AN ANALYSIS OF INFANT AND MATERNAL MORTALITY RATE IN NIGERIA

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AN ANALYSIS OF INFANT AND MATERNAL MORTALITY RATE IN NIGERIA

ABSTRACT

The first five years of life are the most crucial to the physical and intellectual development of children and can determine their potential to learn and thrive for a life time. That is why it is specifically stated as one of the goals of the MDGs to reduce infant mortality by two thirds by 2015. Although there has been a substantial reduction in infant and child mortality rates in most developing countries in the recent past, it still remains a major public health issue in Sub-Saharan Africa, with special reference to Nigeria; the giant of Africa. The main purpose of this study is to ascertain the influencing factors on infant and child mortality in Nigeria. Survey data from the National Health Demographic Survey have been used to examine the patterns of infant and child of mortality. The simple regression estimation technique was employed to investigate the effects of some selected socio-economic variables on infant and child mortality. The selected variables include: the educational attainment of mother s, place of delivery, women’s status respecting decision making in the house

which are; final Say on Mother’s Health Care, final Say on Making Large Household Purchases, final Say on Making Household Purchases for Daily Needs, final Say on Visits to Family or Relatives, final Say on Deciding What to do WithMoney Husbands Earns. The study reveals that their exist positive linear association between infant and child mortality and each of the variables serving as indicators for women’s status. This stu dy was able to find out that place of delivery plays acrucial role, as better places of deliveries significantly reduce infant and child mortality in Nigeria. Also that higher level of educational attainment has negative impact on infant and child mortality.

Nigeria, despite its rich oil wealth has one of the poorest perinatal statistics in the world with perinatal mortality rates ranging from 39 to 130 per 1000. The aim of this review is to describe the state of the Nigerian nation with respect to perinatal deaths, causes of the high perinatal deaths, present interventions in place and ways to reduce this alarming perinatal statistics.

Infant and child mortality rates are important indicators of the health status of a country. This paper presents the spatial analysis of infant and child mortality rates among the geopolitical zones of Nigeria with the objective of highlighting the unevenness in childhood mortality rates among the regions. Data for the study was obtained from the Nigeria Demographic and Health Surveys of 1999 and 2008. The findings of the research show that there were significant spatial differences in infant mortality rates and under-five mortality rates among the country’s geo-political regions in 1999 and 2008 and by rural urban residence. Under-five mortality rates showed significant clustering among the geopolitical zones with the Northeast depicting clusters of highest under-five mortality rates while the Southwest had the lowest under-five mortality rate clusters. The Moran’s I values were significant at p<0.01 confirming the spatial clustering of under-five mortality rates. The infant mortality rate of 75 deaths per 1,000 live births and the under-five mortality rate of 157 deaths per 1,000 live births in Nigeria in 2008 are considered high compared to those of developed countries and to the expected two-third reductions in the rates by 2015. The paper recommends improvement in public health services, enhanced accessibility to medical services, and the education of mothers on the importance of healthy child care practices as panacea for the reduction of childhood mortality rates to acceptable levels.

Globally, childhood mortality rates have decline 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. Many covariates associated with variations in infant and child mortality are interrelated, and it is important to attempt to isolate the effects of individual variables for proper and effective interventions. This study examined the environmental determinants of child mortality using principal component analysis as a data reduction technique with varimax rotation to assess the underlying structure for sixty-five measured variables, explaining the covariance relationships amongst the large correlated variables in a more parsimonious way and simultaneous multiple regression for child mortality modelling in Nigeria. For purpose of robustness, a model selection technique procedure was implemented. Estimation from the stepwise regression

model shows that household environmental characteristics do have significant impact on mortality.

CHAPTER ONE

1.0 INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Infant mortality rate is one of the most important indications of human development. Infant Mortality Rate (IMR) according to is the number of deaths of infants under one year of age per 1000 live births in a given year. Included in the IMR are the neonatal mortality rate (calculated from deaths occurring in the first four weeks of life), and post neonatal mortality rate (from deaths in the remainder of the first year). Neonatal deaths are further subdivided into early (first week) and late (second, third and fourth weeks). In prosperous countries, neonatal deaths account for about two-third of infant mortalities. The IMR is usually regarded more as a measure of social affluence than a measure of the quality of antenatal and obstetric care.

The infant mortality rate is widely accepted as one of the most useful single measure of health status of the community. The infant mortality rate may be very high in communities where health and social services are poorly developed. For example, the neonatal death rate is related to problems arising during pregnancy (congenital abnormalities, low birth weight); delivery (birth injuries, asphyxia), afterdelivery (tetanus, other infections). Thus, neonatal mortality rate is related to maternal and obstetric factors. Maternal mortality as a significant public health problem was first highlighted in 1987 at the first International Safe Motherhood Conference in Nairobi, Kenya. Current estimates of maternal mortality indicate that about 358 000 maternal deaths resulting from complications of pregnancy and childbirth occur annually1. For every maternal death, many more women suffer serious complications.

