Comment

. 2022 Mar 19;399(10330):1117-1129.

doi: 10.1016/S0140-6736(21)02722-7. Epub 2022 Mar 15.

Population health outcomes in Nigeria compared with other west African countries, 1998-2019: a systematic analysis for the Global Burden of Disease Study

Blake Angell¹, Olutobi Sanuade², Ifedayo M O Adetifa³, Iruka N Okeke⁴, Aishatu Lawal Adamu⁵, Muktar H Aliyu⁶, Emmanuel A Ameh⁷, Fatima Kyari⁸, Muktar A Gadanya⁹, Diana A Mabayoje¹⁰, Adesola Yinka-Ogunleye¹¹, Tolu Oni¹², Rabiu Ibrahim Jalo⁹, Fatimah I Tsiga-Ahmed⁹, Sarah L Dalglish¹³, Seye Abimbola¹⁴, Tim Colbourn¹³, Obinna Onwujekwe¹⁵, Eme Theodora Owoaje¹⁶, Gambo Aliyu¹⁷, Sani H Aliyu¹⁸, Belinda Archibong¹⁹, Alex Ezeh²⁰, Chikwe Ihekweazu²¹, Zubairu Iliyasu⁹, Stephen Obaro²², Ebenezer Babatunde Obadare²³, Friday Okonofua²⁴, Muhammed Pate²⁵, Babatunde L Salako²⁶, Fatima H Zanna¹⁷, Scott Glenn²⁷, Ally Walker²⁷, Maha Ezalarab²⁷, Mohsen Naghavi²⁷, Ibrahim Abubakar²⁸

Affiliations

¹ UCL Institute for Global Health, University College London, London, UK; The George Institute for Global Health, University of New South Wales, Sydney, Sydney, NSW, Australia.
² UCL Institute for Global Health, University College London, London, UK; Center for Global Cardiovascular Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
³ Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Epidemiology and Demography, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Lagos, Nigeria.
⁴ Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
⁵ Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Epidemiology and Demography, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria.
⁶ Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.
⁷ Division of Paediatric Surgery, National Hospital, Abuja, Nigeria.
⁸ College of Health Sciences, University of Abuja, Abuja, Nigeria.
⁹ Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria.
¹⁰ University College London Hospitals NHS Foundation Trust, London, UK.
¹¹ UCL Institute for Global Health, University College London, London, UK; Nigeria Centre for Disease Control, Abuja, Nigeria.
¹² MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; Research Initiative for Cities Health and Equity, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
¹³ UCL Institute for Global Health, University College London, London, UK.
¹⁴ School of Public Health, University of Sydney, Sydney, NSW, Australia.
¹⁵ Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria.
¹⁶ Department of Community Medicine, University of Ibadan College of Medicine, Ibadan, Nigeria.
¹⁷ National Agency for the Control of AIDS, Abuja, Nigeria.
¹⁸ Infectious Disease and Microbiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹⁹ Barnard College, New York, NY, USA.
²⁰ Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
²¹ Nigeria Centre for Disease Control, Abuja, Nigeria.
²² Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA.
²³ Sociology Department, University of Kansas, Lawrence, KA, USA.
²⁴ Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Edo State, Nigeria; University of Medical Sciences, Ondo City, Nigeria.
²⁵ Health, Nutrition, and Population Global Practice and Global Financing Facility for Women, Children and Adolescents, World Bank, Washington, DC, USA; Harvard T H Chan School of Public Health, Cambridge, MA, USA.
²⁶ Nigeria Institute for Medical Research, Lagos, Nigeria.
²⁷ Institute for Health Metrics and Evaluation, University of Medicine Washington, Seattle, WA, USA.
²⁸ UCL Institute for Global Health, University College London, London, UK. Electronic address: i.abubakar@ucl.ac.uk.

PMID: 35303469
PMCID: PMC8943279
DOI: 10.1016/S0140-6736(21)02722-7

Comment

Population health outcomes in Nigeria compared with other west African countries, 1998-2019: a systematic analysis for the Global Burden of Disease Study

Blake Angell et al. Lancet. 2022.

. 2022 Mar 19;399(10330):1117-1129.

doi: 10.1016/S0140-6736(21)02722-7. Epub 2022 Mar 15.

Authors

Affiliations

¹ UCL Institute for Global Health, University College London, London, UK; The George Institute for Global Health, University of New South Wales, Sydney, Sydney, NSW, Australia.
² UCL Institute for Global Health, University College London, London, UK; Center for Global Cardiovascular Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
³ Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Epidemiology and Demography, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Lagos, Nigeria.
⁴ Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
⁵ Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Epidemiology and Demography, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria.
⁶ Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.
⁷ Division of Paediatric Surgery, National Hospital, Abuja, Nigeria.
⁸ College of Health Sciences, University of Abuja, Abuja, Nigeria.
⁹ Department of Community Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria.
¹⁰ University College London Hospitals NHS Foundation Trust, London, UK.
¹¹ UCL Institute for Global Health, University College London, London, UK; Nigeria Centre for Disease Control, Abuja, Nigeria.
¹² MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; Research Initiative for Cities Health and Equity, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
¹³ UCL Institute for Global Health, University College London, London, UK.
¹⁴ School of Public Health, University of Sydney, Sydney, NSW, Australia.
¹⁵ Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria.
¹⁶ Department of Community Medicine, University of Ibadan College of Medicine, Ibadan, Nigeria.
¹⁷ National Agency for the Control of AIDS, Abuja, Nigeria.
¹⁸ Infectious Disease and Microbiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹⁹ Barnard College, New York, NY, USA.
²⁰ Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
²¹ Nigeria Centre for Disease Control, Abuja, Nigeria.
²² Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA.
²³ Sociology Department, University of Kansas, Lawrence, KA, USA.
²⁴ Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Edo State, Nigeria; University of Medical Sciences, Ondo City, Nigeria.
²⁵ Health, Nutrition, and Population Global Practice and Global Financing Facility for Women, Children and Adolescents, World Bank, Washington, DC, USA; Harvard T H Chan School of Public Health, Cambridge, MA, USA.
²⁶ Nigeria Institute for Medical Research, Lagos, Nigeria.
²⁷ Institute for Health Metrics and Evaluation, University of Medicine Washington, Seattle, WA, USA.
²⁸ UCL Institute for Global Health, University College London, London, UK. Electronic address: i.abubakar@ucl.ac.uk.

