LAGOS STATE GOVERNMENT

STATISTICAL BULLETIN AND POLICY BRIEF On REPRODUCTIVE HEALTH, FAMILY PLANNING, GENDER AND POPULATION ISSUES

Serial No: 2 September, 2016

PREFACE

The introduction of Statistical Bulletin and Policy Brief on Population, Gender and Reproductive Health (including Adolescent Sexual Reproductive Health) on Lagos State has created a new frontiers to gaining access to a robust, regular, routine and usable indicators that could be used by organizations, institutions and allied research outfits on Lagos State. The Ministry of Health (MoH), in active collaboration with the Lagos Bureau of Statistics (LBS), Ministry of Economic Planning and Budget (MEPB) as well as the Primary Health Care Board (PHCB) and the United Nations Population Fund (UNFPA) embarked on generation and production of Statistical Bulletin and Policy Briefs with a view to ensuring that short term information are readily available for efficient and effective plans, programmes and projects on reproductive health services and information. This edition is the second (2nd) in the series and features data/ indicators on Reproductive and Maternal Health (RMH), Family Planning (FP), Gender and Population structures were extracted from the State Health Management Information System (HMIS) online platform across the 20 LGAs. The Data/indicators were also extracted from Household Survey Report (2014) and Digest of Statistics 2015 produced by the Lagos Bureau of Statistics (LBS). The edition also covers Y2014and Y2015 data and the Ministry of Health through the HMIS Unit of Planning, Research and Statistics Directorate (DPRS), Primary Health Care Board (PHCB) and Lagos Bureau of Statistics (LBS) actively collaborated on this exercise through selection of appropriate Indicators, data gathering, collation, analysis and report writing. The Inter-agency collaboration significantly enhanced service delivery in the State. It is widely hoped that subsequent editions would attract more information in contents, scope and coverage. The United Nations Population Fund (UNFPA) under the 7th LASG/UNFPA Country Programme, funded this activity and was exclusively undertaken by the LBS. The UNFPA is an international Development Partner that promotes the right of women, men and children to enjoy life of healthy and equal opportunity. The Agency supports Countries in using population data for policies and programmes to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS and every girl and woman is treated with dignity and respect. The users of the Bulletin in the Academia, Researchers, Programme Officers and Policy Makers in Lagos State will find this edition very useful.

The Lagos Bureau of Statistics expressed her sincere gratitude to the UNFPA for continuous assistance and support to the State through the Ministry of Economic Planning and Budget. The contributions of staff of the LBS toward successful completion of this study are highly appreciated and commended. Suggestions, comments and constructive criticisms that will ensure improvement in the subsequent edition are welcome.

The Technical Working Group (TWG) consisting representatives from the Ministries of Health, Economic Planning and Budget (MEPB), Primary Health Care Board (PHCB) as well as UNFPA Official jointly identified the indicators that will be featured in the bulletin from the above mentioned sources, and several i meetings were held to determine the timelines (2014-2015) as well as the order of arrangement of the bulletin. In all, a total of 39 indicators were jointly agreed upon and subsequently featured in this edition. The bulletin contains information on Demography, Budget Allocation to Health Sector , Gender, Facilities Attendance, Pregnant women who received IPT1&2, Delivery, Births, Immunization Coverage, Family Planning Services, Number of Birth Relating to Pregnancy, Neo-Natal Mortality, Infant Mortality, Under 5 Mortality, Prevention of Mother to Child Transmission of HIV, Malarial Cases. In conclusion, careful explanations were given on the policy implications of the analysed data and appropriate recommendations suggested for future policy direction. The Ministry of Economic Planning and Budget (MEPB) through the Lagos Bureau of Statistics (LBS) expresses her sincere gratitude to the UNFPA for her continuous assistance and support to the Lagos State Government on publication of Policy Briefs. The contributions of the members of the TWG: Coordinating Director (B ‘Tayo Oseni-Ope, Director LBS); other representatives of the LBS (Mrs. Pemede Bolanle, Mrs Hassan Amira, Miss Aramide Opeyemi, Messrs Baruwa O Basit, Lawal Rasheed, Ligali Kabir); representative of the Ministry of Health (Mrs. Awosika Flora); representative of the Primary Health Care Board (Mrs. Folarin- Williams Adeola) and representative of UNFPA (Mrs. Abiose Jaiyeola) towards the successful conclusion of this study are highly appreciated. Comments, constructive criticisms and suggestions that will ensure improvement in subsequent edition are welcome from all and sundry.

Kadri, Abayomi Adebisi Permanent Secretary Ministry of Economic Planning & Budget Alausa, Ikeja.

ii

CONTENTS

Preface i-ii Table of Contents iii-v Acronyms and Abbreviations vi Introduction vii-viii

Part One: Demography & Gender Lagos State Population Pyramid 1 Percentage Distribution of Women of Reproductive Age 1 Age Composition of Lagos State Residents 1 Lagos State Population Indices 1-4 Proportion of Health Allocation to Annual Budget Size 5 Lagos State Population Indicators 5-6

Part Two: Primary Health Facilities

Attendance i Facility attendance 7 ii 1st Antenatal Visit 7 iii 4th Antenatal Visit 8

Deliveries i Normal Delivery 9 ii Assisted Deliveries 10 iii Complication 10 iv Deliveries by Skilled Birth Attendants 11 v Total Number of Postnatal visits 12

Births i Live Births 13 ii Still Births 13-14

iii

Immunization Coverage

i Total Number of children who received BCG 14-15 ii Number of Children who received Penta 1& 3 15 iii Total number of children who received Measles vaccine 16

Family Planning Services i Number of People counseled for Family Planning 16-17 ii New Family Planning Acceptors 17-18 iii Female 15 – 49 years using modern methods 18 iv Number of women given oral pills 19 v Number of women using injectables 19-20 vi Women using IUCD 20-21 vii Women on Implants 21 viii Sterilization 21-22

Deaths i Number of Deaths relating to pregnancy 22-23 ii Under 5 deaths 23-24

Prevention of Mother To Child Transmission of HIV (PMTCT) i Pregnant women who received HIV counselling and received result (ANC) 24-25 ii Pregnant women who received HIV counselling and received result (L&D) 25-26 iii Pregnant women who received HIV counselling and received result (PNC) 26-27 iv Pregnant women tested HIV Positive 27-28 v Pregnant women on ARV prophylaxis for PMTCT 28-29

Malaria cases i Confirmed Uncomplicated Malaria 29-30 ii Clinically Confirmed Malaria 30-31 iii Pregnant Women who received Malaria IPT 1 & 2 31-33

iv

Part Three: Secondary Health Facilities

Clinical Attendance 34 Deliveries i Normal Delivery 35 ii Caesarean section 35-36 iii Breech 36 iv Vacuum 37 v Forceps 37-38

Births i Live Births 38-39 ii Still Births 39

Deaths Maternal Deaths i 40 Neonatal deaths ii 41 Post Natal deaths iii 42 Under 5 deaths iv 43

Part Four: Reporting Rates & Policy Brief

Reporting Rates 44-46 Policy Brief 46-47 References 47

v

ACRONYMS AND ABBREVIATIONS

ACSM Advocacy, communication and Social Mobilisation AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Care ARV Antiretroviral BCG Bacillus Calmette-Guerin CBR Crude Birth Rate CDR Crude Death Rate CPR Contraceptive Prevalence Rate DHIS Demographic Health Information Scheme EDD Expected Date of Delivery FP Family Planning GBV Gender Based Violence HIB Haemophilus Influenza Type B HIV Human Immunodeficiency Virus HMIS Health Management Information System IPT Intermittent Preventive Treatment IRS Indoor Residual Spraying IUD Intra-Uterine Device IUCD Intra-Uterine Contraceptive Device LASG Lagos State Government LBS Lagos Bureau of Statistics LCDA Local Council Development Area L&D Labour and Delivery LGA Local Government Area LLIN Long Lasting Insecticidal Net MDG Millennium Development Goals M&E Monitoring and Evaluation NDHS Nigerian Demographic and Health Survey NEAP Non-Economic Active Persons PENTA Pentavalent PHC Primary Health Care PHCB Primary Health Care Board PHF Primary Health Facility PMA Performance, Monitoring and Accountability PMTCT Prevention of Mother-to-Child Transmission PNC Post-Natal Care PPRS Planning, Research and Statistics Directorate RMH Reproductive and Maternal Health SP Sulphadoxine Pyrimethamine TB Tuberculosis TFR Total Fertility Rate UNFPA United Nation Population Fund WCBA Women of Child Bearing Age WHO World Health Organisation

vi

INTRODUCTION

Lagos State population continues to attract attention of socio-economic development specialists and researchers across the globe due to her size, structure and demographic processes within the population as well as uncontrollable influx of people into the State for diverse reasons ranges from economic opportunities, large market size, proximity to the sea and airports as well as youth bulge. The State Government has therefore continued to upscale her planning machineries to accommodate new thinking and concern on how to ensure the State harness her population potentials for the overall development through regular collection and compilation of reliable data/ indicators to support her Policies, Plans, Programmes and Projects with a view to determining the areas that require urgent intervention in terms of socio-economic well-being of the entire population of the State. The population continues to grow in leaps and bounds due to the influx of people from the neighbouring States and Countries as well as natural endowment which aptly contributes to her population size and structure. In addition, a great pressure is being exerted on the State infrastructure, such as Roads, Housing, Education and Health facilities to mention a few. It is worthy to mention here that State health care policies and programmes continue to attract patronage from the neighbouring States and the entire country. “A healthy nation is a wealthy nation” so say an age long adage. Thus, provision of qualitative health care services remains one of the cardinal programmes of the successive administrations in Lagos state. The number of Health Facilities in the State has grown tremendously till date: At present, the State could boast of a total 2,116 Health facilities (300 public and 1,816 private). Geographical spread of the State’s Health Facilities revealed that Alimosho Local Government Area with 343 Health facilities (24 Public and 319 private) recorded the largest concentration of these facilities across the State, followed by Oshodi/ Isolo and Surulere Local Government Areas with 170 and 161 Health facilities respectively. On the other hand, the Public Health facilities comprised 270 Primary Health Care Facilities, 26 Secondary Health Care Facilities and three (3) prominent Tertiary Health Facilities. The State also has a significant proportion of Pharmaceutical Companies/ Firms and Chemist Shops providing complementary but non- clinical health care services to the citizenry. Thus, there is the need to ensure availability of reliable and qualitative data on regular basis to measure the level of health care services and challenges in terms of morbidity and mortality along the children, women of reproductive age (15-49years) and other age divide. Available health indicators showed that Reproductive and Maternal Health indices continually show a wide gap in the uptake of such health care services among the State inhabitants especially the women of reproductive age as indicated by the Contraceptive Prevalence Rate (CPR) which stood at 41% and Unmet Need for family Planning (19%) amongst others. Thus, the need to make available a regular, concise and timely information that would guide the directions of healthcare interventions across the 20 LGAs in Lagos State especially in the areas of reproductive and

vii maternal health, family planning, gender mainstreaming as well as population and allied issues necessitated the concept, publication and production of statistical bulletin and policy briefs.

viii

DEMOGRAPHY AND GENDER

LAGOS POPULATION INDICATORS largely responsible for pattern of fertility being witnessed in LAGOS STATE POPULATION PYRAMID the State. PERCENTAGE DISTRIBUTION OF WOMEN OF REPRODUCTIVE AGE

Analysis of Lagos State population along the 5 yearly age- groupings revealed that children below the age of 5years constitute 12.6% while those in age bracket 5-9 years and 10-14 years accounted for 10.5% and 9.2% respectively.

