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 Table of Contents  
Year : 2019  |  Volume : 3  |  Issue : 3  |  Page : 88-93

Community knowledge, attitude, and practices regarding birth registration among women of childbearing age in Akure, Nigeria

1 Department of Community Medicine, University of Medical Sciences, Ondo, Nigeria
2 Department of Public Health Nursing, Ondo State College of Health Technology, Akure, Nigeria

Date of Web Publication15-Oct-2019

Correspondence Address:
Dr. Wasiu Olalekan Adebimpe
Department of Community Medicine, University of Medical Sciences, Ondo
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/LJMS.LJMS_55_18

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Background/Aim: Data on birth registration (BR) is needed in planning and monitoring performance of social interventions and health outcomes. An estimated 230 million children worldwide have never had their births registered and are exposed to social and human rights abuses. The objective of this study was to assess community knowledge, attitude, and practices regarding BR among women of childbearing age in Akure metropolis, Nigeria. Methods: A descriptive cross-sectional study was carried out among 456 eligible mothers selected using multistage sampling techniques. Research instrument used was a semi-structured pretested interviewer-administered questionnaire. Data were analyzed using the SPSS software version 17.0. Results: The mean age of studied respondents was 37.2 ± 7.7 years, 454 (99.6%) were aware of BR. One hundred and fifty-eight (34.6%) were aware of the National Population Commission as the concerned relevant agency of government. About 27.0% had inadequate mean composite knowledge, only 32.0% had favorable mean attitude scores, while 109 (23.9%) had their children <11 years registered at birth. Predictors of good practice of BR include having formal education, delivery within a health facility, having adequate knowledge, and favorable attitude scores to BR. Conclusion: Good awareness and knowledge, but the poor practice of BR characterized mothers under the study, and this suggests a need for improved sensitization of mothers by relevant stakeholders and removal of barriers to the practice of BR.

Keywords: Akure, birth registration, children under 11 years, knowledge, mothers, practice

How to cite this article:
Adebimpe WO, Akpatamu VO. Community knowledge, attitude, and practices regarding birth registration among women of childbearing age in Akure, Nigeria. Libyan J Med Sci 2019;3:88-93

How to cite this URL:
Adebimpe WO, Akpatamu VO. Community knowledge, attitude, and practices regarding birth registration among women of childbearing age in Akure, Nigeria. Libyan J Med Sci [serial online] 2019 [cited 2023 Feb 7];3:88-93. Available from: https://www.ljmsonline.com/text.asp?2019/3/3/88/269227

  Introduction Top

The post-2015 Sustainable Development Goals (SDGs) have reiterated the importance of birth registration (BR) as a fundamental human right for all children of the world. Such data are needed in monitoring performance of social interventions and health outcomes. An estimated 230 million children worldwide have never had their births registered, thereby exposing them to various rights abuses.[1] Less than 10% of Africa's population lives in countries with complete (above 90% coverage) BR.[2] A report on live births, deaths, and stillbirths registration in Nigeria (1994–2007) commissioned by the National Population Commission (NPC) revealed that BR rate of 0.01% in 1994 improved to 23.9% in 2007.[3] A nationwide survey by the National Bureau of Statistics put BR completeness in Nigeria at 30.2% in 2003 which subsequently rose to 42% in 2011.[4],[5]

In Nigeria, the exact number of children who are missing from national registries since the last census in 2006 is not precisely known due to poor routine data collection. These children remain “invisible” and are vulnerable to trafficking and exploitation by human traffickers.[6],[7] With the growing number of internally displaced persons and refugees, most especially in Northern Nigeria, evidence-based studies that could stimulate government interest are necessary to safeguard the rights of children, as well as monitor trends and track progress in population health indicators. This study assessed community knowledge, attitude, and practices regarding BR among women of childbearing age in Akure metropolis.

  Methods Top

Study area

Akure is a city in Southwestern Nigeria and has a population of 588,000 based on a projection of the 2006 National Population Census. The city hosted a regional office of the National Population Commission (NPC), and BR is commonly available at the primary health-care centers usually conducted by a NPC field staff. Children under 5 years constitute significant proportion of the total population. The specific prevalence of the practice of BR for the study area was not known before this study. A woman who successfully completes this procedure and receives a BR card is regarded to have fully completed the BR process.

