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AN ANALYSIS
OF INFANT AND MATERNAL MORTALITY RATE IN NIGERIA
ABSTRACT
The first five years of life are the most crucial to
the physical and intellectual development of children and can determine their
potential to learn and thrive for a life time. That is why it is specifically
stated as one of the goals of the MDGs to reduce infant mortality by two thirds
by 2015. Although there has been a substantial reduction in infant and child
mortality rates in most developing countries in the recent past, it still
remains a major public health issue in Sub-Saharan Africa, with special
reference to Nigeria; the giant of Africa. The main purpose of this study is to
ascertain the influencing factors on infant and child mortality in Nigeria.
Survey data from the National Health Demographic Survey have been used to
examine the patterns of infant and child of mortality. The simple regression
estimation technique was employed to investigate the effects of some selected
socio-economic variables on infant and child mortality. The selected variables
include: the educational attainment of mother s, place of delivery, women’s status
respecting decision making in the house
which are; final
Say on Mother's Health Care, final Say on Making Large Household Purchases,
final Say on Making Household Purchases for Daily Needs, final Say on Visits to
Family or Relatives, final Say on Deciding What to do WithMoney Husbands Earns.
The study reveals that their exist positive linear association between infant
and child mortality and each of the variables serving as indicators for women’s
status. This stu dy was able to find out that place of delivery plays acrucial
role, as better places of deliveries significantly reduce infant and child
mortality in Nigeria. Also that higher level of educational attainment has
negative impact on infant and child mortality.
Nigeria, despite its rich oil wealth has one of
the poorest perinatal statistics in the world with perinatal mortality rates
ranging from 39 to 130 per 1000. The aim of this review is to describe the
state of the Nigerian nation with respect to perinatal deaths, causes of the
high perinatal deaths, present interventions in place and ways to reduce this
alarming perinatal statistics.
Infant and child mortality rates are important
indicators of the health status of a country. This paper presents the spatial
analysis of infant and child mortality rates among the geopolitical zones of
Nigeria with the objective of highlighting the unevenness in childhood
mortality rates among the regions. Data for the study was obtained from the
Nigeria Demographic and Health Surveys of 1999 and 2008. The findings of the
research show that there were significant spatial differences in infant
mortality rates and under-five mortality rates among the country’s
geo-political regions in 1999 and 2008 and by rural urban residence. Under-five
mortality rates showed significant clustering among the geopolitical zones with
the Northeast depicting clusters of highest under-five mortality rates while
the Southwest had the lowest under-five mortality rate clusters. The Moran’s I
values were significant at p<0.01 confirming the spatial clustering of
under-five mortality rates. The infant mortality rate of 75 deaths per 1,000
live births and the under-five mortality rate of 157 deaths per 1,000 live
births in Nigeria in 2008 are considered high compared to those of developed
countries and to the expected two-third reductions in the rates by 2015. The
paper recommends improvement in public health services, enhanced accessibility
to medical services, and the education of mothers on the importance of healthy
child care practices as panacea for the reduction of childhood mortality rates
to acceptable levels.
Globally,
childhood mortality rates have decline over the years due majorly to various
action plans and interventions targeted at various communicable diseases and
other immunizable childhood infections which have been major causes of child
mortality, but the situation seems to remain unchanged in sub-Saharan African
countries, as approximately half of these deaths occur in sub-Saharan Africa
despite the region having only one fifth of the world’s children population.
Many covariates associated with variations in infant and child mortality are
interrelated, and it is important to attempt to isolate the effects of
individual variables for proper and effective interventions. This study
examined the environmental determinants of child mortality using principal
component analysis as a data reduction technique with varimax rotation to
assess the underlying structure for sixty-five measured variables, explaining
the covariance relationships amongst the large correlated variables in a more
parsimonious way and simultaneous multiple regression for child mortality
modelling in Nigeria. For purpose of robustness, a model selection technique
procedure was implemented. Estimation from the stepwise regression
model shows that
household environmental characteristics do have significant impact on
mortality.
