Mothers’ Healthcare Autonomy, Maternal-Health Utilization and Healthcare for Children under-3 Years: Analysis of the Nigeria DHS Data (2008–2018)
Abstract
:1. Introduction
2. Methods
2.1. Data Source and Study Design
2.2. Sample Selection Criteria
2.3. Outcome Variables
2.4. Independent Variables
2.5. Covariates
2.6. Statistical Analysis
2.7. Ethical Standards Disclosure:
3. Results
3.1. Sample Characteristics
3.2. Univariate and Bivariate Analysis
3.3. Regression Result
3.3.1. Association between Mother’s Health Autonomy, Healthcare Utilization and Child’s Immunization
3.3.2. Association between Mother’s Health Autonomy, Healthcare Utilization and Treatment of Diarrhoea
3.3.3. Association between Mother’s Health Autonomy, Healthcare Utilization and Treatment of Fever
3.3.4. Association between Mother’s Health Autonomy, Healthcare Utilization and Treatment of ARI
3.3.5. Interactions Effect
4. Discussion
4.1. Summary of Results
4.2. Relevance of Result
4.3. Relationship between Maternal Healthcare Utilization and Child Healthcare
4.4. Policy Implication
4.5. Strength and Limitations of the Study
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Availability of data and materials
Appendix A
Variables | Immunization± | Diarrhoea | Fever | ARI | ||||
---|---|---|---|---|---|---|---|---|
AOR | CI | AOR | CI | AOR | CI | AOR | CI | |
Health Autonomy (B = Low) | ||||||||
substantial | 1.53 *** | (1.12–2.11) | 1.08 | (0.82–1.43) | 1.53 *** | (1.15–2.05) | 1.65 ** | (1.09–2.52) |
High | 1.87 *** | (1.34–2.62) | 1.16 | (0.83–1.62) | 1.51 ** | (1.09–2.10) | 1.24 | (0.78–1.99) |
Health Utilization (B = Low) | ||||||||
Medium | 3.53 *** | (2.82–4.41) | 1.25 * | (0.96–1.61) | 1.89 *** | (1.47–2.43) | 1.63 *** | (1.21–2.21) |
High | 5.61 *** | (4.01–7.84) | 1.46 | (0.81–2.63) | 2.21 *** | (1.43–3.41) | 2.67 *** | (1.45–4.91) |
Observations | 16694 | 4047 | 4973 | 1575 | ||||
Number of groups | 1295 | 892 | 1037 | 665 |
Immunization± | Diarrhoea | Fever | ARI | |||||
---|---|---|---|---|---|---|---|---|
AOR | CI | AOR | CI | AOR | CI | AOR | CI | |
Health Autonomy(B = Low) | ||||||||
substantial | 1.49 *** | (1.11–2.01) | 1.19 | (0.87–1.62) | 1.47 ** | (1.06–2.04) | 1.56 * | (0.93–2.62) |
High | 1.64 *** | (1.20–2.24) | 1.04 | (0.71–1.50) | 1.28 | (0.89–1.85) | 1.13 | (0.65–1.97) |
Health Utilization (B = Low) | ||||||||
Medium | 3.65 *** | (2.95–4.51) | 1.24 | (0.92–1.68) | 2.03 *** | (1.52–2.70) | 2.11 *** | (1.33–3.34) |
High | 5.33 *** | (3.96–7.17) | 1.59 | (0.80–3.17) | 3.64 *** | (2.14–6.20) | 5.07 *** | (1.97–13.06) |
Observations | 18119 | 3535 | 4151 | 1342 | ||||
Number of groups | 904 | 728 | 841 | 537 |
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Total | Year | |||||