Study design

The study was a community-based cross-sectional descriptive study.

Study population

The study comprised women of reproductive age group (15–49 years) in Akure city who had given birth to at least one child in the last 5 years preceding the survey. All women of the reproductive age group who are nonpermanent residents of the community as at the time of the study were excluded from the study.

Sample size estimation

It was carried out using the Leslie–Fisher's formula for single proportion for population more than 10,000. a P value of 57.1% of proportion of respondents who showed birth certificate as evidence of BR,[8] was used giving a final estimated sampling size of 480 after adjusting for attrition and nonresponse

Sampling techniques

The study adopted a multistage sampling technique. In the first stage, 3 out of 6 wards in Akure were selected by simple random sampling employing simple balloting. The total list of all NPC designated community enumeration areas (EAs), streets, and houses were obtained from the Local government development authority. In Stage II at ward level, 10 EAs were selected from the total list by simple random sampling employing simple balloting. In Stage III, two streets per EA were selected from the list by simple random sampling employing simple balloting. In Stage IV, and on a street, households were selected by a systematic sampling of one in 3 houses on either side after obtaining a list of all the houses on either side of the street. All eligible women met in selected household were interviewed until allocated questionnaires were exhausted and the desired sample size was achieved. In case of shortage of an eligible respondent from a selected household, the next household was selected to replace it.

Ethical considerations

The ethical approval letter was obtained from the Ethical Review Committee of Ondo State Ministry of Health and written informed consent was obtained from each respondent. For the uneducated respondents, written consent was obtained from their educated spouse and verbal consent from the respondents, after duly explaining the procedures and processes.

Instrument for data collection

The tool for data collection was a structured interview-administered questionnaire. The questionnaire consisted of five sections, namely; sociodemographic characteristics, BR, knowledge, attitude, and practice of BR by the respondents. The questionnaire was reviewed by a demographer as well as a reproductive epidemiologist. Pretesting of the research instrument was carried out in neighboring Ondo town. Six trained research assistants were employed in data collection, with the native language version of the questionnaire back-translated to English to ensure uniformly of asking questions.

Data analysis

It was carried out using the Statistical Package for Social Sciences (SPSS) software version 17 (SPSS Inc, Chicago, IL, USA) after data cleaning, double entry, and checking for outlier values. Data were presented as charts and tables. Questions related to knowledge was scored accordingly with Score 1 given to right knowledge for those with “Yes” response and Score 0 given to wrong knowledge for those with “No” response. Total score on knowledge was computed and mean score determined. Respondents with scores equal to and above the mean were classified as having adequate knowledge, while those below the mean score were classified as having inadequate knowledge.

The responses from attitude questions that had strongly agree, agree, indifferent, disagree, and strongly disagree options were scored 5, 4, 3, 2, and 1 in that order for positive attitude and 1, 2, 3, 4, and 5 for negative attitude. Total score was computed and mean score determined. Those that scored above mean score was said to have favorable attitude, while those below mean score was said to have unfavorable attitude. Bivariate analysis was done using the Chi-squared test, while binary logistic regression showcased association between the major outcome variables and some selected variables, most especially sociodemographic. Level of significance was considered at P ≤ 0.05.

  Results Top

[Table 1] shows that the mean age of respondents was 37.2 ± 7.7 years, 442 (88.2%) had between 1 and 4 children, 355 (77.9%) were engaged in monogamous marriages, 204 (44.7%) had completed secondary education, while 320 (70.2%) were engaged in unskilled labor. [Table 2] shows that about 454 (99.6%) were aware of BR, with the hospital and friends accounting for major sources of information among 238 (52.2%) and 233 (29.2%) of the respondents respectively. One hundred and fifty-eight (34.6%) were aware that birth certificates are normally issued after BR, only 137 (30.0%) were aware of the NPC as the agency of government monitoring BR.
Table 1: Sociodemographic characteristics of respondents (n=456)

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Table 2: Knowledge of birth registration among respondents

