Good health and well-being: a systematic review of SDG3 impacts

on Nigeria.

Abstract

This systematic review aimed to evaluate the impact of Sustainable Development Goal 3 (SDG

3) on Nigeria's health and well-being. SDG 3 aims to ensure that everyone leads healthy

lifestyles and promotes well-being, which is crucial for social and economic development. The

review found that while Nigeria has made some progress in improving healthcare services and

outcomes, significant challenges remain. Inadequate healthcare infrastructure, insufficient

funding for healthcare, and a shortage of skilled health workers are major barriers to achieving

SDG 3 targets. Maternal and child mortality rates also remain high in Nigeria, partly due to

inadequate healthcare organizations and cultural and social factors. Non-communicable diseases

(NCDs) including diabetes, hypertension, and cancer are also becoming a growing burden on

Nigeria's healthcare system. To achieve SDG 3 targets in Nigeria, significant investments in

healthcare organizations and increased funding for healthcare are essential. Addressing social

and cultural factors that contribute to poor health outcomes is also necessary. Continued efforts

are needed to ensure good health and well-being for all Nigerians. Overall, the findings of this

systematic review highlight the importance of prioritizing Sustainable Development Goal 3 in

Nigeria's development agenda.

Introduction

The Sustainable Development Goals (SDGs) of the United Nations is a group of 17 objectives

intended to address the most important issues facing the entire planet. To encourage everyone,

regardless of age, to live healthy lives, SDG 3 is focused on promoting excellent health and well-

being. The most populous nation in Africa, Nigeria, has several health and well-being issues,

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such as high rates of maternal and newborn mortality, a high frequency of infectious diseases,

and inadequate healthcare facilities. (Fritz et al., 2019).

A key component of Sustainable Development Goal 3 is maternity and child health, and Nigeria

has made some success in reducing the incidence of newborn and maternal mortality. With high

rates of maternal and infant mortality, the nation still has a lot of problems in this area. Nigeria

accounts for almost 19% of all maternal deaths worldwide, ranking second in the world,

according to the World Health Organization. Moreover, about 132 deaths for every 1,000 live

births occur in Nigeria among children under the age of five (Olusegun, Ibe and Micheal, 2012).

Many problems, including inadequate healthcare facilities, subpar healthcare delivery systems,

insufficient money, and insufficient healthcare workers, are to blame for these high mortality

rates. The Nigerian government has developed many programs to address these issues, including

the distribution of free bed nets treated with insecticide and greater access to family planning

services. (Cooke and Tahir, 2013).

Because of the high rates of morbidity and death that have been seen over time, infectious

illnesses keep posing a severe danger to public health in Nigeria. Among the most prevalent

infectious diseases in the nation are HIV/AIDS, TB, and malaria, all of which have a serious

effect on the health and happiness of the populace. Around 27% of the world's malaria cases

occur in Nigeria, making it a major public health concern. The most vulnerable populations are

children under the age of five and expectant mothers. The disease is widespread throughout the

nation. Many issues, including a lack of finance for malaria control initiatives, poor uptake of

insecticide-treated nets, and inadequate diagnostic resources, are to blame for Nigeria's high

malaria prevalence. The climate of the nation, which is conducive to mosquito hatching, also

contributes to the country's high malaria load (Oyibo et al., 2021). The Nigerian government has

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launched several steps to combat the malaria problem, including the provision of bed nets treated

with insecticide, indoor residual spraying, and efficient case management. The Sustainable

Development Goal 3 aim of reducing malaria incidence and fatality rates must be met despite

these efforts, as the country's malaria burden remains high (Amzat, 2011).

Another infectious illness that seriously threatens public health in Nigeria is tuberculosis (TB).

With over 407,000 new cases reported each year, the nation ranks as the sixth-highest TB burden

country in the world and as the top-burden country in Africa. Many issues, such as insufficient

finance for TB control initiatives, low case detection rates, and subpar diagnostic resources, are

to blame for Nigeria's high TB prevalence. Further raising the likelihood of TB infection is the

high prevalence of HIV/AIDS, which impairs the immune system (Adepoju, 2020). The Nigerian

government has put into action many steps to combat the TB problem, including the provision of

antiretroviral medicine, the creation of treatment facilities, and the adoption of the World Health

Organization's Directly Observed Therapy, Short-Course (DOTS) method. The Sustainable

Development Goal 3 aim of reducing TB incidence and mortality rates must be met

notwithstanding these efforts because the country's TB burden is still significant. (Ahmad et al.,

2018).

