ABSTRACT
This study was carried out to investigate the socioeconomic condition of mothers and
its influence on infant mortality rate in Ikeja Local Government Area of Lagos
State. The specific objective was to highlight
some determinants of high infant mortality rate in Nigeria, examine the
influence of socioeconomic conditions of mothers on infant mortality and
suggest some strategic interventions towards reduction of high infant mortality
rate in Nigeria. Four research hypotheses were formulated for the
study. It employed cross-sectional survey as the research design. It involved
collection of data from a sampled group of 150 mothers within the
child bearing age (15-49 years) with at least a live birth as at the time of
survey in Ikeja LGA selected through purposive sampling. The
instrument, a self-constructed questionnaire was administered and results were
analysed with percentage, t-test and Pearson product moment correlation
coefficient using SPSS. Some of the findings showed that there is no significant relationship between
employment status of mothers and infant mortality, no significant difference in
infant mortality between rich mothers and poor mothers, and no significant
relationship between mothers’ education and infant mortality. However, there
was a significant relationship between place of residence of mothers and infant
mortality. The study then concludes that favourable
living conditions of mothers should be encouraged through standard housing
schemes, environmental sanitation, increased maternal health awareness and free
maternal and child healthcare services.
TABLE OF CONTENTS
Title page i
Certification ii
Dedication iii
Acknowledgement iv
Abstract vi
Table of Contents vii
CHAPTER ONE: Background to the Study
Introduction 1
Statement of the Problem 4
Objectives of the Study 6
Scope of the Study 6
Significance of the Study 6
Definition of Concepts 7
CHAPTER TWO: LITERATURE REVIEW
Introduction 8
Infant Mortality 8
Determinants of Infant
Mortality 10
Socioeconomic condition of
mothers and infant mortality 15
CHAPTER THREE: METHODS
Theoretical Framework 23
Conceptual Framework 23
Intervention Strategy 24
Research hypotheses 25
CHAPTER THREE: METHODS
Methods 26
Research Design 26
Population/Location of
Study 26
Sampling Frame 26
Research Instrument 27
Administration of Research
Instrument 27
Method of Data Analysis 27
CHAPTER FIVE: DATA PRESENTATION, ANALYSIS AND INTERPRETATION
Introduction 28
Response to Questionnaire Items 28
Testing of Research Hypotheses 33
Summary of Findings 36
Discussion of Findings 37
CHAPTER SIX: SUMMARY, CONCLUSION AND
RECOMMENDATIONS
Introduction 39
Summary of Study 39
Implications of Findings
for Policy 39
Recommendations 40
Generalizability of Results 40
Suggestions for Further
Studies 40
Conclusion 41
References 42
Appendix A 49
Appendix B 56
CHAPTER ONE
Background
of the Study
1.1 Introduction
Despite
its human and natural resources, Nigeria with a population of over 170 million and GDP of $235 billion
(World Bank, 2012) and $500 billion when rebased in 2014, is ranked among the
poorest countries in the world; fifty five per cent live below the extreme
poverty line of US$1 a day (World Bank, 2012). Less than one half of the
population has access to safe water (43% in rural areas) and only 41% have
access to adequate sanitation (32% in rural areas). Life expectancy at birth is
52 years. Overall, the adult literacy rate is 56 per cent, however the rate for
males (67%) is much higher than for females (47%). These facts adversely affect
the survival of children and the reproductive health of women in general.
Investing in the health of children and their
mothers is not only a human rights imperative, it is a sound economic decision
and one of the surest ways for a country to set its course towards a better
future (UNICEF, 2008). Simple, reliable and affordable interventions with the
potential to save and improve the lives of millions of children are readily
available. The challenge, particularly in developing countries, has been how to
ensure that these remedies reach the children and families who, so far, have been
passed by.