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About 27.0% had inadequate mean composite knowledge scores of BR, while 73.0% had adequate knowledge scores. However, only 32.0% had favorable mean attitude scores, while 68.0% had unfavorable attitude scores according to [Figure 1]. [Table 3] shows that 338 (74.1%) agreed that BR is necessary, while 351 (76.9%) agreed that BR should be enforced, 423 (92.8%) had antenatal care during the last delivery of a baby; the hospital was the place of delivery of the last baby among 426 (93.4%). One hundred and nine (23.9%) said all their children <11 years were registered at birth, only 192 (42.1%) of respondents showed evidence of BR and their birth certificate seen.
Figure 1: Mean knowledge, attitude, and practice score of birth registration

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Table 3: Attitude and practice of birth registration

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[Table 4] shows that age and level of education were statistically significantly associated with mean knowledge and attitude; only level of education showed a statistically significant association with the practice of completion of BR. On binary logistic regression, [Table 5] shows that women with adequate knowledge of BR were ten times more likely to have done registration of a child's birth compared with those with inadequate knowledge, and this observation was found to be statistically significant (P = 0.001, odds ratio [OR] =10, 95% confidence interval [CI] =3.25–34.9). Respondents with favorable attitude were 3.7 times more likely to have done BR compared to those with unfavorable attitude (P = 0.001, OR = 3.7, 95% CI = 1.7–7.84). Respondents with formal education were 1.6 times more likely to have done BR compared to those without formal education, and this observation was also found to be statistically significant.(P = 0.01, OR = 1.6, 95% CI = 1.08–2.40).
Table 4: Association between sociodemographic status and selected birth registration indices

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Table 5: Predictors of good practice of birth registration on binary logistic regression

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  Discussion Top

Report has shown that countries with a functional civil BR status have been found to have better health outcomes than countries with weaker systems, and there is a significant difference in their ability to plan for social services such as schools, housing, and security.[9] The first formal attempt at institutionalizing civil registration in Nigeria was in 1863, with the promulgation of Ordinance 21 with BR to start in Lagos, which was later expanded to cover the entire country by 1917.[10] This study determined knowledge and practice of BR among mothers who traditionally could have better access to the health-care system during interventions such as immunization, growth monitoring, and family planning.

Almost all the respondents were aware of BR, a pattern that was higher when compared to the percentages reported by other studies,[8],[11] conducted in Southeastern Nigeria where only about two-thirds of the respondents were aware of BR. Awareness is important because it is usually the precursor to respondents searching for more detailed information about the subject matter, and it is likely to determine attitude and eventual practice of BR in this case. Similarly, high awareness was reported in other Nigerian studies.[8] The fact that there is a lot of awareness creation by agencies of government such as the National Population Commission and National Orientation Agency on Radio, Television (TV) programs could account for the high level of awareness.

It was, however, observed that the depth of knowledge of the respondents regarding the process of BR, especially as it relates to National Population Commission as the relevant agency of the government for BR issues was inadequate among a quarter of the respondents. The implications of this are enormous including that women may not know when to register, who should register the child, advantages of BR, and demerits of not registering a child. Similar observation was observed in a study [11] who reported that majority of his respondents had poor knowledge of BR. This little disparity in outcomes of both studies might be related to the source and mode of transmission of information on BR. There is a high chance of getting incomplete and uncensored information when mass media was the major source of awareness or information. This puts readymade access to the health-care workers and electronic media (such as TV and radio) as sources of information at an advantage, since they are easily accessible to most homes even in developing countries like Nigeria. Major challenges facing NPC in Nigeria include inadequate publicity, insufficient number of registration centers, and poor service coverage due to poor budgetary allocation.[3] Thus, increased publicity by the NPC on BR through the use of relevant information, education, and communication media should be embarked upon to increase people's awareness on the location and activities of the NPC in Nigeria.

