TITLE PAGE

HEALTH CARE DELIVERY AND THE PREVALENCE OF INFANT ANDMATERNAL MORTALITY IN JOS NORTH LOCAL GOVERNMENT.

BY

NUHU, KEFAS DALYOP

UJ/2007/SS/0614

A RESEARCH PROJECT SUBMITTED TO THE DEPARTMENT OF SOCIOLOGY,FACULTY OF SOCIAL SCIENCES, UNIVERSITY OF JOS, IN PARTIALFULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF BACHELOR OFSCIENCE (B. SC) DEGREE IN SOCIOLOGY.

NOVEMBER, 2012

1

APPROVAL PAGE

This research work has been read and approved as

meeting the requirements for the award of a Bachelor of

Science (B.Sc.) degree in Sociology in the Department of

Sociology, Faculty of Social Sciences, and University of

Jos.

--------------------------------- ------------------------------- Mr. P. N. Wika

Date Supervisor

---------------------------------- -------------------------------Professor E.G. Best

Date Head ofDepartment

2

---------------------------------- -------------------------------- External Examiner

Date

ATTESTATION

I, NUHU, KEFAS DALYOP with matriculation number

UJ/2007/SS/0614, hereby attest that besides the references

made in this research work, the ideas contained in this

project are solely mine and that the work is not copied,

neither has it been presented here in the University of Jos

or elsewhere for the award of a certificate.

3

---------------------------------------------------------------NUHU, KEFAS DALYOP

Date

DEDICATION

This project is dedicated to God Almighty, for His

mercies and grace upon my life. And also to my Mum, Dad and

my Siblings.

4

AKNOWLEDGEMENTS

5

I am highly indebted to Almighty God who in his

infinite mercy has spared my life thus far and in his wisdom

has granted me the inspiration to write this project, he is

the reason for my academic success today and without him,

this dream wouldn’t have come to reality. May his name be

praised and glorified forever (Amen).

I acknowledge with sincere thanks and gratitude my able

supervisor, Mr. P. N. Wika. Your constructive criticism,

endurance, patience and encouragement in the course of

supervising this project work have really made me proud,

your corrections have always brought me back on track

whenever I drifted, I also appreciate you a lot for

permitting me write on this topic, you made me discover the

academic potential in me. May God in his infinite mercy

reward you abundantly.

I wish to appreciate my level coordinator, Mrs. S.

Kumswa for her encouragement during the course of my

studies. My special appreciation goes to Prof. Ogoh Alubo

who have been my secret mentor academically and whose works

6

have inspired me to write on this topic, I also appreciate

him for giving me some of his materials which I used in this

study, may God bless you sir. My gratitude also goes to my

HOD Department of Sociology, Prof. E.G Best, may God bless

and reward you. My special appreciation also goes to all the

lecturers in the Department of sociology which I passed

through their able tutelage, Prof. Ibanga, Prof. Alubo, Prof

Adelakun, Prof. Ityavyar, Prof Alemika, Prof. Best, Prof.

Gofwen, Prof. Ejikeme, Prof. Idyorough, Dr. Ikoh, Dr.

Orisaremi, Dr. Olumodeji, Mrs. Plang, Mrs. K. C Best, Mr.

Wika, Mr. Gulleng, Mr. Abari, Mrs. Wuya, Mrs. Kumswa – you

people have change my thoughts and expose me to the reality

of the world and society we live in, may God bless you all.

My profound gratitude goes to my family especially my

lovely parents Mr. and Mrs. Nuhu B. Dalyop for their love,

care, prayers, encouragement and ultimately the financial

support given to me to make sure I become somebody in life.

I am highly indebted to you and promise not to let you down

and also ensure that your effort does not go in vein. May

God continue to bless and keep you. My gratitude also goes7

to my lovely siblings, Samuel Dalyop, Samson Nuhu, Comfort

Nuhu. Thanks to you guys for your support and encouragement.

And also to my Bigbros Gaius Nuhu and my Bigsis Salome Manji

and her husband, you people indeed have been great, thanks

for your prayers and encouragement which has always kept me

going. May God bless you all. I also acknowledge my uncles

Mr. Dauda B. Dalyop, Mr. Habila B. Dalyop, Mr. Dachollom and

to all my extended family, may god bless you all.

How can I forget my course mates and friends whom we

both passed through this tedious journey together, Abraham,

Patrick, Muhammed, Elijah, Nanpan, Monday, Jennifer, Fatima,

Anne and many others too numerous to mention, may God bless

you all. And to my close friends, Jaduk Mark, Kweng Danladi,

Peter Philip, Dalyop Dachollom, Matawal Jaja, Eric Innocent,

Kyermun Alpha, Jane Sunday, Jane and John Yusuf, Blessing

Sunday, Mafeng Peter and many others – indeed, you guys have

been friends. May God bless you all.

