The Rate and Causes of Infant Mortality
Chapter One
Objectives of the study
- To test for the difference of two means between infant and child mortality rate.
- To estimate infant and child mortality rate.
- To estimate age specific fertility rate.
- To determine the trend line and forecast of infant and child mortality.
CHAPTER TWO
REVIEW OF RELATED LITERATURE
INTRODUCTION
The purpose of this chapter is to present the conceptual, theoretical framework including literature review to explain demographic, socio-economic, anthropogenic factors, environmental and health determinants of infant and child mortality. This framework will form the basis for the analysis in this study.
CONCEPTUAL FRAMEWORK
In this section, there are some technical concepts relevant to the study and demand for clarification in the way and manner being used in this study. The concepts include neonatal, post-neonatal, infant, child, and under-five mortality.
Neonatal Mortality
The first 28 days of life the neonatal period represent the most vulnerable time for a child’s survival. Neonatal mortality includes deaths that occur during the first 28 days of life (Ouma; Bashar and Tuno, 2014). The neonatal period begins with birth and ends 28 complete days after birth. Neonatal deaths may be subdivided into early neonatal deaths, occurring during the first seven days of life (0-6 days) and late neonatal deaths, occurring after the seventh day but before the 28th day of life. The WHO (2006) shows that, neonatal deaths in developed countries are declining and this is as a result of changing patterns in reproductive health, socioeconomic progress and improved quality of obstetric and neonatal facilities. On the other hand no good historical data on neonatal mortality are available for developing countries.
Causes and determinants of neonatal deaths differ from those causing and contributing to post neonatal and child deaths. Furthermore, WHO (2006) suggests that neonatal deaths and stillbirths stem from poor maternal health, inadequate care during pregnancy, inappropriate management of complications during pregnancy and delivery, poor hygiene during delivery and the first critical hours after birth, and lack of newborn care. The report further points out that some babies die after birth because they are severely malformed, are born very prematurely, suffer from obstetric complications before or during birth, have difficulty adapting to extra uterine life, or because of harmful practices after birth that lead to infections.
Post-neonatal Mortality
Post-neonatal mortality includes death that occurs at ages 1 to 11 months (Ouma; Bashar and Tuno, 2014). Post-neonatal mortality is most often caused by infectious diseases, such as pneumonia, tetanus, and malaria. An important factor in reducing postneonatal mortality is adequate nutrition, particularly breast milk, which provides babies with both the nourishment and the antibodies to fight 7 infectious diseases. Breast milk can be supplemented or substituted by mixing formula; however, it is important that clean water is used. The issue of HIV-infected mothers’ breast-milk has become controversial. A number of countries have instituted policies that recommend that mothers with HIV (human immunodeficiency virus) should not breast-feed, based on some evidence of mother-to-child transmission of HIV through breast-feeding. In contrast there are policies that promote breast-feeding in areas with high HIV prevalence.
CHAPTER THREE
METHODOLOGY
Reconnaissance Survey
A reconnaissance survey was carried out in order to identify the various locations of hospitals in the LGAs. During the reconnaissance survey, oral interviews were carried out on women of child bearing age to ascertain their health care seeking behavior which is where to seek health care assistance in times of illnesses, high risk behavior which is socio-cultural/Religious belief with respect to child birth and addressing infant and child illnesses, family head role and attitude towards infant and child health in the study area. This helped the researcher to get acquainted with the personnel in charge of delivery, pediatrics, gynecology and health extension workers in the hospitals and to determine relevant issues to be address in the questionnaire and also to ascertain the most appropriate sampling technique to be employed and the suitable statistical analysis for the data.
Types of Data
The types of data include:
-demographic and socio-economic data
-nature of sanitation
-nature of water sources
-type of residence by the respondents
-number of infants and children ever died by sex and
-causes of death.
Sources of Data
The data for this study was obtained from both primary and secondary sources.
Primary Sources
These were generated from respondents who provided the required information through the use of questionnaire and private health centers records, field observations, and Focus Group Discussions (FCDs) with respondents in the study area. The data were on demographic and socio-economic characteristics reflecting age, occupation, marital status, education, income, type of accommodation, residence, and source of water. It is design to obtain accurate and valid responses regarding infant and child mortality, number of live birth, and cause of the death.
The Focus Group Discussions (FGDs) is a participatory method which involves bringing six (6) to twelve (12) people to explore issues related to infant and child mortality in Edo State. The target population was household heads and women of reproductive aged 15–49. The discussions will be flexible in order to accommodate unexpected issues that may come up. Three (3) Focus Group Discussions were conducted, one each in the three selected LGAs.
CHAPTER FOUR
RESULTS AND DISCUSSION
INTRODUCTION
The purpose of this study is to analyze infant and child mortality trends and differentials in Edo State. To achieve this purpose, the data obtained in the study was analyzed and computed using descriptive statistics and inferential statistics. The results are presented in this chapter. A total of 386 questionnaires were retrieved out of 400 questionnaires administered on 400 respondents (96.5%).
