US embassy cable - 04LAGOS1341

UNCLAS SECTION 01 OF 03 LAGOS 001341 
 
SIPDIS 
 
FOR S/GAC 
 
E.O. 12958: N/A 
TAGS: TBIO, SOCI, ECON, PGOV, NI 
SUBJECT: FINDINGS OF THE 2003 DEMOGRAPHIC AND HEALTH 
SURVEY; MALARIA, CHILD HEALTH, NUTRITION: PART III OF 
III 
 
REF: (A) LAGOS 1247, (B) LAGOS 1268 
 
1.  Summary.  The findings below were drawn from the 
executive summary of the 2003 Nigeria Demographic and 
Health Survey. Malaria remains a major public health 
problem in Nigeria.  Infant mortality is worse than 
what may have been commonly believed. Most children are 
under-weight or stunted, especially in northern 
Nigeria. The rate of vaccination of children in Nigeria 
is the lowest among African countries in which DHS 
surveys have been conducted since 1998. The PEPFAR- 
related program we will pursue in Nigeria calls for 
complex interagency coordination; we want to begin 
doing this without delay.  We thus seek S/GAC's 
assistance in identifying a seasoned mid-level officer 
available now to press forward.  End summary. 
 
MALARIA CONTROL 
 
2.  Nets. Although malaria is a major public health 
concern in Nigeria, only 12 percent of households 
reported owning at least one mosquito net at the time 
of the survey. Even fewer, 2 percent of households, 
owned an insecticide treated net (ITN). Rural 
households were almost three times as likely as urban 
households to own at least one mosquito net. Overall, 6 
percent of children below five years of age had slept 
under a mosquito net including 1 percent of children 
under an ITN. Five percent of pregnant women had slept 
under a mosquito net the night before the survey, one- 
fifth of them under an ITN. 
 
3. Use of Anti-malarial Drugs Among Pregnant Women. 
Overall, 20 percent reported having taken an anti- 
malarial drug for prevention of malaria during their 
last pregnancy in the five years preceding the survey. 
Seventeen percent reported having used an unknown drug, 
and 4 percent had taken paracetamol or herbs to prevent 
malaria. Only 1 percent had received intermittent 
preventative treatment (IPT) or preventive treatment 
with sulfadoxine-pyrimethamine (Fansidar/SP) during an 
antenatal care visit. Among pregnant women who had 
taken an anti-malarial drug, more than half (58 
percent) had used Daraprim, which has been found to be 
ineffective as a chemoprophylaxis during pregnancy. 
Thirty-nine percent had taken chloroquine, the 
chemoprophylactic drug of choice until the introduction 
of IPT in Nigeria in 2001. 
 
4. Among children who had been sick and had fever or 
convulsions, one-third had been given anti-malarial 
drugs. Most had received the drugs at the onset of the 
fever/convulsions or the following day. 
 
CHILD HEALTH 
 
5. Mortality. On the basis of the 2003 NDHS survey, 
infant mortality is estimated to be 10 per 1,000 live 
births for the 1999-2003 period. This rate is 
significantly higher than the estimates from both the 
1990 and 1999 NDHS surveys.  The earlier surveys 
underestimated mortality levels in certain regions of 
the country, which in turn biased the national 
estimates downward. The higher rate recorded in 2003 is 
more likely due to better data than an actual increase 
in overall mortality risk. 
 
6. The rural infant mortality rate (121 per 1,000) was 
considerably higher in 2003 than the urban rate (81 per 
1,000), in large part because of the difference in 
neonatal mortality rates. As in other countries, low 
maternal education, the low position of mothers on the 
household wealth index, and shorter birth intervals are 
strongly associated with increased mortality risk. The 
under-five mortality rate for the 1999-2003 period was 
201 per 1,000. 
 
7. Vaccinations. Only 13 percent of Nigerian children 
between 12 and 23 months of age could be considered 
fully vaccinated at the time of the survey; that is, 
they had received BCG, measles, and three doses each of 
DPT and polio vaccine (excluding the polio vaccine 
given at birth). This is the lowest rate of vaccination 
among African countries in which DHS surveys have been 
conducted since 1998. Less than half of the children in 
the survey had received each of the recommended 
vaccinations, except polio 1 (67 percent) and polio 2 
(52 percent). More than three times as many urban 
children as rural children were fully vaccinated (25 
percent and 7 percent, respectively). WH0 guidelines 
are that children should be administered all the 
recommended vaccinations by 12 months of age. In 
Nigeria, only 11 percent of children between the age of 
12-23 months received all the recommended vaccinations 
before their first birthday. 
 