---|---|---|---|---|---|---|
2008 | 2013 | 2018 | ||||
N = | % | % | % | % | p-Value | |
Gender | 0.803 | |||||
Male | 17176 | 50.7 | 50.2 | 50.8 | 51.5 | |
Female | 16693 | 49.3 | 49.8 | 49.2 | 48.5 | |
Birth order | 0.001 | |||||
First born | 5541 | 16.4 | 16.2 | 16.6 | 16.2 | |
2–3rd | 11162 | 33.0 | 32.9 | 32.7 | 33.8 | |
4–6th | 11234 | 33.2 | 33.0 | 32.9 | 34.3 | |
7th+ | 5932 | 17.5 | 18.0 | 17.8 | 15.7 | |
Birth weight | 0.000 | |||||
Small | 5003 | 14.9 | 15.5 | 15.0 | 13.5 | |
Average | 13996 | 41.8 | 37.9 | 40.7 | 52.6 | |
Large | 14523 | 43.3 | 46.6 | 44.3 | 33.9 | |
Method of delivery | 0.000 | |||||
Normal | 33046 | 98.0 | 98.5 | 97.9 | 97.0 | |
Caesarean session | 687 | 2.0 | 1.6 | 2.1 | 3.0 | |
Mother’s Age | 0.000 | |||||
15–19 | 2044 | 6.0 | 6.9 | 5.8 | 4.9 | |
20–24 | 6912 | 20.4 | 20.7 | 20.6 | 19.2 | |
25–29 | 9770 | 28.9 | 29.1 | 28.4 | 29.4 | |
30–34 | 7319 | 21.6 | 20.7 | 21.8 | 23.2 | |
35+ | 7824 | 23.1 | 22.7 | 23.4 | 23.3 | |
Mother’s Education | 0.000 | |||||
no education | 16420 | 48.5 | 52.0 | 48.5 | 41.0 | |
primary | 6649 | 19.6 | 21.9 | 19.3 | 15.6 | |
secondary | 8624 | 25.5 | 21.3 | 25.7 | 33.9 | |
higher | 2176 | 6.4 | 4.9 | 6.5 | 9.5 | |
Mother’s EM/Week | 0.000 | |||||
None | 11784 | 34.8 | 34.6 | 35.0 | 35.1 | |
less than once | 6359 | 18.8 | 13.4 | 21.8 | 23.2 | |
at least once | 15700 | 46.4 | 52.1 | 43.2 | 41.8 | |
Father’s Education | 0.000 | |||||
no education | 12854 | 38.4 | 41.9 | 38.2 | 31.3 | |
primary | 6407 | 19.1 | 21.3 | 19.3 | 14.2 | |
secondary | 9948 | 29.7 | 26.2 | 29.2 | 38.6 | |
higher | 4275 | 12.8 | 10.6 | 13.4 | 15.9 | |
Family wealth | 0.000 | |||||
poorest | 8251 | 24.4 | 27.1 | 23.3 | 21.1 | |
poor | 7685 | 22.7 | 23.6 | 23.0 | 19.9 | |
middle | 6433 | 19.0 | 18.2 | 18.8 | 21.2 | |
richer | 6076 | 17.9 | 16.7 | 18.1 | 20.2 | |
richest | 5424 | 16.0 | 14.4 | 16.8 | 17.6 | |
DMF | 0.000 | |||||
Big problem | 11759 | 34.8 | 40.2 | 32.4 | 29.1 | |
not a big problem | 21997 | 65.2 | 59.8 | 67.6 | 71.0 | |
Residency | 0.000 | |||||
Urban | 10781 | 31.8 | 27.7 | 32.9 | 38.2 | |
Rural | 23088 | 68.2 | 72.3 | 67.2 | 61.8 | |
Geopolitical zone | 0.000 | |||||
Northcentral | 5533 | 16.3 | 17.3 | 15.1 | 17.1 | |
Northeast | 7481 | 22.1 | 23.9 | 21.6 | 19.4 | |
Northwest | 10192 | 30.1 | 28.7 | 32.8 | 26.5 | |
Southeast | 2962 | 8.8 | 7.9 | 7.8 | 12.9 | |
Southsouth | 3530 | 10.4 | 10.2 | 10.8 | 10.1 | |
Southwest | 4171 | 12.3 | 11.9 | 12.0 | 13.9 |
Immunization N = 16694 | Diarrhoea N = 4047 | |||||||||||||
No | % | Yes | % | Total | % | χ2 P-Value | No | % | Yes | % | Total | % | χ2 P-Value | |
Health autonomy | <0.01 | <0.01 | ||||||||||||
