Problem of Mass Illiteracy and Public Health Care Services in Nigeria
PURPOSE OF THE STUDY
The general objective of this study is to investigate the determinants of mortality rate among under five children in Nasarawa state. In order to achieve the objective, the study focuses on the following specific areas:
- To identify the factors which influence under-five mortality in Nasarawa
- To assess the influence of the socio-economic status and educational levels of parents on under-five mortality in Nasarawa
- To evaluate the commonest source of medical care provided for sick children in Nasarawa
- To create background for further research on the conditions of children who survive or were better and different from their counterparts who die.
RELATED LITERATURE REVIEW
Traditionally, health was taken care of by medicine-men. These medicine-men inherited their knowledge and skills from their parents about herbs, roots, and how to prepare them, which ailments they cured and how to administer them. Traditional healers are found every where. They live close to the people and the treatments they give are based on various combinations of religion, magical powers and empiricism. It was recognised that under traditional health care services, people were exposed to a lot of risks (Park 2002). With the coming of modern medicine, many modern health facilities are available. Nowadays doctors and nurses are relied upon for the cure and prevention of diseases rather than on traditional medicine-men. Modern medicine more than traditional medicine moves faster towards specialization and rational, scientific approach to disease prevention and cure. The pattern of disease began to change with the comprehensive programmes to avoid illnesses or diseases such as acute respiratory infections, cardiovascular diseases, mental illnesses and others, Park (2002). According to UNICEF (2000) young children are largely dependent upon their parents for good health care and survival. Parents or guardians who should have ensured that their children live in a clean environment, eat nourishing foods, protect them from getting sick or contracting childhood diseases such as polio, measles, whooping cough, tuberculosis, malaria, acute respiratory infections and a host of others could not perform their roles appropriately. That is why many children are exposed to risk factors and preventable causes that affect their health, future and eventually their lives. (UNICEF, 2000), Park (2002).
The purpose of this study was to find out determinants of infant/child mortality rate among children under-five years of age in Nasarawa state.
The available literature on determinants of infant/child mortality rate among children under-five years of age are reviewed under the following sub- headings
*The concept of mortality rate among under five children.
* Global perception of infant/child mortality rate.
*Determinants (causes) of mortality rate among under five children
*Infant/child, mortality control activities by national and international agencies.
*Health needs of children under-five years of age as special population.
*Prevention and control of infant/child mortality rate in Nasarawa state
THE CONCEPT OF UNDER-FIVE MORTALITY
According to Park (1997), the child mortality rate (death rate) is a more refined indicator of the social situation in a country. This is because it reflects the adverse environmental health hazards such as malnutrition, poor hygiene, infection and accidents as well as economic, educational and cultural characteristics of the family. It has been recognised that the infectious diseases of childhood which include measles, whooping cough, diphtheria, diarrhoea and acute respiratory infection can lead to high case–fatality rate in malnourished children. UNICEF, (1996), and Augustus, (2005) define under – five mortality rate (U5MR) as the probability of children dying between birth and five (5) years of age, and this can be the best single indicator of social development and well–being, as compared to Park’s (1997) which reflects income, nutrition, health care, basic education and so on. However, infant mortality rate can be expressed as the probability of new born babies dying between birth and age of less than one year. The majority of deaths during birth or at infant result from infections, asphyxia and birth injuries and complication of premature birth (WHO. 2001). Low birth weight contributes to nearly 80 percent of infant mortality and low birth weight babies who survive have an increased risk of developing diseases and learning disabilities (Darmstadt etal (2003), UNICEF (2001). The health of newborn babies and survival through the first 28 days of life are closely linked to the health of the baby’s mother before and during pregnancy, as well as during labour, childbirth and after birth. Therefore, the need of interventions for maintaining women’s health during these times is important as intervention for improving the health and survival of the new born baby, UNICEF (2001). The under-five mortality is calculated by the formula: the figure of deaths of children under-five years of age (from birth to five years) in a given year over the figure of the live births in the same year multiplied by one thousand, Sofoluwe etal (1996).
GLOBAL PERCEPTION OF UNDER-FIVE MORTALITY
The average global under-five mortality rate (U5MR) declined by 11 percent globally, from 93 deaths in the early 1990s to 83 deaths per 1000 live birth in the year 2000. However, only few or more than 60 countries achieved the targeted one-third reduction. A significant challenge remains in sub- Saharan African, South Asia and the Middle – East and North Africa regions where under – five mortality rates (U5MR) are 175 per 1000, 100 per 1000, and 64 per 1000 respectively. Infant and child mortality remains disturbingly high in developing countries despite the significant decline in most parts of the developed world. The state of the world’s children’s health indicated that about 12.9 million children die every year in the developing world (UNICEF, 1987).
The difference in the survival rates of children in developed and developing countries is a pointer to the third world’s needs for preventive services. However, good health care system, breast feeding, adequate nutrition, clean water, immunization programmes, oral re-hydration therapy and birth spacing as well as revolution in child survival could be achieved. (Park, 1997).
In Africa according to the United Nations Economic Commission for Africa ECA (1994), since 1980s, poverty and low socio-economic status have been major problems on which focus has been given. It is estimated that about 220 million Africans, which constitute a reasonable per cent of the population in the continent currently live in absolute poverty and are unable to meet most of their basic needs such as education, shelter, food, health care, sanitation, clothing, and potable water. In addition, there is massive unemployment problem which created situations like delinquency, crime and social insecurity. Given the prevalent economic situation which has continued to deteriorate, it will not be easy to provide good health care to meet the needs of the children under – five years of age by their parents alone. Therefore they need assistance from governments and other voluntary agencies. ECA (1994).
