|Year : 2013 | Volume
| Issue : 1 | Page : 3-7
Status of birth and death registration and associated factors in the South-south region of Nigeria
Ekaete A Tobin1, Andrew I Obi2, Essy C Isah2
1 Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
2 Department of Community Health, University of Benin Teaching Hospital, Benin-City, Edo State, Nigeria
|Date of Web Publication||18-Oct-2013|
Ekaete A Tobin
Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo state, P.M.B. 08
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The registration of births and deaths in Nigeria, as with most developing countries continues to remain suboptimal with many births and deaths going unregistered. This has negative consequences for economic planning and development.
Objective: The study was undertaken to assess the practice of birth and death registration in South-south Nigeria; and to determine the factors that govern this practice.
Subjects and Methods: Using a cross-sectional descriptive study design, a questionnaire was administered to 324 household heads (or their spouses) in an urban local government area in the South-south geo-political zone of Nigeria. Structured interviewer-administered questionnaires were used for data collection. Data were entered into a spreadsheet and analyzed using SPSS version 15. Categorical data were presented as frequency distribution tables, Chi-square test and Fisher's exact were used to examine relationship between demographic characteristics and respondents' knowledge and practice of birth and death registration.
Results: Awareness of birth registration was high. Awareness of death registration showed differing views as to where and who should statutorily register a death. Sixty-eight percent of those who recorded a birth in the 10 years preceding the study registered it, whereas 61% of those who recorded a death within their household in the preceding 10 years of the study did not register it. Educational level, marital status, and religion were found to be associated with the practice of birth registration, and educational status alone, with death registration.
Conclusion: Much work needs to be done to enlighten the public on vital registration, particularly death registration.
Keywords: Birth, death, registration, status
|How to cite this article:|
Tobin EA, Obi AI, Isah EC. Status of birth and death registration and associated factors in the South-south region of Nigeria. Ann Nigerian Med 2013;7:3-7
|How to cite this URL:|
Tobin EA, Obi AI, Isah EC. Status of birth and death registration and associated factors in the South-south region of Nigeria. Ann Nigerian Med [serial online] 2013 [cited 2019 Jan 20];7:3-7. Available from: http://www.anmjournal.com/text.asp?2013/7/1/3/119979
| Introduction|| |
A functional vital registration system in any country, by supplying the most reliable data on deaths and births and population dynamics, provides indicators for health and development; and pre-requisite data for the effective planning of health and other services, resource allocation, legal, administrative and health policy formulation, program planning, and evaluation. ,, Birth registration data are needed to formulate programs relating to maternal and child health including nutrition, immunization and universal education; and data from death registration provide information on the economic burden of disease, and an understanding of disease etiology. , The right to be registered at birth is founded in article 7 of the United Nations Convention of the rights of the child, now well over a decade old.  Unfortunately, the accuracy of birth and death records, particularly in developing countries, has come under question in several studies with the increasing realization that each year, despite a growing awareness of the importance of vital registration, and the commitment of states under international law to ensure this right, several births and deaths go uncounted. 
Globally, each year, about two-thirds of 57 million annual deaths (representing 38 million deaths) go unregistered, and as much as 40% (48 million) of 128 million births go unregistered, representing one out of three children.  Although it can be argued that census and other large sample surveys may be useful in supplementing demographic data in countries where vital registration system is still at infancy, they are expensive to perform on a routine basis, being frequently marred by politics, disputes about figures, underfunding and topographical challenges; and should rather serve as complements in a comprehensive health information system. ,
Nigeria, a signatory to the convention, established the compulsory registration of births and deaths since 1979, with the National Population Commission (NPC) established and charged with the statutory responsibility of production of vital and demographic data in 1992. , However, several decades after, only a small proportion of these events are actually registered, with the national average for birth registration put at 30%, with 49% in urban areas and 22% rural areas in the 2008 census. , Thus, about 70% of the over 5 million births annually go unregistered.  Interestingly, there is no national average for death registration.
The few published studies carried out in the country to explore the reason for these small proportions show that a large percentage of the populace are aware of vital registration, particularly birth registration, but practice remains poor. , It therefore remains to be investigated whether gaps in awareness, lack of clarity about the registration process, and individual perceptions may be contributory to this observed pattern. This study, therefore, was undertaken to assess the awareness, perception, and practice of birth and death registration in an urban community of southern Nigeria.
| Materials and Methods|| |
The descriptive cross-sectional study was carried out in August 2010 in the Egor local government area of Edo state in the South-south geo-political zone of Nigeria. With an estimated population of 339,899, the local government area occupies a land mass of 93 km 2 , with her headquarters in Uselu. Predominantly urban, Egor is divided into 10 political wards, with occupation of residents varying from trading in food stuffs, wears and miscellaneous items, to farming, civil service, and small entrepreneurial jobs.
