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CHAPTER ONE: INTRODUCTION
1.1 BACKGROUND TO THE STUDY
Infant and child mortality are commonly on top of the agenda of Public health and International development agencies. Recently they have received renewed attention as part of the United Nation‟s Millennium Development Goals (Mahfouz, Surur, Ajak, and Eldawi, 2009). Approximately 10.8million children worldwide die annually, 41 percent of these deaths occur in sub-Saharan Africa and 34 percent in South Asia (UNICEF, 2007). The global death toll in young children has fallen dramatically in the past half-century. Infant and child mortality rates have declined since 1990, which is the baseline for the Millennium Development Goal (MDG) targets. The drop has been greater in East Asia and the Pacific, Latin America and the Caribbean and Europe where estimated infant and child mortality in 2006 was about half that in 1990. Over the same period, infant and child mortality have fallen only fourteen percent in sub-Saharan Africa. Africa as a whole recorded the most sluggish decline in child mortality among the six WHO regions, 42 percent compared with 60-72 percent from other regions (UNICEF, 2007).
UNICEF and National Population Commission (2001) in “Children and Women‟s Rights in Nigeria: A wake-up call situation assessment and analysis” the infant mortality rate (IMR) measures the probability of a child dying before his or her first birthday and child mortality rate (CMR) the probability of death between age one and five. These are powerful indicators of child survival; they measure the quality of child care and including the prevention and management of the major childhood disease.
Sub-Saharan Africa was found to have the highest rates of infants and child mortality, where under development, armed conflict and the spread of HIV/AIDS have
seriously undermined the efforts to improve child survival. The estimated under-five mortality rate exceeds 200 deaths per 1,000 live births in ten countries in this region. Infant and child mortality also remains relatively high in South Africa. (UNICEF et al, 2007).
By 2006, however, three regions-East Asia and the Pacific, Latin America and the Caribbean and Central and Eastern Europe and the Commonwealth of independent state-had achieved under-five mortality rates below 30 deaths per 1,000 live births. This compares with 6 deaths per 1,000 live births in developed regions.
Achieving the Millennium Development Goal four (MDG4) requires that the infant and child mortality rates decline, on average, by 4.4 percent annually between 1990 and 2015. Three regions-East Asia and the Pacific, Latin America and the Caribbean and Europe-achieved this benchmark through 2006 or came close to it, putting them on track to achieve the Millennium Development Goal four (MDG4). In contrasts, the average annual rate of reduction in infant and child mortality since 1990 has been just one percent in sub-Saharan Africa. In recent years, infant and child mortality rates have actually increased in a dozen sub-Saharan Countries. The AIDS epidemic, armed conflict and social instability among others, have contributed to the worsening situation for children in parts of sub-Saharan Africa. In recent years, infant and child mortality rates have actually increased in a dozen sub-Saharan countries. The AIDS epidemic, armed conflict and social instability among others, have contributed to the worsening situation for children in parts of Sub-Saharan Africa (UNICEF et al, 2007).
Auwal (2008) reported that the highest infant mortality rate in Africa shows Angola has 261.1, Sierra Leone has 257.7, Niger has 239.0 and Liberia has 231.1. While the lowest infant mortality rates in African are in Seychelles (11.1), Mauritius
(13.4), Cape Verde (35.3), Algeria (35.7) and Botswana (58.6). According to his findings, the trend and pattern of mortality in any given society is to a large extent a reflection of its economic, political and social status.
Urban-rural mortality differentials in Sub-Saharan Africa show that overall mortality, infant and child mortality in particular, is generally lower in urban than in rural areas (Akoto, 2009; Hill, 2001). Various factors account for this, including high concentration of salaried workers (who generally have higher incomes), better education, the concentration of public infrastructures for example; electricity, sanitation services including water supply, household waste, excreta removal and disinfection and hospital infrastructure are more favourable in urban than in rural area. Similarly Odimegwu (2008) examined the socio-economic determinants of infant mortality in Kenya at both urban and rural settings. Results from the fitted logistic regression show lack of significant socio- economic association with infant in both urban and rural Kenya. According to his findings, this can be due to the nature of the occupations available in rural areas which are usually agriculture-based, so women are not available for long time to care for their children. While in the urban areas, because of the assumed availability of health services, the survival of the child is determined by his/her mother‟s awareness and thus educational level.
UNICEF (2001) stated that with advances in medical science, economic resource and human welfare, it is possible to avoid mortality almost entirely in childhood, except in the most extreme cases or as a result of accidents. Children are most vulnerable in the first few months and years of life. Yet, in the advanced industrialized countries, the under –five mortality rate fell during the 20th century to extremely low levels, averaging only 6 per 1,000 live births by 1998.
