Cablegate: Findings of the 2003 Demographic and Health

This record is a partial extract of the original cable. The full text of the original cable is not available.




E.O. 12958: N/A

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.


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.


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.


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.


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.


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.


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