Nasarawa State has thirteen (13) local government areas with a projected population of 1.2 million from the 1991 census. It is made up of the following three geo-political senatorial districts.
- South Senatorial District – Lafia
- North Central Senatorial District – Akwanga
- Western Senatorial District – Keffi
The framework of this study includes research design, population, sample size and sampling techniques, instrumentation, validation of the instrument, data collection and statistical techniques which are described below in this chapter.
The study was conducted to ascertain the determinants of mortality rate among under five children in Nasarawa State. Therefore, ex-post facto research design was adopted to collect the information needed to test the hypotheses of this study.
In this design, the information associated with the determinants influencing under-five mortality is already available. The information was collected and analyzed to answer the research questions and to test the hypotheses of the study.
The study population comprises all health workers (females) and parents (females of reproductive age group) on scheduled visit to health institutions for prenatal and postnatal care.
Nasarawa State has thirteen (13) functional government general hospitals including the Specialist Hospital Lafia and the Federal Medical Centre (FMC) Keffi.
From each stratum, one government general hospital or maternity centre/ward considered as the health institution in a local government area (LGA) was selected at random. In the process of the selection all the local government headquarters in each stratum were given numbers from which four (4) numbers were randomly selected by way of dips and picks from the South Senatorial Zone being the largest and having the highest number of government general hospitals while three (3) numbers each were selected from the North- Central and Western Senatorial zones blind-foldedly. Thus a total of ten (10) local government areas were selected from the population of 1,200 health workers (females) and parents (females of reproductive age) on scheduled visit to the health institutions. This means that all female health workers and female parents in the selected hospital of Nasarawa state. Thus the distribution total number of both female parents and female health workers in each of the ten (10) chosen health institutions in Nasarawa state during antenatal and postnatal care are as follows: Lafia 100, Obi 100, Awe 100, Doma 100, Akwanga 200, Nasarawa /Eggon 100, Wamba 100, Keffi 200, Nass 100, Toto 100, and the overall total is 1,200 as the study population.
RESULTS AND DISCUSSION
The purpose of this study was to investigate the determinants of mortality rate among under five children in Nasarawa State. To achieve this purpose, the data obtained in the study was analysed and computed using descriptive statistics and chi-square statistics. The results are presented in this chapter.
SUMMARY, CONCLUSION AND RECOMMENDATIONS
The study examines the determinants of mortality rate among under five children in Nasarawa State. The population used for the study consisted of parents (women) and health workers (females) randomly selected from three senatorial districts of Nasarawa State.
The questionnaire which was employed as instrument used to gather information for the study contained four sections: bio-data, factors influencing under-five mortality, quality of child healthcare, health facilities by parents and environmental sanitation. A total of 600 questionnaires were randomly administered to women and health workers (females) through trained research assistants at selected government general hospitals during pre-natal and post natal clinic in Nasarawa State but only 596 were retrieved.
The data collected was analyzed using descriptive statistics (frequencies and percentages) to assess the variables of the study and chi-square statistics were used to test the hypothesis at 0.05 level of significance.
The findings of this study include the following:
- Malaria, diarrhoea, anaemia, and illiteracy of the parents (mothers) were the major determinants influencing under-five mortality in Nasarawa
- The symptoms of childhood diseases such as malaria, diarrhoea, anaemia, which were observed/viewed by health workers to be the determinants of mortality rate among under five children in Nasarawa State were confirmed with the opinion of parents through statistical test of null- hypothesis which was rejected.
- The socio-economic status of parents and source of medical care of children were not significantly associated with factors influencing under-five mortality in Nasarawa State. This could be as a result of the fact that modern health facilities are the most patronized while religious healers are least patronized by the respondents as sources of medical care for their
- According to the descriptive statistics (frequencies and percentages) the findings confirmed that most parents were unable and inadequately receive antenatal/postnatal care as a result of high medical fees, distance to health centers and inadequate health facilities
- Similarly the findings revealed that there was no effective practice of child health care by
The environmental diseases such as malaria, diarrhoea, anaemia, and illiterate people were the serious health problems that influenced under-five mortality in Nasarawa State. The poor standard of living of the people exposes the children to health hazards in Nasarawa State.
This study was guided by the research questions and hypotheses on the basis of which the following recommendations are made:
- It is essential to introduce health education to women in prenatal and postnatal clinics in Nasarawa State in order to instill the habit of personal hygiene in mothers and children as well as to improve environmental health and increase quality life in the family.
- Mothers and children in Nasarawa State should have more access to free health facilities and health services.
- Health educators and health researchers should continue to raise awareness of preventive measures such as environmental sanitation, immunization, health care of the child, general welfare of the child, good nutrition and other interventions for mothers and children below five years of age in both rural and urban areas in Nasarawa
- Finally the government and all the communities in Nasarawa State should intensify efforts to promote the health of its citizens and especially mothers who will deliver healthy children with good behaviour and long live
(b) RECOMMENDATION FOR FURTHER RESEARCH/ STUDY
Any research on this area of study using different age groups, methods, procedures and related work to expand knowledge within the field of the study is permissible.
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