Nigeria, like many other developing countries particularly in Africa, is still far from reducing mortality among children to a level of 6 per 1,000 live births despite the advances in child survival strategies, highlighted most notably by the drive for universal immunization against life-threatening, vaccine-preventable diseases (UNICEF, 2001). Data from the 2008 Nigeria Demographic and Health Survey (NDHS) indicate that the infant mortality rate is 75 deaths per 1,000 live births; while the child mortality rate is 157 deaths per 1,000 live births for the five-year period immediately preceding the survey. This translates to about one in every six children born in Nigeria dying before their firth birthday (NPC and Macro, 2009). This has brought about serious stress in the health sector and therefore, posed a major challenge to social and economic development and prompted an unprecedented government response. However, child mortality is consistently lower in urban areas than in rural areas. There is also variation in the mortality levels across zones. The North West zone to which Kaduna State belongs, has very high prevalence rate of 91 and 139 deaths per 1,000 live births for infant and child mortality respectively (NPC and Macro, 2009).
1.2 STATEMENT OF THE RESEARCH PROBLEM
Globally, childhood mortality rates have declined 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. Environmental, behavioural and socio-economic factors were recognized as important determinants of infant and child survival.
In Nigeria, several studies on child health have been carried out. Mojekwu et al (2012) examined the environmental determinants of child mortality using principal component analysis as a data reduction technique with varimax rotation to access the underlying structure for sixty-five measured variables explaining the covariance relationships amongst the large correlated variables in a more parsimonious and simultaneous multiple regression for child mortality modeling in Nigeria. The result from the stepwise regression model shows that household environmental characteristics do have significant impact on mortality.
Ahonsi (1992) examined the developmental implications of early mortality factors in Nigeria using a proximate determinants framework. The study shows that higher parental income and higher density of modern health facilities constitute the combination of factors most likely to bring about sustained reductions in early mortality levels. Also, Fayehun et al (2006) examined the direct estimates and cox regression on ethnic differentials in childhood mortality in Nigeria using secondary data from Nigeria Demographic and Health Survey (NDHS) 2003 complemented with 40 Focus Group Discussions (FGD) and 40 In-depth Interviews (IDI) among selected ethnic groups in Nigeria. The study indicated significant difference with ethnic groups in the northern part of Nigeria having the highest risk. There is also a significant effect of demographic and socio-economic variables on childhood mortality.
A Population-based study of effect of multiple births on infant mortality in Nigeria by Uthman et al (2010) examined the relationship between multiple births and infant mortality using univariable and multivariable survival regression procedure with Weibull hazard function, controlling for child‟s sex, birth order, prenatal care, delivery assistance, mother‟s age at child birth, nutritional status, educational level, household living conditions and several other risk factors. The results show that children born
multiple births were more than twice as likely to die during infancy as infants born singleton holding other factors constant. Maternal education and household index were associated with lower risk of infant mortality. Similarly, Adetunji (1994;1995) examined the effect of a child‟s place of birth, mother‟s education, region of residence on infant mortality in Nigeria between 1965 and 1979, using data from the 1981/1982 Nigeria Fertility Survey using logistic regression analysis. The study revealed a decline in infant and child mortality between 1965 and 1979. Children born in modern health facilities, irrespective of their mother‟s place of residence, experienced significantly lower rates of infant mortality than those born elsewhere.
Furthermore, Ojikutu (2008) in his study on Pattern of under-five deaths in Lagos State examined the trend in U5MR in Nigeria using secondary data which show that 73.8 percent of the children die before their first birthday, while 37 percent die before the end of their first month. The most common killers of the under-five mortality are found to be Bronco Pneumonia, Sepsis, Anaemia and Malaria. The study concluded that under-five mortality is found to be related to mother‟s education and income. However, age of mothers and their occupation are not significant contributors to U5MR. Traditional beliefs are found to be important in the treatment of diseases of children as mothers who see their sick children as spiritually afflicted will rather seek for spiritual assistance than take them to hospital for treatment. This is consistent with the study by Ogunjuyigbe (2004) on the Perception and attitude of the Yoruba‟s about the existence of abiku (children from the spirit) and the mode of treatment to such children.
Elsewhere, many other researchers using data from different regions of the world on child health have reported their findings on either national, regional or state level with broad generalization of causes of infant and child mortality(NPC, 2009; Rahman, 2009; Odimegwu, 2008; UNICEF, 2001; Mahfouz et al, 2009; Mazharul,
2010; Murray, C.J.L 2007; Karatepe, 2010; Lindstrom, 2001; and Van Poppel, 2005). The impetus for the broad scale studies has been the interest in formulating broad policies and programmes towards achieving Millennium Development Goal four (MDG4), which aims to reduce the global rate under-five mortality by two thirds between 1990 and 2015.