8

Finally, I am grateful to all the women that

participated in this research work and also to Samuel and

Chucks who helped in distributing my questionnaires.

TABLE OF CONTENTS

Title Page - - - - - - - - -i

Approval Page - - - - - - - - -ii

Attestation - - - - - - - - -iii

Dedication - - - - - - - - -iv

Acknowledgements - - - - - - - -v

Table of Contents - - - - - - - -vii

List of Tables - - - - - - - -- ix

Abstract - - - - - - - - - xi

CHAPTER ONE: INTRODUCTION

9

1.1 Background of the Study - - - - - -1

1.2 Statement of the Research Problem - - - -- 4

1.3 Research Questions - - - - - - -8

1.4 Research Objectives - - - - - -- 9

1.5 Significance of the Study - - - - -- 9

1.6 Definition of Key Concepts - - - - -- 10

CHAPTER TWO: LITERATURE REVIEW AND THEORETICALFRAMEWORK

2.1 Introduction - - - - - - - -12

2.2 The Concept of Health - - - - - -12

2.3 Factors Responsible for Infant and Maternal Mortality- - 17

2.3.1 Health Factors Responsible for Infant and MaternalMortality - 18

2.3.2 Non Health Factors Responsible for Infant andMaternal Mortality - 26

2.4 Theoretical Framework - - - - - -36

10

2.4.1 Medical Perspective - - - - - -- 36

2.4.2 Materialist Perspective - - - - -- 43

CHAPTER THREE: RESEARCH METHODLOGY

3.1 Introduction - - - - - - - -48

3.2 Method of Data Collection - - - - -- 48

3.3 Population and Sampling - - - - - -49

3.4 Method of Data Analysis - - - - - -50

3.5 Problems of Data Collection - - - - -- 50

CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS

4.1 Introduction - - - - - - - -52

4.2 Personal Data of Respondents - - - - -53

4.3 Questions on Infant and Maternal Mortality - -- - 58

CHAPTER FIVE : SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1 Summary of Major Findings - - - - -- 68

11

5.2 Conclusion - - - - - - - -70

5.3 Recommendations - - - - - - -71

References - - - - - - - - -75

Appendix - - - - - - - - - 78

LIST OF TABLES

Table 4.1: Distribution of respondents by Age - -- - 53

Table 4.2: Distribution of Respondents by EducationalAttainment - 53

Table 4.3: Distribution of Respondents by Occupation- - - 54

Table 4.4: Distribution of Respondents by Monthly Income- - 55

Table 4.5: Distribution of Respondents by Number ofChildren - - 55

12

Table 4.6: Distribution of Respondents by Years ofMarriage - - 56

Table 4.7: Distribution of Respondents by Age they gotMarried - 57

Table 4.8: Distribution of Respondents on the Number ofChildren Lost during or after delivery - -

- - - - - 57

Table 4.9: Infant/Children born in poor families are athigher risk of mortality that those in richfamilies. - - - - - - 58

Table 4.10: Socio-economic Status of Parents influencesaccess to health care and infant/child nutrition

- - - - -- - 59

Table 4.11: Education attainment of a mother determinesaccess and quality of health care her child(ren)get - - - - - - 60

Table 4.12: A poor sanitary environment with non or poorsocial amenities increase the risk of infant/childillnesses and death - - - 61

Table 4.13: How effective is the service been rendered inthis hospital or health care centre with regardsto antenatal, natal and post natal care? -

62

Table 4.14: How will you rate the cost of service beenprovided in the hospital or health care centre?

- - - - - - 62

Table 4.15: Women from poor families are at a high riskof mortality during pregnancy, child birth andafter delivery - - - 63

13

Table 4.16: Mother’s socio-economic status is likelygoing to determine the kind of health care andnutrition she gets during pregnancy and afterdelivery -63

Table 4.17: Educational attainment of a mother is morelikely going to influence her decision to seekproper health care during pregnancy, child birthand after delivery - - - - - -

- 64

Table 4.18: A dirty or poor sanitary environment with nonor poor social amenities increase the risk ofmaternal illness and death - - 65

Table 4.19: Women awareness and empowerment and animprovement in their living standard will reducethe high risk or prevalence of infant and maternalmortality - - - - - - - 59

Table 4.20: A clean and healthy environment with theprovision of basic social amenities will ensuresafety infanthood and motherhood - 66

Table 4.21: Ways to reduce the causes and prevalence ofinfant and maternal mortality-67

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ABSTRACT

The first five years of life are the most crucial to

the physical and intellectual development of children and

can determine their potential to learn and thrive for a

lifetime. For young children, every single day counts, ‘the

name of the child is today, tomorrow may be too late.

