TABLE OF CONTENTS
Title Page – – – – – – – i
Approval page – – – – – – – – ii
Certification – – – – – – – – – iii
Dedication – – – – – – – – – iv
Acknowledgements – – – – – – – – v
Table of Contents – – – – – – – vi
List of tables – – – – – – – – vii
Abstract – – – – – – – – viii
CHAPTER ONE – INTRODUCTION
Background of the Study – – – – – – 1
Statement of the Problems – – – – – – 4
Purpose of the Study – – – – – – 5
Objectives of the Study – – – – – – 5
Research Questions – – – – – – – 6
Significance of the Study – – – – – – 6
Scope of the Study – – – – – – 7
Operational Definition of Terms – – – – – 7
Umbilical Cord Care Practices – – – – – 8
Warmth Maintenance/Thermal Regulation Practices – – – – 9
Health/Care-Seeking Patterns/ Practices – – – – 9
Socio-demographic Data – – – – – – 9
CHAPTER TWO LITERATURE REVIEW
Concept of Infancy – – – – – – – 10
Infant Care Practices and Related Concepts – – – – – 13
Theoretical Review – – – – – – – 26
Empirical Studies on Infant Care Practices – – – – 33
Summary of
Literature Review and Critical Analysis of Empirical Review – 39
CHAPTER THREE – RESEARCH METHODOLOGY
Research Design – – — – – – – 41
Area of Study – – – – – – – – 41
Popu1ation of Study – – – – – – 42
Sample – – – – – – – – 42
Sampling Procedure – – – – – – 43
Instrument for Data Collection – – – – 43
Validity of Instruments – – – – – 44
Reliability of the instrument – – – – – 44
Ethical Considerations – – – – – – 45
Procedure for Data Collection – – – – – 45
Methods of Data Analysis – – – – – 46
CHAPTER FOUR
PRESENTATION
OF RESULTS
Research Question 1 – – – – – – 47
Research Question 2. – – – – – – – 52
Research Question 3 – – – – – – – – 56
Research Question 4 – – – – – – – 58
Research Question 5:- – – – – – – – 61
Research Question 6 – – – – – – – 62
Research Question 7 – – – – – – – 64
Summary of findings – – – – – – – 73
CHAPTER FIVE
DISCUSSION OF RESULTS
Discussion of findings – – – – – – 75
Implications of the study – – – – – – 84
Limitations of the study – – – – – – 85
Suggestions for further studies – – – – – 85
Summary of the study – – – – – – 86
Conclusion – – – – – – – 88
Recommendations – – – – – – – 89
References – – – – – – – – 90
Appendix I: Questionnaire
Appendix II
LIST OF TABLES
Table 1: Demographic data of the respondents? – 47
Table 2;
Initiation of infant feeding and practice of breastfeeding by respondents. – 49
Table 3: Introduction of weaning feeds/ other adult feeds. – – 51
Table 4: Frequency of infants’ baths. – – – – 52
Table 5: Respondents care of infant clothing / diapers and beddings 54
Table 6: Showing the care of the infants’ cutlery and cockery. 56
Table 7 Respondents are intents off cord care – – 58
Table 8: Showing
respondents’ maintenance of warmth for the infants by their mothers. 60
Table 9: Showing the respondents’ maintenance of warmth during infant baths and warmth in the room. – – – – – – 61
Table 10,
Showing the health/care seeking practices of mothers for their sick infants.- 63
Table 11; Showing the respondent’s adequacy and inadequacy of practices of the different infant care practices in the order of adequacy. – 64
Table 12: Showing the cross tabulation of maternal age against the respondents adoption of the infant care practices. – 66
Table 13: Showing cross tabulation of the determination of the respondents’ adoption of adequate infant are practices by their occupation. 69
Table 14: Cross tabulation for the determination of performance of infant care practices by mother’s level of education. – 71
ABSTRACT
The study examined the infant care practices adopted by mothers in the rural communities of Udi Local Government Area of Enugu state. The objectives of the study were to determine the infant feeding, hygiene/cleanliness maintenance, umbilical cord care, warmth maintenance and health/care-seeking practices adopted by the mothers in the area as well as compare the adequacy of performances by the mothers across the different infant care practices and the association between their adoption of the practices and their demographic characteristics. The research design for the study was a descriptive survey design. The target population of the study were estimated to be 26,486 women of child bearing age of 15 -49 years. Ogebe-ogene, one of the development centres in Udi L.G.A was selected for the study using a simple random sampling technique. Proportionate sampling method was used to draw 12.5% of the sample size of 392 women of child –bearing age from each of the 8 villages in Ogebe-ogene for the study. Snowball method of sampling was used to reach the mothers who met the inclusion criteria. The instrument for data collection was researcher’s developed questionnaire. The collected data were subjected to simple descriptive statistical analysis of frequency and percentage.Chi-square was used to analyse the strength of association between the demographic