The causes of the vast majority of these deaths and complications namely obstetric haemorrhage, sepsis, unsafe abortion, hypertensive disorders, and obstructed labour are preventable3. Maternal mortality is a reflection of women’s place in society and their lack of access to social, health and nutrition services, and to economic opportunities2. Introduction of improved asepsis, caesarean section, blood transfusion services, and improved prenatal care curtailed maternal mortality in industrialized nations almost a century ago4. However, access to these interventions is limited in developing countries.

There are several dimensions to maternal mortality. Fundamentally, a woman’s death during pregnancy or childbirth is not only a health issue but also a matter of social injustice2 reflecting the failure of communities and governments to promote safe motherhood as a human right5, 6. Maternal mortality also reflects disparities in socio-economic development. The overwhelming majority of maternal deaths occur in developing countries2. Sub-Saharan Africa and South Asia account for about 87% of all maternal deaths1. The lifetime risk of maternal death in sub-Saharan Africa is 1 in 31 compared to 1 in 4,300 in developed regions1. The higher risk in developing countries reflects limited quality of care and provision of maternal health services7,8. In sharp contrast, sequel to improvements in obstetric care over the past decades, a pregnant woman in the United Kingdom is reported to face a less than 1 in 19,020 risk of dying from obstetric complications directly related to the pregnant state9.

Goal five of the Millenium Development Goals (MDGs) aims to achieve three-quarter reduction of maternal mortality by 201510. Previous estimates of maternal mortality ratio in Nigeria showed that there had been an increase from 80011 to 1 10012 per 100 000 live births. However, the 2008 Demographic and Health Surveys (DHS) for Nigeria showed a decline in maternal mortality with a maternal mortality ratio of 545 maternal deaths per 100 000 live births13. Facility-based data support the contention that maternal mortality is on the decline. However, the figures remain high14. High maternal mortality in Nigeria is supported by the finding that Nigeria, along with five other countries contributed more than 50% of all maternal deaths worldwide in 200815. Given the weak civic registration and national health information systems in many developing countries, these estimates remain guess work16. Therefore urgent initiatives to monitor maternal morbidity and mortality are imperative17 to provide reliable information for planning and evaluation.

The WHO Global Maternal and Perinatal Health Survey implemented in 2005 aimed to establish a global data system comprising a network of health facilities that will collect focused information on maternal and perinatal health to facilitate identification of morbidity and mortality, monitoring of use of interventions and programme evaluation. This report discusses maternal characteristics associated with maternal mortality in Nigeria.

Common as death may be, gathered statistics of mortality rate, when on the high side apparently becomes disturbing and more catastrophic,especially when the death figures are on theincrease among young children, as this stressesand indicates a future absent the human race. For this reason, health expertsand policy makers have allocated specialinterest to the developments and checkmating of rising child mortality rates. Not only has thisinterest stretched into the international scene, ithas attracted systematic approaches to reducingchild mortality by 2/3 among children under theage of five from 1990 and 2015 as tagged in the

Goals (MDGs) for public health workers,institutions and international developmentagencies. (Fox 2012).Despite this goal of reducing infant and childmortality rate as stated in the MDGs, Childmortality rates still remain unacceptably highespecially in sub-Saharan African countries,where close to 50 percent of childhood deathstakes place, even when the region accounts for only one fifth of the world’s child population(Mesike and Mojekwu 2012). For instance, insub-Saharan Africa, 1 in every 8 children dies before age five- nearly 20 times the average of 1in 167 in developed parts of the world(Mojekwu and Ajilola, 2011). Similarly,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 anddied 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 accountingfor one third of the total number of under fivedeaths worldwide. The report describes the phenomenon as disturbing and grosslyinsufficient to achieve the MDG goal by 2015as only 9 out of the 64 countries with high child mortality rate are on track to meet the MDGgoal.Several factors have been acclaimed to beresponsible for this ugly trend of high child andinfant mortality. Childhood illnesses such asvaccines preventable diseases (VPD), malaria,acute respiratory infections (ARI), and diarrhea contribute substantially to morbidity andmortality among children less than five yearsold. Data from National Health ManagementInformation Systems (NHMIS) shows thatmalaria is by far the most important cause of morbidity (38%) and mortality (28%) in infantsand children, while 75% of malaria deaths occur in children under five. Malaria also accounts for about 11% of maternal deaths, especially for thefirst-time mothers. Estimates show that 50% of the population has at least one episode of malaria each year, whereas children less than age five suffer from two to four attacks a year.Diarrheal illness is reported to be the secondmost common cause of infant deaths and themain cause of under-five mortality. Acute Respiratory Infections (ARI) which include awide range of upper and lower respiratory tract infections (pneumonia), commonly manifestingwith cough, fever and rapid breathing were themain cause of under-five morbidity and infant mortality. UNICEF (2009) indicated that 25%of the population carries the sickle cell trait, andabout 100,000 children born annually isreported to have a serious sickle cell disorder.Aside the health related factors influencingchild survival as mentioned above, there are non-health related or socio-economic factors that can affect a child’s survival. Examples are;

Female Literacy, the status of the mother regarding her level of participation in household’s decision making, access to safe and adequate sanitation, poverty, cultural andgender bias etc.The purpose of this study is to examine theimpact of this non-health related factors oninfant and child mortality rate in Nigeria.

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