However, just as the first five years of life of a child are

crucial, so is the life of the mother during pregnancy,

child delivery and even after delivery, this is because

15

pregnancy outcomes rank among the most pressing reproductive

health challenges all over the world. Globally, an annual

estimate of 600,000 women of reproductive age died of

pregnancy with Nigeria accounting for well over 10 percent

of this figure, this is why Nigeria holds the enviable

second position of infant and maternal only behind India.

The challenges that we face regarding the health of Nigerian

infant/children and their mothers cannot be put off, and

they are insurmountable. The problem of infant and maternal

mortality in Nigeria is precarious, thus, the study was

embark upon to look into health care delivery and the

prevalence of infant and maternal mortality in Nigeria. The

study is intended to explore the conception of health and

the major factors or causes of infant and maternal mortality

in Nigeria with particular reference to Jos North LGA.

However, the study only intends to look at the non health

factors responsible for the prevalence of infant and

maternal mortality, this is because it is social and a

sociological research at such. Factors such as educational,

socio-economic and environmental accounts for infant and

16

maternal mortality in Nigeria, therefore, this study look at

ways in which these factors influence or determine the

prevalence of infant and maternal mortality and ways in

which infant and maternal mortality can be curbed or

curtailed. If the 4th and 5th millennium development goal are

to be achieved, then the government has to put more effort

and political will to curb this menace that has become a

public disgrace.

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CHAPTER ONE

INTRODUCTION

1.1. BACKGROUND OF THE STUDY.

Infant mortality is defined as the number of infant

deaths (one year of age or younger) per 1000 live births

(WHO). Maternal mortality refers to the death of women while

pregnant or within fourty-two days after delivery or

termination of pregnancy excluding accidental causes of

death (WHO). For any woman who succumbs to maternal death,

many more will suffer injuries, infections and disabilities

18

brought about by complications such as obstetric fistula.

This is commonly known as vesico-virginal fistula (VVF), a

hole in the birth canal that allows leakage from the bladder

or rectum into the vagina which is a major complication from

pregnancy and childbirth. This is usually a problem of young

girls who marry early, often before their bodies are ready

for that function.

Just as the first five years of life are the most

crucial to the physical and intellectual development of

children and can determine their potential to learn and

thrive for a lifetime, the health of the mother is also of

utmost important. Even as available data indicates that

Nigeria’s child survival is precarious leading to huge

number of deaths particularly in the first month of life, it

also indicates that maternal mortality is exceedingly high

and nothing short of an obstetric carnage. For young

children and the mothers, every single day counts. The

challenges that we face regarding the health of Nigerian

children and mothers cannot be put off, and they are not

insurmountable. We have tools, resources, and knowledge to19

address our nation’s most critical infant and maternal

survival problems and build on the considerable achievements

that have been made since the world summit for Children in

1990. What is needed is urgent action and greater national

priority placed on children’s issues so that significant

gaps and the growing disparity in child health and survival

do not reverse the progress already made.

Nigeria’s estimated population of over 150 million

makes it the largest country in sub-Saharan Africa and the

tenth most populated country worldwide. Nigeria’s population

is largely rural, with 63.7 percent of the population living

in rural areas. Currently, about 45 percent of Nigeria’s

total population is less than age 15, with about 20 percent

(24million) under age five. The sheer numbers involved,

therefore, demand that child survival issues be placed in

the forefront of the national agenda.

Despite its wealth of human and natural resources,

Nigeria was ranked among the 13th poorest countries in the

world; two of every three Nigerians (66%) live below the

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extreme poverty line of US$1 a day (World Bank, 2001).

Nigeria’s low Gross National Product (GNP) –per capita of

$310 in 1998 – is lower among people living in rural areas,

limiting their access to adequate nutrition, quality health

care, and other basic social services, especially among

vulnerable groups (women and children) (World Bank, 1999;

UNICEF, 1999). Less than one-half of the population has

access to safe water (40% in rural areas) and only 41

percent have access to adequate sanitation (32% in rural

areas). Overall , the adult literacy rate is 56 percent;

however, the rate for males (67%) is much higher than for

females (47%). These facts adversely affects the survival of

children and the reproductive health (RH) status of women in

general.