data of mothers and their performances of the different infant care practices at 0.05 significant level. Major findings revealed that infant feeding was fairly practiced and was placed fourth in the adequacy of performances across the 5 determined infant care practices. Cord care practices were poor and was the least performed as less than average of the respondents adequately performed the optimal cord care practices as operationally defined. Warmth maintenance practices was the best adequately performed infant care and was followed by the hygiene care practices. Health care seeking practices was fairly practiced as a little above the average number of the mothers performed the practices adequately though a significant number (a little below the average) practiced self medication. There was a significant association between the maternal level of education and their adequacy of performance of all the infant care practices determined. Maternal age was significantly associated with their adoption of adequate infant feeding and health /care seeking practices. Occupations of the mothers were significantly associated with their adoption of adequate infant feeding, hygiene maintenance, warmth maintenance and health/care seeking practices. Maternal parity was significantly associated with their performance of adequate infant feeding, cord care, warmth maintenance and health /care seeking pattern. However, no significant difference was found between hygiene/ cleanliness maintenance practices and the maternal parity. Conclusion was drawn that cord care practices was poorly performed with infant feeding and health /care seeking practices only fairly /moderately practiced of all the examined infant care practices. Also, education, occupation, culture and experience (age and parity) were of significant association to the mothers’ practices. It was recommended that health workers and other stake –holders (particularly the public/ community –based nurses) should create more enlightenment/outreach programmes like health education and health visits to encourage improved adoption, and performances of cord care infant feeding and health/ care, seeking practices.
CHAPTER ONE
INTRODUCTION
Background to the Study
Infancy, which
is the period between zero (0) to two (2) years, is a very crucial period in
ones life (World Health Organization (WHO), 2002). It is generally believed
that once a child survives this period the child will successfully thrive
through childhood. Being highly vulnerable, these infants need critical care
from their care givers (that is, mothers, family members, health- practitioners
etc). The objective of these care practices is to ensure the attainment of the
infant’s health and survival.
Infant care
practices are those practices or activities administered to the babies to
ensure their health and survival. In other words, they can be those activities
carried out by mothers and significant others, which help them go through the
process of caring for their babies during this period of infancy so as to
provide the children with suitable environment and conditions (physical, social
and psychological) for proper growth and development (Yolanda, 2007).
Emphasizing the importance of children’s right to survival and health, the
Millennium Development Goals (MDGs) launched in 2005, has as its fourth (4th)
goal, “the reduction of the under five mortality by two-third (2/3) by the year
2015”. To this effect, many countries have instituted programmes like Free
Maternal and Child Health Care Services, Integrated Management of Childhood
Illness (IMCI), Expanded Programme on Immunization (EPI), National Immunization
Days (NIDs) etc. These efforts had only brought a sluggish decline in infant
mortality rates (IMR) globally (Yolanda, 2007). UNICEF (2013) raised an alarm
that Nigeria has only made a sluggish progress in checking the infant and child
mortality between 2009 and 2011. According to the record, Nigeria was second
next to India of the least successful countries in improving their infant
survival. For instance, between 1990 and
2003 the infant mortality rate
in Nigeria stood at 100
deaths per 1000 live births ( National
population commission (NPC) 2008), while the statistical report by
UNICEF (2013) indicated 88 deaths per 1000 live births. This figure is among
the highest in the world.
This moderately
high Infant Mortality Rate (IMR) in the country (an index of both medical and
social standard) is attributed according to UNICEF (2013) and Adekunle (2007)
mainly to the high neonatal and post-neonatal death rates. Darmstadt, Syed, Partel and Kabir (2006)
noted that each year, approximately four million babies die during their first
twenty-eight (28) days of life globally. Yolanda (2007) emphasized that
ninety-nine percent (99%) of these deaths occur in the low and middle-income
countries like Nigeria.