PMID: 35303469
PMCID: PMC8943279
DOI: 10.1016/S0140-6736(21)02722-7

Abstract

Background: Population-level health and mortality data are crucial for evidence-informed policy but scarce in Nigeria. To fill this gap, we undertook a comprehensive assessment of the burden of disease in Nigeria and compared outcomes to other west African countries.

Methods: In this systematic analysis, using data and results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we analysed patterns of mortality, years of life lost (YLLs), years lived with disability (YLDs), life expectancy, healthy life expectancy (HALE), and health system coverage for Nigeria and 15 other west African countries by gender in 1998 and 2019. Estimates of all-age and age-standardised disability-adjusted life-years for 369 diseases and injuries and 87 risk factors are presented for Nigeria. Health expenditure per person and gross domestic product were extracted from the World Bank repository.

Findings: Between 1998 and 2019, life expectancy and HALE increased in Nigeria by 18% to 64·3 years (95% uncertainty interval [UI] 62·2-66·6), mortality reduced for all age groups for both male and female individuals, and health expenditure per person increased from the 11th to third highest in west Africa by 2018 (US$18·6 in 2001 to $83·75 in 2018). Nonetheless, relative outcomes remained poor; Nigeria ranked sixth in west Africa for age-standardised mortality, seventh for HALE, tenth for YLLs, 12th for health system coverage, and 14th for YLDs in 2019. Malaria (5176·3 YLLs per 100 000 people, 95% UI 2464·0-9591·1) and neonatal disorders (4818·8 YLLs per 100 000, 3865·9-6064·2) were the leading causes of YLLs in Nigeria in 2019. Nigeria had the fourth-highest under-five mortality rate for male individuals (2491·8 deaths per 100 000, 95% UI 1986·1-3140·1) and female individuals (2117·7 deaths per 100 000, 1756·7-2569·1), but among the lowest mortality for men older than 55 years. There was evidence of a growing non-communicable disease burden facing older Nigerians.

Interpretation: Health outcomes remain poor in Nigeria despite higher expenditure since 2001. Better outcomes in countries with equivalent or lower health expenditure suggest health system strengthening and targeted intervention to address unsafe water sources, poor sanitation, malnutrition, and exposure to air pollution could substantially improve population health.

Funding: The Bill & Melinda Gates Foundation.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests GA is a current head of the National Agency for the Control of AIDS. CI and SA held leadership roles in the Nigerian Government during the period of writing of this paper. SA is editor in chief of BMJ Global Health. IA was a scientific and technical adviser to the Nigerian Government Presidential Task Force on COVID-19 and ZI is chair of the Nigerian national ethics committee. IA, FO, GA, SA, and IMOA are members of the Presidential Health Reform Committee. All other authors declare no competing interests.

Figures

**Figure 1**
Health system coverage in west African nations, 1998–2019

**Figure 2**
Change in mortality by age group in Nigeria, 1998–2019

**Figure 3**
Rank of west African countries for age-specific mortality in 2019 Mortality in male (A) and female (B) individuals.

**Figure 4**
Rank of age-standardised years of life lost for the top 15 causes in Nigeria across west African countries for 1998 (A) and 2019 (B).

See this image and copyright information in PMC

Comment on

Nigeria: rightly taking its place on the world stage.
The Lancet. The Lancet. Lancet. 2022 Mar 19;399(10330):1093. doi: 10.1016/S0140-6736(22)00511-6. Epub 2022 Mar 15. Lancet. 2022. PMID: 35303468 No abstract available.

References

1. UN World population prospects. 2019. https://population.un.org/wpp/
1. World Bank Current health expenditure (% of GDP) https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?end=2018&start=2000
1. Vollset SE, Goren E, Yuan C-W, et al. Fertility, mortality, migration, and population scenarios for 195 countries and territories from 2017 to 2100: a forecasting analysis for the Global Burden of Disease Study. Lancet. 2020;396:1285–1306. - PMC - PubMed
1. World Bank World Bank Open Data. https://data.worldbank.org/
1. Kress DH, Su Y, Wang H. Assessment of primary health care system performance in Nigeria: using the primary health care performance indicator conceptual framework. Health Syst Ref. 2016;2:302–318. - PubMed

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Population health outcomes in Nigeria compared with other west African countries, 1998-2019: a systematic analysis for the Global Burden of Disease Study

Affiliations

Population health outcomes in Nigeria compared with other west African countries, 1998-2019: a systematic analysis for the Global Burden of Disease Study

Authors

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Abstract

Conflict of interest statement

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