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ANALYSIS
OF BIRTH RATE AND DEATH RATE CASES
CHAPTER
ONE
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.
Over the years, studies have revealed that the progress
countries have made toward
reaching their goals of reducing
by two- third childhood
mortality based on the 1990
progress has been mixed,
with a few countries on-track
toward achieving the
target, others having little or no
success, and some
countries actually losing ground (Bryce J,
Terreri N, Victora CG,
Mason E, Daelmans B, Bhutta ZA, et al,
2006). For about two
decades, the annual number of underfive
deaths only fall from
around 12.4 million to about 8.1
million in 2009 - nearly
22,000 per day or 15 every minute
(You D, Jones G, Wardlaw
T, United Nations Inter-
1990, it is clear that
under-five mortality had fallen. This is
evidence that progress on
child mortality is being made
across all regions of the
world, with many regions having
reduced the under-five
mortality rate by 50% or more
(UNICEF, 2010).
However, evidence from UNICEF, WHO, the World Bank,
and the UN Population
Division report(s) shows that the
highest rates of mortality
in children under age 5 years
continue to occur in
sub-Saharan Africa where, in 2009,
one in every eight
children (129 per 1000 live births) died
before their fifth
birthday-a level nearly double the average
in developing regions (66
per 1000) and around 20 times
the average for developed
regions (6 per 1000) (UNPD,
2010). Under-5 mortality
is increasingly concentrated in
the developing countries:
70% of the world's under-5
deaths in 2009 occurred in
only 15 countries while half of
the deaths occurred in
only five countries: India, Nigeria,
Democratic Republic of the
Congo, Pakistan, and China,
whereas India and Nigeria
together account for nearly onethird
of the total number of
under-5 deaths worldwide
(21% and 10%,
respectively) (You D, Jones G. et al, 2010).
In Nigeria, underneath the
statistics lies the pain of human
tragedy, for thousands of
families who have lost their
children. Even more
devastating is the knowledge,
according to recent
research, that essential interventions
reaching women and babies
on time would have averted
most of these deaths since
preventable or treatable
infectious diseases such
as malaria, pneumonia, diarrhoea,
measles and HIV/AIDS
account for more than 70 per cent of
the estimated one million
under-five deaths in Nigeria
(UNICEF, 2010).
Currently, about 5.9 million babies are born in Nigeria
every year, and nearly one
million children die before the
age of five years. One
quarter of all under-five deaths are
newborns - 241,000 babies
each year. Many deaths occur at
home and are therefore
unseen and uncounted in official
statistics (FMOH, 2011).
Though, when considering the
mortality trends in
Nigeria since 1960, it is very clear that
child deaths are falling,
but not quickly enough as the
current rate of progress
is well short of the MDG target of
Science Journals
Publication(ISSN2276-6359:) Page 2
a two-thirds reduction by
2015. Report from 2008 NDHS
also revealed that
currently, 75 children per 1,000 live
births die before their
first birthday (40 per 1,000 before
the age of one month and
35 per 1,000 between one and
twelve months). Overall,
157 children per 1,000 live
births or about 1 child
out of 6, die before reaching age five
(NDHS 2008).
1.2 PROBLEM OF THE STUYDY
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
Fungal infectious like tinea corporis
(ring worm, tinea pedis (athlete's foot), tinea curis (jock, itch), tinea
capitis, tinea barbas, tinea unguium (onychomycosis, dermatophylid),
subcutaneous and systemic mycosis, opportunistic mycosis and candidiasis is
also on record as part of the health problems that have affected both infants
and mothers. Vesico-vaginal fistulae (VVF) are destroying many women in Nigeria
(about 1.5%) especially in modern Nigeria (26).
Viral
infections have even worsened the already improved childcare programmes in
Nigiera. Some of these viral infections include chickenpox, yellow fever,
rabies, herpes simplex, meningoencephalitis of mumps, parainfluenza,
respiratory synctial virus pneumonia and chronchiolistis adenovirus, common
cold (caused by many viruses), adenovirus conjunctivitis, rubella virus and
papilloma viruses have also contributed minimally to the problems of infants
and mothers (28).
