1. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Child Health Deprivation in Nigeria: An Empirical investigation of determinants By Ataguba, J.E, Ichoku, H.E. and Okorafor, A.O. 2009

2. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Introduction  There is a minimum level of health care a child at a certain age should obtain  If falls below this level, the child is poor in terms of health (dimension).  E.g. @ age 5 - fully immunized  Health a dimension in poverty analysis  Child health for children

3. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Child health deprivation, and poverty on child’s health  Child health deprivation as different from the influence of poverty on child’s health – though interrelated!  Effects of poverty on a child’s health  It is associated with increased neonatal and postneonatal mortality rates,  greater risk of injuries resulting from accidents or physical abuse/neglect,  higher risk of chronic diseases (Aber et al., 1997)  low overall health outcomes  Illness left untreated  Malnutrition and under-nutrition, etc  Growth occurs largely at childhood – Steckel (1995).

4. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Why is child poverty or child health deprivation a worry?  Least Developed countries  account for one-tenth of the worlds population with about one-fifth of annual number of births (see chart).see chart  Poverty is higher than the rest of the world  Poor child health outcomes compared to the rest of the world  If SS Africa is going to catch up with the rest of the world, the best place to begin is child development programs  Early childhood is critical to influence the intellectual, physical, and emotional development of human beings  If missing, this is not reversible e.g. certain diseases in early years can prevent a child from attaining full potential

5. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 World population and annual births 24 million babies each year Back

6. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Why is child poverty or child health deprivation a worry?  Poor and deprived children often grow up to raise poor and deprived children  intergenerational (a vicious cycle) as they have fewer opportunities and capabilities.  malnourished mothers tend to have babies with low birth weight  low birth weight babies tend not to develop fully  strong link between health, productivity and wellbeing  Children are powerless and helpless  They depend largely on the adult for decisions regarding their health, education, etc.  Immunization decisions for example, depends on the parents/caregiver  Investing in children is not an option! It is a must or a necessity!  Based on the Rights of a child

7. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Why child poverty or child health deprivation in Nigeria?  Nigeria has low level of immunisation coverage compared with other SSA countries  measles vaccine coverage of less than 65% for enfants  Inadequacy in the quality of child health services in PHC facilities (Ehiri et al., 2005)  large inequalities between the children of the poor and better-offs  Poverty and inequality and other poor social, demographic and economic determinants of child health

8. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Objectives  Explore the incidence of child health poverty (deprivation) in Nigeria  Children between 12 – 59 months old  Determinants of child health poverty (deprivation) from a composite of indicators of child health status

9. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Methods  Data source: CWIQ (2006) survey  36 states and the FCT  Children data (over 42,000 children)  Used only children between 12 – 59 months (83% of the sample)  Method of analyses  Principal Components Analysis (PCA)  Generate a composite index of for child health deprivation  OLS estimations  To estimate the determinants of child health poverty (deprivation)  Probit model  To determine the factors that predict child health poverty (deprivation)  Cut-offs: 2/3 rd of mean of index (score); score less than 2.

10. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Summary Statistics Table 1: Summary statistics (CWIQ) - Nigeria Note: This is based on children aged 12 – 59 months

11. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Summary Statistics. Immunization coveragePercent No immunization a 21.2% Only one dose 7.0% Only two doses 6.1% Only three doses 8.3% Only four doses 5.8% Only five doses 5.9% Only six doses 3.3% Only seven doses 2.9% Only eight doses 7.6% Only nine doses 6.8% Full dose 25.1% Note: This is based on children between 12 months and 59 months old. A child is fully immunized if he or she had received all of the following vaccines: a dose of BCG, three doses of OPV, three doses of DPT, a dose of yellow fever, a dose of MMR and one dose of measles a. this includes those who reported “do not know” Table 2: Immunization coverage rate - Nigeria

12. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Results [1].

13. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Results [2]

14. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Results [2]

15. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Results [3]

16. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Results: OLS Regression

17. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Results: Predictors of Deprivation

18. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Findings  37% - 51% of the children in Nigeria are deprived of basic child health care services  When mothers are of higher number in the HH roster, the more deprived is the child (i.e. if a mother is the third or fourth wife …)  Breastfeeding children for a longer time increases deprivation suffered (possibly because income-earning mothers may have time to breast than non-income earning poorer mothers)  Older children are less deprived than younger ones  Children delivered in hospitals are less deprived compared to delivery elsewhere

19. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Findings  37% - 51% of the children in Nigeria are deprived of basic child health care services  When mothers are of higher number in the HH roster, the more deprived is the child (i.e. if a mother is the third or fourth wife …)  Breastfeeding children for a longer time increases deprivation suffered (possibly because income-earning mothers may have time to breast than non-income earning poorer mothers)  Older children are less deprived than younger ones  Children delivered in hospitals are less deprived compared to delivery elsewhere

20. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Findings  No significant difference in deprivation across sexes  Children delivered by doctors, nurses, midwife and trained TBA are less deprived compared with untrained TBA and self deliverance (possibly because access to doctor, nurse or midwife may be a proxy for income or mother’s level of information)  Older children are less likely to be deprived health care than younger ones  Children delivered in hospital are less likely to be deprived  children delivered by self and untrained TBA are more likely to be deprived

21. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Implications of findings  Increase facility based delivery  Increase births attended to by trained personnel