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, such

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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 launched several steps to

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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 treatment

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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.

• Distribution of insecticide-treated bed nets

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 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,

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.

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 ✓ 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

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,

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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.

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

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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, including a lack of suitable healthcare

infrastructure, a staffing deficit in the medical field, inadequate health information systems, and

inadequate funding for healthcare.

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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 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.

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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,

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

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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

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

15
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

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.

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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

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

17
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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