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
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.
