APPROACHES TO REDUCE INFANTS MORTALITY RATE IN EKITI STATE - UNIPROJECTS

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APPROACHES TO REDUCE INFANTS MORTALITY RATE IN EKITI STATE




APPROACHES TO REDUCE INFANTS MORTALITY RATE IN  EKITI STATE 


TABLE OF CONTENTS

Contents                                                                                           Pages
COVER PAGE                                                                                
TITLE PAGE                                                                                   
CERTIFICATION                                                                                     
APPROVAL PAGE                                                                         
DEDICATION                                                                                 
ACKNOWLEDGEMENTS                                                            
TABLE OF CONTENTS                                                                          
LIST OF FIGURES                                                                         
LIST OF TABLES                                                                                   
LIST OF APPENDICES                                                                            
ABSTRACT                                                                                     
CHAPTER I – INTRODUCTION
Background to the study                                                                         
Statement of the problem                                                                 
Purpose of the study                                                                        
Significance of the study                                                                           
Scope of the study                                                                                     
Research questions                                                                                    
Research hypotheses                                                                                 


CHAPTER II – REVIEW OF LITERATURE
Review of literature                                                                    
Conceptual framework                                                              
Concept of mortality                                                                  
Causes of mortality                                                                    
Approaches in reducing infant mortality rate in Nigeria                      
Socio-economic determinant of child survival                                   
Theoretical framework                                                               
Summary of literature reviewed                                                           
CHAPTER III – METHODOLOGY
Research design                                                                                   
Area of the study                                                                       
Population of the study                                                                       
Sample and sampling techniques                                                         
Instruments for data collection                                               
Validation of the instrument                                                      
Reliability of the instrument                                                            
Administration of the instrument                                                
Data analysis techniques                                                          

CHAPTER IV – PRESENTATION AND INTERPRETATION OF RESULTS
Research question 1                                                                  
Research question 2                                                                  
Research question3                                                                
Research question 4                                                                    
Research question 5                                                                            
Test of research hypothesis  1                                                            
Test of research hypothesis 2                                                             
Test of research hypothesis 3                                                   
Test of research hypothesis 4                                                    
Test of research hypothesis 5                                                              
CHAPTER V – DISCUSSION OF RESULTS, SUMMARY, CONCLUSIONS,
                           RECOMMENDATIONS
Discussion of results                                                                         
Summary of the study                                                                       
Conclusion                                                                                         
Implication of the findings                                                      
Recommendations                                                                 
Limitations of the study                                                          
Suggestions for further studies                                               


 References                                                                             
Appendix A                                                                           
Appendix B                                                                             
Appendix C                                                                            
Appendix D                                                                                     




LIST OF FIGURES
Figures                                                                                              Pages
Fig 2.1:  Conceptual framework on infant mortality                       
Fig 2.2:  Theoretical framework                                                     



LIST OF TABLE
Tables                                                                                                  pages
Table 4.0: Descriptive analyses showing how immunization reduce           
                   Infant mortality                                                                        
Table 4.1 Descriptive analyses showing how Counseling during antenatal  
      helps to reduce infant mortality                                                   
Table 4.2: Descriptive analyses showing how Health Education helps in     
                 reduce infant mortality                                                                        
Table 4.3 Descriptive analyses showing how free health care reduce            
       infant mortality                  
Table 4.4: Descriptive analyses showing how the use of health facilities       
        helps reduce infant mortality
Table 4.5:Chi-square analyses showing the significant of immunization in    
                reducing infant mortality                                         
Table 4.6: Chi-square analyses showing the significant of Counselling in         
     reducing infant mortality    
Table 4.7: Chi-square analyses showing the significant of immunization        
               in reducing  infant mortality
Table 4.8: Chi-square analyses showing the significant of  free health care    
                    services in reducing infant mortality
Table 4.9: Chi-square analyses showing how health facilities help to reduce  
                   infant mortality   