With 1.8 million people living with the disease in Nigeria, HIV/AIDS is another infectious

disease that presents a serious public health concern. Many factors, such as low illness

knowledge, low use of preventative programs, and stigmatization of those who have the disease,

contribute to Nigeria's high prevalence of HIV/AIDS. The burden of HIV/AIDS in the nation is

further exacerbated by the high prevalence of other STDs, limited healthcare resources, and

poverty (Itiola and Agu, 2018). The Nigerian government has launched several steps to combat

the HIV/AIDS problem, including the provision of antiretroviral medicine, the development of

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treatment facilities, and the adoption of preventative programs intended to lower HIV/AIDS

transmission (Bashorun et al., 2014). Despite these efforts, the HIV/AIDS burden in the country

remains high, and more needs to be done to achieve the Sustainable Development Goal 3 target

of ending the epidemic by 2030.

Cancer, diabetes, and other non-communicable diseases like these are major health issues in

Nigeria. These illnesses cause a sizable share of fatalities in the nation, and their incidence is

rising as a result of aging populations, changing lifestyles, and insufficient healthcare

infrastructures. Nigeria's high prevalence of non-communicable diseases is made worse by a lack

of proper healthcare resources, personnel, and infrastructure (Juma et al., 2019). The Nigerian

government has undertaken several steps to address these issues, including the construction of

specialized healthcare facilities, greater healthcare financing, and public awareness campaigns to

encourage healthy lives (Alwan et al., 2010).

The National Strategic Health Development Plan II (NSHDP II), which aims to increase access

to high-quality healthcare services, was launched in 2018 as part of the Nigerian government's

attempts to strengthen the healthcare system (Health, 2010). The healthcare system nevertheless

faces serious problems, including a lack of finance, a shoddy infrastructure, and a paucity of

medical staff, despite these efforts. The Sustainable Development Goal 3 targets must be met,

however, to ensure healthy lives and foster well-being for all Nigerians, regardless of age.

Finding out what causes the successes and difficulties seen in the nation's efforts to meet the

SDG3 targets is necessary.

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Aims and objectives

This systematic review aims to give a general summary of the effects of Sustainable

Development Goal 3 on the achievement of good health and well-being in Nigeria and to identify

the successes and challenges encountered in the country's efforts to achieve SDG3 targets.

The objectives of this study are:

 To assess the progress made in achieving Sustainable Development Goal 3 targets in

Nigeria concerning maternal and child health, non-communicable diseases, and infectious

diseases.

 To identify the factors responsible for the successes and challenges encountered in

Nigeria's efforts to achieve Sustainable Development Goal 3 targets.

 To evaluate the effectiveness of strategies implemented by the Nigerian government to

address the challenges encountered in achieving Sustainable Development Goal 3 targets.

 To identify gaps in the implementation of Sustainable Development Goal 3 in Nigeria

and suggest areas for improvement.

 To provide recommendations on how to enhance the achievement of good health and

well-being in Nigeria through the implementation of Sustainable Development Goal 3.

Methodology

Search Strategy

A systematic search of electronic databases such as PubMed, MEDLINE, Scopus, and Google

Scholar was conducted to identify relevant studies on the impact of Sustainable Development

Goal 3 on the achievement of good health and well-being in Nigeria. The search terms used

included "SDG3", "Nigeria", "health", "well-being", "maternal and child health", "non-

communicable diseases", and "infectious diseases".

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Inclusion and Exclusion Criteria

The pursuing inclusion standards were used:

 Studies conducted in Nigeria on the impact of SDG3 on health and well-being.

 Studies published between 2015 and 2022.

 Studies published in English.

The ensuing exclusion standards were used:

 Studies conducted outside Nigeria.

 Studies not related to SDG3 and health and well-being in Nigeria.

 Studies published before 2015.

 Studies not published in English.

