INFLUENCE OF TRAINING ON THE PERFORMANCE OF HEALTH PROMOTERS IN MATERNAL, NEWBORN AND CHILD HEALTH EDUCATION IN AKWA IBOM

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Maternal, new-born and child mortality have been on the front burner of public health policy makers and implementers for decades especially in developing and under developed countries. The inclusion of Maternal, New-born and Child Health (MNCH) targets in the Sustainable Development Goals (SDG) highlights the enormity of the challenge and the efforts taken towards reducing maternal, new born and child mortality in Africa. The MNCH training for health promoters was developed towards improving health promoters’ performance; thus a reduction in maternal and infant mortality. The study therefore examined the influence of training on the performance of health promoters in maternal, newborn and child health education.

Triangulation research design was adopted for the study. The study population comprised 155 health promoters and 43000 mothers in Akwa Ibom State. Multi-stage sampling technique was used to select 125 respondents. Questionnaire, Interview Guide and Focus Group Discussion Guide were the instruments used for data collection. Data collected was summarized, coded, analyzed and presented using frequency distribution tables;charts were generated for the variables. Qualitative data was transcribed, coded and synthesized based on prevalent themes expressed by the interviewees. Multiple linear regression analysis was used to test the hypothesis.

Findings revealed that health promoters in Akwa Ibom used flipcharts, diagram boards, slides, manuals and papers designed specifically for MNCH training. The training environment and duration were discovered to be inadequate for training of health promoters. The instruments of social mobilization used by health promoters were identified as mass media, local traditional heads and mothers’ word of mouth. However, findings from the respondents indicated that socialization was averagely low in the aspect of door to door counselling, involvement of mothers in implementation and monitoring of MNCH programmes. Health promoters noted that the health behaviours of mothers have been positively impacted by health messages disseminated to them. It was discovered the mothers revealed that mothers’ health behaviours were impacted upon by the health promoters, but disagreements exist in the aspect of exclusive breastfeeding where some mothers found it difficult to breastfeed exclusively for six months. From the test of hypotheses with a 0.05 pre-set level of significance, it was discovered that health education and/or social mobilization did not significantly influence mothers’ health behaviour.

The study concluded that the training for health promoters in Akwa Ibom state is to an extent deficient as the health promoters do not significantly influence mothers’ health behaviour. A major obstacle for the MNCH campaign planning and execution was discovered to be funding. This study therefore recommends that health promoters should identify sustainable ways of financing health trainings. Also, consideration should be given to selecting the training environment to ensure proper spacing and suitability for learning. The techniques and strategies for socialization and health education should be revisited in Akwa Ibom State with a strong framework included for testing mothers’ adoption of the health information as a measurement of health promoters’ level of efficiency.

Keywords: Training, Health promotion, Health Education, Social Mobilization, Health Behaviour

TABLE OF CONTENTS

Content                                                                               Page                              

Title Page                                                                                                         i

Certification                                                                                                        ii

Dedication                                                                                                                  iii

Acknowledgements                                                                                              iv

Abstract                                                                                                         v

Table of Contents                                                                                            vi

List of Tables                                                                                                   ix

List of Figures                                                                                              x

CHAPTER ONE: INTRODUCTION

  1. Background to the Study                                                                            1
    1. Statement of the Problem                                                                      4
    1. Objective of the Study                                                                             5
    1. Research Questions                                                                              5
    1. Hypotheses                                                                                             6
    1. Scope of the Study                                                                       6
    1. Significance of the Study                                                            7
    1. Operational Definition of Terms                                                         

CHAPTER TWO: REVIEW OF LITERATURE

2.0 Introduction                                                                                                 9

2.1 Conceptual Model                                                                              9

2.2 Review of Relevant Concepts                                                              10

2.2.1 Training and Health Promoters’ Performance                                   10

2.2.2 Health Promotion and Communication                                      12

2.2.3 Health Promotion Strategies                                                                       14

2.2.3.1 Social Mobilization                                                                         14

2.2.3.2 Health Education                                                                                  15

2.2.4 Maternal, Newborn and Child Health Promotions                            17

2.2.4.1 Immunization                                                                                   17

2.2.4.2 Breastfeeding                                                                                       18

2.2.4.3 Hygiene                                                                                             20

2.2.3 Maternal Health                                                                                 21

2.2.4 Newborn and Child Health                                                                       24

2.3 Theoretical framework                                                                             27

2.3.1 Trans-theoretical or Stages of Change Model                                          27

2.3.2 Social Penetration Theory                                                                    29

2.2.3 Goal Orientation Theory                                                                       31

2.4 Empirical Review                                                                                        32

2.5 Summary                                                                                   37

Content                                                                                                      Page