8. Childhood Illness. In the two weeks preceding the 
survey, 10 percent of the children had experienced 
symptoms of acute respiratory infection (ARI) and 31 
percent had had a fever. Among the children who 
experienced symptoms of ARI or fever, almost one-third 
(31 percent) had sought treatment at a health facility 
or from health care provider. 
 
9. About one-fifth of children had had diarrhea in the 
two weeks preceding the survey. Twenty-two percent of 
the mothers reported that their children with diarrhea 
had been taken to a health provider. Overall, 40 
percent had received oral rehydration salts (ORS), 
recommended home fluids, or increased fluids. Less than 
one-fifth of the children (18 percent) had been given 
an ORS solution despite 65 percent of the mothers 
having said they knew about ORS packets. While 20 
percent of the mothers said they had given their sick 
children more liquids than usual, 38 percent of mothers 
said they had curtailed fluid intake. 
 
NUTRITION 
 
10. Breast-feeding. Breast-feeding is almost universal 
in Nigeria.  Ninety-seven percent of children born in 
the five years preceding the survey had been breast- 
fed. Just one-third of the children had been given 
breast milk within one hour of birth (32 percent). Less 
than two-thirds had been given breast milk within 24 
hours of birth (63 percent). Overall, the median 
duration of any breast-feeding is 18.6 months, but the 
median duration of exclusive breast-feeding was only 
half a month. 
 
11. Complementary Feeding. Three-quarters of breast- 
feeding infants between 6-9 months of age-the 
recommended age for introducing complementary foods-had 
received solid or semi-solid foods during the day or 
night preceding the survey. Fifty-six percent had been 
given food made from grain; 25 percent received meat, 
fish, shellfish, poultry or eggs; and 24 percent fruits 
or vegetables. Fruits and vegetables rich in vitamin A 
had been consumed by 20 percent of the breast-feeding 
infants 6-9 months of age. 
 
12. Nutritional Status of Children. Overall, 38 percent 
of the children participating in the survey were 
stunted (short for their age), 9 percent were wasted or 
thin (low weight-for-height), and 29 percent were under- 
weight (low weight-for-age). Generally, children living 
in rural areas or in the north and children of 
uneducated mothers were significantly more likely to be 
undernourished than other children. The children in the 
North West were particularly disadvantaged: one-third 
were severely stunted, which reflects extensive long- 
term malnutrition in the region. 
 
ORPHANS 
 
13. Less than 1 percent of children nationwide had lost 
both parents by the time of the survey. Six percent of 
children under age 15 had lost at least one parent. 
 
COMMENT 
 
14.  The HIV/AIDS findings in Part I (ref A) of our 
three-part report on the 2003 Nigeria Demographic and 
Health Survey provide baseline figures against which we 
will judge our performance as we implement PEPFAR with 
our Nigerian hosts. During the next six months, we will 
set up an in-country interagency mechanism through 
which to coordinate U.S. and Nigerian HIV/AIDS programs 
so that the result of our collective effort will be 
more encouraging than that which would be the case if 
the interested parties were to work separately. We will 
need time. Ambassador Tobias, himself, noted in his 
February 23, 2004 letter introducing PEPFAR to the 
members on Capitol Hill, that "addressing HIV/AIDS in 
the developing world requires confronting overstressed 
and struggling health care systems with limited 
capacity to provide treatment and care; social 
inequalities such as those involving the status of 
women, girls, and the poor; and the varied economic and 
political circumstances (as well as diverse and deeply 
ingrained cultural patterns) as of each country."  We 
will monitor closely and report regularly on the 
evolution of the indicators reflecting these elements 
during the next year.  We will do so to help channel 
substantial resources and rapidly expand the delivery 
of HIV/AIDS services to effective partners committed to 
the principles of the Emergency Plan. 
 
15.  Shortly, we will send to HR and AF a position 
description statement for the person whom we hope will 
soon arrive at post to focus full time on the PEPFAR 
and related programs. We would welcome the engagement 
of the Office of the Global AIDS Coordinator (S/GAC) in 
an active dialogue with our colleagues in HR to 
identify a seasoned mid-level officer who is now or 
will soon be available to fill the position. We would 
also appreciate being sent a current listing of S/GAC 
personnel with whom to work on the program components 
of PEPFAR's implementation in Nigeria. 
 
KRAMER