AGE COMPOSITION OF LAGOS STATE RESIDENTS

Thus, the proportion of children aged 0-14 years in Lagos

State stood at 32.4% which is almost one-third of the entire

Lagos State population pyramid has a wide base depicting a population. Those that are in age bracket 15-64years significant proportion of under 5 children and reflects a representing the working population or labour force decrease in the population of those in age bracket 5-9 years accounted for 65.3% while the remaining population above through 15-19 years. However, an appreciable bulge could 65 years( the senior citizens) stood at 2.3%. be noticed in the proportion of people aged 20-24 years and LAGOS STATE POPULATION INDICIES AS AT YEAR 25-29 years where the State seems to have the largest 2015 concentration of people in working age group. The Reaping of Demographic Dividends in Lagos State are population steeps gradually as the age group reaches the top premised on the availability of wide range of population echelon of the pyramid. indicators for evaluating the size and structures of the In addition, proportion of women 15 years and above in populace, the quantum of government investments, the Lagos State stood at 32% out of which Women of policy environment and commitment to service delivery for Reproductive Age (W15-49years) constitutes 28% and are optimal standard of living of the inhabitants. Such indicators include Crude Birth Rate, Crude Death rate, 1

DEMOGRAPHY AND GENDER

Infant Mortality Rate. Maternal Mortality Ratio, Total SEX RATIO Fertility Rate, Contraceptive Prevalence Rate and Life Lagos State Population Sex Ratio: Expectancy amongst others. 2010‐ 2015

DEPENDENCY RATIO 80 90 100 110 120

Dependency Ratio 2000‐2014 2010 108 90 85 85 85 85 85 85 80 2011 113 70 56 54 60 50 50 48 48 47 47 2012 113 50

40 42 2013 96 30 20 2014 104 10 0 2015 104 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Dependency Ratio Sex Ratio A cursory look at the State age structure along working and non-working age groupings, over a decade ago, revealed The State has a Sex Ratio of 108 male to 100 female in that the State’s Dependency Ratio stood at 85 Non Y2010 and increased marginally to 113 in Y2011 and Economic Active persons (NEAP) to 100 Economic Active Y2012. However, a downward trend was exhibited persons in Y2000. The Dependency Ratio1 remained subsequently in Y2013 where the Sex Ratio stood at 96 relatively stable till Y2005 when a downward trend was males to 100 females. The Sex ratio for years 2014 and 2015 recorded in the Dependency Ratio to 50 persons with stood at 104 males to 100 females each respectively. marginal hover around same proportion till Y2013. However, a significant decresae in Dependency Ratio was recorded in Y2014 with 32 dependents on 100 active working population.

1 Lagos Household Surveys, 2006‐2014

2

DEMOGRAPHY AND GENDER

LIFE EXPECTANCY AT BIRTH Birth Rate3 (CBR) from 43 per 1,000 live births in Y2003 to 41/ 1000 live-births in Y2015 (NDHS). Life Expectancy: 2000‐ 2014 CRUDE DEATH RATE 56 54 54 51 52 50 50 Crude Death Rate (%) 49 50 48 47.9 20 47 47 47 47 47 47 48 46 46 46 15 17 16 16 16 44 15 15 10 14 14 13 13 13 42 5 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

life expectancy 0

In addition, available statistics showed that Life Expectancy at Birth2 for Lagos residents stood at 50 years Crude Death Rate (%) in Y2011 and Y2012, improved marginally to 51years in On the other hand, the Crude Death Rate4 (CDR) also Y2013 and 54 years in Y2014. These increase could be declined moderately from 17 per 1000 livebirths in Y2003 attributed to improved environment as well as greening to 13 per 1000 live births in Y2015. The decrease in the policies of the State Government crude rates could not be divulged from government

sustainable policies and programmes targeting population CRUDE BIRTH RATE control and improved quality of life. Crude Birth Rate (%) TOTAL FERTILITY RATE 44 43 43 43 42 42 42 42 42 Total Fertiity Rate (%) 42 41 41 41 41 666666 41 6 55 5 4 40 4 33 3 2 Crude Birth Rate (%) 1 0

The overall birth experience in the State population over the years revealed a slow but consistent decrease in Crude Total Fertiity Rate (%)

2 Household Surveys 4 World Bank Data www.data.worldbank.org/indicator

3 World Bank Data www.data.worldbank.org/indicator

3

DEMOGRAPHY AND GENDER

In the same vein, the State Total Fertility Rate5 (TFR) also Thus, Infant Mortality Rate which stood at 107 per 1000 witnessed a downward trend from about 6 children per live births in Y2000 reduced significantly to 39 per 1000 woman in Y2003 to about 3-4 children per woman in live births by Y2014 (Lagos Household Survey 2014). Y20146. This significant drop over a decade is attributable to educational exposure of Lagos inhabitants, commitment UNDER 5 MORTALITY RATE to improved health care services and massive health Under 5 Mortality Rate education. 250 201 188182 200 177 MORTALITY RATE 165159 158 153147157 136131 Mortality Rates are important factor in the determination of 150 122117 105 83 the quality of health services available to the teeming 100 Lagosians especially the vulnerable ones; the infants, the 50 less than 5 years old and Women of Reproductive Age (15- 49 years). In Lagos State, statistics showed that death of 0

Infants and under 5 years old Children due to preventive 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 childhood illness/ diseases had significantly dropped due to Under 5 Mortality Rate comprehensive access to wide range of immunization Similarly, the State’s Under 5 Mortality Rate also services and vaccination. witnessed a downward trend from 188 per 1000 live births

in Y2000 to 83 per 1000 live births in Y2014. INFANT MORTALITY RATE

Infant Mortality Rate

120

107110106 100 100100104 94 97 89 90 80 75 68 60 61

40 39 37 20

0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Infant Mortality Rate

5 NDHS 2013, MICS 2011 6 PMA 2014 Lagos

4

DEMOGRAPHY AND GENDER

PROPORTION OF HEALTH EXPENDITURE TO LAGOS STATE POPULATION INDICATORS ANNUAL BUDGET SIZE Lagos State Population Indicators Proportion of Health Allocation to (%)

Annual Budget Size: 2000‐ 2015

9.10

10.00

8.63 8.24

0.0 20.0 40.0 60.0 80.0

9.00 7.77 7.72

7.65

7.38 7.32

8.00 6.68 6.48 6.38

6.08 7.00 Median Age at First Marriage 5.49 24.5 4.96 6.00 (25 to 49 years) 4.75 5.00 3.58 Median Age at First Sex (25 4.00 20.5 to 49 years) 3.00 2.00 Median Age at First 26.5 1.00 Contraceptive Use ‐ Median Age at First Birth (25 24.5 to 49 years) 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Proportion of Health in Budget Size Mean No. Of Living Children 2.1 At First Contraceptive Use It is worthy to note that proportion of health expenditure to Women Having First Birth by 4.9 Age 18 (ages 18‐24) (%) annual budget size which stood at 7.77% in Y2000 and reached lowest level of 3.58% in Y2006. However by 2011, Received FP Info. From 29.3 Provider In Last 12 Months… a remarkable incresae was noted resulting to 8.63% of the Exposed to FP Media in Last 74.4 Budgdet size. The health expenditure declined marginally Few Months (%) afterwards to 7.72% in Y2014 while a proportion of 9.1% was earmarked for Y2015 spending. The State is still far from achieving World Health Organisations (WHO) Lagos State population dynamics are of utmost interest in standard proportion of health expenditure to the annual order to guide Policy, Plans and Programmes targeted at the budget size. populace especially the vulnerable ones and promote the standard of living of the citizenry. There were concerted

efforts being made to understudy the behavioural pattern of women of reproductive age (15-49 years) in Lagos State,

i.e. those in age bracket 18-24 years and 25-49 years as regards uptake of marriage, first sexual experience, first contraceptive use, age at first birth as well as exposure to family planning services and uptake of same within the

same period, 2014.

It was discovered that the Median Age at First

Contraceptive Use stood at 26.5 years, Median Age at First

5

DEMOGRAPHY AND GENDER

Marriage (25 to 49 years) accounted for 24.5 years, Median Age at First Sex (25 to 49 years) stood at 20.5 years, Median Age at First Birth (25 to 49 years) accounted for 24.5 years, Mean No. Of Living Children At First Contraceptive Use accounted for 2.1children, Women Having First Birth by Age 18 (ages 18-24) (%)accounted for 4.9% as well as those that received Family Planning Information from Providers in the last 12 months accounted for 29.3% out of the 77.4% that were exposed to such information and services.

6

PRIMARY HEALTH FACILITIES

FACILITY ATTENDANCE from 842,168 (Y2014) to 1,032,753 (Y2015) showing a difference 190,585 visits representing 22.6% increase. FACILITY ATTENDANCE It is noteworthy that Lagos Mainland recorded the highest drop in patronage from 242,865 to 137,466 representing 8,187,293 STATE INDICATOR 7,514,437 43.4%. Patronage at Kosofe Local Government also dropped 555,117 SURULERE 541,331 from 778,265 (Y2014) to 650,448 (Y2015). 273,477 SOMOLU 262,106 654,825 OSHODI ISOLO 766,839 364,211 OJO 260,788 THE FIRST ANTENATAL VISIT 301,528 MUSHIN 127,879 137,466 LAGOS MAINLAND 242,865 THE FIRST ANTENATAL VISIT 287,343 LAGOS ISLAND 210,957 650,448 KOSOFE 778,265 212,568 TOTAL 215,361 557,346 IKORODU 514,375 13,986 SURULERE 12,093 709,820 IKEJA 559,973 6,319 SOMOLU 6,717 601,042 IFAKO IJAIYE 421,104 20,096 OSHODI ISOLO 15,331 158,295 IBEJU LEKKI 157,005 16,339 OJO 16,896 445,110 ETI‐OSA 299,479 6,709 MUSHIN 6,429 63,450 EPE 55,092 2,572 LAGOS MAINLAND 4,883 182,119 BADAGRY 232,450 4,098 LAGOS ISLAND 5,186 210,196 11,033 APAPA 171,876 KOSOFE 11,225 310,998 11,760 AMUWO ODOFIN 313,031 IKORODU 14,062 1,032,753 9,885 ALIMOSHO 842,168 IKEJA 10,438 362,418 15,227 AJEROMI IFELODUN 396,311 IFAKO IJAIYE 17,474 329,331 5,161 AGEGE 360,543 IBEJU LEKKI 6,135 10,049 ETI‐OSA 7,823 2,092 Y2015 Y2014 EPE 2,321 6,750 BADAGRY 7,772 3,674 APAPA 3,696 9,139 Facility attendance denotes the total number of patients that AMUWO ODOFIN 8,693 33,789 visited the health facilities with the aim of seeking solutions ALIMOSHO 31,454 AJEROMI IFELODUN 12,951 to their respective medical challenges. 13,884 10,939 AGEGE 12,849 The total number of patients that attended the hospital facilities showed an increase of 9% from 7,514,437 in Y2014 Y2015 Y2014 to 8,187,293 in Y2015. Further analysis showed that Mushin Local Government Essential interventions for pregnant women and babies are recorded the highest rate of increase with 135.8%. However, made possible by antenatal care (ANC).To achieve the full the highest number of patronage was recorded in Alimosho life-saving potential that ANC promises, it is essential that 7

PRIMARY HEALTH FACILITIES regular antenatal visits to the Health facilities are made. The ANTENATAL 4TH VISIT first antenatal visit is very crucial especially when done between the 8th and 20th weeks of pregnancy to confirm the ANTENATAL 4TH VISIT pregnancy and EDD, screen, treat, give preventive measures 152,988 and Advice/ Counsel. TOTAL 190,946 SURULERE 9,440 There is a little decline in the number of expectant mothers 17,069 5,031 SOMOLU 3,841 that were received at the health centres before and after 13,244 OSHODI ISOLO 16,902 20weeks in Y2015 as compared with that of Y2014. The drop 13,259 OJO 15,992 5,323 in the number of visits is quite noticeable in Lagos Mainland MUSHIN 5,112 1,941 from 4,883 in Y2014 to 2,572 in Y2015 representing about LAGOS MAINLAND 3,875 2,203 47.3%. However, Oshodi-Isolo and Alimosho recorded some LAGOS ISLAND 2,633 8,393 increase with 20,096 (Y2015), 15,331 (Y2014) for Oshodi- KOSOFE 8,800 7,120 IKORODU 12,324 Isolo while Alimosho had 33,789 (Y2015), 31,454 (Y2014). 9,906 IKEJA 9,267 8,839 IFAKO IJAIYE 10,359 3,431 IBEJU LEKKI 4,343 4,696 ETI‐OSA 5,176 1,201 EPE 1,638 4,690 BADAGRY 5,845 1,593 APAPA 1,751 6,753 AMUWO ODOFIN 7,213 25,024 ALIMOSHO 30,848 8,626 AJEROMI IFELODUN 12,841 12,275 AGEGE 15,117

Y2015 Y2014

Pregnant women that made at least 4 visit to health centres allowed for a good monitoring of maternal and foetal well- being, Pregnancy Induced Hypertension, Anaemia, multiple pregnancy so as to give preventive measures in any of such cases. It further allows for review and modify birth and emergency plan while giving adequate advice/ counselling. The women who completed regular 4 antenatal visit decreased from 190,946 visits in Y2014 to 152,988 in Y2015. The 19.9% decrease is a bit disturbing giving the advocacy of several reach-out programmes and campaign for minimum of 4 antenatal visit. 8

