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Background The coverage of long lasting insecticidal nets (LLIN) and intermittent preventive treatment of malaria in pregnancy (IPTp) uptake for the prevention of malaria commonly vary by geography. Many sub-Saharan Africa (SSA) countries, including Nigeria are adopting the use of LLIN and IPTp to fight malaria. Albeit, the coverage of these interventions to prevent malaria across geographical divisions have been understudied in many countries. In this study, we aimed to explore the differentials in LLIN and IPTp uptake across Nigerian geopolitical zones. Methods We analyzed data from Nigeria Multiple Indicator Cluster Survey (MICS) 2016–17. The outcome variables were IPTp and LLIN uptake among women of childbearing age (15–49 years). A total sample of 24,344 women who had given birth were examined for IPTp use and 36,176 women for LLIN use. Percentages, Chi-square test and multivariable logit models plots were used to examine the geopolitical zones differentials in IPTp and LLIN utilization. Data was analyzed at 5% level of significance. Results The overall prevalence of IPTp was 76.0% in Nigeria. Moreover, there were differences across geopolitical zones: North Central (71.3%), North East (76.9%), North West (78.2%), South East (76.1%), South South (79.7%) and South West (72.4%) respectively. Furthermore, the prevalence of LLIN was 87.7%% in Nigeria. Also, there were differences across geopolitical zones: North Central (89.1%), North East (91.8%), North West (90.0%), South East (77.3%), South South (81.1%) and South West (69.8%) respectively. Women who have access to media use, married, educated and non-poor were more likely to uptake IPTp. On the other hand, rural dwellers and those with media use were more likely to use LLIN. Conversely, married, educated, non-poor and women aged 25–34 and 35+ were less likely to use LLIN. Conclusion Though the utilization of IPTp and LLIN was relatively high, full coverage are yet to be achieved. There was geopolitical zones differentials in the prevalence of IPTp and LLIN in Nigeria. Promoting the utilization of IPTp and LLINs across the six geopolitical zones through intensive health education and widespread mass media campaigns will help to achieve the full scale IPTp and LLIN utilization.
We utilized a nationally representative large data from Nigeria Multiple Indicator Cluster Survey (MICS) 2016–17. A total sample of 24,344 women who had given birth were included for IPTp use and 36,176 women for LLIN use were included for analysis. Through this survey, estimates for a large quantity of indicators concerning the condition of reproductive age women at both rural and urban areas of the 6 geopolitical zones of Nigeria was made. The main sampling strata in the survey were the states in each geopolitical zone, while the primary sampling units (PSUs) were identified as the Enumeration Areas (EAs). The National Integrated Survey of Households round 2 (NISH2) master sample which was developed for the most recent population census, served as the source of EAs for the survey. They employed two-stage sampling: (1) selection of EAs and (2) selection of households. The data can be freely accessed for research purposes on: https://mics.unicef.org/surveys. From the URL, select country (Nigeria), select the survey year (2016–17) and download the data. The MICS 2016–2017 utilized four distinct questionnaires. The first is the household questionnaire, which was used for the collection of household characteristics and basic sociodemographic information of all the household members; the second questionnaire was the individual women questionnaire, designed to collect information from all the women of reproductive age (15–49 years), present in each household; the third questionnaire was the individual men questionnaire. This was designed to elicit information from all men in every other household (one man in every two households) who are within the age of 15 and 49 years; and the fourth questionnaire was for children who were less than 60 months (under-five year children). This fourth questionnaire was administered to the mothers of the children or their caregivers who also live in the sampled households. The following modules were included in the individual women questionnaire: the information panel of the woman, her background, her accessibility to mass media as well as the utilization of information/communication technology, her fertility/birth history, what her desire for last birth was, the maternal and newborn health, the post-natal healthcare checks, any illness symptoms, utilization of contraceptive methods and any unmet need for contraception, any female genital mutilation/cutting, her attitude towards domestic violence/intimate partner violence, her marriage/union status, sexual behaviour, sexually transmitted infection, tobacco and alcohol use and life satisfaction. Our outcome variables were IPTp and LLIN. These were measured dichotomously as yes vs. no if a woman used or did not use. The explanatory variables included in this study were selected based on previous studies [13–17, 23], and are presented in Table 1 below. * For the calculation of household wealth status, household assets such as ownership of electronics and means of transportation (example television and bicycle), house building material quality (example floor, wall and roof types) were considered. Principal component analysis was used to generate factor scores which were assigned to each item and these scores were summed and standardized for each household. The standardized household scores placed each household in a continuous scale according to their relative wealth scores. These scores were subsequently categorized in binary form to rank the households into poor and non-poor households [24]. The MICS data had already developed and classified household wealth quintile as a variable into five groups, each of which was worth 20% of the total: poorest, poorer, middle, richer, and richest. We re-categorized household wealth quintiles into two categories for the analysis: poor (poorest, poorer) and non-poor (middle, richer and richest) [25, 26]. The data used in this study is publicly available and the authors of this manuscript were not involved in the collection of data from the participants. The authors sought for permission from MICS and access to the data was granted after the request was considered and approved. MICS Program is consistent with the standards for ensuring the protection of respondents’ privacy. No further approval was required for this study since MICS Programs are in consistent with the standards for ensuring the protection of respondents’ privacy. To compute the estimates, we adjusted for sampling weights, stratification and clustering by using the survey (‘svy’) module. At the univariate level, the frequency distribution of relevant variables was calculated, the chi-square distribution test of association was calculated at the bivariate level, and the logit model plot was created to determine the geopolitical zones differences in IPTp and LLIN utilization in Nigeria. This approach is consistent with previous studies [27, 28]. Variables that were not statistically significant at the bivariate level were not included in the adjusted logit model plot. The logistic regression model was of the form: where p indicates the probability of IPTp uptake or LLIN use and βis are the regression coefficients associated with the reference group and the xi are the explanatory variables. The p-value of <0.05 was set as being statistically significant. We analyzed the data using the version 14 of Stata statistical software from StataCorp., College Station, Texas, United States of America.
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