CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Child mortality constitute a major concern of public health as shown by records few years back that the rate of newborn mortality is unacceptably high in developing and under-developed countries (USAID, 2009). A recent report by World Health Organization showed that the mortality rate of under-five children persists in low and middle-income countries, posing threat to public health. The leading causes of death among this group of children were recorded to be pre-term birth complications, pneumonia, birth asphyxia (impaired breathing at birth), diarrhoea and malaria (WHO, 2015). The World Health Organization also reported that 45% of child mortality is caused by malnutrition which makes children vulnerable to severe diseases (WHO, 2002). Most of these causes of child mortality could be prevented through simple and cost-effective interventions known as child-survival interventions.
The efforts of global organizations have been aimed at reducing child mortality by incorporating the use of these interventions in primary healthcare services, training healthcare workers on applying them, and providing facilities to ensure appropriate applications; still the rate of child mortality in Sub-Saharan Africa has not met the desired targets of two-third reduction; currently, it stands at 109 per 1000 live births as at 2015 in Nigeria (IGME report, 2015). Possible causes of child mortality persistence in areas such as Nigeria are still bases for study and it involves various sectors of public health.
Recent findings have shown that the attitude and communication skills of healthcare workers could be contributing factors to the high rate of child mortality, although reports have not shown that these factors are the major reason for the high level of persistence in the Sub-Sahara (Anand & Bärnighausen, 2004). It is important to note that these factors are influential in building up the clients’ efficacy and acquisition of necessary skills to implement child-survival strategies. When a baby is safely delivered and has survived the first week after birth, it is the mother’s responsibility to ensure the survival of her child through breastfeeding, seeking postnatal care services when required such as immunization, growth monitoring and so on (Barros, Ronsman, Axelson, Loaiza, Bertoldi, Franca et al., 2012). Therefore, mothers are meant to understand the importance of child-survival strategies and how to carry them out.
With experience and improved technical skills, healthcare workers are capable of inculcating healthy behaviours in their clients through practical explanation of health issues. A Bangladeshi study reported that client’s satisfaction and willingness to practice healthy behaviours was dependent on health worker’s behaviour especially respect and politeness (Jorge, Herga & Ahmed, 2001). On this note, it is reasonable to admit that healthcare workers are important instruments in the course of reducing child mortality rate in areas where persistence remain.
It should be noted that communication is an important aspect of healthcare service delivery and it is influential in such a way that could transform bad healthy habits to positive ones if properly carried out and monitored. Good communication could motivate an individual to change from bad to good habits otherwise it becomes worse and eventually results in situations as worse as death. The sole reason of communication is to derive response in terms of change in attitude and since communication does not only involve informative explanations, it involves inculcation of practical skills and the efficacy to perform them therefore it takes time to create change in the target audience (Bertrand & Kincaid, 1996).
Although it is inappropriate to make conclusions that healthcare workers are responsible for the persistence of child mortality in Nigeria and other sub Saharan localities, but it is highly essential to note that mothers reflect the quality of healthcare services they have received during their course of attending a healthcare centre. A recent report by UNICEF which gave a general overview of the implementation of child-survival strategies in Nigeria showed that child-survival strategies are not fully implemented by mothers and caregivers in Nigeria and this was attributed to poor provider-patient relationship of which communication is a major component. The report gave an estimation that only 17 percent of mothers in Nigeria practice exclusive breastfeeding, 6 percent of babies sleep under insecticide-treated nets to prevent mosquito bites that causes malaria, 18 percent of children under 2 years are considered to be fully immunized according to the recommended guidelines, and some mothers still engage in unhygienic practices which are dangerous to the health of the child (UNICEF, 2015).
In the course of this study, it will be determined the perception of mothers on the efforts of healthcare workers to cause willingness and readiness to implement child-survival strategies through their attitude and communication skills.
1.2 Statement of the Problem
The persistence of child mortality in low and middle-income countries has raised the concern of public health. Major reasons for this persistence has not been readily established which has led to further studies and diverse research designs to categorize the causes of persistence in child mortality. Therefore, the findings will pave way for necessary intervention by pinpointing the source of the problem for adequate implementation of preventive measures in line with the health problem (Black, Morris & Bryce, 2003). Child mortality rate in the world has declined since the inception of Millennium Development Goals (MDGs) as records show; per annum 12.7 million deaths in 1990 have been reduced to 5.9 million deaths as at 2015. Sub-Saharan Africa still has the highest rate of under-five mortality in all the regions of the world, although there was improvement in attaining reduction in mortality rate. Under-five mortality rate decreased from 180 deaths per 1000 live births in 1990 to 83 deaths per 1000 live births in 2015. In Nigeria, a decrease in child mortality has been experienced over the years. The improvement was recorded as a reduction from under-five mortality rate of 213 deaths per 1000 live births in 1990 to 109 deaths per 1000 live births in 2015 (UN IGME, 2015).