LIST OF APPENDICES
Appendices                                                                                         pages
Appendix A: Questionnaire on the approaches to reduce infant mortality   
                    rate in Emure local government Area of Ekiti state               
Appendix B: Reliability statistics using Pearson product moment         
         correlation (PPMC)          
Appendix C: Letter of permission to collect data/information/carry out         
                   Research experiment
Appendix D: List of Hospital and Health Centers                                                                      
                                            ABSTRACT
The study investigated the approaches to reduce infant mortality rate in Emure Local government area of Ekiti state. Nigeria has one of the highest maternal and infant mortality rates in the world and this necessitated the greater attention given to Maternal and Child Health (MCH) services in the country’s. The purpose of the study was to find out if immunization, counseling, health education, free health care services and health facilities will serve as approaches to reduce infant mortality in Emure Local Government Area of Ekiti State.
The research design for the study was survey design of the descriptive research. The sample size of two hundred (200) respondents was used for the study. The respondents were  pregnant women and nursing mothers  in Emure local government area.  Five selected health centre’s and one General Hospital were randomly selected using simple random sampling technique. The instrument used for the study was a 29 –items structured questionnaire. Split -half method was employed to ascertain the instrument using Pearson’s Product Moment Correlation. A coefficient of 1 was obtained at 0.05 level of significant. Descriptive statistic involving frequency counts and percentages were used to answer research question. The generated hypotheses were tested using Chi-Square (x2). All  the hypothesis were tested at 0.05 level of significance.
The findings of the study revealed that that immunization of children helps in reducing infant mortality rate in Emure local government area of Ekiti State. Also findings from the study revealed that counselling during antenatal period and Health Education helps in reducing infant mortality rate in the study area. The researcher concluded that immunization of children, counseling during antenatal period, Health Education, health care services and health facilities helps in reducing infant mortality rate in Emure local government area of Ekiti state. The researcher recommended that State Government should make provision for vaccine for children under the age of five, also Government should make available counselor to educates the women on the approaches to reduce infant mortality.
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CHAPTER I
INTRODUCTION
Background to the Study
Infant mortality refers to deaths of young children, typically those less than one year of age. It is measured by the infant mortality rate (IMR), which is the number of deaths of children under one year of age per 1000 live births.
Procter (2013) defined infant and maternal morality as the death of a child or mothers caused by diseases and other conditions related to pregnancy and childbirth. Therefore, infant and maternal mortality is the death of mother or child caused by diseases and other condition related to pregnancy, labour and childbirth.
The international federation of gynecologist and obstetricians (2009) defined child and maternal death as one occurring during pregnancy or labour as a consequence of pregnancy within forty two (42) days after delivery or abortion. The World Health Organization (WHO, 1998) estimated that 585,000 women die every year from pregnancy related causes, a rate of 430 deaths per 100,000 life birth. This maternal death due to associated causes and maternal condition (pregnancy) is regarded as secondary causes of death. For example, it is well know that cardiac diseases may be aggravated by pregnancy and a pregnant patient who has cardiac disease and dies, will be grouped  them under associated causes (Brown and beneath, 2012). And maternal mortality rate is the number of infant or maternal deaths due to pregnancy and child bearing one thousand (1000) registered live and still births.
Nigeria has one of the highest maternal and infant mortality rates in the world and this necessitated the greater attention given to Maternal and Child Health (MCH) services in the country’s Bamako Initiative (BI) programme. MCH consumers, who are often poor, are also at extraordinary risk of receiving poor or no health care. Nigeria’s infant mortality rate is about 96 per thousand live births in rural area against 75 per a thousand live births in urban area.Uzochukwu & Akpala (2004).
Infant mortality (death of children under one year) and under-five mortality are 100 and 210 per 1000 live birth respectively and these deaths are from preventable causes such as malaria (24%) pneumonia (20%), diarrhea (16%), measles (6%) and HIV/AIDS account for more than 71% of the estimated one million under 5 death in Nigeria in 2004 (FMOTT, 2007).
Some of the contributory factors to infant mortality in Nigeria include malnutrition, poor environmental hygiene, low access and utilization of quality health care services by women and children other include but not limited to low female literacy level, poor family health care practices, lack of access so safe water.
Tindall (2013) defined maternal mortality as death due to pregnancy or childbearing, the commonest causes of which are hypertensive and hemorrhagic disorders. Infant and maternal mortality is an important indicator of the standard of health care of different communities (Brown & Benneth 2012).