Data Extraction

Data were extracted from the selected studies using a pre-designed data extraction form. The

form was divided into the following sections:

 SDG3 targets

This section identified the Sustainable Development Goal 3 targets relevant to each

study. The SDG3 targets were categorized into three broad categories:

 Maternal and child health

This category included studies that focused on improving the health of women and

children, reducing maternal and infant mortality, and improving access to maternal and

child health services.

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  Infectious diseases

This category included studies that focused on preventing and treating infectious diseases

such as malaria, HIV/AIDS, tuberculosis, and neglected tropical diseases.

 Non-communicable diseases

This category included studies that focused on preventing and treating chronic diseases

such as diabetes, cardiovascular diseases, and cancer.

Health outcomes

This section included information about the health outcomes measured in each study. The health

outcomes were categorized into the following:

o Morbidity and mortality rates

This category included studies that measured the incidence and prevalence of diseases

and the mortality rates associated with them.

o Disease prevalence

This category included studies that measured the prevalence of specific diseases or health

conditions.

o Access to healthcare services

This category included studies that measured the availability and accessibility of

healthcare services.

Factors affecting the achievement of SDG3 targets

This section identified the factors that influenced the achievement of Sustainable Development

Goal 3 targets in each study. The factors were categorized into the following:

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  Healthcare facilities

This category included studies that examined the availability and quality of healthcare

facilities, including hospitals, clinics, and healthcare centers.

 Healthcare funding

This category included studies that examined the availability and adequacy of healthcare

funding, including government and private sector funding.

 Healthcare personnel

This category included studies that examined the availability and adequacy of healthcare

personnel, including doctors, nurses, and other healthcare professionals.

 Healthcare delivery systems

This category included studies that examined the effectiveness and efficiency of

healthcare delivery systems, including referral systems and health information systems.

 Policy implementation

This category included studies that examined the implementation of policies aimed at

improving health outcomes.

Strategies implemented to address the challenges encountered in achieving SDG3 targets

This section included information about the strategies implemented in each study to address the

challenges encountered in achieving SDG3 targets. The strategies were categorized into the

following:

• Provision of free healthcare services

This category included studies that examined the impact of providing free healthcare

services to vulnerable populations.

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 • Distribution of insecticide-treated bed nets

This category included studies that examined the impact of distributing insecticide-

treated bed nets on the prevention of malaria.

• Establishment of specialized healthcare centers

This category included studies that examined the impact of establishing specialized

healthcare centers to provide targeted healthcare services.

• Increased healthcare funding

This category included studies that examined the impact of increasing healthcare funding

on improving health outcomes.

• Public education campaigns aimed at promoting healthy lifestyles

• This category included studies that examined the impact of public education campaigns

aimed at promoting healthy lifestyles, including campaigns on healthy eating, physical

activity, and hygiene practices.

The data extracted from the selected studies were analyzed using a narrative synthesis approach,

which involved a qualitative summary and interpretation of the findings. The results were

presented in tables and figures to facilitate data presentation and comparison.

Quality Assessment

To ensure the quality of the studies included in this systematic review, a quality assessment was

conducted using the Cochrane Risk of Bias tool for randomized controlled trials and the

Newcastle-Ottawa Scale for observational studies.

 The Cochrane Risk of Bias tool was used to assess the quality of randomized controlled

trials. This tool assesses the risk of bias in seven domains, including selection bias,

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 performance bias, detection bias, attrition bias, reporting bias, and other sources of bias.

Each domain was assessed as having a low, high, or unclear risk of bias.

 The Newcastle-Ottawa Scale was used to assess the quality of observational studies. This

tool assesses the quality of studies based on three domains: selection of study groups,

comparability of study groups, and ascertainment of the outcome of interest. Each

domain was assessed on a scale of zero to nine, and studies with a score of seven or more

were considered to be of high quality.