PRIMARY HEALTH FACILITIES

Considering the Local Government Areas in the State, condition". The data revealed that 87,099 have normal Surulere recorded the greatest dip in numbers with 9,440 in deliveries in the State in Y2015 compared to 86,634 in the Y2015 against 17,069 of Y2014 giving 44.7% decrease. Y2014. Most of the Local Governments Areas in the State Whereas, Shomolu had an increase of 31% from 3,841 four have reasonable record of normal delivery in their respective antenatal visit in Y2014 to 5,031 in Y2015. primary healthcare centres. However, women in the State especially in the following LGA/LCDAs namely Apapa, DELIVERIES-NORMAL Lagos Mainland, Ojo, Lagos Island, Ikorodu, Ifako-Ijaiye, Deliveries‐NORMAL Ibeju - Lekki and Epe need to be encouraged, motivated and educated on the importance of ANC visits before and during 6,054 Surulere 5,329 pregnancy. 3,858 Shomolu 3,996

8,415 Oshodi Isolo 7,248

7,010 Ojo 7,713 3,591 Mushin 2,829 1,063 Lagos Mainland 2,058 1,803 Lagos Island 2,001 5,429 Kosofe 4,943 4,814 Ikorodu 5,075 3,371 Ikeja 3,061 5,613 Ifako Ijaye 6,134 Y2015 Ibeju Lekki 1,826 2,101 Y2014 1,900 Eti‐Osa 1,577 513 Epe 547 2,867 Badagry 3,438 730 Apapa 1,123 4,014 Amuwo Odofin 3,198 13,842 Alimosho 13,259 5,115 Ajeromi Ifelodun 5,485 5,271 Agege 5,519 2,015 2,014

LGAs 0

0 5000 10000 15000

Normal birth refers to infants born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy. After birth, mother and infant are in good 9

PRIMARY HEALTH FACILITIES

DELIVERIES- ASSISTED and Medical Practitioners would be reduced. This can be realized if pregnant women are enlightened on the importance Deliveries‐ ASSISTED of attending hospitals during pregnancy and after birth. The increase in number of Assisted Delivery is more severe in 6330 Total 8370 Mushin, Lagos Mainland, Lagos Island, Ikorodu, Eti-Osa, 500 Surulere 1231 Badagry and Agege LGAs. 190 Shomolu 332 549 Oshodi… 933 DELIVERIES-COMPLICATION 418 Ojo 1058 739 Mushin 344 Deliveries‐COMPLICATION 698 Lagos… 87 Total 1,410 88 1,580 Lagos… 41 Surulere 148 167 201 Kosofe 436 22 296 Shomolu 30 Ikorodu 230 135 181 Oshodi Isolo 124 Ikeja 217 Y2015 43 204 Ojo Ifako Ijaye 427 Y2014 102 22 Mushin 142 Ibeju Lekki 10 76 120 Lagos Mainland 37 Eti‐Osa 76 18 6 Epe 41 Lagos Island 7 221 107 Badagry 68 Kosofe 102 10 117 Apapa 7 Ikorodu 5 561 79 Y2015 Amuwo… 692 Ikeja 58 947 54 Y2014 Alimosho 1809 Ifako Ijaye 86 115 2 Ajeromi… 119 Ibeju Lekki 5 Agege 263 12 253 Eti‐Osa 18 0 5000 10000 Epe 2 40 Badagry 25 Pregnant women need to be assisted by professional health 10 Apapa 39 care workers with necessary skills, drugs, supplies, 132 Amuwo Odofin 122 equipment and backup during and immediately after 226 Alimosho 455 childbirth in order to reduce both maternal and infant 62 Ajeromi Ifelodun 53 mortality. The data shows that 8,370 numbers of pregnant 36 Agege 52 women assisted by Health Practitioners during delivery in the ‐ 500 1,000 1,500 2,000 year 2014 decreased to 6,330 in the year 2015.This reveals that number of assisted deliveries in the State is drastically Complication of pregnancy are health problems caused by reduced implies that complication and stress for the women pregnancy, this crisis is often associated with the mother or 10

PRIMARY HEALTH FACILITIES the child. The most common causes include maternal DELIVERIES BY SKILLED BIRTH ATTENDANTS bleeding, complication of abortion, high blood pressure, maternal sepsis and obstructed labour. The statistic reveals Deliveries by Skilled Birth that 1,580 (Y2014) went through complication during Attendants deliveries which reduced to 1,410 (Y2015). This indicates Total 96,430 that the availability of delivery facilities, regular ANC 81,337 Surulere 6,958 attendance which complement with skilled Health 4,245 Shomolu 4,067 Practitioners attributed to this decrease. However, the State 3,944 Oshodi Isolo 10,370 Government should continue in their mission to give women 8,866 5,053 Ojo 4,988 adequate medical care during and after delivery in order to 3,716 Mushin 2,142 bring an end to complications during/after delivery. 871 Lagos Mainland 2,045 2,167 Lagos Island 1,635 5,720 Kosofe 4,290 5,562 Ikorodu 5,699 4,822 Y2015 Ikeja 3,022 7,318 Y2014 Ifako Ijaye 5,857 2,260 Ibeju Lekki 2,407 2,488 Eti‐Osa 1,530 463 Epe 480 2,523 Badagry 2,968 931 Apapa 1,025 4,459 Amuwo Odofin 3,370 15,369 Alimosho 13,099 4,502 Ajeromi Ifelodun 3,916 6,811 Agege 5,809

‐ 50,000 100,000 150,000

Health care professionals are individuals and informers providing skilled care. Those studying the trends and uses of skilled attendants have noted that the more educated and wealthier women are, the more likely they are to have their births attended by a professional health practitioner. In view of this, the State Government should make available skilled attendants that are accessible and affordable to the citizens in order to achieve its health millennium goals. The data shows

11

PRIMARY HEALTH FACILITIES that delivery by health care professionals rose from 81,337 in signs of severe illness will be discussed during this period. the year 2014 by 118.56% to (96,430). The data also indicated The postnatal care visit increased by 27.04% from 152,856 that almost all the Local Government have increase number visits in Y2014 to 190,622 visits in Y2015. Across the Local of pregnant women delivered by health care professionals. Government, the increase in patronage is more pronounced at Mushin Local Government with over a 100% increase from PNC VISIT 5,836 (Y2014) to 11,754 (Y2015). There are areas where PNC VISIT decrease are noticed such as: Ibeju Lekki, Lagos Mainland and Agege Local Government Areas with Ibeju Lekki reducing from 2,795 to 1,958visits representing 29.9% 190,622 TOTAL 152,856 17,498 decrease. SURULERE 13,662 9,852 SOMOLU 5,173 15,688 OSHODI ISOLO 12,638 17,503 OJO 14,618 11,754 MUSHIN 5,836 1,450 LAGOS MAINLAND 2,006 3,198 LAGOS ISLAND 2,628 8,312 KOSOFE 7,036 12,615 IKORODU 11,375 7,357 IKEJA 6,313 10,647 IFAKO IJAIYE 9,369 1,958 IBEJU LEKKI 2,795 8,310 ETI‐OSA 5,596 3253 EPE 2213 13,902 BADAGRY 10,951 7364 APAPA 6015 8,480 AMUWO ODOFIN 5,589 17,024 ALIMOSHO 14,086 9,268 AJEROMI IFELODUN 9,239 5,189 AGEGE 5,718

Y2015 Y2014

The Postnatal period is a critical phase in the lives of mothers and new born babies. Most maternal and infant deaths occur during this time. Yet, it is the most neglected period for the provision of quality care. The issues related to Exclusive Breastfeeding, chlorhexidine for umbilical cord care, clinical 12

PRIMARY HEALTH FACILITIES

TOTAL LIVE BIRTH 108,980 as against 111,472 in Y2015. The increase TOTAL LIVE BIRTH experienced shows that appropriate measures were put in place by the State Government to ensure safe and live birth. Nevertheless, Lagos Mainland, Ikorodu and Eti Osa are areas 111,472 TOTAL 108,980 that need supervisory visits to enhance appreciable live birth 7,912 SURULERE 6,639 deliveries. 4,924 SHOMOLU 5,190 10,289 OSHODI ISOLO 8,828 TOTAL NUMBER OF STILL BIRTH 7,845 OJO 8,263 4,242 TOTAL NUMBER OF STILL BIRTH MUSHIN 3,281 1,054 LAGOS MAINLAND 2,497 2,226 1,825 LAGOS ISLAND 2,388 TOTAL 2,161 6,892 103 KOSOFE 7,789 SURULERE 74 6,224 46 IKORODU 6,434 SHOMOLU 29 5,215 121 IKEJA 4,774 OSHODI ISOLO 136 8,916 99 IFAKO IJAYE 9,044 OJO 131 2,244 71 IBEJU LEKKI 2,491 MUSHIN 47 2,398 12 ETI‐OSA 1,868 LAGOS MAINLAND 15 561 LAGOS ISLAND 27 EPE 484 56 3,279 KOSOFE 173 BADAGRY 3,854 261 998 IKORODU 116 APAPA 1,317 124 5,089 IKEJA 3848 AMUWO ODOFIN 3,870 220 17,904 IFAKO IJAYE 215 ALIMOSHO 15,918 49 6,161 IBEJU LEKKI 121 AJEROMI IFELODUN 6,764 17 7,099 ETI‐OSA 23 AGEGE 7,287 EPE 35 BADAGRY 80128 Y2015 Y2014 14 APAPA 9 AMUWO ODOFIN 5882 Live birth refers to having a baby born alive hale and hearty ALIMOSHO 277399 without any complication in which the baby respires and AJEROMI IFELODUN 124149 responds to external stimulus. In order to have a live birth by AGEGE 121165 a pregnant woman, a lot of medical attention is required some of which includes at least four antenatal visits to the hospital, Y2015 Y2014 administration of appropriate vaccines at different stages of pregnancy, seeking of medical advice from medical/health Inability of a baby to respire immediately after birth or while personnel and administration of drugs to keep the foetus in the foetus after 24weeks of gestation is still birth. This healthy. In Y2014, the total live births in the State recorded occur when a pregnant woman undergo delivery labour or

13

PRIMARY HEALTH FACILITIES assisted to deliver by a medical expert through NUMBER OF BCG ADMINISTERED ‘’CEASERIAN BIRTH’’. It could be prevented from NUMBER OF BCG ADMINISTERED happening if adequate medical attention were received during ante natal period. Counselling by medical/midwives 363,285 personnel to expectant mothers at the early stage to delivery TOTAL 339,731 19,133 period is also a preventive measure to avert still birth. The SURULERE 15,661 14,784 total still birth reduced drastically from 2,161 in Y2014 to SHOMOLU 12,752 OSHODI ISOLO 26,367 1,825 in Y2015. However, Surulere, Shomolu, Mushin and 23,191 30,637 OJO 29,506 Epe are areas with sharp increase of still birth in Y2015 15,957 MUSHIN 12,332 compared with what was recorded in Y2014. It is 3,973 LAGOS MAINLAND 5,889 recommended that monitoring and evaluation should be one 5,541 LAGOS ISLAND 5,057 in those areas to prevent future occurrence of still birth. 22,151 KOSOFE 21,388 32,513 IKORODU 31,186 13,035 IKEJA 11,526 21,443 IFAKO IJAYE 22,233 6,782 IBEJU LEKKI 6,206 10,523 ETI‐OSA 9,057 5,445 EPE 4,400 17,513 BADAGRY 14,844 5,555 APAPA 6,657 9,491 AMUWO ODOFIN 9,645 66,881 ALIMOSHO 61,333 20,220 AJEROMI IFELODUN 19,408 15,341 AGEGE 17,460

Y2015 Y2014

Bacille Calmettie – Guerin (BCG) vaccine is primarily administered to babies immediately after birth to prevent Tuberculosis. It is a vital vaccine that every nursing mother should receive for babies during post natal services for sound immunity. The total BCG administered to babies across the State in Y 2014 was 339,731 compared to 363,285 recorded in Y2015. Awareness of the vaccine by nursing mothers is as a result of government effort on health issues to ensure adequate medical attention are received by people using

14

PRIMARY HEALTH FACILITIES government health facilities. Lagos Mainland still experience antigens) or weakened live viruses. Hence, the introduction decrease in BCG vaccine intake in Y2015 compared to of pentavalent vaccine into the routine immunization Y2014 Figure. Supervisory visit is recommended by schedule in the State Health care facilities is not only Government personnel to ensure that more nursing mothers imperative but a step in the right direction. The data revealed bring their babies for the vaccine. that 554,168 of children less than 5 years were immunized in year 2014 while 619,972 were immunized in year PENTAVALENT VACCINE 2015.there are increase in the number of child under 5 Pentavalent Vaccine immunized across the State. However, Government are enjoined to continue with its advocacy programme on 619,972 Total 554,168 immunization especially in Apapa and Lagos Mainland were 32,179 Surulere 23,558 we have decrease number of immunized children in the Shomolu 33,858 28,318 Y2015 compared to Y2014. 44,606 Oshodi Isolo 36,930 Ojo 45,993 41,714 32,554 Mushin 23,480 7,636 Lagos Mainland 11,904 11,100 Lagos Island 8,812 46,972 Kosofe 49,637 55,990 Ikorodu 50,316 19,504 Y2015 Ikeja 16,543 34,905 Ifako Ijaye 32,280 Y2014 11,362 Ibeju Lekki 10,391 22,277 Eti‐Osa 17,517 10,544 Epe 9,403 27,101 Badagry 22,801 10,332 Apapa 10,598 17,429 Amuwo Odofin 16,802 95,367 Alimosho 83,012 36,535 Ajeromi Ifelodun 33,213 23,728 Agege 26,939 ‐ 400,000 800,000

Pentavalent Vaccine is a combination of five vaccines-in-

one that prevents diphtheria, tetanus, whooping cough, hepatitis b and haemophilus influenza type b, all through a single dose. Immunization is the most highly effective intervention for protecting babies from infectious disease. Vaccines are either parts of the viruses or bacteria (called 15

PRIMARY HEALTH FACILITIES

NUMBER OF PATIENTS THAT RECEIVED MEASLES recorded 266,627 as against 294,202 in Y2015. Kosofe VACCINE and Lagos mainland Local Government are areas that

NUMBER OF PATIENTS THAT need more awareness campaign on measles vaccine to RECEIVED MEASLES VACCINE boost the intake by patients in those localities.

