Prevalence, Pattern and Factors Associated with Developmental Delay amongst Under-5 Children in Nigeria: Evidence from Multiple Indicator Cluster Survey 2011-2017.

BACKGROUND: Children develop dynamically, and when a child fails to reach age-appropriate developmental milestones compared to their peers, it is considered a developmental delay. In developing nations like Nigeria, several demographics, socioeconomic, childcare and external factors may influence the highly individualised process. This study assessed the prevalence and pattern of developmental delay, across Nigeria's geopolitical zones including identified factors associated with developmental delay, providing insight for appropriate interventions to prevent disability in affected children. METHODS: This was a secondary analysis of data from the Multiple Indicator Cluster Survey (MICS), which was carried out in rounds 4 (2011) and 5 (2016/2017). Every 5 years, the UNICEF-supported MICS cross-sectional household survey is carried out using the cluster sampling method. A semi-structured, questionnaire administered by the interviewer was used to obtain individual and household-level data. This study comprised a weighted sample of 17,373 under-5 children who had complete data from both survey rounds on characteristics deemed significant for the study. Data were analysed using SPSS version 23. Using the Chi-square test and multivariate binomial logistic regression, factors linked to developmental delay were identified, with 95% confidence intervals (CIs) provided and the significance level set at 5%. RESULTS: The mean age and sex distribution of the children surveyed in both rounds was comparable, with a male preponderance of 51.2% in round 4 and 50.4% in round 5. In both round 4 (51.2%) and round 5 (49.0%), the Northeast zone had the highest prevalence of overall developmental delay while the least prevalence was seen in the Southwest zone (20.3%) and the Southeast zone (14.7%) in round 4 and round 5, respectively. Across all the zones, delay in the literacy-numeracy domain of development was the most prevalent, with the highest (91.3% and 86.7%, respectively) in the Northeast zone during both rounds of the survey. Delay in the physical domain was, however, the least prevalent form of developmental delay across the zones, with the least in South South (20.6%) and Southeast (5.4%) in rounds 4 and 5. The odds of developmental delay were 1.5 and 1.7 times higher amongst children 4 years old than 3 years old in both rounds of the survey. The likelihood of having developmental delay was found to increase with the severity of stunting amongst the children during both rounds of the survey (odds ratio [OR] =1.5; 95% CI = 1.20-1.78 in round 4 and OR = 1.4; 95% CI = 1.16-1.58 in round 5). Children from the poorest wealth index had higher odds of developmental delay (OR = 5.8; 95% CI = 4.92-6.82 in round 4 and OR = 2.5; 95% CI = 1.99-3.10 in round 5). CONCLUSION: The prevalence of developmental delay is high across all zones; however, the burden varies amongst them. The age of the child, nutritional status and wealth index were indicators of developmental delay in Nigerian under-5 children. This underscores the need for surveillance and interventions focussed on improving child literacy, nutritional status and household standard of living across the zones.

After obstetric fistula repair; willingness of women in Northern Nigeria to use family planning.

Utilisation of modern family planning (FP) is important for women with obstetric fistula (OF). Preventing pregnancy ensures a proper healing and the success of fistula repair. In Northern Nigeria, prevalence of OF is high while the prevalence of FP utilisation is low. This study assessed the willingness to use family planning among 420 women receiving care at obstetric fistula centres in three northern Nigerian States using a semi-structured questionnaire. Concerning family planning methods, 56.7% were aware, only three (1.3%) had ever utilised any method and 63.8% were willing to use a family planning method in the near future. Age, type of marriage and the presence of surviving children were the significant predictors of willingness to use family planning among women with fistula. There is a moderate awareness of family planning with very low utilisation rates. However, a high proportion of these women are willing to use FP. Therefore, there is a need for integration of FP services with OF services. Impact statement What is already known on this subject? Obstetric fistula remains a problem of public health significance in developing countries and emphasis is being laid on surgical repair which is successful in 80-95% of cases. What do the results of this study add? The willingness of women with OF to use FP to improve repair success rate and prevent recurrence by delaying pregnancy. What are the implications of these findings for clinical practice and/or further research? It provides a proxy for post-repair practice. It also assesses the integrated fistula repair services which include counselling and providing the use of family planning services.