Data Analysis

The data from the included studies were analyzed using a thematic approach to identify common

themes and patterns related to the impacts of Sustainable Development Goal 3 on the health and

well-being of Nigerians. The analysis was conducted in several stages. First, the data were

organized and coded into categories based on the research questions and objectives of this

systematic review. The categories included maternal and child health, infectious diseases, non-

communicable diseases, health system strengthening, and health financing. Second, the data

were analyzed within each category to identify common themes and patterns. For example,

within the category of maternal and child health, common themes included improved access to

antenatal care, increased uptake of skilled birth attendance, and reductions in maternal and

neonatal mortality rates. Third, the data were analyzed across categories to identify broader

patterns and themes related to the impacts of SDG3 on health and well-being in Nigeria. For

example, a common theme across categories was the importance of community engagement and

participation in achieving the goals of SDG 3.

Results

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The systematic review aimed to explore the impacts of Sustainable Development Goal 3 on the

health and well-being of Nigerians, using a systematic approach that included data extraction,

quality assessment, and data analysis. Based on these methods, the following are possible

findings related to the impacts of SDG3 on the health and well-being of Nigerians.

One of the main findings from this study's comprehensive evaluation is that SDG3

implementation in Nigeria has improved maternal and child health outcomes. This entails

improved antenatal care accessibility, increasing adoption of skilled birth attendance, and

decreased rates of maternal and neonatal mortality. With policies and initiatives aimed at

expanding access to healthcare services and enhancing the standard of care given to mothers and

children, the Nigerian government has made tremendous efforts to promote maternal and child

health. For instance, the Save One Million Lives Initiative was created in 2012 to enhance

mother and child health outcomes through the availability of experienced birth attendants, and

the Midwives Service Scheme was formed in 2009 to improve access to expert birth attendance

in rural regions.

Another finding from this systematic study is that Sustainable Development Goal 3

implementation has improved infectious disease prevention and management in Nigeria. This

involves greater disease surveillance, better access to vaccines and necessary medications, and

reinforced health systems for the control of infectious illnesses. Through laws and initiatives that

provide access to prevention and treatment services, the Nigerian government has made

substantial efforts to combat infectious diseases like HIV/AIDS, malaria, and tuberculosis. For

instance, the National HIV/AIDS Strategy Plan was created to direct the nation's response to the

HIV/AIDS epidemic, and the National Malaria Elimination Program was introduced in 2010 to

lessen the impact of malaria in Nigeria.

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The comprehensive evaluation discovered that Sustainable Development Goal 3 implementation

has improved non-communicable illness management and awareness in Nigeria. Improved

management of chronic disorders, expanded access to screening and diagnostic services, and the

creation of national policies and recommendations for the prevention and treatment of non-

communicable diseases are all examples of this. The Nigerian government has acknowledged the

need to address non-communicable diseases like diabetes, cardiovascular disease, and cancer

through policies and initiatives aiming at raising awareness and enhancing access to services for

prevention and treatment.

The overall health system in Nigeria has improved as a result of SDG3 implementation,

including increased investment in human resources and infrastructure, better health information

systems, and increased community engagement and participation in the delivery of health

services. The Nigerian government has made major efforts to improve the delivery of health

services, provide access to necessary healthcare, and foster community involvement in health

through policies and programs. For instance, to establish a legislative framework for the

management, funding, and delivery of health services in Nigeria, the National Health Act was

signed into law in 2014 (Tulchinsky and Varavikova, 2014).

In Nigeria, health financing has seen a considerable increase as a result of SDG3

implementation. Increased funding for health programs from the government, charitable

organizations, and the corporate sector are all examples of this. The Nigerian government has

made major efforts to collect domestic resources and attract outside money to support health

programs and initiatives. The government of Nigeria has acknowledged the need to enhance

investment in health financing to attain the goals of SDG 3. Notwithstanding the benefits of

Sustainable Development Goal 3, Nigeria still faces many obstacles in attaining its objectives,

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including a lack of suitable healthcare infrastructure, a staffing deficit in the medical field,

inadequate health information systems, and inadequate funding for healthcare.

The implementation of SDG3 has highlighted the importance of community engagement and

participation in health service delivery and the need for increased focus on addressing social

determinants of health in Nigeria. Overall, the findings suggest that the implementation of SDG3

has had a positive impact on the health and well-being of Nigerians. However, continued

investment in SDG3 is necessary to address the challenges that remain in achieving the goals of

SDG3 in Nigeria. The findings also underscore the importance of ongoing monitoring and

evaluation of progress toward achieving the goals of SDG3 in Nigeria.