In
the present era of improved control of the environment, proper management of
human waste, improved personal hygiene, medical facilities and dispensation
including vaccination, there has been substantial reduction in the incidence
and effect of these diseases. Although life expectancy has increased
considerably, changing conditions are replacing the old health problems with
more disability and chronic illness, where treatment and management prove very
expensive to undertake (12). Infancy is a delicate stage of life and the
individual is prone to a lot of disease conditions, because of immature
tissues, organs and cells and also because of the behavioral patterns of these
mentally immature beings.
The average maternal mortality rates in
developed countries is
between 10-15/100,000 live
births while developing
countries record rates 100-
200 times this number
(Rosenfied, 1989). The
problem of maternal deaths
is worst in sub-Saharan
Africa with the maternal
mortality rates there being
higher than anywhere else
in the world (WHO,
2004). The situation in
Nigeria is especially grave as
we still record maternal
mortality rates in the order
of 800-1,000 per 100,000
live births (N.P.C. 2003)
and thus rank among the
nations with the highest
number of maternal deaths
(WHO, 2004).
1.3
OBJECTIVE OF THE STUDY
1. To evaluate the rate of infant and
maternal mortality in Nigeria.
2. To know the causes of infant and
maternal mortality in Nigeria.
3. To know whether the high rate
of infant and maternal mortality has
reduced the Nigerian population.
4. To evaluate the past and present
efforts made by government to ensure good health through proper health care
delivery such immunization e.tc.
5. To recommend possible solutions to
the problem of infant and maternal mortality in Nigeria.
1.4 RESEARCH QUESTION
1. How can one evaluate the rate of
infant and maternal mortality in Nigeria?
2. What are the causes of infant and
maternal mortality in Nigeria?
3.
Can high rate of infant and maternal
mortality reduced the Nigerian population?
4. What are the past and present
efforts made by government to ensure good health through proper health care
delivery such immunization?
5.
Can there be any possible solutions to the problem of infant and
maternal mortality in Nigeria?
1.5 RESEARCH HYPOTHESIS
H0: One cannot evaluate the rate of
infant and maternal mortality in Nigeria.
H1: One can evaluate the rate of
infant and maternal mortality in Nigeria.
H0: There are no causes of infant and
maternal mortality in Nigeria.
H1: There are causes of infant and maternal mortality in
Nigeria.
H0: High rate of infant and maternal mortality does not reduce
the Nigerian population.
H1: High rate of infant and maternal
mortality reduces the Nigerian population.
H0: There are no efforts made by
government to ensure good health through proper health care delivery such
immunization.
H1: There are no efforts made by
government to ensure good health through proper health care delivery such
immunization.
1.6 SIGNIFICANCE OF THE STUDY
This study is on the analysis of
infant and maternal mortality rate in Nigeria. This research work is going be
beneficial to the entire public, students, lecturers and as well as research.
1.7
SCOPE OF THE STUDY
The focus on the analysis of infant
and maternal mortality rate in Nigeria
1.8 LIMITATION OF STUDY
Despite the limited scope of this study
certain constraints were encountered during the research of this project. Some of the constraints experienced by the
researcher were given below:
i. TIME: This was a major constraint on the
researcher during the period of the work. Considering the limited time given
for this study, there was not much time to give this research the needed
attention.
ii. FINANCE: Owing to the financial difficulty prevalent
in the country and it’s resultant prices of commodities, transportation fares,
research materials etc. The researcher did not find it easy meeting all his
financial obligations.
iii. INFORMATION
CONSTRAINTS:
Nigerian researchers have never had it easy when it comes to obtaining
necessary information relevant to their area of study from private business
organization and even government agencies. Infants and maternal mothers
difficult to reveal their internal operations. The primary information was
collected through face-to-face interview getting the published materials on
this topic meant going from one library to other which was not easy.
Although these problems placed limitations on
the study, but it did not prevent the
researcher from carrying out a detailed and comprehensive research work on the
subject matter.
1.9 DEFINITION OF TERMS
Infant mortality rate: Infant mortality rate is one of the most important indications
of human development. Infant Mortality Rate (IMR) according to[1] 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[2]. The IMR is usually regarded more as a measure of social
affluence than a measure of the quality of antenatal and obstetric care.
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