Infant and maternal survival in Nigeria is threatened

by nutritional deficiencies and illnesses, particularly

malaria, diarrheal diseases, Acute Respiratory Infections

(ARI), and Vaccine Preventable Diseases (VPD), which account

for the majority of morbidity and mortality. There is need

for an enabling environment through well-articulated21

policies, projects, and programmes’ to ensure wholesome

development of Nigerian infant/maternal and enhance the

guilty of life.

At the dawn of the twenty-first century, it is tragic

that one in seven Nigerian children die before his or her

fifth birthday (FOS/UNICEF, 2001). Infant and child

mortality rates are exceedingly high, and Nigeria ranks 15th

highest in the world among countries with high under-five

mortality (UNICEF,2001). With more than one million children

dying annually from preventable diseases, Nigeria is one of

the least successful of African countries in achieving

improvement in the past four decades, in spite of advances

in universal immunization and oral- rehydration therapy

(ORT) for diarrheal diseases, and the wealth of Nigeria’s

human natural resources.

Although the 1999 Nigerian Demographic and Health

Survey (NDHS) shows some improvement in Infant Mortality

Rate (IMR) and Under Five Mortality Rate (U5MR), these rates

still fall short of the World Summit for Children (WSC)

22

national goals for reducing IMR (50/60 per 1,000) and U5MR

(70/80 per 1,000) by one-third by 2006. The 1999 NDHS report

cautions, however, that its mortality rates are likely to be

underestimates. The huge variations in these rates among

different parts of the country, notably urban and rural

areas and north and south, are striking. UNICEF’s 1999

Multiple Indicator Cluster Survey (MICS) shows that U5MR was

almost 1.5 times higher in rural areas than urban areas and

that almost twice as many children died before their fifth

birthday in the northwest than in the southwest of Nigeria.

Maternal mortality in Nigeria is also high, varying

between 700 and 800 deaths per 100,000 live births with wide

geographical disparity ranging from 166 per 100,000 in the

Southeast to1,549 per 100,000 live births in the Northeast

(1999 NDHS). Nigeria contributes to 10 percent of worlds

maternal mortality deaths with an average of seven for every

1,00 births. With about 2.4 million live births annually,

about 17,000 Nigerian women die annually. Or put it another

way, one woman dies every 30 minutes from complications of

pregnancy and childbirth (NPC/UNICEF, 2001). These23

indicators have a negative impact on child survival, since

children who lose their mothers experience an increased risk

of death or other complications, such as malnutrition.

Studies have shown that children who lose their mothers

during childbirth, particularly female children, are 10

times more likely to die than those whose mothers survive

(Strong, 1992). For each woman who dies, approximately 20 –

30 others suffer short- and long-term disabilities from

complication of pregnancy and childbirth. Major causes of

maternal mortality are haemorrhage, infection, unsafe

abortion, hypertensive disease of pregnancy, and obstructed

labour.

1.2. STATEMENT OF THE RESEARCH PROBLEM.

Statistics from Save the Child organization (2011), an

international non- profit group, has revealed that almost

800,000 Nigerian children die every year before their fifth

birthday, making Nigeria the country with the highest number

of new born deaths in Africa. The statistics showed that

healthcare is under-funded, under-utilized, and irregular in

24

the country, resulting in high infant and child mortality

rates, particularly in the Northern states. Many rural

clinics lack structure, medical equipment, drugs and

qualified staff to provide quality health services.

Infant mortality is a dark spot on Nigeria’s health

profile. Available data indicates that Nigeria’s child

survival is precarious leading to huge number of deaths

particularly in the first months of life. The situation

which is much higher than the sub Saharan average of 175 per

100,000 is dire because:

Nigeria has been reported to have the worst U5MR[under five mortality rates] in Africa, rangingfrom 235 to 198 per 1000 live births in 1990 to2003 respectively… Four killer diseases in synergywith malnutrition still account for up to 90% ofchildhood deaths (Nigerian Health Review 2006;45).

The above passage confirms an earlier position that

under five mortality rates are higher than the average in

sub Saharan Africa (Federal Government of Nigeria 2004; 4).

Immunization which protect children from some

conditions has declined precipitously in Nigeria. The

federal government has acknowledged the precipitous

25

decline; “The routine immunization coverage that had reached

80% in the early 1990s has nosedived to an all time low by

2000” (Federal Government of Nigeria 2004:4). In 2004, many

states in the North rejected polio immunization alleging

that the vaccines contain anti-fertility agents (Yahaya

2007).

The major cause of childhood deaths are malaria, acute

respiratory infection, diarrhoea, and a host of diseases

such as measles, tetanus, tuberculosis, polio, diphtheria,

etc which are vaccine preventable. Those conditions act in

concert with poor “malnutrition, poor immunization status,

household poverty and food insecurity. Other factors are

maternal illiteracy, poor living conditions (housing, water

and sanitation) and poor home practices for childcare during

illness” (HERFON 2006:47).