CHAPTER ONE
1.0 INTRODUCTION
1.1 BACKGROUND
OF THE STUDY
Infant mortality rate is one of the most
important indications of human development. Infant Mortality Rate (IMR)
according to is the number of deaths of infants under one year of age per 1000
live births in a given year. Included in the IMR are the neonatal mortality
rate (calculated from deaths occurring in the first four weeks of life), and
post neonatal mortality rate (from deaths in the remainder of the first year).
Neonatal deaths are further subdivided into early (first week) and late
(second, third and fourth weeks). In prosperous countries, neonatal deaths
account for about two-third of infant mortalities. The IMR is usually regarded
more as a measure of social affluence than a measure of the quality of
antenatal and obstetric care.
The infant mortality rate is widely
accepted as one of the most useful single measure of health status of the
community. The infant mortality rate may be very high in communities where
health and social services are poorly developed. For example, the neonatal
death rate is related to problems arising during pregnancy (congenital
abnormalities, low birth weight); delivery (birth injuries, asphyxia),
afterdelivery (tetanus, other infections). Thus, neonatal mortality rate is
related to maternal and obstetric factors. Maternal mortality as a
significant public health problem was first highlighted in 1987 at the first
International Safe Motherhood Conference in Nairobi, Kenya. Current estimates
of maternal mortality indicate that about 358 000 maternal deaths resulting
from complications of pregnancy and childbirth occur annually1. For every
maternal death, many more women suffer serious complications.
The causes of the vast majority of these
deaths and complications namely obstetric haemorrhage, sepsis, unsafe abortion,
hypertensive disorders, and obstructed labour are preventable3. Maternal
mortality is a reflection of women's place in society and their lack of access
to social, health and nutrition services, and to economic opportunities2.
Introduction of improved asepsis, caesarean section, blood transfusion
services, and improved prenatal care curtailed maternal mortality in
industrialized nations almost a century ago4. However, access to these
interventions is limited in developing countries.
There are several dimensions to maternal
mortality. Fundamentally, a woman's death during pregnancy or childbirth is not
only a health issue but also a matter of social injustice2 reflecting the
failure of communities and governments to promote safe motherhood as a human
right5, 6. Maternal mortality also reflects disparities in socio-economic
development. The overwhelming majority of maternal deaths occur in developing
countries2. Sub-Saharan Africa and South Asia account for about 87% of all
maternal deaths1. The lifetime risk of maternal death in sub-Saharan Africa is
1 in 31 compared to 1 in 4,300 in developed regions1. The higher risk in
developing countries reflects limited quality of care and provision of maternal
health services7,8. In sharp contrast, sequel to improvements in obstetric care
over the past decades, a pregnant woman in the United Kingdom is reported to
face a less than 1 in 19,020 risk of dying from obstetric complications
directly related to the pregnant state9.
Goal five of the Millenium Development
Goals (MDGs) aims to achieve three-quarter reduction of maternal mortality by
201510. Previous estimates of maternal mortality ratio in Nigeria showed that
there had been an increase from 80011 to 1 10012 per 100 000 live births.
However, the 2008 Demographic and Health Surveys (DHS) for Nigeria showed a
decline in maternal mortality with a maternal mortality ratio of 545 maternal
deaths per 100 000 live births13. Facility-based data support the contention that
maternal mortality is on the decline. However, the figures remain high14. High
maternal mortality in Nigeria is supported by the finding that Nigeria, along
with five other countries contributed more than 50% of all maternal deaths
worldwide in 200815. Given the weak civic registration and national health
information systems in many developing countries, these estimates remain guess
work16. Therefore urgent initiatives to monitor maternal morbidity and
mortality are imperative17 to provide reliable information for planning and
evaluation.
The WHO Global Maternal and Perinatal
Health Survey implemented in 2005 aimed to establish a global data system
comprising a network of health facilities that will collect focused information
on maternal and perinatal health to facilitate identification of morbidity and
mortality, monitoring of use of interventions and programme evaluation. This
report discusses maternal characteristics associated with maternal mortality in
Nigeria.
