PREDICTORS OF INFANT-SURVIVAL PRACTICES AMONG MOTHERS ATTENDING PAEDIATRIC CLINICS IN IJEBU-ODE, OGUN STATE, NIGERIA

CHAPTER ONE

INTRODUCTION

1.1  Background to the Study

Global deaths among infants recorded for a period of four years from 2012 to 2015 showed a marginal improvement towards achieving the target for the Millennium Development Goal-four with records of 35 to 32 deaths out of 1,000 live births (United Nations Inter-Agency Group, 2015). In spite of efforts made towards infant-survival all over the world, recent data on infant mortality shows a rate of 56 deaths for every 1,000 births in regions in Africa. This is in contrast to other regions such as East-Asia with 14 deaths per 1,000 live births and the Middle East with 20 deaths for every 1,000 live births (Bado & Appunni, 2015).

In 1990, the Millennium Development Goal-four was initiated as part of the eight millennium goals with the aim of reducing child and infant mortality by two-thirds between 1990 and 2015 (Adegboye, Kotze, Adegboye, 2014; Diallo, Meda, Sommerfelt, Traore, Cousens & Tylleskar, 2012). Reports have given the global percentage reduction in infant and child mortality to be 53% over the 15-year goal which was aimed at 75% reduction (Murray, Wang, Fullman, Lopez & Murray, 2015). Also, in 2015, countries in Sub-Saharan Africa recorded an achievement of 52% of the 75% target and remain major contributors to the global mortality burden of infants (Adedini, Odimegwu, Imasiku, Ononokpono & Ibisomi, 2015). This shows that the goal was not attained. Recent data on infant mortality in Nigeria shows a prevalence of 69 deaths per 1,000 live births which has ranked the country as one of the top ten nations in infant mortality (Ezeh, Agho, Dibley, Hall & Page, 2015).

Infant death lingers as a huge problem in developing countries (Fehling, Nelson, Ahn, Eckardt, Tiernan, Purcell et al, 2013). In June 2012, more than 80 countries represented by government officials, partners from private sectors, civil societies, and religious organizations gathered for the Child-Survival Call to Action. The forum was convened by the governments of Ethiopia, India, and the United States, in collaboration with the United Nations Children’s Fund (UNICEF) and challenged the world to lessen infant and child mortality to 20 or lesser deaths per 1,000 live births in every country by 2035 (Koffi, Mleme, Nsona, Banda, Amouzou & Kalter, 2015). Beyond the challenges of establishing infant-survival in developing countries are underlying reasons why these conditionscontinue to constitute the challenge (Chatterjee & Paily, 2011) and these are the essential issues of concern.

A vast number of studies have identified certain factors that put infants at risk of mortality. Infections, vaccine-preventable diseases, nutritional inadequacies, sanitation challenges and health status of the mother during pregnancy have been documented (Cheraghi, Poorolajal, Hazavehi & Rezapur-Shahkolai, 2014; Jarso, Workicho & Alemseged, 2015). Other factors contributory to infant mortality from investigations include poor antenatal planning of mothers, poor service provision by healthcare service providers, inadequate birthing practices of care-givers and poor health-information dissemination to mothers of infants (Atulomah & Atulomah, 2015). If these factors are not critically attended to, infant mortality will continue to be an issue without lasting solutions (Joshi, Sharma & Teijlingen, 2013).

Some of the requirements of mothers include skill-building in preparation for enhancing the survival of their infants, getting skills that will strengthen them to take their infants for immunisation (Oyo-Ita, Wiysonge, Oringanje, Nwachukwu, Oduwole & Meremikwu, 2016), practicing exclusive breastfeeding, imbibing positive sanitary habits and preventing cases of diarrhoea and malaria (Fadnes, Engebretsen, Moland, Nankunda, Tumwine & Tylleskär, 2010). These should be essential components of health-literacy instructions communicatedto mothers of infants during antenatal care sessions.

Also, behaviour-change in mothers of infants to enhance their self-efficacy in ensuring that they carry-out activities that will ascertain the survival of their infants will be as a result of comprehensible health-instructions (Elder, Pequegnat, Ahmed, Bachman, Bullock, Carlo et al, 2014). Furthermore, programs with innovative approaches to engage key influencers such as fathers and other family members around the mother to provide positive social-support for her could be more successful in changing her behaviour to improve maternal and infant care (Altrena, Martin, Egondi, Bingham and Thuita,2016).

Infants are a group of individuals who have neither control over themselves nor the power to cater or care for themselves. They are delicate subgroup of a population. Their survival is a fundamental pointer to the level of maternal and child health, therefore, investigating their well-being is an investment for the development of any nation (Sathiyasusuman & Hamisi, 2012).

1.2  Statement of the Problem

About 353,000 births are reported to occur daily around the world, yet, infants are exposed to the risk of mortality as these births occur (Ayele, Zewotir & Mwambi, 2016). One main challenge in attaining the target reduction in infant death is that most infant health programs do not get to the mothers through tangible programs (Lassi, Middleton, Crowther & Bhutta, 2015).

Few studies have recognised components leading to lack of infant care and poor survival of infants. Issues involving the personal-level predisposition of mothers stem from factors such as health-literacy instructions and counsels communicated to mothers at antenatal sessions. Most of these counsels have either not been strategically delivered to mothers or have not been adequately delivered to them in ways by which they are empowered, encouraged and willing to ensure the survival of their infants (Lu & Johnson, 2014; Owor, Matovu, Murokora, Wanyenze & Waiswa, 2010; Rosato, Lewycka, Mwansambo, Kazembe, Phiri & Chapota, 2014).

Also, environmental-level factors have posed a challenge in ensuring infant-survival. Such deficienciescome from lack of social-support from family members and significant others in the lives of nursing mothers. Nursing mothers should receive reinforcements in terms of encouragements to carry-out instructions received for infant care, positive advises and assistancefrom those around them in order to enable them carry-out activities that will strengthen the survival chances of their infants (Fry-Bowers, Maliski, Lewis, Connell & DiMatteo, 2014).

Mothers should receive health instructions and counsels during preconception and antenatal periods, and support in the many ways they will require assistance in order to practice skills that will prolong the lives of infants (Berglund & Lindmark, 2016; McInnes, Hoddinott, Britten, Darwent & Craig, 2013). If they are not adequately equipped with skills regarding what to do during the period preceding delivery, after delivery and how to respond to emerging situations that threaten the lives of their infants, they will be weak in ensuring the survival of their infants.It will therefore be of immense benefit to investigate into how these personal and environmental-level factors can collectively be predictors of infant-survival practices among mothers.The aim of this study was to consider the predictors of infant-survival practices among mothers whose infants attend paediatric clinics in Ijebu-ode, Ogun state, Nigeria.