294,202 TOTAL 266,627 NUMBER OF PEOPLE COUNSELLED FOR FAMILY 17,083 SURULERE 12,328 PLANNING 13,136 SHOMOLU 10,811 20,468 OSHODI ISOLO 18,163 NUMBER OF PEOPLE COUNSELLED 23,416 FOR FAMILY PLANNING OJO 20,818 15,931 MUSHIN 12,934 4,221 460,837 LAGOS MAINLAND 5,004 TOTAL 402,856 20,318 5,628 SURULERE 13,680 LAGOS ISLAND 4,411 18,032 SHOMOLU 22,921 20,515 KOSOFE 24,995 28,374 OSHODI ISOLO 23,291 25,046 31,737 IKORODU 23,624 OJO 27,517 10,244 17,030 IKEJA 9,145 MUSHIN 8,403 16,573 5,555 IFAKO IJAYE 15,857 LAGOS MAINLAND 5,605 25,831 5,156 LAGOS ISLAND 29,409 IBEJU LEKKI 4,378 26,170 KOSOFE 24,414 10,432 ETI‐OSA 8,226 40,163 IKORODU 36,540 4,064 19,660 EPE 4,027 IKEJA 19,295 12,166 56,642 BADAGRY 9,882 IFAKO IJAYE 39,937 4,075 8,466 APAPA 4,592 IBEJU LEKKI 12,134 5,515 8,051 ETI‐OSA 5,842 AMUWO ODOFIN 8,446 4,796 EPE 3,819 51,266 ALIMOSHO 42,052 20,505 BADAGRY 23,910 15,456 15,746 AJEROMI IFELODUN 14,555 APAPA 15,202 11,275 6,300 AGEGE 12,379 AMUWO ODOFIN 6,125 77,281 ALIMOSHO 62,139 19,310 AJEROMI IFELODUN 10,649 Y2015 Y2014 13,406 AGEGE 12,024 Measles vaccine is usually administered to babies at Y2015 Y2014 9months and 12months of age to prevent measles infection. It is a contagious disease that is spread from Family Planning is a modern method of birth control and one person to another through the air, adequate care child spacing. There are various forms of Family Planning should be taken and all the required injections should amongst which are pills, injections, male and female condom, be taken to prevent measles attack. The number of diaphragm and IUCD. A client that wants to do family people that received measles vaccine once in Y2014 planning needs adequate counselling and undergo test in 16

PRIMARY HEALTH FACILITIES order to ascertain the one that is suitable for the patient as NEW FAMILY PLANNING ACCEPTORS well as prevent complications. Across the State, the numbers of family Planning clients counselled in Y2014 were 402,856 NEW FAMILY PLANNING and increased to 460,837 in Y2015. The increase was ACCEPTORS pronounced in Ifako Ijaye and Alimosho Local Government in Y2015 figures compared to what it were in Y2014. 85,240 TOTAL 85,489 However, the number of client counselled in Ibeju Lekki 3,911 SURULERE 2,663 decline from 12,134 in Y2014 to 8,466 in Y2015. It is 5,128 SHOMOLU 5,355 recommended that more outreach Health Campaign on 6,177 OSHODI ISOLO 7,063 Family Planning should be foster in that Local Government 4,759 OJO 4,998 to improve the turn out. 3,388 MUSHIN 2,225 1,391 LAGOS MAINLAND 1,819 4,211 LAGOS ISLAND 2,173 4,399 KOSOFE 4,392 9,390 IKORODU 6,997

3,534 IKEJA 3,534 6,268 IFAKO IJAYE 5,982 1,670 IBEJU LEKKI 1,945 1,853 ETI‐OSA 1,929 1,190 EPE 816 4,611 BADAGRY 5,899 1,509 APAPA 2,779 1,868 AMUWO ODOFIN 1,611 12,797 ALIMOSHO 16,247 3,872 AJEROMI IFELODUN 3,057 AGEGE 3,314 4,005

Y2015 Y2014

Family Planning is the bedrock of preventing unwanted pregnancy as this will reduce the overwhelming population in the State. Tremendous effort needs to be put in place to

ensure that new acceptors of Family Planning come on board; this will ease the adverse effect that our teeming population posed on the economy. I n Y2014, new acceptors of Family

Planning recorded 85, 489 and reduced slightly to 85,240 in 17

PRIMARY HEALTH FACILITIES

Y2015. It is worthy to note that government should intensify that were recorded in Y2015. It could be deduced that the more effort to bridge the gap and ensure that new family slight increment on females 15-49years using modern Planning acceptors are on the increase through awareness and contraceptives is due to awareness campaign on reproductive adequate counselling. health programmes carried out in the State, the need to have numbers of children that couples could cater for. Local FEMALES (15-49) USING MODERN Government Areas such as Agege, Apapa, Ikeja, Lagos CONTRACEPTIVES Mainland and Shomolu recorded decrease in the usage of FEMALES 15‐49 USING MODERN modern contraceptives in their figures of Y2015 compare to CONTRACEPTIVES their Y2014 data. However, it is recommended that State government should ensure availability of these contraceptives 152,603 151,677 and regular counselling on the importance of its usage to 6,966 5,726 6,229 SHOMOLU 8,217 these Local Government. 11,403 12,448 7,260 OJO 9,126 6,348 3,062 2,949 LAGOS MAINLAND 4,006 5,592 4,219 10,319 KOSOFE 9,693 15,967 14,094 6,460 IKEJA 7,615 10,884 10,772 3,838 IBEJU LEKKI 4,006 3,936 3,459 1,880 EPE 1,548 7,338 8,290 2,810 APAPA 4,094 4,872 4,442 24,867 ALIMOSHO 22,997 4,208 3,666 8,477 AGEGE 10,197

Y2015 Y2014

Modern Contraceptives were invented for both male and female to prevent the risk of getting pregnant. There are lots of modern contraceptives among which are: - male and female condom, pills, injectables, implant, diaphragm, female and male sterilisation and lntra uterine device (IUD). Research shows that females between the ages of 15-49 years are in their fertility period and could be pregnant after sexual intercourse. The result of females 15-49years using modern contraceptives in Y2014 was 151,677 compared to 152,603 18

PRIMARY HEALTH FACILITIES

WOMEN WHO RECEIVED ORAL PILLS (Y2015). Meanwhile, Ojo and Agege had over 50% decrease from the record of 1,357 (Y2014) down to 647 (Y2015) for WOMEN WHO RECEIVED ORAL Ojo LG and decrease of 1,630 (Y2014) to 812 (Y2015) in PILLS Agege.

97,186 TOTAL 92,938 5,359 WOMEN WHO USING INJECTIBLES SURULERE 5,663 3,921 SOMOLU 3,593 9,117 OSHODI ISOLO 8,286 WOMEN WHO USING INJECTIBLES 6,508 OJO 6,997 97,186 3,220 TOTAL 92,938 MUSHIN 2,650 5,359 912 SURULERE 5,663 LAGOS MAINLAND 1,450 3,921 1,994 SOMOLU LAGOS ISLAND 1,921 3,593 4,535 9,117 KOSOFE 5,624 OSHODI ISOLO 8,286 4,542 6,508 IKORODU 5,346 OJO 6,997 5,972 3,220 IKEJA 5,971 MUSHIN 2,650 8,202 912 IFAKO IJAIYE 7,929 LAGOS MAINLAND 1,450 2,831 1,994 IBEJU LEKKI 2,166 LAGOS ISLAND 1,921 4,603 4,535 ETI‐OSA 3,738 KOSOFE 5,624 857 4,542 EPE 796 IKORODU 5,346 3,128 5,972 BADAGRY 3,231 IKEJA 5,971 1,818 8,202 APAPA 1,273 IFAKO IJAIYE 7,929 4,553 2,831 AMUWO ODOFIN 3,911 IBEJU LEKKI 2,166 15,404 4,603 ALIMOSHO 12,512 ETI‐OSA 3,738 AJEROMI IFELODUN 5,443 857 5,434 EPE 796 4,267 AGEGE 4,447 3,128 BADAGRY 3,231 1,818 APAPA 1,273 4,553 Y2015 Y2014 AMUWO ODOFIN 3,911

15,404 ALIMOSHO 12,512 5,443 Pregnant women who received oral pills increased with AJEROMI IFELODUN 5,434 4,267 11.3% from 13,387 in Y2014 to 14,900 in Y2015 which AGEGE 4,447 indicate an increased awareness in the use of pills to prevent unsolicited pregnancy. Y2015 Y2014 Local Government (LG) level reveals that in Amuwo Odofin, the pregnant women who received oral pills increased from Family Planning (FP) Injection prevent unsolicited 356 in Y2014 to 631 in Y2015 which is an increase of 77.2% pregnancy and also allows for pregnancy spacing. The total and Mushin had 62% increase from 1,017 (Y2014) to 1,648 numbers of women that received FP Injection increased 19

PRIMARY HEALTH FACILITIES slightly with about 4.3% from 69,459 in Y2014 to 72,429 in IUCD INSERTED Y2015. Alimosho Local Government recorded the highest number of IUCD INSERTED women that took FP Injection from 11,170 (Y2014) to 14,328

(Y2015), an increase of 28%, Mushin Local Government 16,399 TOTAL 15,418 increased from 1,238 (Y2014) to 2,327 (Y2015) making an 1,294 SURULERE 862 increase of 88%. The number of pregnant women that took SHOMOLU 358 FP Injection in Lagos Mainland Local Government decreased 317 968 with 39.2% from 1,713 (Y2014) to 1,042 (Y2015). OSHODI… 844 1,018 OJO 1,035 245 MUSHIN 274

140 LAGOS… 223 247 LAGOS… 427 954 KOSOFE 778 777 IKORODU 486

986 IKEJA 985 1,375 IFAKO IJAYE 1,532 101 IBEJU LEKKI 97 604 ETI‐OSA 353

90 EPE 40 712 BADAGRY 903 210 APAPA 408 668 AMUWO… 640

3,142 ALIMOSHO 2,948 1,414 AJEROMI… 1,097 1,096 AGEGE 1,169 Y2015 Y2014

Intrauterine Contraceptives Device (IUCD) is one of the family planning methods. It is a device that is usually inserted

into the female uterus (womb) to prevent pregnancy. The above chart shows that 15,418 females preferred the use of IUCD to other forms of contraceptives in Y2014 and the

20

PRIMARY HEALTH FACILITIES usage increased to 16,399 in Y2015. Apapa, Lagos Island and three to five years depending on the number of rods inserted. Lagos Mainland Local Government are areas with decrease It should be noted that females tested and found the usage usage in Y2015 compared to what it were in Y2014. convenient usually opt for the usage in order to prevent complications. Tremendous increase was recorded in the IMPLANT Y2015 data (13,567) of women who used implant contraceptives as against 8,610 women recorded in Y2014. IMPLANT Ibeju Lekki Local Government showcases slight reduction in