The study population comprised heads of households (or their spouses) who have been resident in the community for at least 6 months prior to the survey. A minimum sample size of 320 was obtained using the formula for a simple proportion, and prevalence set as 74.8% from a previous study,  with a non-response rate of 10%.
Random sampling was used to select a ward- ward 8- within the local government area. A preliminary survey of houses in the ward gave the average number of households as one per house. Systematic random sampling was then used to select every tenth house. In each selected house, the head of household or in the absence of one, the spouse was recruited to participate in the study. Where there was more than one household in a building, simple random sampling was used to select one household for the study. Written informed consent was obtained from each participant, thereafter an interviewer-administered structured questionnaire focusing on demographic characteristics, awareness, perception and practice of birth, and death registration was administered. Analysis was done using SPSS version 15, SPSS Inc, Chicago IL 60606-6412. Results were presented in tables and charts, and chi-square was used to test for association between qualitative variables. Statistical significance was set at P < 0.05. Where the expected frequency in more than 20% of cells was <5, or any cell had an expected cell count <1, Fisher's exact test was used to test for statistical significance of the association between the variables.
| Results|| |
A total of 324 people participated in the study. Mean age of respondents was 38.76 ± 14.01 years. One hundred and sixty-five (50.9%) were males and 232 (71.6%) were married. The predominant religion was Christianity for 291 (89.8%) respondents, followed by African traditional religion 25 (7.7%) and Islam 8 (2.5%). One hundred and fifty-one (46.5%) were unskilled, 114 (35.3%) semi-skilled, and 59 (18.2%) skilled. A greater proportion of respondents were in the unskilled and semi-skilled social class. Twenty-nine (9.0%) had no formal education, 109 (33.6%) had primary-level education, 141 (43.5%) had secondary, and 45 (13.9%) had tertiary-level education. The greater proportion, 180 (55.6%) were of the Benin ethnic group.
Two hundred and eighty-four (87.7%) respondents were aware of birth registration, primary source of information being the health-care worker for 123 (43.3%), 83 (29.2%) the mass media, 47 (16.5%) a family member, and 4 (1.4%) the church.
One hundred and seventy-three (63.1%) respondents had heard of NPC, of which 112 (63.6%) knew the full meaning as NPC, and 93 (52.8%) knew where the nearest NPC office was located. Two hundred and five (72.1%) respondents mentioned that the official center for birth registration was the hospital, 48 (16.9%) the NPC office, 18 (6.4%) the church, 2 (0.7%) the police station, and 11 (3.9%) the court.
Health-care workers (68.3%) and NPC officials (42.6%) were mentioned as persons statutorily responsible for birth registration. Others included the traditional ruler by 21 (7.4%) respondents, court officer by 25 (8.8%), and police officer by 14 (4.3%) respondents.
In respect of births that should not be registered because they were taken outside a health facility, 84 (29.6%) said that births that occur in a vehicle, train or plane should not be registered, 83 (29.2%) birth in the farmland, 71 (25.0%) birth at home, 64 (22.6%) birth within prison walls, and 77 (27.1%) births in the psychiatric hospital.
Primary reason for birth registration as suggested by respondents included for purposes of declaration of age 52 (18.3%), self-identification 52 (18.3%), employment requirement 40 (14.1%), child education 32 (11.3%), government planning 19 (6.7%), medical/government records 4 (1.4%), and welfare/social benefits 27 (9.5%). Fifty-eight (20.4%) of 284 respondents did not know the reason for birth registration. Two hundred and fifty-one (88.4%) respondents knew there was a difference between birth registration and obtaining a birth certificate.
Two hundred and nineteen (67.6%) of 324 households in the community had recorded a birth within the
10 years preceding the study, of which for 149 (68.0%) households, the birth was registered, and for 70 (32.0%) households, it was not registered. For households where the birth was not registered, reasons given for non-registration included lack of funds to pay for registration, home delivery, delivery in remote villages with no center for registration, and ignorance of venue for registration. Of 149 respondents who registered a birth, 145 (98.2%) obtained a certificate.
One hundred and ninety-five (60.2%) respondents were aware of death registration with source of information as the mass media for 55 (32.2%) respondents, health-care worker for 48 (28.9%) and family for 54 (31.6%) respondents.
One hundred and sixty-seven respondents (74.9%) mentioned the hospital as the official site for death registration, with less than half of the respondents 96 (49.1%) citing the NPC office. Twenty-four (12%) mentioned the court and 8 (4%) the church.