Low | 1674 | 13.1 | 145 | 3.7 | 1819 | 10.9 | 113 | 15.5 | 373 | 11.3 | 486 | 12.0 | ||
Substantial | 7507 | 59.0 | 1739 | 43.9 | 9246 | 55.4 | 475 | 65.0 | 2022 | 60.3 | 2497 | 61.7 | ||
High | 3548 | 27.9 | 2081 | 52.5 | 5629 | 33.7 | 143 | 19.6 | 921 | 27.8 | 1064 | 26.3 | ||
Health utilization | <0.01 | <0.01 | ||||||||||||
Low | 8464 | 66.5 | 848 | 21.4 | 9312 | 55.8 | 561 | 76.7 | 1999 | 60.3 | 2560 | 63.3 | ||
Substantial | 3555 | 27.9 | 2309 | 58.2 | 5864 | 35.1 | 150 | 20.5 | 1112 | 33.5 | 1262 | 31.2 | ||
High | 710 | 5.6 | 808 | 20.4 | 1518 | 9.1 | 20 | 2.7 | 205 | 6.2 | 225 | 5.6 | ||
Fever N = 4973 | ARI N = 1575 | |||||||||||||
No | % | Yes | % | Total | % | χ2 P-Value | No | % | Yes | % | Total | % | χ2 P-Value | |
Health autonomy | <0.01 | <0.01 | ||||||||||||
Low | 360 | 14.9 | 216 | 8.4 | 576 | 11.6 | 122 | 14.5 | 53 | 7.3 | 175 | 11.1 | ||
Substantial | 1416 | 58.7 | 1483 | 58.0 | 2899 | 58.3 | 481 | 57.0 | 440 | 60.2 | 921 | 58.5 | ||
High | 638 | 26.4 | 860 | 33.6 | 1498 | 30.1 | 241 | 28.6 | 238 | 32.6 | 479 | 30.5 | ||
Health utilization | <0.01 | <0.01 | ||||||||||||
Low | 1653 | 68.5 | 1263 | 49.4 | 2916 | 58.6 | 600 | 71.1 | 345 | 47.2 | 945 | 60.0 | ||
Substantial | 643 | 26.6 | 1058 | 41.3 | 1701 | 34.2 | 216 | 25.6 | 321 | 43.9 | 537 | 34.1 | ||
High | 118 | 4.9 | 238 | 9.3 | 356 | 7.2 | 28 | 3.3 | 65 | 8.9 | 93 | 5.9 |
RANDOM EFFECT | Immunization | Diarrhoea | Fever | ARI | ||||
---|---|---|---|---|---|---|---|---|
CI | CI | CI | CI | |||||
Variance at community level | 0.00 *** | (0.00–0.01) | 2.85 *** | (1.34–6.07) | 0.10 *** | (0.05–0.22) | 0.13 *** | (0.05–0.32) |
Variance at Household | 2.46 *** | (1.82–3.32) | 1.30 ** | (1.04–1.63) | 1.57 *** | (1.19–2.06) | 1.67 *** | (1.15–2.43) |
Log likelihood | −6880.2246 | −1788.5715 | −3065.34 | −934.90057 | ||||
Model fit Statistics LR test | 272.25 *** | 11.49*** | 43.13 *** | 14.52 *** | ||||
ICC from Null model: | ||||||||
Community | 0.25 | (0.23–0.27) | 0.11 | (0.06–0.16) | 0.13 | (0.10–0.18) | 0.21 | (0.05–0.22) |
Household | Community | 0.86 | (0.83–0.88) | 0.61 | (0.44–0.76) | 0.83 | (0.74–0.90) | 0.87 | (0.05–0.22) |
Observations | 16694 | 4047 | 4973 | 1575 | ||||
Number of groups | 1295 | 892 | 1037 | 665 |
Variables | Immunization | Diarrhoea | Fever | ARI | ||||
---|---|---|---|---|---|---|---|---|
AOR | CI | AOR | CI | AOR | CI | AOR | CI | |
Survey year | ||||||||
ref = 2008 | ||||||||
2013 | 1.63 *** | (1.36–1.95) | 1.42 *** | (1.12–1.78) | 0.32 *** | (0.24–0.44) | 0.44 *** | (0.33–0.60) |
2018 | 2.33 *** | (1.84–2.94) | 1.06 | (0.82–1.37) | 2.43 *** | (1.82–3.25) | 1.98 *** | (1.41–2.77) |
Health Autonomy | ||||||||
ref = Low | ||||||||
