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STATISTICAL 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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