World Health Organization in Yolanda (2007)
reported that these deaths occur at home where the infants are cared for by
their mothers, relatives and traditional birth attendants (TBAs). (UNICEF 2013)
and Yolanda (2007), emphasized that these deaths can be avoided through simple,
affordable interventions, outreach and family/community care, health education
to improve home- care practices, recognition of danger signs, generation of
demand for skilled care and positive/increased health-seeking behaviour to
appropriate health care facility.
Reducing infant
mortality and morbidity, therefore, does not require only medical break
through, expensive technology or the make-over of national health systems but
major strides can be made by putting existing solutions into general practices
(UNICEF 2013). As Martines, Paul, Bhutta, Koblinsky, Soucat and Walker (2005)
noted, most infant survival programmes have focused too heavily on pneumonia,
diarrhea, malaria and vaccine- preventable diseases which account for only
thirty-six percent (36) of infant mortality. From the fore-going, it is deduced
that most of these instituted programmes like free- Maternal and Child Health
Care, Integrated Management of Childhood Illnesses, etc are objectively
health-facility-based interventions while most deaths occur at home due to
preventable causes which could be averted by simple methods such as house-hold
hygiene practices, good nutritional practices and health/ care seeking behavior
for these infants (Olatunji 2013).
The World Health
Organization (WHO) in Peeyush and Pragti (2012) therefore, provided more
comprehensive (hospital and home-based care) essential guidelines for newborn
and infant care. These include: hygiene maintenance during and after delivery,
keeping the infant warm, early initiation and exclusive breast-feeding, care of
the cords, eyes, care during illness, immunization etc. These practices,
according to Peeyush and Pragti (2012) meant “the mother and family preparing
for birth, choosing a safe place for delivery, keeping the process of delivery
clean, avoiding cold, breastfeeding early and exclusively, and understanding
(and reacting to) potential danger signs.
Although mothers
who access health care facilities are taught these infant care practices during
their antenatal visits and the perinatal periods, they also get the influences
of the family and community members in forms of suggestions, advices and
contributions in caring for their babies. These may thus, create rooms for some
controversial suggestions, ideas and practices, some of which might be harmful
for the child’s health even though, they seem to be culturally acceptable.
Worse still, mothers who habitually do not access health care facilities are
more at risk to these dangers as they do not have prior knowledge of the proper
essential newborn and infant care guidelines exposed to those that access
health facilities.
Some of these
practices which may still be in existence include, the introduction of coconut
water (mmiri aku-oyibo in Igbo Language), as a pre-lacteal before initiation of
breastfeeding of the infant. This is believed to help in reducing the severity
of intestinal colicky (Afo-Mkughe “in Igbo Language”), which normally, most
infants experience within their first three months of life. Other practices
include; removal /expressing out of the colostrum which is believed to cause
loose stool for the infant, massage of the infant’s abdomen and umbilical stump
using hot-water, believing that it initiates stooling, increases peristaltic
movement and speeds up the falling-off of the umbilical stump and its healing;
rubbing of herbs/local concoctions like palm kernel oil (enu-aki) on the
infant’s skin and body, even giving the child’s urine to the child with
infantile conditions like fevers and convulsions believing that they drive the
causative demons away, application of a poultice .on the parietal frontannelle
of an infant to treat sunken frontannelle in a malnourished/dehydrated child
etc. These practices even when objected to by these mothers might be forced on
them by the families with the notion that they (the mothers) are inexperienced.
Based on the
above considerations, it becomes necessary to look into the infant care
practices adopted by mothers in rural communities, since research, as already
indicated, has shown that most of the infant deaths occur at home where the
infants are cared for by their mothers and relatives (WHO in Yolanda, 2007) and
with little or no involvement of the formal health care system (Darmstadt et
al, 2006). Besides, since these deaths can be avoided through simple affordable
interventions like health education to improve home-care practices, (Yolanda,
2007), it becomes necessary to empirically ascertain the home-based care
practices of these rural mothers. It is hoped that the information obtained
from this study will assist in guiding the needed health education to improve
the mothers’ home care practices.
Statement of the Problem
INFANT CARE PRACTICES ADOPTED BY MOTHERS IN THE RURAL COMMUNITIES OF UDI LOCAL GOVERNMENT AREA OF ENUGU STATE