The nutritional status of children is a most urgent

challenge all over the country, but particularly in the

northern regions, childhood malnutrition is a major crisis.

The child survival experiences show that at the base of the

26

problem is poverty. As Ogoh Alubo noted in his inaugural

lectures, series 41 titled “In sickness and in health:

Issues in the sociology of health in Nigeria”, up to 60

percent of Nigeria’s under five children are underweight,

stunted and manifest all visible signs of poor nutrition

such as protruding stomachs and shrivelled limbs.

Experiences show that many parents are unable to provide the

necessary diet, many fall back on carbohydrates such as

garri, tuwon masara and pure starch. Even when fluids are

provided, these do not go beyond akamu. The needed nuts and

pulses, proteins, vitamins and irons are deficient in these

foods and hence infants stay malnourished, underweight and

more prone to diseases. This situation is a further

manifestation of what is here called the social production

of sickness. The issue is about the structural location of

parents which divides the children, in the popular parlance,

into aje butter and aje kwaki. While many of children in latter

category present with kwashiorkor and stunted growth, some

in the former show childhood obesity (ibid).

27

The high infant mortality is also due to bout of

diarrhoea, most of it from contaminated water (Alubo and

Ibanga 1994). The factors driving the poor child survival

records point mostly to material poverty.

Just as infant mortality is one of the dark spot in

Nigeria’s health profile, so is maternal mortality, as the

two are different sides of a coin. The different sources

comes to one conclusion: maternal mortality is exceedingly

high and nothing short of an obstetric carnage. According to

the 2006 Nigeria Health Review,

Nigeria has one of the highest maternal mortalityratios in the world, contributing 10% of allmaternal deaths. WHO estimates that about 55,000Nigerian women who die annually from pregnancy andchildbirth complications, an average of 150 womenevery day, or one woman in every ten minutes(HEFRON 2006: 53-54).

The data show that one mother dies out of every 100

deliveries and another 20 may suffer long term complications

(Shiffman 2007, Federal Government of Nigeria 2004).

Nigeria’s maternal mortality experience is exceeding only by

28

India, Nigeria occupies the unenviable second position in

the world (Shiffman 2007:797).

The overall picture, bad as it is, however conceals

huge disparities between regions as well as between urban

and rural centres (Alubo 2010). The centre for reproductive

rights presents the situation in more clear terms:

A woman in Nigeria has 1-in-18 risk of dying inchildbirth or from pregnancy related causes duringher lifetime, which is higher than the overall 1-in-22 risk for women in Sub Saharan Africa. Therisk of maternal deaths are even greater forcertain Nigerian women without formal education.The MMR in the Northern region is consistentlyover 1000 per 100,000 live births, compared to MMRin the Southern region, which is frequently below300 per 100,000 live births. As at 2007, mostNorthern states had MMRs of about 1000 per 100,000live births. Meanwhile, some states in theSouthern region such as Ogun, have MMRs that areconsistently below 200 per 100,000 live birth andthat are progressively decreasing (Centre forReproductive Rights 2008:13).

According to Alubo (2010), if data were disaggregated

by socio-economic status, the differences between the

various strata would be no less striking. This is because

from the materialist point of view, the privations which

manifest as diseases and death are essentially indices of

29

poverty and one’s position within the socio-economic

structure. Thus, issues of early marriage, nutrition in

pregnancy, access to ante-natal services and adequate rest

during pregnancy are all conditions skewed against the poor.

Already, there are data to show that rising incidence of

poverty is the main factor in deteriorating maternal

mortality and morbidity. According to Harrison (1997), the

introduction of user fees and the over Structural Adjustment

of which it was a part, led to rapid decline in ante-natal

attendance on the one hand, and increases in maternal

mortality on the other. The situation also led to more

complications resulting in higher numbers of caesarean

sections as the poorer people who could not afford the new

charges paid with the lives of their mothers, wives and

sisters.

There is a great deal of issues surrounding infant and

maternal mortality in Nigeria, however, this research

intends to find out the relationship or the impact of health

care delivery and the prevalence of infant and maternal

30

mortality in Nigeria with a case study of Jos North Local

Government Area of Plateau State.

1.3. RESEARCH QUESTIONS.

This research work is set to asked questions such as:

I. What are the causes of infant and maternal mortality

in Jos North?

II. Does socio-economic status of parents have an

influence on infant and maternal mortality?

III. What is the relationship between educational

attainment of parents and health care delivery in

Jos North?

IV. Does environmental conditions have an impact on

infant and maternal mortality in Jos North?