Common as
death may be, gathered statistics of mortality rate, when on the high side
apparently becomes disturbing and more catastrophic,especially when the death
figures are on theincrease among young children, as this stressesand indicates
a future absent the human race. For this reason, health expertsand policy
makers have allocated specialinterest to the developments and checkmating of
rising child mortality rates. Not only has thisinterest stretched into the
international scene, ithas attracted systematic approaches to reducingchild
mortality by 2/3 among children under theage of five from 1990 and 2015 as
tagged in the
Goals (MDGs) for
public health workers,institutions and international developmentagencies. (Fox
2012).Despite this goal of reducing infant and childmortality rate as stated in
the MDGs, Childmortality rates still remain unacceptably highespecially in
sub-Saharan African countries,where close to 50 percent of childhood
deathstakes place, even when the region accounts for only one fifth of the
world’s child population(Mesike and Mojekwu 2012). For instance, insub-Saharan
Africa, 1 in every 8 children dies before age five- nearly 20 times the average
of 1in 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 anddied 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 accountingfor one third of the total number of under fivedeaths
worldwide. The report describes the phenomenon as disturbing and
grosslyinsufficient to achieve the MDG goal by 2015as only 9 out of the 64
countries with high child mortality rate are on track to meet the
MDGgoal.Several factors have been acclaimed to beresponsible for this ugly
trend of high child andinfant mortality. Childhood illnesses such asvaccines
preventable diseases (VPD), malaria,acute respiratory infections (ARI), and diarrhea
contribute substantially to morbidity andmortality among children less than
five yearsold. Data from National Health ManagementInformation Systems (NHMIS)
shows thatmalaria is by far the most important cause of morbidity (38%) and
mortality (28%) in infantsand children, while 75% of malaria deaths occur in
children under five. Malaria also accounts for about 11% of maternal deaths,
especially for thefirst-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 secondmost common cause of infant deaths and themain cause of under-five
mortality. Acute Respiratory Infections (ARI) which include awide range of
upper and lower respiratory tract infections (pneumonia), commonly
manifestingwith cough, fever and rapid breathing were themain cause of
under-five morbidity and infant mortality.
1.2
PROBLEM OF THE
STUYDY
The
infant mortality rate is widely accepted as one of the most useful single
measure of health status of the community. The infant mortality rate may be
very high in communities where health and social services are poorly developed.
For example, the neonatal death rate is related to problems arising during
pregnancy (congenital abnormalities, low birth weight); delivery (birth
injuries, asphyxia), afterdelivery (tetanus, other infections). Thus, neonatal
mortality rate is related to maternal and obstetric factors. Maternal mortality as a
significant public health problem was first highlighted in 1987 at the first
International Safe Motherhood Conference in Nairobi, Kenya. Current estimates
of maternal mortality indicate that about 358 000 maternal deaths resulting
from complications of pregnancy and childbirth occur annually1. For every
maternal death, many more women suffer serious
Fungal infectious like
tinea corporis (ring worm, tinea pedis (athlete's foot), tinea curis (jock,
itch), tinea capitis, tinea barbas, tinea unguium (onychomycosis,
dermatophylid), subcutaneous and systemic mycosis, opportunistic mycosis and
candidiasis is also on record as part of the health problems that have affected
both infants and mothers. Vesico-vaginal fistulae (VVF) are destroying many
women in Nigeria (about 1.5%) especially in modern Nigeria (26).
Viral infections have even worsened the already improved
childcare programmes in Nigiera. Some of these viral infections include
chickenpox, yellow fever, rabies, herpes simplex, meningoencephalitis of mumps,
parainfluenza, respiratory synctial virus pneumonia and chronchiolistis
adenovirus, common cold (caused by many viruses), adenovirus conjunctivitis,
rubella virus and papilloma viruses have also contributed minimally to the
problems of infants and mothers (28).
In the present era of improved control
of the environment, proper management of human waste, improved personal
hygiene, medical facilities and dispensation including vaccination, there has
been substantial reduction in the incidence and effect of these diseases.
Although life expectancy has increased considerably, changing conditions are
replacing the old health problems with more disability and chronic illness,
where treatment and management prove very expensive to undertake (12). Infancy
is a delicate stage of life and the individual is prone to a lot of disease
conditions, because of immature tissues, organs and cells and also because of
the behavioral patterns of these mentally immature beings.