13,567 its usage from 196 in Y2014 to 158 in Y2015. TOTAL 8,610 797 SURULERE 263 TOTAL NUMBER OF STERILISATION 571 SHOMOLU 276 848 OSHODI ISOLO 488 TOTAL NUMBER OF STERILISATION 533 OJO 421 2,288 183 TOTAL 18,719 MUSHIN 138 153 Surulere 342 374 LAGOS MAINLAND 352 65 Shomolu 7 428 LAGOS ISLAND 576 42 Oshodi Isolo 689 863 112 KOSOFE 585 Ojo 204 1,019 81 IKORODU 454 Mushin 161 709 IKEJA 614 Lagos Mainland 60 1 1,136 Lagos Island 13,846 IFAKO IJAYE 423 158 Kosofe 5 IBEJU LEKKI 196 31 325 Ikorodu 58 ETI‐OSA 224 102 Ikeja 2 81 EPE 51 39 Ifako Ijaye 30 515 BADAGRY 378 5 Ibeju Lekki 325 235 4 APAPA 185 Eti‐Osa 419 502 AMUWO ODOFIN 413 Epe 2,739 44 ALIMOSHO 1,366 Badagry 43 458 Apapa 30 AJEROMI IFELODUN 267 1,093 Amuwo Odofin 80 AGEGE 940 946 Alimosho 2,282 469 Y2015 Y2014 Ajeromi Ifelodun 140 164 AGEGE 26

Implant is another modern contraceptive used for family Y2015 Y2014 planning; it is inserted in the skin of patient that prefers this type of family planning. The device after insertion produces Elimination of all form of life and other biological agents is progestogen in the body for birth control. It has a life span of known as Sterilisation. It is peculiar to female and very rare 21

PRIMARY HEALTH FACILITIES in male, it is done by total blockage of the fallopian tube in NUMBER OF DEATHS RELATING TO PREGNANCY female for pregnancy prevention. The total number of clients (WOMEN) sterilised in Y2014 was 18,719 and reduced drastically to NUMBER OF DEATHS RELATING TO 2,288 in Y2015. The reduction could be attributed to a lot of PREGNANCY (WOMEN) factors amongst which are: - fewer numbers of client opted for sterilisation, inadequate enlightenment health campaign 181 programmes and fear of inability to produce children again in State Indicator 720 8 Surulere 15 case the unexpected happens. Across the Local Government, 2 Shomolu 7 Epe has no record of sterilisation for both years, while 18 Oshodi Isolo 9 Amuwo Odofin, Apapa and Kosofe have no record for 9 Ojo 8 5 Y2014. However, in Lagos Island Local Government, only Mushin 6 0 one client turns up for sterilisation in Y2015 as against 13,846 Lagos Mainland 2 2 clients in Y2014. Scale up campaign is advised for citizens in Lagos Island 11 26 that locality. Kosofe 13 1 Ikorodu 9 4 Ikeja 2

50 Ifako Ijaye 39 8 Ibeju Lekki 11 1 Eti‐Osa 1 5 Epe 0 4 Badagry 13 0 Apapa 2 5 Amuwo Odofin 519 13 Alimosho 29 4 Ajeromi Ifelodun 7

16 Agege 17

0 200 400 600 800

2015 2014

A pregnancy-related death is defined as the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication. The death of a woman during pregnancy, at delivery, or soon after delivery is a tragedy for her family and for society as a whole. Five direct complications account for most of maternal deaths: haemorrhage, infection, unsafe abortion, eclampsia (very

22

PRIMARY HEALTH FACILITIES high blood pressure leading to seizures), and obstructed NUMBER OF UNDER 5 DEATH labour. While these are the main causes of maternal death, unavailable, inaccessible, unaffordable, or poor quality care NUMBER OF UNDER 5 DEATH is fundamentally responsible. The Lagos State Government had intensified efforts to educate women of reproductive age 457 State Indicator 434 to adopt healthy lifestyles during pregnancy. 52 Surulere 4 Further analysis on women pregnancy– related deaths across 13 Shomolu 4 the State revealed that about 720 and 181 women died as a Oshodi Isolo 27 result of pregnancy complications in year 2014 and 2015 26 Ojo 5 respectively. There is a tremendous decrease in the number 10 Mushin 79 of women pregnancy related death in Y2015. The decrease 67 Lagos Mainland 1 may be due to the State Government intervention and 12 Lagos Island 5 improved enlightenment campaigns on the control of women 28 Kosofe 40 reproductive health, maintenance of healthy diet and weight. 66 5 Ikorodu 2 83 On desegregation of the result by Local Government, Ifako Ikeja 55 34 Ijaye LG with 50 cases recorded the highest number of Ifako Ijaye 26 12 pregnancy related deaths in Y2015, followed by Kosofe with Ibeju Lekki 19 0 26 number of cases and Oshodi Isolo which recorded 18 Eti‐Osa 1 0 cases. While Apapa LG recorded no number of cases in Epe 0 26 Y2015 whereas Eti-Osa and Ikorodu Local Government Badagry 21 16 recorded only I case of pregnancy related deaths in Y2015 Apapa 8 23 respectively. However, Alimosho LG recorded 5 number of Amuwo Odofin 7 15 cases in Y2015 as against 519 recorded in Y2014. Alimosho 32 9 Ajeromi Ifelodun 16 Therefore, the State Government should continue to 12 Agege 30 strategize and address issues which prevent access to health 0 100 200 300 400 500 care by our pregnant women. Efforts should be intensified to make quality Health care available, accessible and affordable 2015 2014 to every pregnant woman in the State. Also, healthy pregnancy and health advocacy programme should be Under 5 deaths or child mortality refers to the death of infants introduced or fortified in Ifako Ijaye Local Government area and children under the age of five or between the age of one for all women of reproductive age to reduce pregnancy month to four years depending on the definition. A child's related death cases. death is emotionally and physically hard on the parents. But

the State Government in its efforts had tried to make health

care available, accessible and avoidable to its citizens both in 23

PRIMARY HEALTH FACILITIES urban and sub urban areas. The leading causes of death of PREGNANT WOMEN WHO RECEIVED HIV children under five include: prematurity, malaria, diarrhea, COUNSELLING, GOT TESTED AND COLLECTED malnutrition, pneumonia and infections. RESULT (AT ANC)

Further analysis of the under 5 death across the State revealed PREGNANT WOMEN WHO RECEIVED that 434 and 457 children died under the age of 5 in Y2014 HIV COUNSELLING, GOT TESTED AND and Y2015 respectively. There was an increase of 23 cases COLLECTED RESULT (AT ANC) of under-5-death in Y2015 compared with Y2014. At Local Government level, Ikeja LG with 83 cases recorded the highest number of under-5-death in Y2015 followed by 123,998 State Indicator 111,881 Mushin LG with 79 cases and Surulere LG with 52 cases. 5,031 However, Epe LG recorded no cases of under-5- death in both Surulere 3,922 6,310 Y2014 and Y2015 whereas Eti-Osa and Lagos Island LGs Shomolu 6,502 13,790 recorded only 1 case of such death in Y2015 respectively. Oshodi Isolo 10,674 6,273 Ojo 5,040 1,827 Mushin 3,328 The Lagos Government should embark on massive maternal 697 Lagos Mainland 2,481 health and Child mortality reduction advocacy. Also, the 3,552 Lagos Island 2,672 State Government should not relent in its child survival 7,609 Kosofe 9,062 strategies and interventions. In addition, proper attention Ikorodu 6,367 should be focused to Ikeja, Mushin and Surulere LGs to 4,105 9,908 reduce the child mortality rate to the bearest minimum. Ikeja 9,354 11,781 Ifako Ijaye 10,416 3,751 Ibeju Lekki 4,818 7,012 Eti‐Osa 5,219 2,059 Epe 2,280 4,319 Badagry 7,042 3,329 Apapa 3,159 4,450 Amuwo Odofin 1,715 13,298 Alimosho 7,373 3,826 Ajeromi Ifelodun 3,149

8,809 Agege 9,570

0 50,000 100,000 150,000

2015 2014

24

PRIMARY HEALTH FACILITIES

HIV is transmitted through unprotected sexual intercourse PREGNANT WOMEN WHO RECEIVED HIV (anal or vaginal), transfusion of contaminated blood, sharing COUNSELLING, GOT TESTED AND COLLECTED of contaminated needles, and between a mother and her infant RESULT (AT L & D) during pregnancy, childbirth and breastfeeding.

PREGNANT WOMEN WHO RECEIVED HIV The State Government through its various health policies had COUNSELLING, GOT TESTED AND introduced HIV counseling for pregnant women in both COLLECTED RESULT (AT L& D) Primary and Secondary health facilities during Antenatal care 8,078 to enlighten them on the mode of the spread of HIV/AIDS State Indicator 8,016 310 and ways people can reduce their chances of getting the Surulere 196 230 incurable and deadly disease. Shomolu 160 445 Oshodi Isolo 475 The number of pregnant women across the State who 913 Ojo 270 received HIV/AIDS counseling, got tested and received result 530 Mushin 300 53 during Antenatal Care (ANC) was 111,881 and 123,998 in Lagos Mainland 575 338 Y2014 and Y2015 respectively. This remarkable increase in Lagos Island 207 352 2015 may be as a result of continuous enlightenment Kosofe 318 137 campaigns on HIV/AIDS embarked upon by the relevant Ikorodu 592 662 Agencies of Government in the State. At the Local Ikeja 288 1,042 Government level, Oshodi Isolo (13,790), Alimosho (13,298) Ifako Ijaye 585 65 and Ifako Ijaye (11,781) reportedly recorded the highest Ibeju Lekki 314 204 number of Pregnant women who received HIV/AIDS Eti‐Osa 308 16 counseling, got tested and obtained result in year 2015 Epe 7 306 whereas, Lagos Island (697), Mushin (1,827) and Epe (2,059) Badagry 666 113 recorded the lowest number in Y2015. Apapa 332 188 Amuwo Odofin 359 1,307 Alimosho 1,516 378 Ajeromi Ifelodun 293 489 Agege 255

0 2000 4000 6000 8000 10000 2015 2014

It is very important for the Pregnant women to receive HIV/AIDS counseling, get tested and obtain result at child Labour and Delivery (L&D).The number of pregnant women

across the State who received HIV/AIDS counseling, got

25

PRIMARY HEALTH FACILITIES tested and received result during child labour and PREGNANT WOMEN WHO RECEIVED HIV delivery(L&D) was 8,016 and 8,078 in year 2014 and 2015 COUNSELING, TESTING AND RECEIVED respectively. There is an increase of 62 (0.77%) in 2015 and RESULTS AT POST NATAL CARE (PNC) this may be due to the quality of trained health personnels in the various primary, secondary and tertiary health centres in PREGNANT WOMEN WHO RECEIVED HIV the State. Further analysis on Local Government level, COUNSELING, TESTING AND RECEIVED RESULTS AT POST NATAL CARE (PNC) Alimosho (1,307) , Ifako Ijaye (1,042) and Ojo (913) State Indicator 8,618 reportedly recorded the highest number of Pregnant women 6,452 228 Surulere 332 232 who received HIV/AIDS counseling, got tested and obtained Shomolu 127 93 result during child labour and delivery in year 2015 while, Oshodi Isolo 109 Ojo 171 Epe (16), Lagos Island (53) and Ibeju Lekki (65) recorded the 209 908 Mushin 627 lowest number in year 2015. 131 Lagos Mainland 345 75 Lagos Island 128 33 Advocacy health programmes and enlightenment campaigns Kosofe 302 1,283 should be strengthened in Lagos Mainland, Epe and Ibeju Ikorodu 660 836 Ikeja 259 Lekki Local Government for continuous sensitization of 452 Ifako Ijaye 1,212 353 pregnant women on the need to receive HIV/AIDS Ibeju Lekki 368 271 counseling, carry out HIV/AIDS test at child labour and Eti‐Osa 29 67 Epe 113 delivery. 362 Badagry 252 554 Apapa 200 117 Amuwo Odofin 235 638 Alimosho 297 1,615 Ajeromi Ifelodun 541 199 Agege 107 0 2000 4000 6000 8000 10000 2015 2014

HIV/AIDS counseling and test are part of the Post Natal Care

(PNC) introduced by the State Government to reduce the chances of a baby getting the deadly disease during breastfeeding as well as to combat HIV/AIDS as enshrined in the Sustainable Development Goal.

