Modelling individual fertility levels in Malawian women: a spatial semiparametric regression model

Structured additive distributional hurdle Poisson modelling of individual fertility levels in Nigeria

Fertility is one of the dynamic components of population and has been modelled through children ever born per woman, which is a count variable that can be characterized with excessive zeros origination from women without any births. In order to examine the spatial variation across states of Nigeria, we proposed the use of hurdle models that classifies the data into a truncated count and point mass of zeros. We adopt distributional regression model that allows all parameters of the hurdle model to be linked to covariates of different types so as to allow for accessing the spatial variations and nonlinear forms of metrical covariates on the level of fertility and in the likelihood of having no child. Data was sourced from the 2013 Nigeria Demographic and Health Survey. Findings reveal the existence of north-south divide in the average level of fertility and in the likelihood of a woman not giving birth to any child. Women with higher level of education and those from richer or richest households have higher likelihood of having no child, but this is not the case for women with primary or secondary education, users of traditional or modern contraceptive, ever-married women and those working. There is therefore the need to strengthen family planning policies so that investment in contraceptive would yield the expected results in Nigeria.

Regional variations in the use of postnatal care in Nigeria: a spatial analysis

Maternal health outcomes vary considerably in Nigeria, with maternal mortality ratio ranging from 165 per 100,000 live births in the South-west to 1549 per 100,000 live births in the North-east. One important maternal health indicator is an adequate use of postnatal care (PNC); however, the evidence is sparse on its spatial distribution across regions in Nigeria. This paper thus examined the spatial distribution of uptake of postnatal care in Nigeria using data from the 2013 Nigeria Demographic and Health Survey, with a sample of 12,127 women aged 15-49 years. The Bayesian-structured additive regression of the logit model was used to examine the spatial relationships. The results revealed a north-south divide in the use of postnatal care, with higher PNC uptake established in the latter. Interestingly, results showed significant intra-region residual spatial variations with higher PNC use in Yobe and Bauchi in North-east Nigeria compared to other states within the region. The findings indicate the need for policymakers to develop state- and region-specific health policy and intervention programs to address the inequity in postnatal care coverage and usage across regions in Nigeria.

Spatial variation of management of childhood diarrhea in Malawi

This study reports the spatial variability in household management of diarrhea among under-fives in Malawi. Using data from 2010 Malawi Demographic and Health Survey, we examined oral rehydration and feeding practices of mothers and caregivers of 3105 children with an episode of diarrhea by mapping district effect residual in geo-additive probit model and analyzing residual spatial effects in a Bayesian approach. The findings suggest that although diarrhea is relatively less prevalent in the Northern Region, this region lags behind in terms of adoption of appropriate practices for home-based management of diarrhea in children compared to the Central Regions and Southern Regions. A cluster of five predominantly rural districts in the eastern part of the Southern Region showed remarkably high level of household care for childhood diarrhea relative to the rest of the country. The fixed effects show the importance of breastfeeding, paternal education, wealth index, and ethnicity on oral rehydration, while paternal education, marital status, and ethnicity show significant influence on feeding for children with a diarrhea episode. The paper discusses the apparent inverse relationship between regional prevalence of diarrhea episodes and care-seeking practices for childhood diarrhea in Malawi, and makes relevant recommendations for policy.