In Nigeria, inadequate health facilities, lack of
transportation to institutional care, inability to pay for services and
resistance among some populations to modern health care (such as immunization)
are key factors behind the country’s high rates of new-born and child mortality
and morbidity (UNICEF, 2009). Cultural attitudes and practices that
discriminate against women and girls contribute, inadvertently to child
morbidity and mortality. While poor service delivery, parents who have low levels
of education and lack of information about immunization are major reasons for
low coverage among children (UNICEF, 2012).
Childhood mortality has been at the centre of
developmental discourse more importantly since the beginning of the twentieth
century. For instance, reduction of child mortality is the fourth of the United
Nations' Millennium Development Goals (MDGs). The rationales for this special
attention are not farfetched. One, although mortality is a necessity of life
and inevitable phenomenon, its untimely occurrence and varieties, especially
under-5 mortality, bring about diverse social, economic and psychological
trauma not only to the members of bereaved family, but to their immediate
communities, various social and developmental organizations, the nation and
entire world in general.
Two, in
almost all cultures in the world, childbirth is an event that attracts
celebration and children serve as symbols of joy and success to their parents
and the entire society, so, their sudden and untimely demise leaves behind
sorrow and confusion to the victims of such unfortunate occurrence. Three,
child mortality negate the concepts of reproduction and motherhood and if not
properly stem it may lead to total extinction of entire humanity. Four, childhood
mortality remains disturbingly high in developing countries especially in
sub-Saharan Africa despite the significant decline in most parts of the
developed world. The child mortality statistics reports of the World Health Organization
(2012) reveal staggering fact that about 7.6 million children under the age of
five die every year and more than half of these early child deaths are due to
conditions that could be prevented or treated. More worrisome than this is the
child mortality statistics of the World Bank (2006) which reveals that the
death toll among children under-5 years has well reached some 11 million
annually, with a clause that “more than 10 million of these occur in the
developing world and sub-Sahara Africa is the region most affected and accounts
for more than one-third of deaths of children under-5 years (World Bank, 2006).
This
asymmetric geographical distribution and patterns persist even in the 2012
child mortality statistics. Thus, level of child mortality is a significant
indicator of level of development of a given country, region or continent which
makes child mortality to remains a major public health issue in developing
countries where it is estimated that over 10 million preventable child deaths
occur yearly. In addition, progress in child mortality reduction remains
unacceptable in Sub-Saharan Africa. With special reference to Nigeria, the
giant of Africa, available statistics suggest that child mortality levels
continue to be high and exhibit wide geographic disparities (NPC, 1998; 2004;
2009). These factors and many more reveal the needs for
continuous and rigorous research in the areas of child mortality most
especially in sub-Saharan Africa.
Child
mortality defined as the likelihood for a child born alive to die between its
first and fifth birthday, is one of the most sensitive and commonly used
indicators of the social and economic development of a population. Thus, it is
frequently on the programme of public health and international development
agencies and has received renewed attention as a part of the United Nation’s
Millennium Development Goals (MDG; Espo, 2002). The MDG target is to reduce
child mortality by two thirds in the year 2015. This is pertinent as the
progress and future of any country depends on how healthy the children are.
This is reflected in their access to basic health care, nutritious food and a
protective environment, and if these are not available, the country’s mortality
rates would increase and economic potentials diminish (WHO, 2008). Globally,
according to the UN Interagency Group on Child Mortality Estimation (2011) a
significant amount of progress has been made towards achieving the target of
reducing mortality rate by two thirds among children under five. For instance
the number of under-five deaths worldwide has declined from more than 12
million in 1990 to 7.6 million in 2010. However, the highest rates of child
mortality are still in Sub-Saharan Africa-where 1 in 8 children dies before the
age of 5 years, more than 20 times the average for industrialized countries (1
in 167) and South Asia (1in 15) despite action plans, interventions and broad
approaches toward improving child’s health in the region (WHO, 2005). Further,
West African countries in particular experienced mortality up to three times
higher than neighbouring countries in Northern and Southern Africa (Balk et
al., 2004) and of all the under-five deaths which occur, five countries
namely; India, Nigeria, Democratic Republic of the Congo, Pakistan and China
account for about 50% with India (22%) and Nigeria (11%) together accounting
for a third of all under-five deaths. Nigeria, despite its wealth of human and
natural resources, the Federal Ministry of Health’s Integrated Maternal,
New-born and Child Health Strategy and the fact that it is one of the first
African countries with an integrated plan to look after mothers, new-borns and
children right through from conception to the child’s fifth birthday, is one of
the least successful of African countries in achieving improvements in child
survival in the past four decades (Nigeria Health Journal, 2011).
