Publication date: 
September 1, 2015

Seattle, WA – Childhood survival improved in every state in Nigeria, but in many places rates of malnutrition have increased since 2000. Polio immunization rose throughout the country, yet rates of coverage for other vaccines flatlined or faltered over time. Stark geographic disparities deepened for a number of interventions, underscoring many of the challenges facing Nigeria’s health system.

Published today in BMC Medicine, “Benchmarking health system performance across states in Nigeria: systematic analysis of levels and trends in key maternal and child health interventions and outcomes, 2000–2013,” provides the first-ever comprehensive assessment of Nigeria’s gains and gaps in addressing state-level health needs. The study’s results, which can be further explored through the interactive Nigeria Health Map data visualization, came from a broader primary health care project funded by the Bill & Melinda Gates Foundation.

Nigeria recorded marked improvement for a subset of health interventions, particularly for polio immunization rates and ownership of insecticide-treated nets. Nonetheless, absolute levels of coverage remained fairly low by 2013, indicating that heightened efforts to scale up intervention access and use may be needed. Most states experienced minimal progress – or even declines – in coverage for more routine maternal health services such as antenatal care and skilled birth attendance.

“Subnational benchmarking, particularly for a country as large and economically diverse as Nigeria, is vital for understanding where health programs and interventions are working – and where more resources or policy attention are needed,” said Dr. Emmanuela Gakidou, IHME Director of Academic Development and Training and the study’s senior author. “With its recent successes in driving down polio, Nigeria has shown what can happen with focused investments, locally tailored campaigns, and improved monitoring. Yet these gains may be short-lived if addressing Nigeria’s large inequalities in health aren’t more highly prioritized.”

Additional findings include the following:

  • Under-5 mortality fell in every state from 2000 to 2013, and the state-level differences in childhood survival narrowed over time. At the same time, several states in northern Nigeria experienced under-5 mortality rates that rivaled the highest worldwide, exceeding 150 deaths per 1,000 live births in 2013. These are the same states where rates of childhood malnutrition, as measured by the percentage of children who are underweight, have actually increased since 2000.
  • Nationally, Nigeria has increased access to and use of malaria interventions since 2009 – an important gain given that 30% of the world’s malaria cases and deaths occurred within the country’s borders in 2013. Nonetheless, the rates at which high-risk populations – children with suspected malaria and pregnant women – received proper care remained quite low. By 2013, no state recorded coverage of artemisinin-based combination therapies among children under 5 that exceeded 20%.
  • Amid rising immunization rates for the oral polio vaccine, Nigeria experienced minimal progress in improving more routine vaccination coverage, namely around the diphtheria-pertussis-tetanus vaccine. State-level trends for these vaccines, which have similar dosing requirements (three) and immunization schedules, were quite heterogeneous. These findings suggest that amid expansive disease-focused immunization campaigns, routine delivery platforms for multi-dose vaccines have not necessarily experienced similar success.
  • Coverage of maternal health interventions reflected the country’s history of north-south disparities, which are largely related to differences in wealth, educational attainment, and urban development. These results indicate that barriers to accessing and using health services, particularly those related to maternal health, remain in Nigeria’s more remote, impoverished regions.

Explore the Nigeria Health Map at

To learn more about these results or other projects at IHME, please contact e[email protected].