Further analysis across the State revealed that 6,452 and 8,618 women received counseling, got tested and received

HIV/AIDS result during Post Natal Care (PNC) in Y2014

and y2015 respectively. There was an increase of 2,166 26

PRIMARY HEALTH FACILITIES

(25.13%) cases in Y2015. This incredible increase in year PREGNANT WOMEN TESTED HIV POSITIVE 2015 could be due to strict compliance of Health workers to the directives of the State Government on the intensive care PREGNANT WOMEN TESTED HIV for nursing mother at Post Natal Care (PNC). At the Local POSITIVE Government level, Ajeromi Ifelodun (1,615), Ikorodu (1,283) and Mushin (908) LGs recorded the highest number of 1,947 State Indicator 3,356 143 women who received HIV/AIDS counseling, got tested and Surulere 192 25 obtained result during post natal care in year 2015. However, Shomolu 21 158 Kosofe (33), Epe (67) and Lagos Island (75) recorded the Oshodi Isolo 205 47 Ojo 289 least number in year 2015. Therefore Kosofe, Epe and Lagos 255 Mushin 257 Island Local Governments should renew their commitment in 63 Lagos Mainland 63 32 providing intensive Post Natal Care (PNC) to every woman Lagos Island 23 52 who visits any of the Government health facility in their Kosofe 198 57 Ikorodu 168 areas. 93 Ikeja 33 22 Ifako Ijaye 33 11 Ibeju Lekki 4 24 Eti‐Osa 33 34 Epe 182 75 Badagry 82 47 Apapa 69 83 Amuwo Odofin 103 536 Alimosho 662 94 Ajeromi Ifelodun 648 96 Agege 91 0 1000 2000 3000 4000

2015 2014

The human immunodeficiency virus (HIV) is a retrovirus that

infects cells of the immune system, destroying or impairing their function. HIV is transmitted through unprotected sexual intercourse (anal or vaginal), transfusion of contaminated blood, sharing of contaminated needles, and between a

mother and her infant during pregnancy, childbirth and breastfeeding.

The State Government through its Health related Agencies had educated its citizens through various enlightenment campaigns on the prevention and control of HIV/AIDS. An 27

PRIMARY HEALTH FACILITIES infected HIV pregnant woman can transmit the infection to PREGNANT HIV WOMEN WHO RECEIVED ARV the baby in the womb as well as during child birth or PREGNANT HIV WOMEN WHO breastfeeding. RECEIVED ARV

Across the State, the analysis of pregnant women tested HIV 115 State Indicator 101 positive showed that 3,356 and 1,947 pregnant women were 6 2 tested HIV positive in Y2014 and Y2015 respectively. The Shomolu 1 1 number of cases declined by 1,409 (72.38%). At the Local 4 0 Ojo 2 Government level, Alimosho with 536 reported cases 4 2 1 recorded the highest number of pregnant women tested HIV Lagos Mainland 7 0 positive in Y2015 followed by Mushin with 255 numbers of 8 3 Kosofe 3 cases and Oshodi Isolo which recorded 158 cases. However, 1 1 33 Ibeju Lekki, Ifako Ijaye and Eti-Osa LGs with 11 and 22 and Ikeja 24 11 24 number of cases recorded the lowest number of pregnant 3 0 Ibeju Lekki 2 women tested HIV positive in Y2015 respectively. 3 4 0 Epe 3 0 The drastic decline in the number of women tested HIV 0 0 Apapa 6 positive in Y2015 could be attributed to advocacy 12 13 38 programmes embarked upon by the State on the control and Alimosho 16 1 prevention of HIV/AIDS in the State. 0 0 Agege 1

050100150

2015 2014

Antiretroviral (ARV) drugs are special drugs that a doctor or

nurse can give to a woman infected with HIV/AIDS to reduce

the risk of transmission to the baby during pregnancy or

breastfeeding. There is no cure for AIDS. However, there are

drugs that can slow down the HIV virus, and the damage to

one’s immune system. There is no way to “clear” the HIV out

of one’s body. The newer, stronger Antiretroviral (ARVs)

have also helped reduce the rates of most opportunistic

infections (OIs).

Furth analysis on number of pregnant HIV positive women

who received Antiretroviral Prophylaxis for PMTCT (AZT)

drugs across the State revealed that 101 and 115 pregnant

28

PRIMARY HEALTH FACILITIES

HIV positive women received the special drugs in year 2014 CONFIRMED UNCOMPLICATED MALARIA and 2015 respectively. The increase in the number of CONFIRMED UNCOMPLICATED pregnant HIV positive woman who received ARV in 2015 MALARIA may be due to the awareness created by the State Government 727,306 on the use of ARV to reduce the risk of a woman to transmit State Indicator 640,848 25,995 Surulere 18,594 HIV to their babies as well as the ability of the drugs to help 29,141 Shomolu 25,153 them to live longer. 49,163 Oshodi Isolo 47,120 27,909 On desegregation to Local Government level, Alimosho with Ojo 18,705 16,126 38 number of cases recorded the highest number of Pregnant Mushin 10,441 7,382 HIV positive women who received ARV in Y2015, followed Lagos Mainland 12,025 8,780 Lagos Island 9,640 by Ikorodu with 33 reported number of cases and Amuwo- 46,642 Kosofe 38,879 Odofin which had 12 reported cases.. However, Agege, 65,858 Ikorodu 65,720 85,173 Apapa, Badagry, Epe, Ibeju Lekki, Lagos Island Island and Ikeja 67,048 65,872 Ojo recorded no cases of pregnant HIV positive women who Ifako Ijaye 56,139 20,606 received such ARV drug. Ibeju Lekki 19,324 36,866 Eti‐Osa 27,209 14,559 Epe 7,959 11,951 Badagry 12,588 24,344 Apapa 17,399 40,085 Amuwo Odofin 46,355 82,629 Alimosho 74,367 42,934 Ajeromi Ifelodun 44,040 25,291 Agege 22,143

0 200,000 400,000 600,000 800,000

2015 2014

Malaria is an infectious disease of tropical countries. It is spread by mosquitoes. It is manifested by fever along with chills and rigors. Unless it is diagnosed and treated promptly, it can be fatal. A single mosquito bite may be enough to cause the infection. Malaria disease can be categorized as uncomplicated or severe (complicated). In general, malaria is a curable disease if diagnosed and treated promptly and correctly. Malaria may be described as uncomplicated when the malaria infection is not life threatening and is easily treatable.

29

PRIMARY HEALTH FACILITIES

The State Government had introduced different malaria CLINICALLY CONFIRMED MALARIA prevention and control interventions such as larviciding, indoor residual spraying (IRS), free distribution of long CLINICALLY CONFIRMED lasting insecticidal nets (LLINs), sulphadoxine- MALARIA pyrimethamine (SP) etc. to combat malaria in the State. 480,918 State Indicator 603,805 25,450 Surulere 29,890 17,071 Across the State, the number of people with confirmed Shomolu 23,478 46,962 uncomplicated malaria in year 2014 and 2015 were 640,848 Oshodi Isolo 44,944 23,744 and 727,306 respectively. There was an increase of 86,458 Ojo 20,410 21,728 Mushin 13,197 confirmed uncomplicated malaria cases inY2015. At Local 11,521 Lagos Mainland 16,217 Government level, Ikeja with 85,173 recorded the highest 14,628 Lagos Island 18,588 30,323 number of confirmed uncomplicated malaria cases in year Kosofe 44,555 69,166 2015 followed by Alimosho and Ifako Ijaye LGs which Ikorodu 74,854 18,575 reportedly recorded 82,629 and 65,872 number of cases Ikeja 20,473 24,359 Ifako Ijaye 21,940 respectively. However, Lagos Mainland (7,382), Lagos 210 Ibeju Lekki 1,432 12,666 Island (8,780) and Badagry (11,951) reportedly recorded Eti‐Osa 15,435 5,698 lowest number of such cases in year 2015. Epe 10,223 12,349 Badagry 17,626 16,831 Malaria advocacy programmes still need to be strengthened Apapa 18,056 27,633 Amuwo Odofin 44,857 by the State Government in Ifako Ijaye, Alimosho and Ikeja 57,291 Alimosho 94,303 Local Governments to reduce the incidence of malaria in the 27,392 Ajeromi Ifelodun 50,599 17,321 areas. Agege 22,728 0 200,000400,000600,000800,000

2015 2014

Most malaria infections cause symptoms like the flu, such as

a high fever, chills, and muscle pain. Symptoms tend to come and go in cycles. Some types of malaria may cause more serious problems, such as damage to the heart, lungs, kidneys, or brain. These types can be deadly. Clinical findings in malaria are extremely diverse and may range in severity from

mild headache to serious complications leading to death, particularly in falciparum malaria. Clinical features of

malaria are; a change in behaviour, confusion or drowsiness; impaired consciousness or unarousable coma;

30

PRIMARY HEALTH FACILITIES multiple/recurrent convulsion; deep breathing or respiratory PREGNANT WOMEN WHO RECEIVED distress; difficulty in breathing or demonstrable pulmonary MALARIA IPT 1 oedema as may be seen radiologically; circulatory collapse or shock; jaundice; haemoglobinuria; bleeding tendency; PREGNANT WOMEN WHO RECEIVED MALARIA IPT 1 prostration i.e generalized weakness so the patient cannot walk, or sit up without assistance; and severe anaemia with 119,706 or without congestive cardiac failure. TOTAL 114,890 6,564 SURULERE 5,927 5,029 The clinical incidence of malaria in the State was examined SOMOLU 5,366 10,977 for Y2014 and Y2015. The findings revealed that about OSHODI ISOLO 8,474 8,462 603,805 and 480,918 clinical malaria cases was recorded in OJO 13,029 3,447 Y2014 and Y2015 respectively across the State. At the Local MUSHIN 2,961 1,134 Government basis, Ikorodu (69,166), Alimosho (57,291) and LAGOS MAINLAND 1,802 2,616 Oshodi Isolo recorded the largest number of clinical malaria LAGOS ISLAND 2,503 KOSOFE 5,692 cases in year 2015 whereas Ibeju Lekki (210), Epe (5,698) 6,504 6,101 IKORODU 6,341 and Lagos Mainland (11,521) recorded the lowest number of 7,613 IKEJA 8,118 cases. 10,258 IFAKO IJAIYE 10,701 IBEJU LEKKI 3,430 2,925 6,328 ETI‐OSA 5,288 1,185 EPE 1,143 3,950 BADAGRY 4,338 2,360 APAPA 1,741 5,850 AMUWO ODOFIN 5,015 22,353 ALIMOSHO 15,642 6,357 AJEROMI IFELODUN 7,072 5,810 AGEGE 5,521

Y2015 Y2014

The percentage number of respondents who received at least

one dose of Sulphadoxine- Pyrimethamine (SP) during their most recent pregnancy refer to Intermittent Preventive

Treatment 1 (IPT1)

Malaria infection during pregnancy is a major public health

problem, with substantial risks for the mother, her fetus and 31

PRIMARY HEALTH FACILITIES the neonate. Intermittent Preventive Treatment (IPT) of PREGNANT WOMEN WHO RECEIVED MALARIA malaria in pregnancy is a full therapeutic course of IPT II antimalarial medicine given to pregnant women at routine PREGNANT WOMEN WHO antenatal care visits, regardless of whether the recipient is RECEIVED MALARIA IPT 2 infected with malaria. IPT reduces maternal malaria episodes, maternal and fetal anaemia, placental parasitaemia, low birth 97,186 weight, and neonatal mortality. TOTAL 92,938 5,359 Pregnant women who received malaria IPT1 showed a slight SURULERE 5,663 3,921 increase of 4.2% from 114,890 in Y2014 cases to 119,706 in SOMOLU 3,593 9,117 the Y2015. Highest increase was noticed in Lagos Mainland OSHODI ISOLO 8,286 6,508 with 37.1% and Ojo with 35.1%. However, Alimosho and OJO 6,997 3,220 Apapa recorded 42.9% and 35.6% increase respectively. MUSHIN 2,650 LAGOS MAINLAND 912 1,450 LAGOS ISLAND 1,994 1,921 KOSOFE 4,535 5,624 4,542 IKORODU 5,346

5,972 IKEJA 5,971

8,202 IFAKO IJAIYE 7,929

2,831 IBEJU LEKKI 2,166

4,603 ETI‐OSA 3,738

857 EPE 796 3,128 BADAGRY 3,231 1,818 APAPA 1,273 4,553 AMUWO ODOFIN 3,911 15,404 ALIMOSHO 12,512 5,443 AJEROMI IFELODUN 5,434 4,267 AGEGE 4,447

Y2015 Y2014

Intermittent Preventive Treatment 2 (IPT2) is the percentage

number of respondents who received at least two doses of

Sulphadoxine- Pyrimethamine (SP) during their most recent

pregnancy.