CHAPTER THREE: METHODOLOGY

3.0 Introduction                                                                                                   38

3.1 Research Design                                                                                      38

3.2 Population                                                                                                        38

3.3 Sample size and sampling Technique                                                     39

3.4 Research Instruments                                                                          43

3.4.1 Structured Questionnaire                                                                       43

3.4.2 Interview Guide                                                                 43

3.4.3 Focus Group Discussion Guide                                                           43

3.5 Validity of Research Instrument                                                                44

3.6 Reliability of Research Instrument                                                   44

3.7 Administration of Research Instrument                                                   44

3.8 Method of Data Analysis                                                              45

CHAPTER FOUR: DATA ANALYSIS,RESULTS AND DISCUSSION OF FINDINGS

4.0 Introduction                                                                                           46

4.1 Presentation of Results                                                                     46

4.1.1 Presentation of Qualitative Results                                              46

4.1.1.1 Communication Materials                                                 46

4.1.1.2 Adequacy of training environment                                          47

4.1.1.3 Duration of Training for Health Promoters                                 47

4.1.1.4 Social Mobilization carried out by Health Promoters                      48

4.1.1.5 MNCH Education and Mothers’ Health Behaviour                           49

4.1.2 Presentation of Quantitative Results                                              50

4.1.2.1 Interpretation of Quantitative Results                                          55

4.2 Test of Hypotheses                                                                              65

4.2.1 Decision Rule                                                                                      65

4.3 Discussion of Findings                                                                   67

CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1 Summary                                                                                             72

5.2 Conclusion                                                                                    73

5.3 Recommendations                                                                                   74

5.4 Suggestion for Further Studies                                                                  75

      References                                                                                             76

      Appendices                                                                                                    83

LIST OF TABLES

Table                                                                                                                        Page

2.1 Key Maternal, Newborn and Child Health Indicators                               21

3.1 List of Selected Local Governments, Ward, Health Facility and Number of Registered Mothers                                                       40

3.2 Proportion of the Number of Registered Mothers per Health Facility   42

3.3 Proportional Distribution of Registered Mothers’ Sample Size                42

4.1 Respondents Socio- Demographic features                                                    50

4.2 Mothers who vaccinated their babies                    53

4.3 Mothers who believed that Breastfeeding a baby is a good habit            54

4.4 Mothers who give hygiene a lot of attention                                                 54

4.5 Level of Social Mobilization by Health Promoters in Akwa Ibom            55

4.6 Extent to which MNCH Education is given to mothers by Health Promoters                59

4.7 Level of Health Promoters Influence on Mothers’ Health Behaviours 62

4.8 Influence of Social Mobilization on Mothers’ Health Behaviours     65

4.9 Influence of Health Education on Mothers’ Health Behaviours         66

4.10 Influence of Health Education and Social Mobilization on Mothers’ Health Behaviours                                                                       66

LIST OF FIGURES

Figure                                                                                                                Page

2.1 Conceptual Model                                                                                         9

4.1 Respondents’ Age Range                                                                                51

4.2 Respondents’ Marital Status                                                                         52

4.3 Respondents’ Household size                                                                       52

4.4 Respondents’ Number of Children                                              53       

4.5 Mothers who had vaccinated their babies and mothers with Positive perception of breastfeeding and hygiene                                     54

4.6 Level of Social Mobilization by Health Promoters in Akwa Ibom           58

4.7 Level of Health Promoters influence on Mothers’ Health Behaviours   61

CHAPTER ONE

INTRODUCTION

1.1Background to the Study

Nigeria accounts for about ten percent of maternal deaths in the world with an estimated 814 maternal deaths for every 100,000 live births (World Bank, 2015). The morbidity and mortality among children in Nigeria is  10,900 per 100,000 live births and the infant mortality rate (IMR) which is at 6,900 per 100,000 live births is still higher than many other countries in Sub-Saharan Africa with similar GDP as made known by WHO (2015). Maternal New-Born and Child mortality have been on the front burner of public health policy makers and implementers for decades. Ogunjimi, Ibe and Ikorok (2012) define maternal death as the “death of women while pregnant or within 42 days of termination of pregnancy irrespective of the duration and site of the pregnancy from any cause related to, or aggravated by the pregnancy or its management but not from accidental or incidental causes” (P.34). Child mortality “is the death of a child under five years, while infant mortality is the death of a child under 1 year” (WHO, 2006; 2).

Illnesses during pregnancy or within forty-two (42) days of termination of pregnancy as well as pregnancy management issues contribute to maternal death. Some of the acute illnesses that lead to maternal mortality are anaemia in pregnancy due to malaria, intra-partum and post-partum hemorrhage, sepsis, obstructed labour, and hypertensive conditions in pregnancy. However, Pneumonia, malaria, and diarrhea, under nutrition and malnutrition, are major causes of childhood morbidity in Nigeria. It is estimated that 24% of children under five (5) years of age are underweight and 36% of children are estimated to be stunted (WHO, 2015).

The enormity of the challenges of maternal new-born and child health issues influenced the creation of the Millennium Development Goals (MDGs) and the subsequent Sustainable Development Goals (SDGs). According to the WHO (2014), for an increased success rate of achieving the number four (4) (reducing child mortality) and number five (5) (improve maternal health), MDGs were highly needed because of the encouragement noted in the reduction in global child and maternal deaths (50%) from 1990 (baseline for the MDGs). Despite the efforts put into achieving the goal of reducing maternal mortality and infant morbidity, women and children across the world still die from preventable illnesses.  The inability to realize the MDG’s objective of reducing maternal and child mortality led to the Maternal New Born and Child Campaign in Nigeria as part of the Sustainable Development Goals – SDG’s (National Primary Health Care Development Agency, 2015). The Maternal New-born and Child Health campaign adopted development communication activities supported by trainings for health promoters in an attempt to boost their performance.

INFLUENCE OF TRAINING ON THE PERFORMANCE OF HEALTH PROMOTERS IN MATERNAL, NEWBORN AND CHILD HEALTH EDUCATION IN AKWA IBOM