1.4. RESEARCH OBJECTIVES.

a) General Objectives:

31

This research aims at investigating health care

delivery and the prevalence of infant and maternal mortality

in Jos North Local Government Area of Plateau state.

b) Specific objectives:

Specifically, the research aims at investigating the

following:

I. To assess the causes of infant and maternal

mortality in Jos North.

II. To establish the relationship between socio-economic

status of parents on infant and maternal mortality

in Jos North.

III. To analyse the relationship between educational

attainment of parents and health care delivery in

Jos North.

IV. To identify some environmental conditions and its

impact on infant and maternal mortality in Jos

North.

V. To proffer solutions to the problems that will be

identified in the course of this study.

32

1.5. SIGNIFICANCE OF THE STUDY.

Infant and maternal mortality is a dark spot on Nigeria’s

health profile, hence this research will serve the following

purposes:

i. It intends to serve as a document for policy framework

which can be used by government and other relevant

agencies.

ii. It aims at contributing to the existing

knowledge/literature on the subject matter of this

investigation.

iii. The research will help in proffering solutions to the

problems of infant and maternal mortality as identified

in this research.

1.6. DEFINITION OF KEY CONCEPTS.

Concepts are interpretive devices. In the social

sciences, they are used for the interpretation of phenomena,

since social science do not demand precise definitions as it

is the case with natural science. There arises the need

33

therefore, to use operational or conceptual definition of

the major concepts employed in this research.

Health care delivery: This refers to the extent to which

individuals who perceived themselves to be sick or have an

identified ill-health condition can be attended to at a

source known to offer reliable, safe and effective care.

This care should also be accessible, acceptable and

affordable. Also known as health services, deals with

anything that can be done to prevent the occurrence of

disease. Such things like environmental sanitation,

vaccination, provision of good water, cleaning of personal

effects like clothing’s, underwear’s, hair, etc. health

care or services can simply be termed as preventive actions

against diseases.

Infant mortality: This is defined as the number of infant

deaths (one year of age or younger) per 1000 live births.

simply put, it is the mortality of live-born infants in the

first year of life. Infant mortality has become a major

topic of discourse in recent times, this is because infants

34

have a slim chances of seeing their first birthday and

children their fifth birthday. Any death occurring before

the first and fifth birthday of infants and children is what

is termed infant/child mortality. This death can occur as a

result of complications during birth, disease that may occur

after birth and the health condition of the child.

Maternal mortality: Maternal mortality according to World

Health Organization (WHO) using the tenth revision of the

International Classification of Diseases (ICD-10) can be

defined as a death of a woman while pregnant or within 42

days of termination of pregnancy, irrespective of the site

or duration of pregnancy, from any cause related to, or

aggravated by the pregnancy or its management, but not from

accidental or incidental causes. Direct maternal deaths are

those resulting from complications of the pregnant state

(pregnancy, labour and puerperium), from interventions,

omissions, incorrect treatment, or from chain of events

arising from any of the above while indirect maternal death

are those due to previously existing disease or disease that

develop during pregnancy, and not due to direct obstetric

35

causes but which was aggravated by the physiological effects

of pregnancy.

CHAPTER TWO

LITERATURE REVIEW AND THEORETICAL FRAMEWORK

2.1 INTRODUCTION

The chapter review popular conceptions on health care

delivery and the prevalence of infant and maternal

mortality. The concept of health has become a major concern

36

to both government and the citizenry, even scholars in the

field of medicine, nursing, psychologist, education,

psychiatry, social work, sociology etc have for a long time

chosen it as a subject of academic discourse.

The research will explore the following

The concept of health

Factors responsible for infant and maternal mortality

Theories of health

2.2 THE CONCEPT OF HEALTH

The concept of health in modern societies is strongly

influenced by it in modern times. Explanations for events

such as illness are rarely understood, for example, in

religious terms, at least not by the majority of lay people

in countries such as UK and the USA, though such ideas may

be prevalent in particular communities. Medical information

is disseminated and available in numerous ways today,

especially through television, the Internet and other media.

If the development of an individualistic medical model has

shaped lay understanding and experience of health, then

37

modern cultures have been equally conducive to its

widespread acceptance. It would be surprising, under these

circumstances, to find an entirely separate system of ‘folk

beliefs’ about illness, shaped by a non-medical culture.

At the same time, enough has already been said to

indicate health, illness and medicine refer to a wide range

of events and experiences, and ideas about these are bound

to contain tensions and contradictions, as well as

ambivalence about the role of medical treatments in dealing

with them (William and Calnan, 1996). Sociological research

on lay concepts of health has provided important insight

into the complexity and sophistication of views about such

matters. Whilst this work has shown the widespread inclusion

of medical messages about health, it has also shown how this

is translated and reconciled with other areas of life, and

assessed against alternative sources of information. Modern

ideas about health and illness can also draw earlier

notions, such as the need for ‘balance’ in sustaining well-

being.

