CHAPTER ONE

INTRODUCTION

            Background of study

Stakeholders in the global health sector have made a tremendous effort to improve upon the health care of children all over the world which has seen some successes. Though these successes are not at its all-time high as the reduction of child morbidity is still a daunting task to these experts. According to Kippenberg et al, (2005) about two-thirds of newborn or child deaths from the global perspective can be attributed to child infections, prematurity, and asphyxia which are illnesses that are preventable. 99% of these illnesses happen in less developed countries. Child morbidity is a cause of mortality among children though not all diseased children end up dying. The Sustainable Development Goals (SDGs) as part of the Agenda 2030 adopted by the General Assembly in 2015 had one out of its seventeen goals being good health and wellbeing which seeks to reduce neonatal and under five years mortality to as low as 12 per 1000 live births and 25per 1000 births respectively. It also seeks to end the epidemic of tuberculosis and other diseases in all countries. To make this goal attainable, all countries especially low to middle-income countries where child mortality rates, especially newborn mortality rates, are high, need to make more effort.

Globally, for some years now, there has been a tremendous improvement in the world’s population health in terms of reducing mortality rates. Sub-Saharan Africa was not left out in the reduction in mortality rates and an increase in life span. Until the recent onset of HIV/AIDS in the last decade, this resulted in an improvement in human welfare (Becker et.al 2005). Child morbidity in this part

of the world is a very crucial issue to be dealt with by the actors in this sector. Child morbidity can be as a result of several conditions which includes respiratory infections, HIV/AIDS among others.

One major problem confronting the developing world is the rate of mortality of pre-school children as a result of morbidity from acute respiratory infections (WHO, 2017). The incidence of child morbidity is usually determined by the nature of pre-delivery, delivery and post-delivery attention given to these children in their prime times.

With reference to the developed world, during the last hundred years, acute respiratory infections were the major causes of infant and child mortality for both infants and adults. On the other hand, the recognition of acute respiratory infections as a serious problem in public health among children in developing countries was until recently. The magnitude of ARI causing child morbidity in developing counties was first documented and published in the early 1960s (Garenne et al, 1992). In recent times, the World Health Organization and its related international bodies have prioritized interventions to resolve ARI (WHO, 2017). In 1976 at the World Health Assembly, the contribution of ARI to child mortality raised increasing concerns. This lead to the creation of the ARI Technical Advisory group in 1983 by WHO in Geneva.

Dealing with child morbidity also requires that we deal with the health of the mothers as well since the health of the mother will have a direct influence on the health status of an unborn child during the antenatal and the delivery stages specifically. The labor supply of the mother hence her income level affects child morbidity. Research has shown that improvement in the prenatal care and nutrition levels of the mother has a direct influence on maternal labor productivity especially among the vulnerable families (Ranis et al, 1985; Tambi, 2017). If there is the provision of quality clinical services to the mothers during this stage, it can go a long way to impact on her labor supply and income levels and hence; the health of the child (Mahiti et al, 2015)

According to Mahiti et al (2015), the benefits of antenatal and delivery care for children has advantages in that, these care services have enabled health care providers to determine the problems the pregnant mothers encounter by checking for diseases affecting the mothers in order to counsel them on the best practices in order to avoid the transfer of these diseases to the unborn children and also to ensure safe delivery which will be devoid of certain birth complications. World Health Organization (2013) reported that the post-natal period which is the days and weeks after child delivery are the most tender and important phase of a mother and infant child’s life, but unfortunately the most neglected period of quality health service delivery. Lack of necessary care within this period could cause serious ill health that could lead to death. The kind of skilled health care attention given during pregnancy and delivery are much higher than after childbirth. Child deaths are mostly recorded during this period.

Ghana as a developing country is not new to child morbidity. World Health Organization (2017) estimated that almost 10 million under 5children die every year from medical conditions that could have been treated simply with health care interventions. Most of these diseases and deaths largely happen in sub-Saharan Africa of which Ghana is part. From this background, natal care will have the tendency of impacting on the Child morbidity rate in Ghana.

            Statement of the problem

Children are very vulnerable and for this reason, need a lot of attention and care. GDHS (2014) reported that pneumonia and other respiratory tract infections have been the major cause of child ill health and death in Ghana. ARI has a wide range of effects like a bacterial and viral infection of the lungs and respiratory tracts. Other varieties of triggers include exposure to air pollution, low birth weight, malnutrition, and overcrowding, which are all important risk factors. Acute respiratory infections contribute to almost 33 percent of all deaths in pre-school children in developing countries. Many risk factors for respiratory diseases have already been identified and exposure to outdoor concentrations of air pollution has been pointed out as possibly being one of them (Gouveia & Fletcher, 2000) Mother’s report from the GDHS (2014) estimated 4 percent ARI symptoms in children under the age of five, but it is necessary to note that children in remote areas are likely to experience symptoms of ARI two times more than their counterparts living in urban areas.

Several studies have outlined factors confronting child health with relation to post-natal care of children including neonates and infants as emanating from factors such as diseases (Diarrhea, Pneumonia, asphyxia, Malaria among many others). Some studies have cited that more than one million child mortalities as a result of morbidity that occur in Africa are within the first week of life, half of them on the first day of life. Fengxiu Ouyang et al. (2013) claimed that between 3 to 4 million stillbirths occur annually across the world as a result of maternal morbidity and almost 97- 99% could be found in less developed countries. The continuous incidents and cases of childhood diseases and mortality in Ghana have generated a lot of concern among various stakeholders of public health in the country.

The perinatal rate in Ghana as of 2014 was 38/1000 of all pregnancies in the five years prior to the survey (GDHS, 2014). WHO (2009) and other partners also estimated that stillbirth was as high as 38/1000 pregnancies. Prior to the Ghana Demographic and Health Survey (GDHS, 2014), they identified about 4% of pre-school children with ARI symptoms. The issue of concern is the continuous morbidity of children in the country through Acute Respiratory Illnesses such as pneumonia bronchiolitis in the phase of interventions in post-natal care for children. Perhaps it is the emphasis on the antenatal and delivery care for the children or an increase in a mother’s income level to purchase proper health care that could offer a drastic reduction in the morbidity of children in the country.