CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND INFORMATION

The fourth goal and one of the most important issues in the Millennium Development Goals (MDGs) is to reduce infant and child mortality by two-thirds from 1990-2015, (UNICEF, 2006).Infant mortality rate (IMR) is one of the most important sensitive indicators of the economic and health status of a community. This is because more than any other age-group of a population, infants’ survival depends on the economic conditions of their environment (Madise, 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 public health strategies (Park, 2005).

Child mortality rates still remain unacceptably high in sub-Saharan African countries as approximately half of childhood deaths take place in sub-Saharan Africa despite the region having only one fifth of the world’s children population (Smith, 2010). For instance, in sub-Saharan Africa, 1 child in 8 die before age five- nearly 20 times the average of 1 in 167 in developed parts of the world (Ojikutu, 2008).

Similarly, at the dawn of the twenty-first century, it is tragic that one in seven Nigerian children die before his or her fifth birthday (UNICEF, 2000). A baby born in Nigeria is 30 times more likely to die before age five than one born in an industrialised country (UNICEF, 2001). Infant and child mortality rates are exceedingly high, and Nigeria ranks 15th highest in the world among countries with high under-five mortality (UNICEF, 2001).

With more than one million children dying annually from preventable diseases, Nigeria is one of the least successful of African countries in achieving improvements in child survival in the past four decades, in spite of advance in universal immunization and oral re-hydration therapy (ORT) for diarrhoea disease, and the wealth of Nigeria’s human and natural resources, (Kayode, Adekanmbi,and Uthman, 2012).

Current indicators from 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 and died 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 accounting for one third of the total number of under five deaths worldwide. The report describes the declining rate as disturbing and grossly insufficient to achieve the MDGs by 2015 as only 9 out of the 64 countries with high child mortality rate are on track to meet the MDGs target.

Striking as it may be Nigeria is Africa’s most populous country, with a population of 153.8 million in 2010 and one of the most developed economies in Africa (World Bank, 2011). The petroleum industry provides 95% of foreign trade earnings and about 80% of budget revenues. Yet, agriculture is the main source of revenue for two-thirds of the population. Still, more than 50% of Nigerians live in poverty with corruption and poor infrastructure as the main obstacles to sustainable development. Thus, Nigeria is said to be a major contributor to infant mortality rate globally and also a major contributor to the estimated stillbirths of 32 per 1000 deliveries in Sub-Saharan Africa, which is the highest globally (Onwughalu, 2007).

Moreover, there are regional variations in infant mortality rate in the country. Considering the 10-year period before the 2003 Nigerian Demographic and Health Survey, the North East displays the highest infant mortality (125 deaths per 1,000 live births) of Nigeria’s six regions, while the North West exhibits the highest under-5 mortality (269 per 1,000 live births). The North-Central region’s infant and child mortality rates (respectively, 103 and 165 deaths per 1,000 live births), while noticeably lower than in other northern areas, still greatly exceed the rates in the South East and South West. The South East’s infant and child mortality rates, at 66 and 103, respectively, are the lowest of Nigeria’s six regions. The South-South’s infant and child mortality rates, at 120 and 176, respectively, are the highest of the southern regions,(Aguwamba, et al, 2009). This implies that the North East exhibits the country’s highest regional IMR of 125, while the South East’s IMR of 66 is the lowest of Nigeria’s regions.

The association between economic factors and infant mortality was reinforced when improvements in overall infant mortality levels over time ran parallel with general economic development in most industrialized countries during the twentieth century, (Masuy-Stroobant, 2001). Furthermore, since the Second World War, corroboration of the strong inverse relationship between economic development and mortality rates has been found repeatedly among countries and areas within countries. At the individual level, significant social inequalities are repeatedly recorded, even when the overall IMR reaches very low levels (Haglund et al., 1993).

Nigeria for the past few years has recorded rapid and high economic growth which translates to increase in income per capita. This performance ought to affect health outcome indicators such as infant mortality rate positively, but the Table 1.1 below proves otherwise, though it has not been econometrically verified. The total GDP and per capita income increased to N37, 303.41

billion in 2011 and N226, 920.19 respectively from N33, 984.75 billion and N213, 351.43 in 2010, while Real GDP growth slowed to 7.36% in 2011from 7.98% in 2010, NBS (2011).

Figure 1.1: Growth Trend of Real Gross Domestic Product (%) &GDP per capita growth rate in Nigeria, 1970-2011.

 gdpgr, 1970, 25

gdppcgr, 1970, 22.1

gdpgr, 1971, 14.2

11.2

gdppcgr,gdpgr,1971 11974,.5

gdpgr, 1985gdpgr,,9. 71988, 9.9

gdpgr, 2003,4 10.36

gdpgr, 1976, 9

gdppcgr, 1974, 8.3

gdpgr, 1990, 8.2

gdpgr

7.698

gdpgr, 1979, 6.8 gdppcgr,gdppgdcgr,pgr,1985,71988,1989, 77..12

gdppcgr, 2010,403

2009,

7

gdppcgdpgrgr,,1976,1977, 56.9

gdppcgr, 1990, 5.5