A SURVEY ON BIRTH AND DEATH REGISTRATION IN A SEMI-URBAN SETTLEMENT IN MIDDLE-BELT NIGERIA T.M. Akande Senior Lecturer / Consultant Dept of Epid. & Community Health, University of Ilorin, Ilorin, Nigeria O. O. Sekoni Senior Registrar Dept of Epid & Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria. ABSTRACT Objectives: This is a descriptive cross-sectional survey conducted in a semi-urban settlement in the Middle-Belt of Nigeria to determine awareness, attitude and practice of birth and death registration. Methods: This is a descriptive cross-sectional survey. Three hundred and two heads of households were interviewed in houses selected by systematic random sampling and birth registration certificate checked for children below 11 years. Results: The study showed that awareness of birth registration was high in the study population and the major source of awareness is through government agencies and mass media play very little role. The awareness of death registration is however very low. Out of the 217 (71.9%) households that had children below 11 years, total children below 11 years is 473 children, 354 (74.8%) of them had their births registered and only 202 (57.1%) had registration certificate during the interview. Of the 209 households that recorded deaths in the household within the last 10 years only 24 (11.8%) households reported registering deaths in the last 10 years. Conclusion: Birth registration and death registration need to be complete for planning purpose, which is largely deficient as shown by this study. It is therefore important to conduct further studies to identify ways forward towards improving birth and death registration in Nigeria. Key words: Birth, death registration, semi-urban, Nigeria 56
INTRODUCTION Birth and death are vital events that are registered in most countries. While birth and death registration in developed countries is done well enough to be useful for determining population changes and planning, the situation in most developing countries is very poor (1-4). Reports show that 1 in 3 newborns of about 40 million births are unregistered (5). The importance of registration of births and deaths for national and local planning has not received adequate attention in Nigeria (1). In Nigeria birth and death registration started from the colonial era and is currently carried out by National Population Commission, which was inaugurated in 1989(6). Very few studies have been conducted in communities in Nigeria to determine the extent to which these vital events are registered. This study examined the awareness, attitude and practices birth and death registration in a semi-urban community in the Middle Belt of Nigeria. MATERIALS AND METHOD The study is a descriptive cross-sectional survey conducted in 2003 in Oke-Oyi town in Kwara State, Nigeria. Oke-Oyi is a semi urban community with an estimated population of 38,760. It is the administrative capital of Ilorin East Local Government, Kwara State. Like most LGA headquarters, Oke-Oyi town has a National Population Commission office located within the Local Government office building. Oke-Oyi has a primary health center and few private clinics. It also has a secondary school and primary school and the town has electricity supply. Systematic random sampling was used to select houses from all streets in the community. With the use of semi-structured, pre-tested questionnaire, trained research assistants interviewed the head of selected households. The interviewer also checked for possession of birth certificates in households with children below 11 years. The questionnaire was used to collect information on respondents demographic characteristics, knowledge, attitudes and practices towards birth and death registration. Data was checked and entered using Epi-Info 6.04 computer software. Analysis was done to produce frequency, mean, standard deviation and range. RESULTS Of the 302 respondents interviewed 279 (92.4%) were heads of households. About three quarters of those interviewed were fathers, 17.0% were mothers while the rest were guardians. The mean age of respondents is 52 + 13.34 years. Two hundred and forty (79.5%) of respondents were males while 62 (20.5%) were females. Less than half (42%) of respondents had no formal education, 35.3% had primary education, 10.2%, and 12.5% had secondary and tertiary education respectively. The respondents were predominantly (92%) Yoruba. About two-thirds (65.5%) of the households were monogamous families, 31.3% were polygamous and 3.2% were single parent families. The mean number of children born into the households interviewed was 6.49. Altogether 217 households had children below 11 years. The mean number of children in the households that were aged less than 11 years is 2.18 ± 1.16. Most of the respondents interviewed in the households 288 (97.6%) were aware that births are supposed to be registered. However, only 94(32%) were aware that deaths were supposed to be registered. Also, majority of the respondents 195 (81.9%) of respondents knew there is a difference between birth registration and obtaining a birth certificate. 57
Most of the respondents 246 (81.5%) felt births are registered at the local government while 34 (11.3%) and 1(0.4%) felt birth registration is done at the hospital and at the court respectively, while 21 (7.0%) had no idea of where births are registered. Seventy seven (24.5%) respondents felt deaths were registered at the local government and 20 (6.6%) at the hospital and 1 (0.4%) at the court and majority 204 (67.5%) had no idea. About two-thirds 197 (65.2%) of respondents had heard of the National Population Commission. Almost all 278 (94.9%) of respondents had heard of parents registering birth of their children. On the other hand only 73 (25.6%) of respondents had heard of any family that registered death. Source of awareness of registration of births and deaths was mostly form government agencies (63.1%), mass media (19.1%), interaction with other people 6.2%, while 28 (11.61%) were not aware at all. Virtually all 294 (99.3%) of respondents felt it was necessary to register births while only 118 (39.1%) felt that registration of deaths was necessary. The respondents perceived reasons for birth registration were; for future purposes and planning 135 (44.7%), 101 (33.4%) was for the purpose of school enrollment while other reasons given include, to know the age of the child 9 (2.9%) and to know the birth date 8 (2.6%). The perceived reasons for death registration were; 52 (17.2%) for remembrance, 36 (11.9%) know the occurrence and number of deaths and 13 (4.3%) to know the number of people in the population. Out of the 302 households surveyed 217 (71.9%) had children below 11 years old and these households had a total of 473 children below 11 years, 354 (74.8%) of them had their births registered and only 202 (57.1%) of them had their birth registration certificate produced during the interview. Out of 302 households interviewed 209 said they had recorded deaths in the household within the last 10 years and only 24 (11.8%) households reported registering deaths in the last 10 years. DISCUSSION The study was conducted in a semi-urban community which as shown in this study has population characterized by presence of people of various educational status and occupation. Majority of the respondents are males this is because most head of the households are males. Awareness of birth registration in this community is high as shown by over 90% of respondents who had knowledge of birth registration and have heard of parents who registered their children s birth. The most common source of awareness is through the government agencies. Locating the National Population Commission in Local Government Offices is therefore a major advantage. It is however doubtful if communities outside the Local Government headquarters will have this level of awareness since this study showed that few people became aware through the mass media and interpersonal information. It will be necessary to use the mass media for wide dissemination of information on registration of births and deaths. Awareness of death registration is low among the study population. Jewkes et al also reported low knowledge of death registration in Egypt (4). This shows that even the government agencies put more emphasis on birth registration and information on death registration is not disseminated as much as that of birth registration. In a semi-urban community like Oke-Oyi where home deliveries are common and the available health facilities may not issue birth certificates, most parents will take advantage of birth registration to obtain a birth certificate. About 80% of the respondents knew the difference between birth registration and birth certificate. 58
Even though almost all respondents were aware of birth registration only about two-third knows about the National Population Commission, which is the government agency responsible for registration of births and deaths and despite location of its office in the town. One of the main reasons people in this community register births is to get a certificate to be used during school enrollment for their children. There appears to be little knowledge on why registration is necessary and the perception is often on the need for a certificate to achieve something else (4). There appears to be no specific thing tied to making registration of deaths important by the people. If a National Policy is formulated and enforced to make death registration necessary for legal burial or disposal of a body registration of deaths will receive a major boost. While almost all respondents felt it was necessary to register births only about a third of them felt it was necessary to register deaths. This certainly had influence on their practice as shown by this study in which about three-quarters of children below 11 years in the households were registered and only 11.5% of deaths that occurred within 10 years to the interview were reported to have been registered. Several studies have reported serious under-registration of deaths in developing countries (4,7-12). Adeloklu John found that the number of deliveries in the hospitals was more than the number of registered births and no death was registered at the centers studied in New Bussa also located in Middle Belt Nigeria (1). Meville found under-registration of infant deaths remains a serious problem in Jamaica (2). Fairly good coverage of birth registration of births without a commensurate level of death registration will bring about much limitation in the use of data for proper planning. Vital statistics registration began in 1965, but registrars only recorded births (1965-1980:) and not deaths. They did not understand the importance of registration of births and deaths for national and local planning (1). An alternative system for registering birth and deaths was instituted in 1964 in Igbo-Ora, a rural Nigerian town apart from the conventional registration procedures. An assessment in 1974 showed that birth registrations were at least 95% complete and death registrations were approximately 87% complete; however, for children under 1 year of age death registrations were only 49% complete (7). This system is certainly too costly but far better than the current conventional system in which individuals were expected to register births and deaths themselves. To improve vital registration, institutions should become registration centres for all vital events occurring there (births, stillbirths, deaths)(2,8). All health institutions need to be involved in the registration of births and deaths if substantially greater levels of completeness are to be achieved (4). Presently only the National Population Commission has the constitutional duty to register births and deaths. National Population Commission currently does not have the manpower and resources to cover all health institutions where these vital events occur. For adequate and reliable data, birth registration and death registration need to be complete. There is dearth of information on the extent to which birth and death registration in Nigeria is complete. Few studies conducted have shown under-registration of births and deaths in Nigeria. More studies need to be conducted to provide additional information and to use this to identify the way forward towards improving birth and death registration in Nigeria. 59
REFERENCES E.O Adekolu-John (1988). A study of vital and health statistics of the Kainji Lake Area of Nigeria. Afr J Med Med Sci.; 17(3):149-56. B. Melville (1992). The problem of under-registration of infant deaths in Jamaica. Trop Doct.; 22(3): 125-6. A.M. McCaw-Binns, K. Fox, K.E. Foster-Williams, D.E. Ashley, B. Irons (1996). Registration of births, stillbirths and infant deaths in Jamaica. Int J Epidemiol; 25(4): 807-13. R. Jewkes, K. Wood (1998). Competing discourses of vital registration and personhood: perspectives from rural South Africa. Soc Sci Med.; 46(8): 1043 56. AFRICA HEALTH (1998). UNICEF report highlights unregistered births. Afr Health; 20(5):39. National Population Commission (1989)National Population Commission Decree (No. 23 of 1989), Annu Rev Popul Law; 16:4. O. Ayeni, A. Olayinka (1979). An evaluation of a special-type vital statistics registration system in a rural area of Nigeria. Int J Epidemiol; 8(1): 61-8. I. Ndong, S. Gloyd, J. Gale (1994). An evaluation of vital registers as sources of data for infant mortality rates in Cameroon. Int J Epidemiol.; 23(3): 536-9. F.A. Akesode (1980). Registration of births and deaths in Lagos, Nigeria. J Trop Paediatr.; 26(4): 150 5. S. Becker, Y. Waheeb., B. el-deeb, N. Khallaf, R. Black (1996). Estimating the completeness of under-5 death registration in Egypt. Demography; 33(3): 329 39. T.A. Mohammed (1990). Registration of births and infants deaths in Demo village in Fayoum governorate. J Egypt Public Health Assoc; 65(1-2): 207-20. M. El-shalakani (1985). Estimating the completeness of births and deaths registration in Egypt through dual record systems. Genus; 41(1-2): 119 32. 60
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