Medium | 1.53 *** | (1.12–2.11) | 1.08 | (0.82–1.43) | 1.53 *** | (1.15–2.05) | 1.65 ** | (1.09–2.52) |
High | 1.87 *** | (1.34–2.62) | 1.16 | (0.83–1.62) | 1.51 ** | (1.09–2.10) | 1.24 | (0.78–1.99) |
Health Utilization | ||||||||
ref = Low | ||||||||
Medium | 3.53 *** | (2.82–4.41) | 1.25 * | (0.96–1.61) | 1.89 *** | (1.47–2.43) | 1.63 *** | (1.21–2.21) |
High | 5.61 *** | (4.01–7.84) | 1.46 | (0.81–2.63) | 2.21 *** | (1.43–3.41) | 2.67 *** | (1.45–4.91) |
Child Level Covariates | ||||||||
Gender | ||||||||
ref = Male | ||||||||
Female | 1.02 | (0.89–1.18) | 0.91 | (0.76–1.10) | 0.99 | (0.84–1.16) | 0.97 | (0.76–1.23) |
Birth order | ||||||||
ref = First born | ||||||||
2–3rd | 0.72 *** | (0.57–0.92) | 1.11 | (0.80–1.54) | 0.88 | (0.66–1.18) | 0.97 | (0.64–1.47) |
4–6th | 0.55 *** | (0.42–0.73) | 1.15 | (0.79–1.67) | 0.90 | (0.65–1.25) | 0.78 | (0.48–1.27) |
7th+ | 0.52 *** | (0.36–0.74) | 1.45 | (0.90–2.33) | 0.93 | (0.62–1.39) | 0.80 | (0.44–1.44) |
PWB | ||||||||
ref = Small | ||||||||
Average | 1.37 ** | (1.08–1.74) | 0.96 | (0.75–1.22) | 1.31 ** | (1.02–1.67) | 1.51 ** | (1.07–2.13) |
Large | 1.29 ** | (1.01–1.64) | 1.26 * | (0.98–1.63) | 1.57 *** | (1.22–2.04) | 2.17 *** | (1.54–3.08) |
Delivery method | ||||||||
Ref = normal birth | ||||||||
C & S | 1.84 *** | (1.18–2.86) | 0.55 | (0.22–1.42) | 0.96 | (0.50–1.86) | 0.95 | (0.36–2.55) |
Maternal and Household Level Covariates | ||||||||
Mothers’ age | ||||||||
Ref = 15–19 years | ||||||||
20–24 | 1.70 ** | (1.08–2.68) | 0.83 | (0.55–1.23) | 1.52 ** | (1.01–2.29) | 1.58 | (0.89–2.80) |
25–29 | 2.75 *** | (1.72–4.40) | 0.96 | (0.62–1.48) | 1.41 | (0.92–2.17) | 1.50 | (0.82–2.75) |
30–34 | 3.17 *** | (1.92–5.21) | 1.13 | (0.69–1.85) | 1.56 * | (0.98–2.50) | 1.78 * | (0.92–3.44) |
35+ | 3.55 *** | (2.11–5.97) | 1.07 | (0.63–1.82) | 1.48 | (0.90–2.43) | 1.77 | (0.88–3.56) |
Mothers’ education | ||||||||
ref= No education | ||||||||
primary | 1.87 *** | (1.47–2.37) | 1.04 | (0.78–1.38) | 1.57 *** | (1.19–2.07) | 1.29 | (0.90–1.85) |
secondary | 2.89 *** | (2.19–3.80) | 1.10 | (0.75–1.63) | 1.58 *** | (1.13–2.20) | 1.42 | (0.92–2.20) |
higher | 2.78 *** | (1.89–4.08) | 1.18 | (0.52–2.71) | 2.68 *** | (1.50–4.79) | 1.63 | (0.74–3.59) |
Media exposure/Week | ||||||||
ref = None | ||||||||
less than once | 1.29 ** | (1.02–1.63) | 1.09 | (0.84–1.43) | 1.04 | (0.81–1.33) | 1.27 | (0.87–1.85) |
at least once | 1.51 *** | (1.22–1.87) | 1.25 * | (0.98–1.60) | 1.46 *** | (1.16–1.85) | 1.69 *** | (1.24–2.30) |
Father’s education | ||||||||
ref = low | ||||||||
primary | 1.86 *** | (1.44–2.42) | 1.33 ** | (1.00–1.76) | 1.11 | (0.86–1.44) | 0.78 | (0.53–1.15) |
secondary | 1.98 *** | (1.52–2.56) | 1.49 ** | (1.08–2.06) | 1.21 | (0.92–1.60) | 0.94 | (0.64–1.38) |