Childhood
deaths in Nigeria are usually caused by avoidable environmental threats to
health which stem most often than not from traditional problems that have long
been resolved in the wealthier countries, such as a lack of clean water,
sanitation, adequate housing, and protection from mosquitoes, other insects and
animal disease vectors and in people’s beliefs and attitudes concerning
childcare and behavioural practices into health strategies (Feyisetan &
Adedokun, 1992; Ogunjuyigbe, 2004). Though, common causes of child mortality
and morbidity include diarrhoea, malaria, measles and acute respiratory
infections, studies have shown that in Nigeria, many children die mainly from
malaria, diarrhoea, whooping cough, tuberculosis and bronchopneumonia
(Ogunlesi, 1961; Baxter-Grillo & Leshi, 1964; Morley, 1973; Animashaun,
1977; Ayeni, 1980). Ogunjuyigbe (2004) viewed morbidity and mortality of the
child to be influenced by the underlying factors of both biological and
socio-economic that operates through proximate determinants. Jinadu et al.
(1991), in a study, found dirty feeding bottles and utensils, inadequate
disposal of household refuse and poor storage of drinking water to be
significantly related to the high incidence of diarrhoea.
Children
from poor households are more vulnerable to these attendant risks compared with
children born to better off families. They are usually more exposed to risks
such as inadequate water and sanitation, indoor air pollution, crowding and
exposure to disease vectors and are more likely than not to be undernourished.
They are, therefore, at greater risk of severe
disease, and are more likely to suffer from more than one disease when ill.
They are less likely to have access and use
preventive and curative interventions, and those
who do receive treatment are less likely to receive
appropriate quality services (Wagstaff et al., 2004). Thus, at the dawn
of the 21st century, childhood mortality
which is an indicator of health status of a country
is very crucial and remains a daunting issue for
these developing countries and Nigeria in particular
where poverty rates are disproportionately high.
1.2 Statement of the Problem
Childhood
mortality as a concept measures the number of deaths between 0 and 5 years of
age. Childhood mortality can be sub-divided into two major groups namely:
infant mortality and under-five mortality. The infant mortality rate (IMR)
measures the probability of a child dying before his or her first birthday
(i.e. mortality between 0 and 1 year of age), while under-five mortality rate
(U-5MR) is the probability of death between ages 1 and 5 years. These are
powerful indicators of child survival, as children are most vulnerable in the
early years of life, particularly during the first year. Both measures are
synthesized and termed childhood mortality and they are indicative of quality
of childcare, including the prevention and management of the major childhood
illnesses (National Planning Commission, 2001).
While many
health indicators are required to arrive at a comprehensive assessment of the
health status of a population, a particularly sensitive and widely used summary
indicator is the Infant Mortality Rate (Visaria, 1985). Infant Mortality refers
to death of children in age group 0-1. Infant Mortality Rate (IMR) is the
number of infant deaths that occur per thousand live births in a population in
one calendar year. It is one of the universally accepted indicators of health
status of not only infants but also of the whole population and of
socio-economic conditions under which they live.
Infancy is a period of rapid growth and increased demand for calories and
proteins. In Nigeria infant mortality is a major public health concerns as
debilitating picture of poverty, diseases and malnutrition still constitutes an
unholy decimal in the country landscape. Presently demographic data on Infant
Mortality Rate (IMR) are still hugely inadequate as many deaths occur at home
and are not recorded in official statistics. However it is estimated that over
157 children per 1,000 live births or approximately 1 child out of 6 dies
before reaching age five.