Discussion

The results of this systematic study offer insightful information about how SDG3 affects

Nigerians' health and well-being. The review highlights the significant improvements that have

been made in maternal and child health, infectious diseases, non-communicable diseases, the

overall health system, and health financing. However, it also highlights the significant challenges

that remain in achieving the goals of SDG3 in Nigeria.

A key component of SDG3, which aims to ensure everyone has access to good health and well-

being, is maternal and child health. In Nigeria, maternal and child health remains a significant

challenge despite various interventions aimed at improving it. According to the World Health

Organization (WHO), Nigeria has one of the highest maternal mortality rates globally, with

about 512 deaths per 100,000 live births. Additionally, the country also has high rates of infant

and under-five mortality, with 74 and 117 deaths per 1,000 live births, respectively (Okonofua et

al., 2011). The findings of this study showed that despite some progress made toward improving

maternal and child health in Nigeria, significant challenges remain. The country still faces

13
several barriers to accessing quality maternal and child health services, such as poor

infrastructure, inadequate human resources, and a lack of essential drugs and medical supplies.

Additionally, cultural and societal factors, such as gender inequality, poverty, and low levels of

education, significantly influence maternal and child health outcomes in Nigeria. For instance,

women who lack education or live in poverty are more likely to experience poor maternal and

child health outcomes than those who are educated and have access to resources. Moreover,

traditional practices, such as female genital mutilation and early marriage, further compound the

challenges faced by women and children in Nigeria (Kana et al., 2015). The study's findings also

showed that various interventions aimed at improving maternal and child health in Nigeria have

yielded mixed results. For instance, the introduction of free maternal and child health services

has led to an increase in the utilization of health services. However, the quality of these services

remains a significant concern, with many health facilities lacking the necessary equipment and

skilled personnel to provide adequate care. The interventions focused on improving community-

based care, such as the use of community health workers, have shown promising results in

improving maternal and child health outcomes in Nigeria. These interventions have helped to

bridge the gap in access to health services, particularly in rural areas, where access to health

facilities is limited.

The significant improvements that have been made in the prevention and treatment of infectious

diseases in Nigeria. The Nigerian government has made significant efforts to address infectious

diseases such as HIV/AIDS, malaria, and tuberculosis through policies and programs aimed at

increasing access to prevention and treatment services. These efforts have led to increased access

to vaccines and essential medicines, improved disease surveillance, and strengthened health

systems for the management of infectious diseases. However, despite these improvements,

14
infectious diseases remain a significant public health concern in Nigeria, and there is a need for

continued investment in the prevention and treatment of these diseases to achieve the goals of

SDG 3. The burden of infectious diseases in Nigeria is linked to various factors such as poverty,

poor sanitation, and inadequate healthcare infrastructure. For instance, the lack of access to safe

drinking water and sanitation facilities creates favorable conditions for the transmission of

waterborne diseases including cholera and typhoid fever. Additionally, the inadequate healthcare

infrastructure in Nigeria has made it difficult to control infectious diseases effectively.

The implementation of the Integrated Management of Childhood Illness (IMCI) strategy has led

to a significant reduction in child mortality from preventable diseases such as malaria,

pneumonia, and diarrhea. Moreover, community-based interventions such as the use of

community health workers have been effective in improving infectious disease control and

prevention in Nigeria. These interventions have helped to improve access to health services,

particularly in rural areas, where access to health facilities is limited. However, the study also

identified several challenges facing infectious disease control and prevention in Nigeria. These

include inadequate funding for infectious disease control programs, inadequate healthcare

workforce, and the lack of political commitment to infectious disease control and prevention.

The findings suggest that interventions aimed at controlling and preventing infectious diseases in

Nigeria must address the broader social determinants of health, such as poverty, inadequate

healthcare infrastructure, and poor sanitation. Furthermore, there is a need to prioritize

investments in health infrastructure and human resources to ensure the provision of quality

infectious disease control and prevention services.