However, Mahfouz (2009) carried out a study on levels and determinants of infant and child mortality in Malakal town-Southern Sudan using questionnaires and interviews. The study concluded that there was high need for infant and child immunization in Malakal town in addition to health education campaigns for parents and community in general.
A study by Wilopo (2000) on levels, trends and differentials of infant and child mortality and life expectancy at birth in the district of Purworejo, Central Java using baseline data collected by Community Health and Nutrition Research Laboratories, Gadjah Mada University shows that an indirect technique was used by applying data on children ever born and children surviving according to the mother‟s age and the duration of marriage to West mortality model. The study also shows that a female mortality is slightly lower than male infant mortality but probability of dying between ages 1 to 4 is slightly higher among male children. The life expectancy decline is a consistent with the IMR trend.
Studies have also been carried out on socio-economic determinants on infant mortality in Kenya (Odimegwu and Mustapha, 2008), the relationship between socio-economic differences and economic uncertainty among infant and child mortality in Turkey (Karatepe, 2010) and socio-economic determinants of neonatal, postnatal, infant and child mortality in Bangladesh (Quamrul, 2010). Sufficient details are lacking in understanding the levels and determinants of infant and child mortality at the Local
Government level, given the peculiarities of each Local Government Area in Nigeria. Kaduna State has unacceptably high mortality rate and disease burden profile. In 2003, infant mortality rate were 115 per 1,000 live births; under-five mortality were 205 per 1,000 live births (PATHS, 2010). These figures represent a worsening trend. Leading causes of morbidity and mortality are communicable disease, malaria, diarrhea diseases, respiratory tract infection and vaccine-preventable diseases (VPD).
The high population growth, present downturn in the economy and high level of poverty and destitution are now accompanied by ignorance, poor nutrition, inadequate sanitation and unsafe drinking water, high rate of environmental pollution and rising incidence of prostitution among the young women in Chikun Local Government Area, most of who are unemployed secondary school leavers. The present states of overcrowding and economic squalor are very significant factors in the high mortality rate (Laah, 2003). Infants and children under five years in particular have been the most exposed group for those unfavourable conditions in the Local Government Area. Therefore, there is need for an in-depth study to identify the main causes behind these phenomena.
Also, empirical information is scarce or of variable quality and results from national surveys on health examining the levels and trends, socio-economic and demographic differentials of childhood mortality in Nigeria are only just becoming available. Moreover, community studies dealing with infant and child mortality are lacking in Chikun Local Government Area.
Against the backdrop of the above, this research investigated the socio-economic and demographic differentials of infant and child mortality in Chikun Local Government Area, Kaduna State. Therefore, the study attempts to address the following questions: 3075874989
a. What is the rate of infant and child mortality in the study area?
b. What are the causes of infant and child mortality in the study area?
c. What are the differences in infant and child mortality among socio-economic groups in the study area?
d. What are the urban-rural differentials in infant and child mortality in the study area?
1.3 AIM AND OBJECTIVES
The aim of this study is to analyze the infant and child mortality differentials in Chikun Local Government Area, Kaduna State. This will be achieved through the following specific objectives; to
i. determine the rate of infant and child mortality in the study area?
ii. examine the factors affecting infant and child mortality in the study area?
iii. analyse the socio-economic and demographic determinants of infants and child mortality in the study area?
iv. assess the urban-rural differentials in infant and child mortality in the study area?
The research hypothesis was tested at the level of 0.05 significance difference for the null hypothesis, that is;
Ho: There is no significant difference in infant and child mortality between socioeconomic groups.
1.5 SIGNIFICANCE OF THE STUDY
Information on infant and child mortality rates not only enriches the understanding of a country‟s socio-economic situation but also sheds lights on the quality of life of the population under study. And studies of mortality indicators have shown the differentials by socio-economic and demographic characteristics which helps to identify populations that are at high risks. Also preparation, implementation, monitoring and evaluation of population, health and socio-economic programmes and policies depend to a large extend on a target population.
Generally, that fact that no such detailed study has been conducted in Chikun Local Government Area makes it an interesting research work. It is hoped that the information generated would not only be useful in identifying at-risk populations but it would also form baseline indicators of the current mortality situation, which can be compared with data collected at a later point to determine whether improvements in child health and quality of life have occurred over time.
Also data generated could be useful in formulating government policies and programmes towards achieving Millennium Development Goal four (MDG4) which aims to reduce infant and child mortality by two-third between 1990 and 2015.
1.6 SCOPE AND DELIMITATION
The study is on analysis of infant and child mortality differentials in Chikun Local Government Area, Kaduna State. Six of the twelve wards selected were; Gwagwada, Kunai, Kuriga (rural); Maraban rido, Nassarawa, Sabon tasha (urban). The study elicited information on the rates, causes, socioeconomic and demographic differentials and urban-rural differentials of infant and child mortality among women
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