Bayesian Hierarchical and Decomposition Analysis of Pregnancy-Related Mortality in Nigeria Using NDHS 2018-2023/24
Article Sidebar
Page Numbers:
325-338
Digital Object Identifier:
10.58578/mjms.v4i2.9166
Viewed: 43 times
Downloaded: 50 times
LYAS Publisher cordially invites qualified professionals to serve as Editors or Reviewers. Your expertise will make an important contribution to maintaining and strengthening the academic quality of our publications. Interested applicants are kindly requested to complete the application form at the following link: Editors & Reviewers
Please feel free to contact us if you need any further information about the submission process or if you have any additional questions.
Authors:
Adeyemo S.O1*, Ohaegbulam E.U2, Duruojinkeya P3 
Copyright :
Authors retain copyright and grant the journal right of first publication.
Main Article Content
Abstract
Nigeria continues to face one of the highest burdens of pregnancy-related mortality globally, yet recent measurement evidence remains constrained by gaps in direct reporting. This policy and measurement note examines the availability of direct sibling-history estimates in the Nigeria Demographic and Health Surveys (NDHS), with particular attention to the absence of an updated pregnancy-related mortality ratio (PRMR) in the 2023–24 reporting cycle. The NDHS 2018 reported a national PRMR of 512 per 100,000 live births (95% CI: 447–578). However, the NDHS 2023–24 Key Indicators and Summary Reports do not publish an updated sibling-history-based PRMR, thereby limiting direct assessment of mortality trends. Proxy indicators suggest modest progress, including a decline in the total fertility rate from 5.3 to 4.8 and an increase in skilled birth attendance from 43% to 46%, although rural–urban and zonal disparities persist. Exploratory Bayesian hierarchical modeling using NDHS 2023–24 microdata produced an illustrative national PRMR estimate of approximately 462 per 100,000 live births (CrI: 392–532), suggesting a possible modest decline, while rural estimates remain high at approximately 612. The findings indicate that the absence of a published direct PRMR weakens evidence-based monitoring of SDG 3.1 and limits independent assessment of progress in reducing pregnancy-related mortality. This note contributes to policy measurement by highlighting the need for routine inclusion of sibling-derived PRMR estimates in future DHS reports, alongside microdata access to support independent verification and more equitable maternal health planning.
Citation Metrics:
Downloads
Article Details
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
References
Alkema, L., Chou, D., Hogan, D., Zhang, S., Moller, A. B., Gemmill, A., Fat, D. M., Boerma, T., Temmerman, M., Mathers, C., & Say, L. (2016). Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: A systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet, 387(10017), 462–474. https://doi.org/10.1016/S0140-6736(15)00838-7
Alkema, L., Zhang, S., Chou, D., Gemmill, A., Moller, A. B., Fat, D. M., Say, L., Mathers, C., & Hogan, D. (2017). A Bayesian approach to the global estimation of maternal mortality. The Annals of Applied Statistics, 11(3), 1245–1274. https://doi.org/10.1214/16-AOAS1014
Betrán, A. P., Wojdyla, D., Posner, S. F., & Gülmezoglu, A. M. (2005). National estimates for maternal mortality: An analysis based on the WHO systematic review of maternal mortality and morbidity. BMC Public Health, 5, Article 131. https://doi.org/10.1186/1471-2458-5-131
Federal Ministry of Health and Social Welfare of Nigeria, National Population Commission, & ICF. (2024). Nigeria Demographic and Health Survey 2023–24: Key indicators report. Federal Ministry of Health and Social Welfare of Nigeria, National Population Commission, and ICF. https://dhsprogram.com/pubs/pdf/PR157/PR157.pdf
Feehan, D. M., & Borges, G. M. (2021). Estimating adult death rates from sibling histories: A network approach. Demography, 58(4), 1525–1546. https://doi.org/10.1215/00703370-9368990
Graham, W. J., Brass, W., & Snow, R. W. (1989). Estimating maternal mortality: The sisterhood method. Studies in Family Planning, 20(3), 125–135. https://doi.org/10.2307/1966567
Hanley, J. A., Hagen, C. A., & Shiferaw, T. (1996). Confidence intervals and sample-size calculations for the sisterhood method of estimating maternal mortality. Studies in Family Planning, 27(4), 220–227. https://doi.org/10.2307/2137958
Helleringer, S., Pison, G., Kanté, A. M., Duthé, G., & Andro, A. (2014). Reporting errors in siblings’ survival histories and their impact on adult mortality estimates: Results from a record linkage study in Senegal. Demography, 51(2), 387–411. https://doi.org/10.1007/s13524-013-0268-3
Helleringer, S., Pison, G., Masquelier, B., Kanté, A. M., Douillot, L., Duthé, G., Sokhna, C., & Delaunay, V. (2014). Improving the quality of adult mortality data collected in demographic surveys: Validation study of a new siblings’ survival questionnaire in Niakhar, Senegal. PLOS Medicine, 11(5), Article e1001652. https://doi.org/10.1371/journal.pmed.1001652
ICF. (2018). DHS maternal mortality indicators: An assessment of data quality and estimation methods (DHS Analytical Studies No. 46). The DHS Program.