This devastating and long standing
health care crunch is influenced by combination of interrelated factors which
includes high numbers of births per mother with short spacing between births,
poor weaning foods, use of infants formulas (cow's milk), inadequate healthcare
delivery system, unhygienic practices and sanitations, poor feeding practices
and low educational attainment.
Infant mortality rate (IMR) is one of the most
important sensitive indicators of the socioeconomic and health status of a
community. This is because more than any other age-group of a population,
infant’s survival depends on the socioeconomic conditions of their environment
(Madise et al 2003). It is one of the components of United Nations human
development index (UN, 2007). Hence its description is very vital for
evaluation and planning of the public health strategies (Park, 2005). One of
the most important items in the Millennium Development Goals (MDG) is to reduce
infant and child mortality by two-thirds between 1990 and 2015 (UNICEF, 2006).
The cause of the high rates of infant mortality,
especially neonatal mortality are linked to untimely pregnancies, low birth
weight and unsafe delivery, etc. These are also major causes of maternal
mortality. Dealing with one of the significant causes of infant and maternal
deaths - unsafe deliveries, it is evident from all accounts that literate women
are more likely to have their deliveries in an institution or at least attended
by trained practitioners. Literacy definitely enhances women’s exposure to the
modern health sector and the ease and confidence with which they can deal with
this sector. This increased confidence leads to an increased ability to deal
with emergency situations during pregnancy, delivery, infant illness and
therefore to improved women’s survival and infant survival. Literate women are
more likely to avail themselves of antenatal care, tetanus toxoid injection,
iron and folic acid tablets, institutional delivery and complete immunisation
for the infants.
Thus, this study examines the socioeconomic
condition of mothers and infant mortality rate in Ikeja Local Government Area
of Lagos State.
1.3 Objectives of Study
Generally, the research is designed
to examine the socioeconomic condition of mothers and its influence on infant
mortality rate in Ikeja Local Government Area of Lagos State. Specifically, the
objectives of this study are to:
1. Highlight
some determinants of high infant mortality rate in Nigeria.
2. Examine
the influence of socioeconomic conditions of mothers on infant mortality
3. Propose
ways of improving the socioeconomic conditions of Nigerian mothers
4.
Suggest some strategic
interventions towards reduction of high infant mortality rate in Nigeria.
1.4 Scope of the Study
The
academic scope of the study is the influence of socioeconomic condition of
mothers nad infant mortality. The geographical scope is some selected primary
and secondary health centres in Ikeja Local Government Area of Lagos State.
1.5 Significance of the Study
The
study will be of utmost importance to different stakeholders in the following
ways:
1.
Women: it will enlighten
them on the influence their socioeconomic conditions have on infant mortality.
It will also expose them to methods that can be adopted to maintain good health
for themselves and their children as well as reduction of the cases of infant mortality
at the family level
2.
Children: the study will
benefit them by reducing the prevalence of infant mortality among them and
improve their survival chances.
3.
Health workers: the study
will expose them to intervention strategies that can be adopted to help mothers
and infants to overcome the causative factors of infant mortality.
4.
Government: this study
will also assist the government in the area of policy formulation,
implementation, enlightenment and resource mobilisation to tacke the menace of
infant mortality and generally improve the nation’s rating on the global Human
Development Index.
5.
Society: for everyone,
the study will contribute to body of literature on the topic and engender a
collective action to reduce the incidence of infant mortality in our society
and increase the overall life expectancy of an average Nigerian.
1.6 Definition of Concepts
1.
Mothers:
females within
the child bearing age (15 – 49) with
at least a live birth as at the time of carrying out this study.
2.
Socio-economic
condition: the
situation of mothers and families in terms of their societal prestige,
educational qualification, economic wealth, place of residence and overall
standard of living.
3.
Infant
Mortality: the death of live births before their
first birthday.
4.
Infant
Mortality Rate: the frequency of deaths of infants
before their first birthday out of the total live births recorded within a
specified period.
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