The distribution showed that there is slight increase of 4.6%

in the number of pregnant women who received malaria IPT2

32

PRIMARY HEALTH FACILITIES from 92,938 in Y2014 to 97,186 in Y2015. A cursory look into the Local Government revealed that Alimosho Local Government increased by 2,892 (23.1%) pregnant women that took IPT2 from 12,512 (Y2014) to 15,404 (Y2015). Notwithstanding, Kosofe Local Government had a decrease of 19.3% from 5,624 (Y2014) to 4,535 (Y2015) and Lagos Mainland decreased from 1,450 (2014) to 912 (Y2015) making 37.1% decrease.

33

SECONDARY HEALTH FACILITIES

CLINICAL ATTENDANCES 35% decrease from 6,263 (Y2014) to 4,048 (Y2015). Notwithstanding, tremendous increase was recorded at CLINICAL ATTENDANCES Amuwo Odofin and Epe. An increase of 89.6% from 6,126 169,077 TOTAL 185,081 (Y2014) to 11,612 (2015) was recorded in Amuwo Odofin 19,804 SL 19,851 and 59.7% increase was recorded in Epe. 6,483 SOM 6,326 11,765 ISOLO 14,510 4,048 MUS 6,263 17,082 LAGOS ISLAND 20,128 4,346 ONIKAN 4,726 3,142 HARVEY RD 3,844 20,404 IFAKO 19,932 10,353 GB G H 12,381 8,235 IKD 14,351 4,010 IJEDE 4,146 6,109 IBJ/LK 5,763 794 AGBOWA 769 3,355 EPE 2,101 266 KT EJINRIN 192 6,109 BAD 7,254 11,612 AMUWO 6,126 797 APAPA 1,246 8,801 ALIM 13,404 5,668 AJIF 6,968 15,894 ORILE 14,800

Y2015 Y2014

The secondary healthcare data revealed that the Clinical Attendance reduced from 185,081 in Y2014 to 169,077 in Y2015, an indication of 12% decrease. The decrease is more pronounced at Ikorodu, Apapa and Mushin General Hospitals. A drop of 42.6% from 14,351 in Y2014 to 8,235 in Y 2015was recorded at Ikorodu General Hospital. Apapa recorded 449 drop in the numbers of Clinical Attendance given 36% decrease while Mushin had

34

SECONDARY HEALTH FACILITIES

DELIVERIES-NORMAL The data revealed that 13,788 pregnant women have normal delivery in the year 2014 using secondary health facilities in Deliveries‐NORMAL the State against 12,945 in the Year 2015.

12,945 GRAND TOTAL 13,788 DELIVERIES- CAESEAREAN 1,100 SL 1,238 491 Deliveries‐ CAESEAREAN SOM 593

ISOLO 822 953 10,288 GRAND TOTAL 10,024 305 MUS 283 947 SL 921 1,665 LAGOS ISLAND 269 1,480 SOM 261 ONIKAN 309 777 357 ISOLO 741 337 229 HARVEY RD 404 MUS 248 1,242 1,514 IFAKO 1,233 LAGOS ISLAND 1,226 879 ONIKAN 156 GB G H 860 159 141 511 HARVEY RD 158 IKD 1,021 Y2015 1,206 286 IFAKO 1,105 IJEDE 315 Y2014 GB G H 482 587 443 IBJ/LK 735 543 IKD Y2015 59 914 AGBOWA 66 173 Y2014 IJEDE 190 EPE 228 218 361 IBJ/LK 364 18 KT EJINRIN 14 22 AGBOWA 29 674 BAD 193 875 EPE 144 AMUWO 816 ‐ 469 KT EJINRIN ‐ 90 402 APAPA 135 BAD 522 1,191 AMUWO 644 ALIM 1,276 411 481 APAPA 35 AJIF 516 51 1,092 854 ALIM 1,042 ORILE 747 AJIF 408 ‐ 5,000 10,000 15,000 449 694 ORILE 646

‐ 4,000 8,000 12,000

35

SECONDARY HEALTH FACILITIES

A caesarean delivery is a surgical procedure in which a Health Practitioner, this occurs in about 4 percent of full- foetus is delivered through an incision in the mother's term births. Most babies born in this position are healthy. abdomen and uterus. The data disclosed that 10,024 have Doctor will recommend caesarian section rather than a caesarean delivery in the year 2014 against 10,288 in the vaginal birth if the baby shows signs of distress or is too big year 2015 .The high rate of caesarean delivery were more to pass safely through the birth canal. If Doctor finds out that severe at ten Secondary Health Facilities in the State. a baby is in the breech position a few weeks before delivery, they might try to change the position of the baby. If the baby DELIVERIES-BREECH is still in the breech position when labour starts, most Doctors Deliveries‐BREECH recommend a cesarean delivery. The data showed that 115 babies were in breech position at the secondary health 1138 GRAND TOTAL 115 facilities in the year 2014 as against 1,138 in the year 2015. 4 SL 5 6 SOM 0 4 ISOLO 4 3 MUS 3 0 LAGOS ISLAND 39 0 ONIKAN 0 2 HARVEY RD 0 18 IFAKO 16 8 GB G H 21 IKD 1054 2 Y2015 IJEDE 0 0 Y2014 0 IBJ/LK 4 0 AGBOWA 0 10 EPE 12 0 KT EJINRIN 0 23 BAD 0 4 AMUWO 0 0 APAPA 0 0 ALIM 0 2 AJIF 7 0 ORILE 2 0 500 1000 1500

A baby is considered in a breech position when their feet are positioned to be delivered before their head. According to the 36

SECONDARY HEALTH FACILITIES

DELIVERIES-VACUUM using vacuum at secondary health facilities in the State in the year 2015 against 18 in the year 2014. The decrease could be Deliveries‐VACUUM attributed to reproductive health programme embarked by the State. 11 GRAND TOTAL 18 0 SL 0 DELIVERIES-FORCEPS 0 SOM 0 1 ISOLO 0 Deliveries‐FORCEPS 0 MUS 0 GRAND TOTAL 0 LAGOS ISLAND 5 SL ONIKAN 0 0 SOM 1 HARVEY RD 1 ISOLO 2 IFAKO 7 MUS 1 GB G H 2 LAGOS ISLAND IKD 0 ONIKAN 0 Y2015 0 HARVEY RD IJEDE 0 Y2014 IFAKO IBJ/LK 0 0 GB G H AGBOWA 0 0 IKD Y2014 0 EPE 0 IJEDE Y2015 0 KT EJINRIN 0 IBJ/LK 0 AGBOWA BAD 0 6 EPE AMUWO 2 KT EJINRIN 0 APAPA 0 BAD ALIM 0 0 AMUWO 0 AJIF 1 APAPA 0 ORILE 0 ALIM AJIF 0 5 10 15 20 ORILE

0204060 A vacuum extractor uses a small, soft cup that is applied to the top and back of the baby’s head. A tube runs from the cup to a vacuum pump that provides suction. During a Forceps are surgical instrument that resembles a pair of contraction, the physician pulls or applies gentle traction to tongs and can be used in surgery for grabbing, maneuvering, the baby’s head while suction from the vacuum assists in or removing various things within or from the body. They pulling the baby’s head out of the birth canal so the baby can can be used to assist the delivery of a baby as an alternative be delivered. The data revealed that 11 women delivered to the vacuum extraction method. The data revealed that 55 37

SECONDARY HEALTH FACILITIES pregnant women delivered using forceps in the year 2015 TOTAL LIVE BIRTH while the data was drastically reduced to 40 (72%) in the Y2015. The analysis further showed that forceps deliveries TOTAL LIVE BIRTH were mostly done in the following secondary health care 24,435 facilities in the State namely Epe, Amuwo-Odofin, Isolo, TOTAL 46,725 2,068 Ifako, Lagos Island, Somolu and Gbagada General Hospital; SURU LERE 4,254 and Harvey Road and Ijede Health Centres 714 SHOMOLU 1,552 However, this assisted deliveries could be reduced 1,578 ISOLO 3,278 drastically by sensitizing pregnant women on the importance 533 MUSHIN 1,123 and need to attend health facility frequently for their health LAGOS ISLAND 3,096 care before and during pregnancy. 5,932 487 ONIKAN 1,002 487 HARVEY RD 1,052 2,450 IFAKO 4,555 1,396 GBAGADA G H 2,620 IKORODU 2,032 2,937 543 IJEDE 1,017 926 IBEJU LEKI 1,989 87 AGBOWA 178

407 EPE 768 KETU EJINRIN 19 34 Y2015 1,182 BADAGRY 2,381 1,607 AMUWO 2,459 Y2014 118 APAPA 302

2,327 ALIMOSHO 4,551 868 AJEROMI… 1,840 1,510 ORILE 2,901

The total live births obtained from Twenty One (21) Secondary Health facilities in the State were examined. The result shows a total of 46,725 live births were recorded in Y2014 and dropped to 24,435 in Y2015.

The reduction are prevalent in Alimosho, Agbowa, 38

SECONDARY HEALTH FACILITIES

Ijede, Ifako, Mushin and Isolo General Hospitals. It is Still birth refers to inability of newly born babies to respond recommended that adequate visits should be made on to external stimulus after delivery by an expectant mother. regular basis to these secondary health facilities to At times, babies could be in still birth position after maturity ascertain the causes of the shortfall. of the foetus in which evacuation is sought by Caesarean Section. In Y2014, the total still birth across the twenty one TOTAL STILL BIRTH (21) General Hospitals was 1,072 compared to 1,008 in Y2015. The slight decrease showcased could be due to TOTAL STILL BIRTH patients not attending adequate ante natal care, not using 1,008 TOTAL 1,072 drugs prescribed by medical experts. Ketu Ejinrin has no 63 SURU LERE 37 record of still birth in Y2015. 22 SHOMOLU 25

52 ISOLO 48 14 MUSHIN 9 LAGOS ISLAND 242 215 6 ONIKAN 8 12 HARVEY RD 12 IFAKO 89 80 58 GBAGADA G H 77 54 IKORODU 82 14 IJEDE 18 52 IBEJU LEKI 87 0 AGBOWA 16 42 EPE 33 0 KETU EJINRIN 0

95 BADAGRY 106 40 AMUWO 42 9 APAPA 4

60 ALIMOSHO 85 26 AJEROMI… 41 ORILE 58 47

Y2015 Y2014

39

SECONDARY HEALTH FACILITIES

MATERNAL DEATHS respectively. There was an increase of 32 cases in year 2015 when compared with year 2014. Though, pregnancies related MATERNAL DEATHS complications cannot be accurately predicted but can be

STATE INDICATOR 189221 treated, the State Government still needs to strengthen its ISOLO 17 maternal and mortality deaths rate reduction policies. 0 SOMOLU 6 At the General Hospital level, Lagos Island Maternity ISOLO 12 10 Hospital with 59 cases recorded the highest number of MUSHIN 02 maternal deaths in year 2015, followed by Ifako Ijaye and LAGOS ISLAND 3759 Alimosho General Hospitals which reportedly recorded 31 ONIKAN 01 HARVEY RD 01 and 20 cases respectively in year 2015. However, Somolu, IFAKO IJAYE 3133 Onikan, Harvey Road and Apapa General Hospitals recorded 16 GBAGADA 11 no case of maternal deaths whereas, Epe and Mushin General IKORODU 1115 hospitals recorded 1 and 2 cases of maternal deaths IJEDE 24 respectively in year 2015. IBEJU/LEKKI 410 AGBOWA 0 EPE 18

KETU EJINRIN 010 BADAGRY 1117

AMUWO‐ODOFIN 12 APAPA 0 4 ALIMOSHO 2023 7 AJEROMI IFELODUN 5 ORILE 1018 0 100 200 300

2015 2014

Maternal death is the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication. Every minute in a day, somewhere in the world, a woman dies from pregnancy related complications such that this represents a significant cause of death among women of reproductive age. The analysis of maternal deaths at various secondary health facilities across the State revealed that 189 and 221 cases of maternal deaths were recorded in Y2014 and Y2015 40

SECONDARY HEALTH FACILITIES

NEONATAL DEATH reportedly recorded in Y2015. There is a reduction in the neonatal deaths by 17 in Y2015. NEONATAL DEATH At the General Hospital level, Ikorodu General Hospital with 67 number of cases recorded the highest number of neonatal STATE INDICATOR 346363 death in year 2015, followed by Gbagada and Amuwo- 32 ISOLO 19 Odofin General Hospitals which recorded 52 and 48 number SOMOLU 01 of cases respectively. On the other hand, Somolu, Lagos ISOLO 4353 Island, Ibeju Lekki, Ijede, Ketu Ejirin, Ajeromi/Ifelodun, MUSHIN 0 LAGOS ISLAND 0 Onikan, Harvey Road and Mushin General Hospitals ONIKAN 0 recorded no case of neonatal death in 2015 whereas Agbowa 0 HARVEY RD 1 and Apapa General Hospital recorded 1 and 2 cases IFAKO IJAYE 32 49 respectively. GBAGADA 0 52