ICF. (2022). Guide to DHS statistics (Version 2). The DHS Program. https://dhsprogram.com/data/Guide-to-DHS-Statistics/index.cfm
Kassebaum, N. J., Barber, R. M., Bhutta, Z. A., Dandona, L., Gething, P. W., Hay, S. I., Kinfu, Y., Larson, H. J., Liang, X., Lim, S. S., Lozano, R., Mokdad, A. H., Naghavi, M., O’Brien, E., Pinho, C., Vos, T., Wang, H., Whiteford, H. A., & Murray, C. J. L. (2016). Global, regional, and national levels of maternal mortality, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1775–1812. https://doi.org/10.1016/S0140-6736(16)31470-2
Merdad, L., Hill, K., & Graham, W. (2013). Improving the measurement of maternal mortality: The sisterhood method revisited. PLOS ONE, 8(4), Article e59834. https://doi.org/10.1371/journal.pone.0059834
Mgawadere, F., Kana, T., & van den Broek, N. (2017). Measuring maternal mortality: A systematic review of methods used to obtain estimates of the maternal mortality ratio in low- and middle-income countries. British Medical Bulletin, 121(1), 121–134. https://doi.org/10.1093/bmb/ldw056
National Population Commission, & ICF. (2019). Nigeria Demographic and Health Survey 2018. National Population Commission and ICF. https://dhsprogram.com/pubs/pdf/FR359/FR359.pdf
Oweibia, M., Elemuwa, C. O., Egberipou, T., Timighe, G. C., Sylvanus, P., & Wilson, T. R. (2025). Maternal and child health trends in Nigeria: A scoping review of NDHS 2018 vs. NDHS 2023 [Preprint]. medRxiv. https://doi.org/10.1101/2025.05.18.25327864
Rutenberg, N., & Sullivan, J. M. (1991). Direct and indirect estimates of maternal mortality from the sisterhood method. In Proceedings of the Demographic and Health Surveys World Conference (Vol. 3, pp. 1669–1696). Institute for Resource Development/Macro International.
Stanton, C., Abderrahim, N., & Hill, K. (2000). An assessment of DHS maternal mortality indicators. Studies in Family Planning, 31(2), 111–123. https://doi.org/10.1111/j.1728-4465.2000.00111.x
Wilmoth, J. R., Mizoguchi, N., Oestergaard, M. Z., Say, L., Mathers, C. D., Zureick-Brown, S., Inoue, M., & Chou, D. (2012). A new method for deriving global estimates of maternal mortality. Statistics, Politics, and Policy, 3(2), Article 3. https://doi.org/10.1515/2151-7509.1038
World Health Organization. (1997). The sisterhood method for estimating maternal mortality: Guidance notes for potential users. World Health Organization. https://iris.who.int/handle/10665/64007
World Health Organization, United Nations Children’s Fund, United Nations Population Fund, World Bank Group, & United Nations Department of Economic and Social Affairs, Population Division. (2025). Trends in maternal mortality 2000 to 2023: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. World Health Organization. https://www.who.int/publications/i/item/9789240108462