FAMILY AND COMMUNITY PRACTICES FOR CHILD SURVIVAL, GROWTH AND DEVELOPMENT AMONG MOTHERS IN ENUGU STATE

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Abstract

The main purpose of the study was to identify the Family and Community Practices for child Survival, Growth and Development among mothers in Enugu State. To achieve this purpose, eight research questions were formulated and six null hypotheses postulated and tested for significance at .05. Quantitative data were collected from 1969 mothers using family and community practices Questionnaire (FCPQ). The data collected were analyzed using frequency distribution, percentage and mean to answer the research questions and chi-square was used to test the hypotheses. The findings of the study showed that the mothers adopted FCPs except hygiene and use of insecticide treated bednets practices in Enugu State. The findings further indicated that the mothers adopted FCPs except hygiene and use of insecticides treated bednets practices to a great extent. Level of education, age, parity occupation and location of residence had significant influence on mothers’ adoption of FCPs in Enugu State. It was recommended, among others, that there was need to develop a more effective means of imparting information to mothers, caretakers and the entire community on the needs and advantages of adoption of FCPs for child SGD to a great extent.   

CHAPTER ONE

Introduction

Background of the Study

            It has been estimated that more than ten million children in developing countries die of preventable and curable conditions before their fifth birthday (WHO, 2000). This high mortality among children is a global public health problem and a threat to child survival which takes a higher toll on developing countries, including Nigeria. Child survival in Nigeria is threatened by nutritional deficiencies and other curable and preventable illnesses particularly malaria, diarrhoeal diseases, acute respiratory infections and vaccine preventable diseases which account for the majority of morbidity and mortality in childhood (Policy Project/Nigeria, 2002). Traditionally, most of the control measures to reduce incidence of these diseases had been multiple diseases-specific control programmes found to have administrative, political and technical difficulties in the delivery of health services (Steinwand, 2001). 

            In response to these identified difficulties, the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) led the development of an alternative approach known as Integrated Management of Childhood Illness (IMCI). This initiative is a strategy that emerged in response to continuing high child morbidity and mortality. WHO (2000) described IMCI as an integrated approach to child health that focuses on the well-being of the whole child. WHO added that IMCI strategy aimed at reducing death, illness, and disability due to five major causes (i.e., malaria, acute respiratory infections, diarrhoea, measles and malnutrition). Its target was to address childhood death as well as promote improved growth and development among children under 5 years of age. IMCI, according to WHO (2000), includes both preventive and curative elements that are implemented by health facilities as well as by families and communities.

            Hill, Kirkwood and Edmond (2004) identified the three main components of the IMCI strategy as follows:

  • improvement in the case management skills of health staff through the provision of locally adapted guidelines on IMCI and activities to promote their use;

improvement in the health system required for effective management of childhood illness, and

  • improvement in family and community practices. This third component is the focus of this study. These three components encompass curative, disease preventive and health promotive activities.

The first component of IMCI focused on improving the health worker’s skill. The improvement involves training and reinforcement of correct performance for detection and treatment of major causes of childhood illnesses (i.e., acute respiratory infections, diarrhoea, measles, malaria and malnutrition).

            The training would be based on the use of adapted guideline known as algorithm to assess signs and symptoms, classify illness on the basis of treatment needs and provide appropriate treatment including education of the child’s mother or caretaker. The guideline relies on detection of cases or sickness based on simple clinical signs without tests, and offer empirical treatment.

The second component of IMCI focused on improving the essential elements of the health system. The improved health system involved ensuring the availability of essential drugs and other supplies; improving organization of work at health facility level; improving supervision and monitoring; improving health information data; and health sector reforms.

Despite all these improvements made in the above two components of IMCI, UNICEF (1997) observed that significant reduction in child morbidity and mortality was not achieved. In other words, the purposes of the two components were not satisfactorily achieved and hence, the need for an alternative approach was suggested by yet the same WHO and UNICEF.

Family and Community Practices (FCPs) was developed in 1997, in response to the inability of improved care at health facility level to reduce significantly childhood morbidity and mortality. This was sequel to the observation that most mothers and caretakers did not seek care at health facilities (UNICEF, 1997). UNICEF (1999) noted that 40-80% of all child deaths occur in the home without the child receiving appropriate care from a trained health worker or attending a health facility. They incidentally observed that 72% of these threatening deaths were preventable or curable, but people did not seem to use existing low-cost technologies that improve the quality of care for sick children. Hill, Kirkwood and Edmond (2004) noted that families have the major responsibility for caring for their children. They suggested that success in child survival programmes require partnership between health workers and families with support from their communities.

Family as a unit within the community is defined by Ingalis and Salerno (1991) as a special grouping, usually of biologically related persons bound by strong ties of intimacy and caring. The family has the responsibility to provide attention, love, affection, support and services, to meet the physical, mental and social needs of the child and also teach the child the ethical and spiritual concept of the community. The type and quality of care provided by the family is of immense importance to the child’s health and well-being (Ingalis & Salerno, 1991). MacQueen, et al. (2001) defined community as a group of people with diverse characteristics who are linked by social ties, share common perspectives and engage in joint action in geographical locations or settings. This definition applies to the study because Enugu State is seen as a community of diverse but closely knitted social ties and share common perspectives and engages in joint actions in geographical locations.

Practices refer to the actions and behaviours of mothers and caretakers to provide food, healthcare, stimulation and emotional support necessary for child SGD (Engle, 1999). This definition elaborates that the actions and behaviours emanating from the family and community should lead to child’s optimal well-being. Engle further explained that it was not only the practices that were critical to child survival, growth and development but also the way these practices were performed with affection and responsiveness to the child.

UNESCO (2000) conceptualized child survival as a process of seeking a healthy state at birth and in the early months and years of life. Aina, Etta and Zeitlin (1992) viewed child survival as the application of all available resources and knowledge to curb infant and child mortality. A close look at the two definitions of child survival could show that they are similar because they perceived child survival as application of child survival programmes or strategies. The implication of the above could be that child survival involves programmes or strategies that will help to improve the health of children. It could be observed that when these programmes or strategies are implemented properly at the family level, they could now result to optimal growth and development.

Child growth refers to a child attaining a certain growth norm or process of steadily increasing in size (UNESCO, 2000). Child growth in the present context is a process of a child attaining steady increase in size. However, growth and survival can be influenced by how well a child is developing both socially and psychologically.

Davis (1999) understood child development to mean the gradual changes in a child’s physical, mental and emotional state viewed together as a whole. Child development is a process of change in which the child learns to handle even more complex levels of moving, thinking, feeling and relating to others. Child development occurs continuously following recognized patterns, although having some variations according to cultural influences. The child’s family and community provide the child with early care that helps the child to survive, grow and develop. A summary of the above conceptions could show that child development implies a process of change whereby the child learns more complex things such as moving, thinking, feeling and relating to others. This summarization of the concept of development was adopted by the researcher in the present study in order to study mothers’ adoption of FCPs in Enugu State.

FAMILY AND COMMUNITY PRACTICES FOR CHILD SURVIVAL, GROWTH AND DEVELOPMENT AMONG MOTHERS IN ENUGU STATE