Although pregnancy is a physiological phenomenon, pregnant women commonly experience physiological and psychological changes. Pregnancy may be accompanied by complication that could be of fatal consequences, pregnant women are thus prone to risk, it follows therefore, that the care of a pregnant women deserves the highest priority in every community especially Abakaliki metropolis where the present sturdy is to be conducted.Infant and maternal mortality has implication not only to the family and community but also to the nation at large. With high accidence of infant and maternal mortality, a nation is regarded as a developing country. A study carried by Waboso (1993) shows that every year hundreds and thousands of Nigerians children and women die from complication of pregnancy, childbearing and puerperium be it directly or indirectly.
 Maternal and Child mortality is not an uncommon event in several parts of the developing world. Mothers and children are at highest risk for disease and death. While motherhood is often a positive and fulfilling experience, for too many women, it is associated with ill–health and even death (Olatoye, 2009). The death of a woman during pregnancy, labor or pueperium is a tragedy that carries a huge burden of grief and pain, and has been described as a major public health problem in developing countries. Women have an enormous impact on their families’ welfare. Deaths of infants/children under five are peculiar and closely related to maternal health. One million children die each year because their mother has died, and the risk of death of children less than five years doubles if mothers die in childbirth. More than 25,000 children die everyday and every minute a woman dies in child birth. Worldwide, every year about 500,000 women die due to child birth and over 9 million children under age five die mostly from preventable and treatable diseases (WHO, 2003).
Available evidence indicates that Africa accounts for the highest burden of mortality among women and children in the world (Udofia and Okonofua, 2008; Prata  et al., 2008). This unhealthy trend has become a matter of great concern, calling for concerted approach for all and sundry. The Millennium Development Goals (MDGs) by the global community focuses attention, resources, and action on improving the well-being of all peoples. Two of the goals (MDGs 4 and 5) were to reduce the childhood mortality rate and maternal mortality ratio, by two-thirds and three quarters (75%), respectively between 1990 and 2015. It is expected that decline in child/maternal mortality must accelerate substantially in the period to 2015, if any country is to reach these goals.
Nigeria is the most populous Black Country in Africa with 140 million people including 75 million children (Ogbonaya and Aminu, 2009). The child and maternal mortality rate of this country is very significant and has implications for the attainment of the MDGs. It has been noted that Nigeria is lagging behind in achieving universal coverage of key maternal and child health intervention and will unlikely meet the target of the MDGs. According to UNICEF Executive Director, Ann Veneman, “midway to 2015 deadline for MDGs, Nigeria continues to record unacceptably high maternal, newborn and child mortality”. Nigeria ranks as one of the 13 countries in the world with the highest maternal mortality rate and is still not listed among the 10 countries seen to have made rapid progress to meet the goals.
 Despite this goal of reducing infant and child mortality rate as stated in the MDGs, Child mortality rates still remain unacceptably high especially in sub-Saharan African countries, where close to 50 percent of childhood deaths takes place, even when the region accounts for only one fifth of the world’s child population (Mesike and Mojekwu 2012). For instance, in sub-Saharan Africa, 1 in every 8 children dies before age five- nearly 20 times the average of 1 in 167 in developed parts of the world (Mojekwu and Ajilola, 2011). Similarly, UNICEF (2010) in the state of the world’s children report noted that 8.1 million children across the world who died in 2009 before their fifth birthday lived in developing countries and died from a disease or a combination of diseases that could easily have been prevented or treated. It also noted that, half of these deaths occurred in just five countries namely, India, Nigeria, the democratic republic of Congo, Pakistan and China; with India and Nigeria both accounting for one third of the total number of under five deaths worldwide. The report describes the phenomenon as disturbing and grossly insufficient to achieve the MDG goal by 2015 as only 9 out of the 64 countries with high child mortality rate are on track to meet the MDG goal.
Several factors have been acclaimed to be responsible for this ugly trend of high child and infant mortality. Childhood illnesses such as vaccines preventable diseases (VPD), malaria, acute respiratory infections (ARI), and diarrheal contribute substantially to morbidity and mortality among children less than five years old. Data from National Health Management Information Systems (NHMIS) shows that malaria is by far the most important cause of morbidity (38%) and mortality (28%) in infants and children, while 75% of malaria deaths occur in children under five. Malaria also accounts for about 11% of maternal deaths, especially for the first-time mothers. Estimates show that 50% of the population has at least one episode of malaria each year, whereas children less than age five suffer from two to four attacks a year. Diarrheal illness is reported to be the second most common cause of infant deaths and the main cause of under-five mortality. Acute Respiratory Infections (ARI) which include a wide range of upper and lower respiratory tract infections (pneumonia), commonly manifesting with cough, fever and rapid breathing were the main cause of under-five morbidity and infant mortality. UNICEF (2009) indicated that 25% of the population carries the sickle cell trait, and about 100,000 children born annually is reported to have a serious sickle cell disorder.
