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