This Chapter also discusses the demographic and socioeconomic characteristics of respondents obtained from the field. The variables considered in the primary data source include mothers age at birth, current marital status, type of marital union and age at marriage others are age at first pregnancy, birth spacing, number of children ever born, ante natal care (ANC) attendance, immunization practices and breastfeeding practices. The rest are parent‟s tribe, religion, level of education, and postnatal care.
Economic factors considered are parent‟s income level and employment status. Also considered are the environmental factors such as sources and use of water as well as the toilet types and liquid waste disposal methods.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
SUMMARY OF FINDINGS
Evidence from the hospital survey showed that the level of under-five mortality in Edo state has remained high since the past ten (10) years with an estimated U5MR of 163/1,000 live births. The above U5M ratio may be higher than the average estimated for the north-West zone of Nigeria. The major findings of the study reveal that major cause of morbidity in the study area is malaria (26.9%), major causes of death in the study area are malaria (30.1%) and it also showed that 39% of the children are within the ages of 0-1year. Mortality also varies with the marital status of the respondent, where the high rate of mortality was experienced by mothers who are married but not living with their husbands and widows.
The major factors that determined mortality in the study area is distance to the health facility. These factors have influence on the levels of U5M. The result shows that the rates and levels of U5M vary with levels of mother‟s education, income, employment, access to and use of health facilities, attitude to immunization, breastfeeding and distance to health facilities. In specific terms the findings show that children mothers with no education have greater risk of dying before their fifth birthday than those born by educated mothers. This is because educated mothers have higher confidence in reaching out for medical attention for their children but have better income and more independence in tackling matters of ill health in the family. Therefore, it should be noted that the challenges we face today regarding the health of under-five Nigerian children cannot be put off, since they are not insurmountable. That is, we have the tools, resources, and knowledge to address our nation’s most critical child survival problems and build on the considerable achievements that have made since the World Summit for Children in 1990. In general, progress in reducing under-five mortality depends on the commitment by academics, governments, international agencies, health care professional associations, donors and nongovernmental organizations to work together towards achieving Sustainable Development Goals.
An analysis of the major characteristics of respondents revealed that majority of the women sampled are mostly young (35 years and below) as against their older counterparts. The background characteristics of the respondents reveal that majority (64.3%) are between the age group 25-34 years. This is observed to be a reflection of the rate of infant and child mortality in the study area. Infant and child mortality appeared to be rather on the high side. The level of infant and child mortality is rather too high compared to what is obtainable in the state. The rather high level of under-five mortality is a reflection of early age at marriage.
Marital status has been able to bring about differences in infant and child mortality in the study area. The results of the survey revealed that significant proportions (34.4%) were married and currently living with their husbands. Married women who are not currently living with their husbands and widows experience more under-five mortality compare to those living with their husbands.
The analysis by infant/child mortality and income per month shows that respondents who earned less than ₦30,000 per month had the highest mortality of five and above infants and children who are under five years, however, respondents without income per month do not experience neither infants nor child mortality. This is a sharp contrast with Mahfouz, Adil, David, Abdelrahim (2009) that low income affects the accessibility of medical services.
For infant/child mortality and children ever born, it was observed that those with few children ever born had more number of infants and children less than five year compared to those respondents with more children ever born. However, this high proportion with no infant mortality and child mortality among most respondents could be as a result of under reporting of death. This is consistent with United Nations (2010) findings that in certain culture, women appear to be more likely to state duration of marriage correctly than to give correct information about their age, so the estimation procedure based on data classified by duration of marriage may be preferred.
Evidence from the hospital survey showed that the level of under-five mortality in Edo state has remained high since the past 10 years with an estimated U5MR of 163/1,000 live births even after considering a myriad of factors, including heterogeneity in study design.
Considering the trends in under-five mortality in Edo State since 2005, there is no doubt that the trends has been on the decrease, although the decrease is small over the years up to 2014 in which 2011, 2012, 2013 and 2014 saw steady declined or no change in the trends of infant and child mortality. Six variables were found to be the most contributing factors of infant and child mortality in the study area and they are distance to health facilities, age at first marriage, age of the mother, marital status, educational attainment, and breast feeding.
CONCLUSION
The primary aim of this paper was not to calculate U5MR for Edo State but to see the trend in the progress made since 2005, which will serve as a wake -up call assessment towards achieving the 2020 SDGs target and to examine the under-five morality differentials and factors that contributes to infant and child mortality rate in the state. Any society wishing to make material and spiritual progress must assure that women are fully integrated into its productive, educational, cultural and political activities. The goals of development include improving standards of living minimizing poverty, increasing access to education and employment, and reduction in social inequality, and women as a group deserve special attention and consideration of their problems. Their low economic status, marrying at younger age and marital instability are some of the causes of high infant and child mortality. Involving women in the nation‟s development is essential to reducing fertility rates
Higher levels of education, employment outside the home, lower infant and child mortality and increased income are among the factors that can increase the level of economic development in the country. Perhaps, the most significant factor is improving in the status of women, which is important in its own right above and beyond any influence it has on mortality. This has to be given particular attention in the nation‟s population policy.