The average
maternal mortality rates in
developed
countries is between 10-15/100,000 live
births
while developing countries record rates 100-
200
times this number (Rosenfied, 1989). The
problem
of maternal deaths is worst in sub-Saharan
Africa
with the maternal mortality rates there being
higher
than anywhere else in the world (WHO,
2004).
The situation in Nigeria is especially grave as
we
still record maternal mortality rates in the order
of
800-1,000 per 100,000 live births (N.P.C. 2003)
and
thus rank among the nations with the highest
number
of maternal deaths (WHO, 2004).
1.3 OBJECTIVE
OF THE STUDY
1. To evaluate the
rate of infant and maternal mortality in Nigeria.
2. To know the
causes of infant and maternal mortality in Nigeria.
3. To know whether
the high rate of infant and maternal
mortality has reduced the Nigerian population.
4. To evaluate the
past and present efforts made by government to ensure good health through
proper health care delivery such immunization e.tc.
5. To recommend
possible solutions to the problem of infant and maternal mortality in Nigeria.
1.4 RESEARCH
QUESTION
1. How can one evaluate
the rate of infant and maternal mortality in Nigeria?
2. What are the
causes of infant and maternal mortality in Nigeria?
3. Can high rate of infant and maternal mortality reduced the
Nigerian population?
4. What are the
past and present efforts made by government to ensure good health through
proper health care delivery such immunization?
5. Can there be any possible solutions to the
problem of infant and maternal mortality in Nigeria?
1.5 RESEARCH
HYPOTHESIS
H0: One cannot evaluate
the rate of infant and maternal mortality in Nigeria.
H1: One can
evaluate the rate of infant and maternal mortality in Nigeria.
H0: There are no
causes of infant and maternal mortality in Nigeria.
H1: There are causes of infant and maternal mortality in
Nigeria.
H0: High rate
of infant and maternal mortality does
not reduce the Nigerian population.
H1: High rate of
infant and maternal mortality reduces the Nigerian population.
H0: There are no efforts
made by government to ensure good health through proper health care delivery
such immunization.
H1: There are no
efforts made by government to ensure good health through proper health care
delivery such immunization.
1.6 SIGNIFICANCE
OF THE STUDY
This study is on
the analysis of infant and maternal mortality rate in Nigeria. This research
work is going be beneficial to the entire public, students, lecturers and as
well as research.
1.7 SCOPE OF THE STUDY
The focus on the
analysis of infant and maternal mortality rate in Nigeria
1.8 LIMITATION OF STUDY
Despite the limited scope of this study certain
constraints were encountered during the research of this project. Some of the constraints experienced by the
researcher were given below:
i. TIME: This was a major constraint on the
researcher during the period of the work. Considering the limited time given
for this study, there was not much time to give this research the needed
attention.
ii. FINANCE: Owing to the financial difficulty
prevalent in the country and it’s resultant prices of commodities,
transportation fares, research materials etc. The researcher did not find it
easy meeting all his financial obligations.
iii. INFORMATION
CONSTRAINTS: Nigerian
researchers have never had it easy when it comes to obtaining necessary
information relevant to their area of study from private business organization
and even government agencies. Infants and maternal mothers difficult to reveal
their internal operations. The primary information was collected through
face-to-face interview getting the published materials on this topic meant
going from one library to other which was not easy.
Although these problems placed limitations
on the study, but it did not prevent the
researcher from carrying out a detailed and comprehensive research work on the
subject matter.
1.9 DEFINITION
OF TERMS
Infant mortality rate: Infant mortality rate is one of the most important
indications of human development. Infant Mortality Rate (IMR) according to[1]
is the number of deaths of infants under one year of age per 1000 live births
in a given year. Included in the IMR are the neonatal mortality rate
(calculated from deaths occurring in the first four weeks of life), and post
neonatal mortality rate (from deaths in the remainder of the first year).
Neonatal deaths are further subdivided into early (first week) and late
(second, third and fourth weeks). In prosperous countries, neonatal deaths
account for about two-third of infant mortalities[2]. The IMR is usually
regarded more as a measure of social affluence than a measure of the quality of
antenatal and obstetric care.
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