IKORODU 6772 IJEDE 0 IBEJU/LEKKI 0 1 AGBOWA 0 EPE 6 9 KETU EJINRIN 0

BADAGRY 1215 AMUWO‐ODOFIN 1948 APAPA 12 41 ALIMOSHO 52 AJEROMI IFELODUN 0 66 ORILE 610

0 100 200 300 400

2015 2014

Neonatal death is the death of a baby within the first 28 days of life. The concern of the State Government is to reduce mortality rate in Lagos State. In order to achieve this, the Lagos State Government has intensified effort to provide quality child and maternal health care to its citizens. An attempt was made to analysis of neonatal deaths in the secondary health facilities in the State. In absolute term, 363 neonatal deaths were recorded in Y2014 while 346 was

41

SECONDARY HEALTH FACILITIES

POST NATAL DEATH programmes on child care in the secondary health facilities in the State. POST NATAL DEATH At the General Hospital level, Alimosho General Hospital with 32 cases recorded the highest number of postnatal deaths in year 2015, followed by Orile Agege and Gbagada STATE INDICATOR 136 181 ISOLO 1112 General Hospitals that recorded 30 and 20 number of cases SOMOLU 01 respectively. However, Somolu, Lagos Island, Ibeju Lekki, ISOLO 15 12 Ketu Ejirin, Ajeromi/Ifelodun, Harvey Road and Mushin MUSHIN 01 LAGOS ISLAND 0 General Hospitals recorded no case of postnatal death in ONIKAN 01 Y2015 while Agbowa General hospital recorded only 1 case, HARVEY RD 0 0 Onikan and Apapa General Hospitals recorded 2 cases of IFAKO IJAYE 1116 GBAGADA 0 20 such death each. IKORODU 915 IJEDE 07 IBEJU/LEKKI 0 AGBOWA 2 EPE 49 KETU EJINRIN 0 BADAGRY 6 15 AMUWO‐ODOFIN 4 16 APAPA 210 ALIMOSHO 2832 AJEROMI IFELODUN 07 ORILE 1930

0 50 100 150 200

2015 2014

Postnatal death is the death of a baby or child within the period of 28 days to 1 year (12 months) of life. An attempt was also made to the analysis of postnatal deaths in the secondary health facilities in the State. Further analysis revealed that 136 postnatal deaths were recorded in year 2014 whereas in year 2015 181 cases of postnatal deaths were recorded in the secondary health facilities across the

State. There was an increase of 45 cases in year 2015. The State should continue to fortify its advocacy health

42

SECONDARY HEALTH FACILITIES

NUMBER OF UNDER- 5 DEATHS number of death cases were reportedly recorded across the State. NUMBER OF UNDER‐ 5 DEATHS At the General Hospital level, Ikorodu General Hospital had the highest number of under-5 death cases in year 2015, followed by Orile Agege and Alimosho General Hospitals STATE INDICATOR 181184 ISOLO 69 with 20 and 18 number of cases respectively. Nevertheless, SOMOLU 03 Somolu, Mushin, Lagos Island, Onikan, Harvey Road, 5 ISOLO 11 Ibeju/Lekki, Ijede, Ketu-Ejirin Ajeromi/Ifelodun General 0 MUSHIN 1 Hospitals recorded no case of under-5 deaths. However, Epe LAGOS ISLAND 0 and Amuwo-Odofin General Hospitals recorded 2 and 4 ONIKAN 0 cases respectively in year 2015. HARVEY RD 0 IFAKO IJAYE 612 GBAGADA 0 15

IKORODU 52 76 IJEDE 0 IBEJU/LEKKI 0 AGBOWA 67 EPE 25 KETU EJINRIN 0 BADAGRY 79 AMUWO‐ODOFIN 14 APAPA 68 ALIMOSHO 1827 AJEROMI IFELODUN 08 ORILE 20 41 0 50 100 150 200

2015 2014

Under 5 deaths or child under 5 death or under 5 mortality refers to the death of infants and children under the age of five or between the age of one month to four years depending on the definition. In order to investigate under 5 deaths rate across the State, analysis of data sets at secondary health facilities in the State were carried out. The result indicated that 184 under-5 death cases was recorded in year 2014 while in year 2015, 181 43

REPORTING RATES AND POLICY ISSUES

YEAR 2014 REPORTING RATES ended up submitted for that year. This implies that data captured in this bulletin for the Primary Health Facilities are 43.4 INDICATOR 53.8 insufficient and thus, may not give the true picture of the Surulere 21 38 activities/observations in the Primary Health Facilities. 29.9 Shomolu 53.4 53.4 High reporting rate are predominant in Ikorodu, Ifako Ijaye, Oshodi/Isolo 63.4 42 Ojo 46.8 Apapa. and Amuwo Odofin, LG/LCDAs thus the data 31.2 Mushin 41.6 gathered from these Local Government Areas are more Lagos Mainland 27.6 33.4 reliable than other areas. 40.8 Lagos Island 53.3 40.5 YEAR 2015 REPORTING RATES Kosofe 54.9 66.9 Ikorodu 87.1 60.2 Ikeja 66.7 57.7 INDICATOR 64.2 70 Ifako/Ijaye 72.3 Surulere 38.9 68.1 48.7 Ibeju Lekki 69.3 62.9 22.6 Shomolu Eti‐Osa 36.3 73.4 38.6 67.9 Epe 47.5 Oshodi/Isolo 75 Badagry 44.6 55.1 52.4 Ojo 55.9 Apapa 72.7 81.2 Mushin 49.9 65.6 53.7 Amuwo Odofin 73.3 29.6 33.2 Lagos Mainland 36 Alimosho 42.1 58.7 62.6 62.5 Lagos Island 65.5 Agege 33 47.6 43.9 Kosofe 62 89.6 050100 Ikorodu 95.8 % of Timely Reports % of Total Reports 71.9 Ikeja 75.6 76.3 Ifako/Ijaye 76.9 79.7 The reporting rates refer to the percentage of Primary Ibeju Lekki 82.7 50.7 Health Facilities (PHF) that forwarded their data to the Eti‐Osa 56.5 58.9 Demographic Health Information Scheme (DHIS) as and Epe 61.7 69.2 when due. There are two categories of this; those that Badagry 72.8 85.8 submitted on or before the scheduled date (Timely Reports) Apapa 87.7 71.7 and all those that eventually submitted (Total Reports). Amuwo Odofin 81 42.8 Timely report is very important as it makes data available Alimosho 51.1 63.7 on time to Researchers, Planners, Government, and all data Ajeromi/Ifelodun 68.7 50.2 users, for programmes and projects, designing plans, and Agege 56.8 policy formulation. 050100 In the year 2014, it was observed that on the average, less % of Timely Reports % of Total Reports than half of the Primary Health Care Centres (PHCs) submitted their reports on time while just about half of them

44

REPORTING RATES AND POLICY ISSUES

In the year 2015, about 6 of every 10 Primary Health Care TIMELY REPORTS FOR Y2014 & Y2015 facilities in Lagos State submitted their data to the DHIS. Surulere and Lagos Mainland had a very low reporting rate.

It is advisable that Officers in charge of data keeping/ 57.7 STATE INDICATOR 43.4 mamagement on PHF in those LGAs should be sensitized 38.9 Surulere 21 on the importance and availability of data. They could be 62.9 Shomolu 29.9 assisted with deployment of a Monitoring and Evaluation 67.9 Oshodi/Isolo 53.4 (M & E) staff for easier and timely data collation and Ojo 55.1 dissemination. 42 49.9 Although, high reporting rates were recorded in Ikorodu, Mushin 31.2 29.6 Ikeja, Ifako-Ijaiye, Ibeju-Lekki, Badagry, Apapa, and Lagos Mainland 27.6 62.6 Amuwo Odofin. However, there is the need to encourage Lagos Island 40.8 47.6 PHCs in those areas since an 100% rate is essential for Kosofe 40.5 89.6 proper planning and policy formulation. Ikorodu 66.9 71.9 2015 Ikeja 60.2 76.3 2014 Ifako/Ijaye 70 79.7 Ibeju Lekki 68.1 50.7 Eti‐Osa 22.6

58.9 Epe 38.6

Badagry 69.2 44.6 85.8 Apapa 72.7 71.7 Amuwo Odofin 65.6 42.8 Alimosho 33.2 63.7 Ajeromi/Ifelodun 58.7 50.2 Agege 33

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The DHIS reveals that across the 20 LG/LCDAs in Lagos State, there was a general increase in timely submission of reports in year 2015 when comparered with the previous year. An impressive reporting rate of 6 out of every 10 PHCs were recorded on the average, which is a move in the right direction. A better approach could account for at least 45

REPORTING RATES AND POLICY ISSUES

9 out of every 10 PHCs. State Government should intensify 8. Fortifying of Monitoring and Evaluation of effort in Surulere and Lagos Mainland LGAs to find out Maternal and Child Health activities in both public their respective challenges and proffer solutions for better and private health facilities in the State to reduce service delivery in the areas. maternal, neonatal, postnatal and under-5 deaths. 9. The State Government should step-up its intervention and enlightenment campaigns on the POLICY ISSUES control of women reproductive health, maintenance 1. There is the need to encourage, motivate and of healthy diet and weight. educate women in the State especially in Apapa, 10. Strengthening of referral system and quality of Lagos Mainland, Ojo, Lagos Island, Ikorodu, Ifako- service by provision of ambulances and Ijaiye, Ibeju-Lekki and Epe LG/LCDAs on the establishment of quality assurance mechanism in importance of ANC visits before and during both primary and secondary health facilities to pregnancy reduce maternal and mortality deaths. 2. At Mushin, Lagos Mainland, Lagos Island, 11. Advocacy programmes for the improvement of the Ikorodu, Eti-Osa, Badagry and Agege LGAs more health seeking behaviour of women of child- advocacy programmes should be embarked upon to bearing-age and the community in general on reduce the number of pregnant women being preventable maternal and child health interventions assisted by Health Practitioners during delivery. such as essential obstetric care, family planning 3. Generally, the State Government should continue in services and to increase utilization of the Primary their mission to give women adequate medical care Health Care Centres which is the first point of during and after delivery in order to bring an end to contact for all women and members of the complications during/after delivery. community. 4. The State Government should strengthen sentinel 12. Addressing issues that prevent access to health care surveillance on malaria treatment across the State. by our pregnant women to reduce pregnancy related 5. Malaria elimination and reduction operation deaths in the State. strategies should be reviewed annually in the State 13. Efforts should be intensified to make quality Health so as to determine a better way of combating this care available, accessible and affordable to every common disease. pregnant woman in the State. 6. Malaria advocacy programmes still need to be 14. Also, healthy pregnancy and health advocacy strengthened by the State Government in Ifako programmes should be introduced or fortified in Ijaye, Alimosho and Ikeja Local Government Areas Ifako Ijaye Local Government area for all women to reduce the incidence of malaria in the areas. of reproductive age to reduce pregnancy related 7. Strengthening of Malaria Advocacy, death cases. Communication and Social Mobilization (ACSM) 15. The State Government should continue to fortify its coordination at all levels in the State. advocacy health programmes on child care at the secondary health facilities in the State. 46

REPORTING RATES AND POLICY ISSUES

16. Proper attention should be focused to Ikeja, Mushin 6. NDHS 2013, MICS 2011 and Surulere Local Government Areas to reduce child mortality rate to the bearest minimum. 17. Advocacy health programmes and enlightenment campaigns should be strengthened in Lagos Mainland, Epe and Ibeju/Lekki Local Government Areas for continuous sensitization of pregnant women on the need to receive HIV/AIDS counseling, carry out HIV/AIDS test at child labour and delivery. 18. Kosofe, Epe and Lagos Island Local Government Areas should renew their commitment in providing intensive Post Natal Care (PNC) to every woman who visits any of the Government health facility in their areas. 19. The reach-out programme and the campaign for expectant mothers to take their first antenatal booking visit seriously should be sustained. 20. Nevertheless, Lagos Mainland, Ikorodu and Eti- Osa are areas that require supervisory visits to enhance appreciable live birth deliveries.

REFERENCES

1. State Health Management Information System (HMIS) online platform by Ministry of Health. 2. Household Survey Report (2014) produced by Lagos Bureau of Statistics (LBS). 3. Digest of Statistics 2015 produced by Lagos Bureau of Statistics (LBS). 4. Performance, Monitoring and Accountability (PMA) 2014 Lagos 5. World Bank Data www.data.worldbank.org/indicator 47