higher | 2.57 *** | (1.87–3.54) | 1.62 ** | (1.00–2.63) | 1.34 | (0.92–1.94) | 2.05 *** | (1.22–3.43) |
Family wealth | ||||||||
ref = poorest | ||||||||
poor | 1.43 ** | (1.08–1.88) | 1.23 * | (0.97–1.56) | 1.34 ** | (1.05–1.71) | 0.98 | (0.69–1.39) |
middle | 1.89 *** | (1.41–2.53) | 1.91 *** | (1.34–2.72) | 1.30 * | (0.98–1.75) | 0.87 | (0.58–1.31) |
richer | 2.62 *** | (1.88–3.67) | 1.28 | (0.83–1.98) | 1.83 *** | (1.26–2.68) | 1.17 | (0.70–1.98) |
richest | 4.02 *** | (2.69–6.02) | 1.91 ** | (1.01–3.60) | 1.91 *** | (1.19–3.08) | 1.19 | (0.60–2.36) |
Community Level Covariates | ||||||||
Residency | ||||||||
ref = Urban | ||||||||
Rural | 0.85 | (0.70–1.04) | 0.81 | (0.59–1.10) | 1.40 ** | (1.08–1.80) | 1.21 | (0.84–1.74) |
Geopolitical zone | ||||||||
ref = Northcentral | ||||||||
North east | 0.57 *** | (0.43–0.75) | 0.82 | (0.57–1.17) | 1.14 | (0.84–1.55) | 0.74 | (0.49–1.11) |
Northwest | 0.28 *** | (0.21–0.38) | 0.74 | (0.50–1.07) | 1.47 ** | (1.06–2.05) | 1.00 | (0.62–1.64) |
Southeast | 1.15 | (0.84–1.57) | 1.80 | (0.86–3.77) | 0.84 | (0.56–1.26) | 0.97 | (0.54–1.72) |
Southsouth | 1.20 | (0.90–1.62) | 0.68 | (0.36–1.29) | 0.71 * | (0.47–1.05) | 1.10 | (0.63–1.90) |
Southwest | 0.54 *** | (0.40–0.73) | 0.60* | (0.34–1.04) | 0.66 * | (0.41–1.05) | 0.52 | (0.24–1.14) |
Distance to medical facility | ||||||||
(ref = Big problem) | ||||||||
Not a problem | 1.21 ** | (1.02–1.45) | 1.28 ** | (1.04–1.59) | 1.31 *** | (1.08–1.59) | 1.58 *** | (1.21–2.08) |
Constant (Intercept) | 143.29 *** | (22.82–99.51) | 1.56 | (0.38–6.46) | 5.99 * | (0.94–38.08) | 1.00 | (1.00–1.00) |
Observations | 16694 | 4047 | 4973 | 1575 | ||||
Number of groups | 1295 | 892 | 1037 | 665 |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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Ariyo, T.; Jiang, Q. Mothers’ Healthcare Autonomy, Maternal-Health Utilization and Healthcare for Children under-3 Years: Analysis of the Nigeria DHS Data (2008–2018). Int. J. Environ. Res. Public Health 2020, 17, 1816. https://doi.org/10.3390/ijerph17061816
Ariyo T, Jiang Q. Mothers’ Healthcare Autonomy, Maternal-Health Utilization and Healthcare for Children under-3 Years: Analysis of the Nigeria DHS Data (2008–2018). International Journal of Environmental Research and Public Health. 2020; 17(6):1816. https://doi.org/10.3390/ijerph17061816
Chicago/Turabian StyleAriyo, Tolulope, and Quanbao Jiang. 2020. "Mothers’ Healthcare Autonomy, Maternal-Health Utilization and Healthcare for Children under-3 Years: Analysis of the Nigeria DHS Data (2008–2018)" International Journal of Environmental Research and Public Health 17, no. 6: 1816. https://doi.org/10.3390/ijerph17061816