A child„s right to survival is fundamental. It is the building block towards the realization of a child„s potential and on it hinges other basic rights of the child. Yet, many children do not enjoy this right. In Edo state infant and child mortality ratio (163/1,000 live births) is extremely high representing one of the country‟s development challenges. National estimates of U5MR is 157/1,000 live births. As Nigeria intends to lower its underfive mortality to meet up the SDG by 2020 it is therefore a wake-up call for a more concerted effort to be made in order to bring down the observed high rate of infant and child mortality. If this be the situation in the state then government must double its effort at combating the challenge particularly in the rural areas where health facilities are totally absent and access to urban settlements is difficult due to distance to the location of the health facilities.
RECOMMENDATIONS
The critical correlates of infant and child mortality therefore are age of the mother, age at first marriage, level of education, type of occupation and type of accommodation. This analysis suggests the need for more research to determine the additional variable needed to further reduce the observed infant and child mortality levels, since only 95% of their variance can be ascribed to the selected socio-economic indicators considered here.
Providing more basic health facilities within the urban and in rural communities and raising the level of girl-child education hold the key to our rapid advance to meeting the millennium development goals.
- Edo State Government should bring health services nearer to the communities especially in Irrua community so that mothers will have access to both during pregnancy and after. The impact of delivery a child with the help of a medical professional is enormous.
- Government of Edo state is called upon to sincerely encourage girl-child education through focused advocacy by religious leaders and traditional rulers. More girls‟ secondary Schools should be established in all the Local Government Areas.
- Increase the availability and accessibility of life saving services in health facilities in all the three Local Government Areas. This can be done through increasing coverage and quality of existing new born health programmers and packages, by strengthen the continuum of care and by honoring its previous commitments to more funding resources and accountability.
- Edo State Government should develop integrated approach to child health tackling under-five mortality will need an integrated approach to child health. These essential interventions can be implemented through a mix of delivery channels that are already in wide use, including outreach and community and facility-based services, while also taking advantage of longer-term opportunities such as community capacity to deliver integrated services. This will help address neonatal causes of under-five mortality and diseases that still have high mortality rates, most notably malaria, pneumonia and diarrhea.
- Girls in Irrua community, Edo state areas should be encouraged to go to school up to at least secondary level. This will first of all increase age at first birth and therefore reduce child deaths at first birth order. It will also increase the survival of their children since child survival is found to increase with maternal age and level of education in the study area.
- State Government should embark on enduring process of institutionalizing PHC in the state with the provision of necessary skills, management techniques, and capacity building through the active involvement, participation, and sense of ownership by communities at village and districts levels.
- If SDG to be achieved and needless loss of under-five child death prevented, it is essential that national governments, international agencies and civil societies increase attention to systematically preventing and tracking under-five deaths. Partners must work together now to increase their efforts and resources, focusing not just on one intervention or cause but on developing a functional continuum of basic services that save lives and improve health for millions of newborns and children.
- Government should collaborate with ministry of health to develop strategies to improve adequate breast feeding, vaccinations, zinc and vitamin A supplementation, insecticide-treated mosquito nets, oral rehydration therapy, antibiotic treatment of infection and treatment of malaria across the state. ix. Community leaders (spiritual and temporal) in the state are called upon to engage in advocacy for the sensitization of mothers with no education who are locked away from modern practices by cultural practices such as the puda system. Focus should be on antenatal care, intra-partum cares, post-natal care, extra care for sick new born and referral systems.
- Political consideration and regional pride in the state should be set aside when issues of data collection storage and release for academic use research purposes especially in Edo South Local Government Area.
- Government at all levels should support the Midwifes Service Scheme (MSS) to recruit and deploy midwives, with emphasis in all the Local Government Areas in the state.
Recommendation(s) for Further Research
Ø As a future work, determinants of mortality risk among children between the ages 1-5 in Edo State in addition to the determinants of infant mortality risk can be analyzed. Factors associated with child mortality risk might be different than those associated with infant mortality. Therefore explanatory variables other than the ones used in this study can be included to the model.
Ø A further study may examine the impact of public health provision, income, inequality, and female education on under-five mortality within different areas in the state. In addition, a question also arises if public spending on health could effectively reduce under-five mortality when health care is profit-oriented. How commercialized health care system influence public sector performance should be carefully considered.
Ø Further studies on other contextual factors such as socio-cultural factors influencing infant and child mortality are needed in Nigeria.
Ø The influences of contextual determinants on infant and child mortality need to be further explored with the use of qualitative data.
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