Consanguineous marriages: Implications for under-five mortality - PDF document

Consanguineous marriages: Implications for under-five mortality clustering- A qualitative study from rural northern Nigeria. Olatunji Alabi 1 , Clifford Obby Odimegwu 2 and Olusola Omisakin 1 1 Department of Demography and Social Statistics, Federal University, Birnin-Kebi, Kebbi State, Nigeria. 2 Department of Demography and Population Studies, University of the Witwatersrand, South Africa. *Correspondence to: Olatunji Alabi, Federal University, Birnin Kebbi, Nigeria, Email: yomistorii@yahoo.com Abstract Background: Under-five mortality remains high in Nigeria and northern Nigeria in particular. The concepts of under-five mortality clustering and the potential impact of socio- cultural practices like consanguineous union on the clustering of death in certain family remains under researched. This paper explores the potential implication of consanguineous union on under-five mortality clustering in rural northern Nigeria. Methods: The study employed qualitative data collection method through the use of indepth interview with women with at least two under-five deaths from compounds with families who have lost 60% or more of their children from Nahuche Health and Demographic Surveillance System (Nahuche HDSS). A total of 56 IDI interviews were conducted between April-May, 2015 using a pre-tested structured interview guide to elicit information on the influence of consanguineous marriages on under-five mortality clustering. Result: Findings from the study showed that 68% of the participants were into consanguineous union. Most women in such marriages were not aware of the health implication of such union however such women had lost at least two of their children before their naming ceremony. Consanguineous union is seen mostly from traditional and religious perspective in the study area and mostly is without the consent of the couple Conclusion: The findings from the study underscore the need for awareness on the potential of socio-cultural practices like consanguineous marriage in supporting high regime of under- five mortality clustering and thus calls for awareness on the health implication of such union on the child health outcomes. Keywords: Under-five, mortality, clustering, northern Nigeria.

Introduction Undoubtedly, under-five mortality remains very high in most developing countries and sub- Saharan African countries in particular. There were almost 7 million of under-five deaths reported globally in the year 2013 (UNICEF, 2013) with wide variation between the developed and the developing countries. The highest rate of under-five mortality was from sub-Saharan Africa and Oceania (UNICEF, 2013). Nigeria is one of the countries with the most worrisome child health indicators and remains the second largest contributor of under- five mortality in the world after India. Within Nigeria, there is variation between regions and place of residency. Studies on determinants of under-five mortality have explored various levels of factors influencing under-five mortality from the individual (mother and child level factors), family and recently, neighbourhood factors. However, such studies are still limited as it neglects other contextual factors at neighbourhood or community level that may influence the clustering of child mortality in particular, socio-cultural factors (Adedini et al., 2013). There are limited studies focusing on the effect of socio-cultural practices on the under-five mortality in a culturally sensitive and oriented society like northern Nigeria. The lack of studies on the effect of socio-cultural factors on infant and child mortality in Nigeria was identified as one of the gaps in the literature on studies on determinant of under-five mortality in Nigeria (Adedini, 2014). Furthermore, one area which have suffered neglect in the study on under-five mortality in developing countries in general and Nigeria in particular is the aspect of under-five mortality clustering. There is dearth of literature on the concept of mortality clustering in Nigeria. Klouda and Adamu (2013) and Rain (1997) are the two studies, to our knowledge, that have addressed the topic of mortality clustering in Nigeria. Under-five mortality clustering simply defined as the variability in the spread of under-five mortality in the population. It explores why under-five mortality clustered within certain individual, family or community. Vandezande, Moreels and Matthijs, 2010 opined that child deaths are unevenly distributed among women. In studying mortality clustering in a population, population genetics have suggested genetic problems in certain families as a factor in mortality clustering (kuate-Defo & Diallo, 2002). Certain genetic deformation may be present in children born to the same mother thus, some parental traits are sometimes found in their offspring. Underlying genetic variability between families, due to consanguinity or the high prevalence of the gene for sickle cell hemoglobin may also have played a major role in the concentration of child deaths in certain families within such communities (Ronsmans, 1995). Consanguineous marriage is allowed in the Northern part of Nigeria and it is not uncommon to see blood relations getting married to one another.

Consanguineous union is used as a proxy for the effect of “genetic fraility” on under -five mortality in the study area since the study does not involve laboratory test of collected specimens like blood sample to test for possible effect of genetic disorders and its impacts on under-five mortality among couples in such union. To this end, this paper explore the implications of the socio-cultural practice of engaging in consanguineous marriages as being commonly practiced in the Muslim dominated northern Nigeria on the high under-five mortality in the region in particular and Nigeria as a whole. Data and Research Methods Study Area: Nahuche Health and Demographic Surveillance System (Nahuche HDSS) site is located within six districts of Nahuche-Keku, Nahuche-Ubandawaki, Gada, Karrrakai, Bela and Rawayya in Bungudu Emirate of Zamfara State, northwest Nigeria. The population of the surveillance area stood at 142,127 as at December, 2013. Nahuche HDSS was established through funding from UKaid (Department for International Development) and the Norwegian Government in 2009 through the PRRINN-MNCH 1 programme and Zamfara State Ministry of Health. Infrastructures are generally substandard with poor road networks making some of the villages non-accessible especially during rainy season. Economic, maternal and child health indicators for most of the areas under the surveillance are among the worst in the country. For instance, there is high rate of home deliveries and very low health services utilization due to poverty and cultural factors such as lack of standing permission to access health services for maternal and child health (Alabi et al., 2016). Data and Methods: The study was carried out with purposively selected samples of women with at least two under-five deaths from compounds with more than two-third under-five deaths generated from the mortality dataset sampling frame from Nahuche HDSS. Nahuche HDSS quantitative data are collected once in every six months to update the database. Compound level clustering was assessed by adopting Kuate-Defo and Dialo (2002) methodology of classifying compounds according to the number of under-five deaths reported per compound : (i) ‘‘no concentration’’ comprises of the selected family in the sample whose children have all survived; (ii) ‘‘low concentration’’ includes families who have lost le ss than 20% of their children; (iii) ‘‘medium concentration’’ families hav e lost 20 – 59% of their children; and (iv) ‘‘high concentration’’ contains those families who have lost 60% or more of their children. The study employed Indepth interviews (IDI) to examine the effect of consanguineous marriages on under-five mortality clustering among selected women. A total of 56 IDI interviews were conducted between April-May, 2015 using a pre-tested structured interview 1 Partnership for Reviving Routine Immunization in Northern Nigeria; Maternal Newborn and Child Health Programme.