PRECEDING CHILD SURVIVAL AND UTILISATION OF MATERNAL HEALTHCARE SERVICES AMONG NIGERIAN WOMEN

Abstract

Maternal health care (MHC) service utilization in Nigeria has remained unacceptably low for ages. Numerous studies have been undertaken to understand this phenomenon. Some studies have assessed how preceding child survival predicts the death of a subsequent child and subsequent fertility behaviours and patterns but not a lot has examined the effect of preceding child survival on MHC service use. This work sought to examine the relationship between preceding child survival and antenatal care (ANC), skilled attendant at birth (SAB) and postnatal care (PNC) utilisation among Nigerian women. The children recode dataset of the Nigeria Demographic and Health Survey (NDHS) 2013 was used with a sample size of 98335. The main objective of this work was to determine how preceding child survival influences MHC services utilisation for subsequent birth, therefore since the main interest in this work was preceding child survival, only women with second or higher order births were considered. This is because first-order birth women have no preceding child. The relationship between preceding child survival and MHC services utilisation was examined using descriptive statistics and four logistic regression models: the first three models considered the main predictor variables, bio-demographic and socio-economic variables respectively, while the fourth model combined all the predictor variables with preceding child survival. Thereafter, regional analyses were carried out to investigate the differences across regions. Association and statistical significance were expressed as odds ratio (OR) with 95% confidence interval (Cl). Descriptive analysis revealed that the North West (32%) region had the highest population while the South East (9.7%) region had the least population. Over 60% of Nigerians are in the poor and middle wealth quintile while the remaining are in the rich wealth quintile. More than half ( 52.8%) of respondents had no form of education and majority (60.6%) of respondents are into selling of goods. Bivariate analysis revealed that preceding child death increased the odds of ANC, SAB and PNC utilisation by 5.8%, 10% and 2.6% respectively and multivariate analysis revealed that preceding child death had the greatest influence on SAB as it had the highest level of association and significance (OR=1.71 Cl= 1.57-1.87). For most of the regional analysis, only model I, one MHC service revealed a statistically significant association: North central (PNC: OR=2.15, Cl=1.17-3.96), North East (SAB: OR=1.88, Cl= 1.39-2.54), North West (ANC: OR=1.23, Cl=1.02-1.48, SAB: OR=1.31, Cl= 1.02-1.69), South South (SAB: OR=1.41, Cl=1.14-1.74), except for South West where both models of SAB were statistically significant. (SAB: model I: OR=1.44, Cl=1.13-1.83, model II: OR=1.39, Cl=1.07-1.80).On the other hand, South East revealed no statistically significant association for all MHC services studied. It is surprising to observe that women who experience preceding child death seem not to learn from the experience and do not opt for MHC services. This makes one wonder if these women even appreciate that the occurrence may have been because of their non-use of MHC services. It is therefore necessary that other studies are carried out to understand women's perception about child mortality and MHC services utilisation.