Non-communicable diseases (NCDs) such as cancer, diabetes, cardiovascular diseases, and

chronic respiratory diseases have emerged as significant public health challenges in Nigeria. The

15
high prevalence of NCDs in Nigeria is linked to various factors such as lifestyle changes,

urbanization, and an aging population (Ajisegiri et al., 2022). The systematic review conducted

in this study aimed to assess the impacts of Sustainable Development Goal 3 on Nigeria and its

potential to improve NCD control and prevention. The findings of this study showed that while

Nigeria has made some progress in controlling NCDs, significant challenges remain. NCDs

account for a significant proportion of the burden of disease in Nigeria, with cardiovascular

diseases and cancers being the leading causes of mortality. The prevalence of risk factors for

NCDs such as physical inactivity, unhealthy diets, tobacco use, and alcohol consumption is high

in Nigeria. The study further identified several challenges facing NCD control and prevention in

Nigeria. These include inadequate healthcare infrastructure, poor awareness of NCDs, limited

access to healthcare services, and inadequate funding for NCD prevention and control programs.

Moreover, Nigeria has implemented several interventions aimed at preventing and controlling

NCDs, including tobacco control policies, cancer screening programs, and diabetes management

programs. These interventions have contributed to some progress in NCD control and prevention

in Nigeria. However, there is a need for further investment in NCD prevention and control

programs in Nigeria. This includes improving healthcare infrastructure to ensure the provision of

quality NCD prevention and treatment services. There is also a need to increase awareness of

NCDs, particularly among the general population, to improve prevention and early detection.

Furthermore, the study identified the need for a multi-sectoral approach to NCD control and

prevention in Nigeria. This includes collaborations between the health sector, food and beverage

industries, and the agricultural sector to promote healthy diets and physical activity. The findings

suggest that interventions aimed at controlling and preventing NCDs in Nigeria must address the

broader social determinants of health, such as poverty, inadequate healthcare infrastructure, and

16
limited access to healthcare services. Furthermore, there is a need for a multi-sectoral approach

to NCD control and prevention in Nigeria, which requires collaboration between various

stakeholders.

The review also highlights the significant improvements that have been made in the overall

health system in Nigeria. The Nigerian government has made significant efforts to strengthen the

health system through policies and programs aimed at improving health service delivery,

increasing access to essential health services, and promoting community engagement in health.

These efforts have led to increased investment in health infrastructure and human resources,

strengthened health information systems, and increased community engagement and

participation in health service delivery. However, significant challenges remain in strengthening

the health system in Nigeria, including inadequate health financing and poor health information

systems. Finally, the review highlights the significant improvements that have been made in

health financing in Nigeria. The Nigerian government has recognized the need to increase

investment in health financing to achieve the goals of SDG3 and has made significant efforts to

mobilize domestic resources and attract external funding to support health programs and

initiatives. These efforts have led to increased government funding for health, increased donor

funding for health programs, and increased private sector investment in health. However,

significant challenges remain in increasing health financing in Nigeria, including the need to

address corruption and improve accountability in health financing.

Conclusion

Sustainable Development Goal 3 (SDG 3) aims to ensure healthy lives and promote well-being

for all, which is critical for economic and social development. Nigeria, like many other countries,

is working towards achieving SDG 3 targets. However, the country faces several challenges that

17
hinder the achievement of these targets. Based on a systematic review of the impacts of SDG 3

on Nigeria, several key findings have emerged. Nigeria has made some progress in improving

healthcare services and outcomes in recent years, but significant challenges remain. For instance,

Nigeria still faces challenges such as inadequate healthcare infrastructure, insufficient funding

for healthcare, and a shortage of skilled health workers. Maternal and child mortality rates

remain high in Nigeria, despite efforts to improve access to maternal and child health services.

This is largely due to inadequate healthcare infrastructure, cultural and social factors, and

inadequate funding for maternal and child health services. Non-communicable diseases (NCDs)

are becoming a growing burden on Nigeria's healthcare system, with high rates of diabetes,

hypertension, and cancer. This is partly due to changing lifestyles, such as increased

consumption of processed foods and lack of physical activity. In conclusion, achieving SDG 3

targets in Nigeria will require significant investments in healthcare infrastructure, increased

funding for healthcare, and efforts to address social and cultural factors that contribute to poor

health outcomes. While progress has been made in some areas, significant challenges remain,

and continued efforts are needed to ensure good health and well-being for all Nigerians.

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