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ANALYSIS OF BIRTH RATE AND DEATH RATE CASES

 

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ANALYSIS OF BIRTH RATE AND DEATH RATE CASES

 

 

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.

            Over the years, studies have revealed that the progress

countries have made toward reaching their goals of reducing

by two- third childhood mortality based on the 1990

progress has been mixed, with a few countries on-track

toward achieving the target, others having little or no

success, and some countries actually losing ground (Bryce J,

Terreri N, Victora CG, Mason E, Daelmans B, Bhutta ZA, et al,

2006). For about two decades, the annual number of underfive

deaths only fall from around 12.4 million to about 8.1

million in 2009 - nearly 22,000 per day or 15 every minute

(You D, Jones G, Wardlaw T, United Nations Inter-

1990, it is clear that under-five mortality had fallen. This is

evidence that progress on child mortality is being made

across all regions of the world, with many regions having

reduced the under-five mortality rate by 50% or more

(UNICEF, 2010).

However, evidence from UNICEF, WHO, the World Bank,

and the UN Population Division report(s) shows that the

highest rates of mortality in children under age 5 years

continue to occur in sub-Saharan Africa where, in 2009,

one in every eight children (129 per 1000 live births) died

before their fifth birthday-a level nearly double the average

in developing regions (66 per 1000) and around 20 times

the average for developed regions (6 per 1000) (UNPD,

2010). Under-5 mortality is increasingly concentrated in

the developing countries: 70% of the world's under-5

deaths in 2009 occurred in only 15 countries while half of

the deaths occurred in only five countries: India, Nigeria,

Democratic Republic of the Congo, Pakistan, and China,

whereas India and Nigeria together account for nearly onethird

of the total number of under-5 deaths worldwide

(21% and 10%, respectively) (You D, Jones G. et al, 2010).

In Nigeria, underneath the statistics lies the pain of human

tragedy, for thousands of families who have lost their

children. Even more devastating is the knowledge,

according to recent research, that essential interventions

reaching women and babies on time would have averted

most of these deaths since preventable or treatable

infectious diseases such as malaria, pneumonia, diarrhoea,

measles and HIV/AIDS account for more than 70 per cent of

the estimated one million under-five deaths in Nigeria

(UNICEF, 2010).

Currently, about 5.9 million babies are born in Nigeria

every year, and nearly one million children die before the

age of five years. One quarter of all under-five deaths are

newborns - 241,000 babies each year. Many deaths occur at

home and are therefore unseen and uncounted in official

statistics (FMOH, 2011). Though, when considering the

mortality trends in Nigeria since 1960, it is very clear that

child deaths are falling, but not quickly enough as the

current rate of progress is well short of the MDG target of

Science Journals Publication(ISSN2276-6359:) Page 2

a two-thirds reduction by 2015. Report from 2008 NDHS

also revealed that currently, 75 children per 1,000 live

births die before their first birthday (40 per 1,000 before

the age of one month and 35 per 1,000 between one and

twelve months). Overall, 157 children per 1,000 live

births or about 1 child out of 6, die before reaching age five

(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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