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AN ANALYSIS ON INFANT MORTALITY RATE IN ABIA
STATE
CHAPTER ONE
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. UNICEF (2009) indicated that 25%of
the population carries the sickle cell trait, andabout 100,000 children born
annually isreported to have a serious sickle cell disorder.Aside the health
related factors influencingchild 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
andgender bias etc.The purpose of this study is to examine theimpact of this
non-health related factors oninfant and child mortality rate in Nigeria.
(NDHS 2008).
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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