In this study, a little less than one-quarter of respondents claimed to have registered their children and about half of this figure was able to show BR cards as evidence. The proportion of children whose births were registered in this study was lower when compared to half that was reported in a study [12] and supported by a NPC 2009 study [13] for urban communities. However, possession of birth certificate in this study was higher or better when compared with the NPC report of 2009 when more than three-quarter of the respondents have not registered their children or were not with birth certificates. A birth certificate is required to access basic services and to exercise many of the fundamental rights of a child. Without a birth certificate, a child may not be able to easily enroll in school or access health-care services such as immunization and free health care. In some countries, an adult without a birth certificate may not have the right to marry, to vote, to be employed in the formal sector, to obtain a passport to travel outside his country of birth, or to register the births of his children. Thus, BR is central to the achievement of the SDGs, most especially No. 2 and 4, which are, respectively, related to the achievement of universal primary education and reduction of child mortality.

The observation that formal education is a significant determinant of the respondents' knowledge and practice of BR in our study was, not unusual, and it is in agreement with findings reported locally elsewhere.[11],[12] This further buttresses the need to embark on public awareness campaigns perhaps in local languages, in addition to other social networks in a bid to increase the awareness of BR among the less educated populace. Delivery within a health facility was significantly associated with the practice of BR in this study. Considering the fact that, many BR centers are located within the premises of health-care facilities may have contributed to this finding. Attaching BR centers to health facilities has been one of the feasible strategies to improve coverage of BR in developing countries. In the rural areas where deliveries occur more outside health facilities, it could be concluded that enlightening birth attendants in those places on the importance of BR and other places where such services could be accessed would be advantageous to the system. This also underscores the need for community-based BR centers to carter for those who may have delivered their babies outside the formal health-care facilities.


The authors wish to thank the community leaders who assisted in smooth data collection and movements within the communities, as well as individual mothers who voluntarily gave consent toward taking part in this study.

Financial support and sponsorship

All financial contributions to this research were basically from individual contributions by all the authors.

Conflicts of interest

There are no conflicts of interest.

  References Top

Cappa C, Gregson K, Wardlaw T, Bissell S. Birth registration: A child's passport to protection. Lancet Glob Health 2014;2:e67-8.  Back to cited text no. 1
Mahapatra P, Shibuya K, Lopez AD, Coullare F, Notzon FC, Rao C. Civil registration systems and vital statistics: Successes and missed opportunities. Lancet 2007;370:1653-63.  Back to cited text no. 2
National Population Commission. Frequently Asked Questions (FAQs) on Birth Registration. National Population Commission; 2008.  Back to cited text no. 3
AbouZahr C, de Savigny D, Mikkelsen L, Setel PW, Lozano R, Lopez AD. Towards universal civil registration and vital statistics systems: The time is now. Lancet 2015;386:1407-18.  Back to cited text no. 4
National Bureau of Statistics. Nigeria Multiple Indicator Cluster Survey 2011 Report. Abuja, Nigeria: National Bureau of Statistics; 2011.  Back to cited text no. 5
Makinde OA. Infant trafficking and baby factories: A new tale of child abuse in Nigeria. Child Abuse Rev 2015;24:2420-6.  Back to cited text no. 6
Makinde OA, Azeez A, Bamidele S., Oyemakinde A, Oyediran KA, Adebayo W. Development of a master health facility list in Nigeria. Online J Public Health Inform 2014;6:e184.  Back to cited text no. 7
Akande TM, Sekoni OO. A survey on birth and death registration in a semi-urban settlement in Middle-Belt Nigeria. Eur J Sci Res. 2005;8:56-61.  Back to cited text no. 8
Phillips DE, AbouZahr C, Lopez AD, Mikkelsen L, de Savigny D, Lozano R. Are well functioning civil registration and vital statistics systems associated with better health outcomes? Lancet 2015;386:1386-94.  Back to cited text no. 9
Adedini SA, Odimegwu CO. Assessing knowledge, attitude and practice of vital registration system in South-West Nigeria. IFE Psychol Int J 2011;19:456-71.  Back to cited text no. 10
Isara A, Atimati A. Socio-demographic determinants of birth registration among mothers in an urban community in Southern Nigeria. J Med Trop 2015;17:16-25.  Back to cited text no. 11
  [Full text]  
Tobin EA, Obi AI, Isah EC. Status of birth and death registration and associated factors in the South-South region of Nigeria. Ann Niger Med 2013;7:3-7.  Back to cited text no. 12
National Population Commission and ICF Macro. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro; 2009.  Back to cited text no. 13


  [Figure 1]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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