Aside the health related factors influencing child survival as mentioned above, there are non-health related or socio-economic factors that can affect a child’s survival. Examples are; Female Literacy, the status of the mother regarding her level of participation in household’s decision making, access to safe and adequate sanitation, poverty, cultural and gender bias etc.
Nigeria, like many other developing countries particularly in Africa, is still far from reducing mortality among children to a level of 6 per 1,000 live births despite the advances in child survival strategies, highlighted most notably by the drive for universal immunization against life-threatening, vaccine-preventable diseases (UNICEF, 2001). Data from the 2008 Nigeria Demographic and Health Survey (NDHS) indicate that the infant mortality rate is 75 deaths per 1,000 live births; while the child mortality rate is 157 deaths per 1,000 live births for the five-year period immediately preceding the survey. This translates to about one in every six children born in Nigeria dying before their firth birthday (NPC and Macro, 2009). This has brought about serious stress in the health sector and therefore, posed a major challenge to social and economic development and prompted an unprecedented government response. However, child mortality is consistently lower in urban areas than in rural areas.
Statement of the Problem
For any country who wants to achieve the objective of the World Health Organization (WHO), that is, reduction on the risk associated with child birth and childbearing, such country must equip all the health care services in her country. This work tends to emphasis on the approaches in reducing infant mortality rate in Ekiti state using EmureEkiti as a focus point.
Infant mortality is a major health problem all over the world. According to World Health Organization (WHO), more than one woman, die every minute from pregnancy and child birth, about 585,000 die every year. Emure Local Government Area is not an exception and the rate of children and women that die of pregnancy and child birth in the area is not known, that necessitated this study to find out approaches to reduce infant mortality rate in Emure Local Government Area of Ekiti State.
Purpose of the Study
The aim of this study is to investigate the approaches in reducing infant mortality in Emure Local Government Area of Ekiti State. This will be achieved through the following specific objectives; to
1.     Determine if immunization will serve as an approach to reduce infant mortality in Emure Local Government Area of Ekiti State.
2.     Determine if counseling will help to reduce infant mortality rate in Emure Local Government Area of Ekiti State
3.     Find out if health education will be one of the approaches to reduce infant mortality rate in Emure Local Government Area of Ekiti State.
4.     Examine if free health care services will serve as a factor in reducing infant mortality rate in Emure Local Government Area of Ekiti State.
5.     Find out if pregnant women make use of health facilities in Emure Local Government Area of Ekiti State.
Significance of the Study
This research study is significant for many reasons. It provides information on the approach in reducing infant mortality in Emure Local Government Araa of Ekiti State. The data collected will be useful both to the government and health personnel’s and equally useful to the expectant mothers.
 It is hoped that the information generated would not only be useful in identifying at-risk populations but it would also form baseline indicators of the current mortality situation, which can be compared with data collected at a later point to determine whether improvements in child health and quality of life have occurred over time. Also data generated could be useful in formulating government policies and programmes towards achieving Millennium Development Goal four (MDG4) which aims to reduce infant and child mortality by two-third between 1990 and 2016.
Scope of the Study
The study is on the approaches to reduce infant mortality rate in Emure Local Government Area of Ekiti State. The study will cover the rate of infant mortality rate, factor affecting infant mortality rate and approaches in reducing infant mortality rate among women in Emure Local Government Area of Ekiti State.
Research Questions
This study is designed to address the following research questions;
1.        Does immunization of children help in reducing infant mortality rate?
2.        Does counseling during anti-natal period help in reducing infant mortality rate?
3.        Does Health Education helps in the prevention of infant mortality rate?
4.        Does free health care services helps in reducing infant mortality rate?
5.        Does pregnant women in Emure Local Government Area of Ekiti State make use of health qualities in reducing infant mortality rate?
Research Hypothesis
The research hypothesis was tested at 0.05 level of significance difference for the null hypothesis. The following hypotheses were formulated for this study:
1.     Immunization will not significantly serve as an approach to reduce infant mortality rate in Emure Local Government Area of Ekiti State.
2.     Counseling will not significantly help to reduce infant mortality rate in Emure Local Government Area of Ekiti State.
3.     Health Education will not have any significant approach to reduce infant mortality rate in Emure Local Government Area of Ekiti State.
4.     Free health care service will not significantly help to reduce infant mortality rate in Emure Local Government Area of Ekiti State.
5.     Health facilities will not serve as an approach to reduce infant mortality rate in Emure Local Government Area of Ekiti State.