetes, cancer, and road traffic injuries.
• Road Traffic Injuries: Nigeria ranks second in the world for road traffic crash fatalities. Over 7,000 deaths and 26,000 injuries occur annually.

2. Health Care Utilization

• Immunization Coverage: Immunization rates in Nigeria are among the lowest in Sub-Saharan Africa, with only 13% of one-year-olds receiving all recommended vaccines in 2003, compared to 27% in 1990. Measles immunization coverage was 36% in 2003.
• Exclusive Breastfeeding: Only 17% of children under six months are exclusively breastfed, up from 1% in 1990.
• Antenatal and Delivery Care: 60% of pregnant women received antenatal care in 2003, and 36% received delivery care from a health professional. These rates have not significantly improved since 1990.
• Contraception Use: 12% of married women use any contraceptive method, and 8% use modern methods.
• HIV/AIDS Awareness and Testing: 86% of women and 97% of men are aware of HIV/AIDS. However, only 45% of women and 63% of men know that condom use prevents transmission. 13.6% of men and 6.4% of women have been tested for HIV.
• Health Service Utilization: 57% of children with diarrhea and 21% of children with cough or fever did not receive care in 2003. 44% of children and adults who were ill or injured in the previous two weeks did not seek care in 2004.
• Barriers to Care: Cost and distance are the most frequent barriers, with 30% of women citing cost and 24% citing distance or lack of transport.

3. Millennium Development Goals (MDGs)

• Progress: Nigeria has made some progress in reducing child mortality and malnutrition, but maternal care has not improved significantly.
• Challenges: The country faces significant challenges in achieving the health-related MDGs, particularly in reducing HIV/AIDS, malaria, and TB.
• Target Indicators: The goal is to halve under-five mortality and reduce maternal mortality by three-quarters between 1990 and 2015.

4. Household and Community Determinants

• Maternal Education: Strongly associated with improved health outcomes and health service utilization. Children of mothers with primary education have a 20% lower mortality risk, and those with secondary or higher education have a 40% lower risk.
• Socio-Economic Status: Higher household wealth is linked to better access to health services.
• Urban-Rural Differences: Rural areas have worse health outcomes and lower service utilization. For example, 7% of rural one-year-olds received all recommended vaccines in 2003, compared to 25% in urban areas. 51% of rural pregnant women received antenatal care, compared to 83% in urban areas.

5. Health System and Policy

• Governance and Management: The health system is managed at different levels of government, with federal responsibility for tertiary services, state for secondary services, and local governments for primary services.
• Policy Challenges: There are significant regional disparities in health outcomes and service utilization, and systemic issues such as corruption and inefficient management hinder progress.
• Role of the Private Sector: The private sector plays a limited role in health care provision, with low coverage of health services and high costs for many.

6. Health Care Financing

• Government Expenditure: Federal government health expenditures have increased, but remain low compared to GDP. In 2003, health spending was around 3.5% of GDP.
• Funding Gaps: Funding gaps are significant, particularly in primary health care (PHC), and extra resources are needed to achieve the MDGs.
• Marginal Budgeting for Bottlenecks (MBB): MBB is a key strategy to identify and address financing bottlenecks in the health system.

Key Information

• Under-five mortality remains high, with regional disparities.
• Immunization rates are low, and preventive interventions such as insecticide-treated nets (ITNs) are rarely used.
• Maternal mortality is high, with significant risk linked to high fertility and poor access to emergency obstetric care (EOC).
• Maternal education is a key determinant of health outcomes and service utilization.
• Urban-rural differences are significant, with rural areas having worse health outcomes and lower service utilization.
• HIV/AIDS, malaria, and TB remain major public health challenges.
• Non-communicable diseases (NCDs) are increasing in prevalence.
• Health financing is inadequate, and extra resources are needed to meet the MDGs.

Conclusion

Nigeria's health system faces significant challenges, including high child and maternal mortality, poor immunization coverage, and limited access to health services. Maternal education and socio-economic status play a crucial role in health outcomes and service utilization. Regional disparities are pronounced, with the northern zones experiencing the worst health outcomes. The government and international donors must work together to improve health financing, expand health service availability, and address systemic issues such as corruption and inefficient management to achieve the health-related MDGs.