38

In the first place it need to be recognized that health

may be an overriding concern to health care professionals

and researchers, including medical sociologists, but not for

lay people in everyday life. Health, for many, and for most

of the time, is part of the ‘natural attitude’ to life, in

which taken-for-granted meanings are an essential background

and are unconsidered for much of the time. In his study of

risky behaviour and HIV, Bloor (1995), for example, drawing

on the writings of Alfred Schutz, distinguished between ‘the

world of routine activities’ and ‘a world of considered

alternatives and calculative action’ in interpreting how

health risks were perceived by his respondents. Bloor’s

study reinforces the view that daily life presupposes

health, unless it is threatened by events of information

that draw the people into considering alternatives. Health

risks vie with the routine nature of daily life, with its

own pressures and pleasures, constraints and potentialities.

As widely seen, only a minority of people are forced, or

choose, to abandon an assumption of health as a given. Those

concerned with health promotion (as opposed to the treatment

39

of illness) who wish to encourage people to become more

health-conscious have to face this issue in doing so. Health

is not necessarily a pressing and overriding value,

consciously considered on a daily basis. Information on

health risks is actively interpreted within specific social

contexts (Alaszweski and Horlick-Jones, 2003).

In addition to this, lay thinking about the causes and

origins of good and ill health has been found to be

characterized by complex considerations. Even if health is

often taken for granted, and only missed when it is felt to

be compromised, this does not mean that people lack clear

ideas about the relationship between health and illness. In

one of the earliest and most influential studies of lay

concepts of health, Herzlich (1973) showed how, among a

sample of 80 middle-class French respondents (mostly from

Paris) health was linked to the connection between

individuals and ‘the way of life’. Health beliefs, or the

‘representations of health’ as Herzlich called them, located

the source of illness in the character of urban living, with

its tendency to create stress, fatigue and nervous tension.40

This, it was felt, could ‘facilitate’ or ‘release’ forces

that could aid the development of illness. But such forces

could also ‘generate’ illness – that is, be more

pathological in their own right – and not just exacerbate

existing problems, for example, by making an infection

worse.

Positive health, on the other hand, was seen to be

inherent in the individual. The balance or ‘equilibrium’

between the healthy individual and illness could be upset by

a number of features of environment. Cancer was linked to

allergies, and to the nervous strain of city life and the

polluted atmosphere found there. Mental illness was linked

to the ‘restlessness’ of modern living and heart disease to

the ‘many worries which people live in a certain state of

anxiety’ (Herzlich, 1973: 22). Whilst the respondents in

this study recognized that individuals attributes to poor

health, these attributes were never seen as both necessary

and sufficient. The individual’s ‘nature’, heredity,

temperament and predisposition might make the individual

41

vulnerable, but the’ way of life’ remained crucial to the

development of poor health.

If Herzlich’s work set out to provide a framework for

understanding the links between way of life and the

individual in lay concepts of health, subsequent work has

explored their variation across different age and social

groups. In a study which build conceptually on Herzlich, but

draws on a large national study of health and lifestyle in

the UK, Blaxter (1990) has provided a detailed picture of

some of these variations. This study also shows that health

is not a single or unitary concept, but one that has a

number of dimensions as applied to different areas of life

and lifestyles (Blaxter, 2003, 2004).

However, there are two important additions to this

general picture. The first is that health has a moral

dimension, reflecting not only the adoption or maintenance

of a healthy lifestyle, but also how people respond to

illness and deal with its aftermath. Illness runs the risk

of devaluing a person’s identity, either because of

42

causation (e.g. smoking, sexual contact, failure to ‘keep

well’) or because of inappropriate behaviour in the face of

symptoms. Moral dimensions of health have found in a number

of other studies, such as Conrad’s (1994) study of students

in the USA and G. Williams’ (1984) study of middle-aged and

older people with arthritis in England. From this viewpoint

illness is not simply a deviation from biological norms, as

in the medical model, but a significant departure from

social norms.

Second, Blaxter shows that health, illness and disease

are not always mutually exclusive in lay thought.

Respondents in her study often reported that they saw

themselves as healthy despite having serious conditions such

as diabetes, this implies that it is possible to have a

disease and not be ill as well as being ill and not have a

disease. There is clearly a strong motivation towards

feeling and being seen to be healthy, if at all possible.

