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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