Respondents' perception of relevance of death registration included for census purposes 65 (33.3%), to identify ghost workers in an establishment 5 (2.6%), to collect claims and benefits 36 (18.5%), for proof of death 5 (2.6%), for burial rites 21 (10.8%), government planning 10 (5.1%), to establish cause of death 16 (8.2%), and as a memorial of death 6 (3.1%). Thirty-one (15.9%) respondents did not know any reason for death registration.
Seventy-eight (23.5%) households had recorded a death in the 10 years preceding the study, of which for 47 (60.3%) households, the death was unregistered compared to 31 (39.7%) households that registered the death. Reasons given for non-registration of deaths included death that took place at home, lack of clarity on the registration process, death involving a newborn and a belief that the death was the will of God. Of the 31 who registered a death, 23 (74.2%) obtained a death certificate.
Educational level was significantly associated with awareness of birth registration [Table 1]. Educational level, religion, and marital status were significantly associated with the practice of birth registration [Table 2].
|Table 1: Factors associated with awareness of birth registration (N = 324)|
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Gender and age were not significantly associated with the practice of birth registration (P = 0.59 and P = 0.74, respectively).
Awareness of death registration increased significantly as level of education increased (P < 0.001). Demographic variables of educational level, gender, religion, and marital status had no association with the practice of death registration (P = 0.66, 0.52, 0.97 and 0.48, respectively).
| Discussion|| |
Although industrialized nations register virtually all their births and deaths, vital registration continues to remain suboptimal in developing countries. Sub-Saharan Africa has the highest percentage of children under age five who are not registered at birth (66%); for reasons including amongst others inadequate infrastructure, low awareness among parents, high costs of obtaining a birth certificate, and discrimination based on gender and ethnicity. ,
In this study, awareness of birth registration was high, as was also reported in a study conducted in Kwara State, Nigeria.  Awareness of death registration, though lower than for birth registration, was higher than what was reported in Kwara state (32%).  However, the fact that as much as 40% of respondents had not heard of death registration, and 15% did not know the relevance, underscores the need to raise the awareness through aggressive enlightenment campaigns. Literacy affected awareness of birth and death registration significantly; therefore designing messages in the local language and delivered through informal media may be useful.
Interestingly, although the health worker provided information on birth registration for the majority, the role was taken over by the mass media for death registration. This role reversal shows that health officers place more value on birth than on death registration. The role played by officers of the NPC in birth registration was known to a large number of respondents, but the use of the NPC facility for birth or death registration was unknown to the majority. This might be because the NPC officers are more likely to be stationed in government hospitals, where they are more conspicuous. Wrong notions about birth and death registration, including where registration can be done and knowing the responsible officer needs to be urgently addressed through enlightenment campaigns as they may in fact hinder the practice of registration.
About 60% of births had been registered in this urban community, which is higher than the national average for urban communities (48.8%). Not surprisingly, the educated tended to register their births, probably as a result of a better understanding of the usefulness of birth registration. The use of birth certificates for school enrolment may be the reason why a large number could differentiate between birth registration and a birth certificate. The fact that illiterate parents, single parents, and practitioners of African traditional religion were more likely not to register their birth implies that such persons should be identified by social workers during pregnancy and not only told of the need for such, but also followed up to ensure registration is done after delivery. Interestingly, illiterate mothers and single parents are also more likely to prefer home delivery, one of the reasons given for non-registration of birth. They also have less access to information on birth registration, and more likely to have wrong conceptions or outright ignorance on the need for registration. Lack of funds for payment of birth registration as a reason for non-registration of birth is not new, but may be a pointer to activities of unscrupulous officers who may use the opportunity to extort clients. A recent survey in Mozambique showed that the main reasons given by parents for not registering their children at birth were the cost of registration, inability to travel long distances to the Registry Office and lack of knowledge about the importance of birth registration. Cultural barriers to birth registration included the time taken to name a child for which consultations with the family's ancestors were needed, and the lack of willingness of mothers to register a child without the presence of the father. 
One reason given for non-registration of death in this study was death involving a newborn. This was also observed in studies carried out in Igbo-ora, Nigeria  and Jordan  where death registration of infants was 49% and 28% complete respectively. Death that took place at home and ignorance of the death registration process were also identified as deterrents to the registration process, and should be tackled through intensive enlightenment campaigns.
| Conclusion|| |
Although a considerable number of respondents had heard of birth and death registration, the practice of birth registration in this community was higher than death registration. Educational level significantly affected awareness of birth and death registration, and only became relevant, together with marital status and religion in the practice of birth registration. Improving vital registration will require intensive enlightenment campaigns designed in the local languages and addressing identified misconceptions about registration.
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[Table 1], [Table 2]
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