This issue becomes particularly salient when the question of

disability is considered, given the complex relationship

between health and a range of different disabling43

conditions. For individuals with stable disabilities, or

conditions that are not accompanied by generalized illness

or ‘malaise’, being healthy may be redefined to incorporate

how the person feels now, not in relation to the general

norm. adaptation to illness or disability alters the

baseline from which the individual judges the nature of

health and its implications.

While medical sociology has made an important

contribution to understanding the rationality, relevance and

socially contextualized nature of lay health belief, it is

important not to overstate the argument. Whilst individuals

have unique insights into their own situations, these cannot

be substituted for the expert knowledge in all and every

circumstance (Atkinson, 2003).

2.3 FACTORS RESPONSIBLE FOR INFANT AND MATERNAL MORTALITY.

Without healthy mothers, you cannot have healthy

children. The issue of maternal health actually begins with

44

the conception of the child in the mother’s womb. The health

of the baby within the mother, the circumstances and events

of her birth, her early infancy, childhood, adolescence,

early adulthood, her experiences as regards nutrition, child

care, education, physical, mental, intellectual and

emotional development; all have vital and independent roles

to play in what we term maternal health (Sariki, 2008). Also

children who are raised by physical and emotional nurturing

environment will be more likely to survive and less likely

to succumb to illness and disease.

UNICEF observes that infant/child and maternal

mortality have many triggers. Both direct and indirect.

Poorly funded and culturally inappropriate health and

nutrition services, food insecurity, inadequate feeding

practice and lack of hygiene are direct causes of mortality

in both children and mothers. The indirect causes may be

less obvious externally, but play just as large role in

mortality statistics. Female literacy adversely affects

maternal and child survival rates and is also linked to

early pregnancy. In many countries, especially where child45

marriage is prevalent, the lack of primary education and

lack of access to healthcare contribute significantly to

child and maternal mortality statistics. UNICEF also notes

that discrimination and exclusion of access to health and

nutrition services due to poverty, geographic and political

marginalization are factors in mortality rates as well

(Sariki, 2008).

The researcher has decided to categorized the factors

responsible for infant and maternal mortality into Health

and Non Health factors.

2.3.1 Health factors responsible for infant and

maternal mortality.

Nigeria’s maternal mortality is particularly dire as it

comprises only 1 percent of the world’s population but

accounts for 10 percent of maternal mortality (Alubo, 2012).

According to the 2010-2015 National Health Development Plan

(2010-2012), the main causes of maternal mortality are;

haemorrhage, infection, anaemia, obstructed labour, unsafe

46

abortion and enclampsia. These factors are briefly discussed

below.

Although specific studies on haemorrhage in Nigeria are

scanty, the contribution of postpartum haemorrhage to

maternal mortality is well documented. According to National

Health Development Plan, Haemorrhage accounts to 23% of

maternal mortality in Nigeria. According to Balachandran, in

the studies he conducted in Kaduna, Northern Nigeria

documented postpartum haemorrhage as the most common cause

of maternal mortality. In Nigeria, as in other countries of

the world, haemorrhage is most commonly cause by uterine

anatomy. Other most common causes include retention of the

placenta or placental fragments, trauma to the genital

tract, prolonged second stage of labour, multiple

gestations, past history of postpartum haemorrhage, ante

partum haemorrhage, uterine fibroids, mismanaged third stage

of labour, and caesarean section.

Infection is another factor that is the leading cause

of maternal mortality in women worldwide, especially in the

47

developing world, mainly by haemorrhage, and infection.

Though haemorrhaging will be hard to treat in areas of

limited resources, infection takes days to finally cause

death, and so is preventable. Infection is brought mainly by

preterm rupture of the amniotic membrane, and the prolonged

period before birth. The longer this period, the more likely

infection will set in and subsequent death. This can easily

be treated by administration of antibiotics, and sterile

delivery, the early antibiotics are taken, the higher the

survival rate and the lower the morbidity.

Iron deficiency and anaemia during pregnancy, two

nutritional disorders of public health importance, are

common in developing countries. Anaemia, defined as

haemoglobin concentration below 110g/1 has been recognised

as an important public health problem globally, with high

prevalence, especially among children and women of

childbearing age in developing countries. In Nigeria,

anaemia prevalence in pregnancy varies across regions. Iron

deficiency (believed to be the most common cause of anaemia

in pregnancy) like its anaemia has been recognised as the48

number one nutritional disorder in the world affecting

pregnant women in both developing and developed countries.

According to the National Food Consumption and Nutrition

Survey in 2003, 43.7% of pregnant women in Nigeria are iron

deficient. Animal and human studies have shown that iron

deficiency, anaemia as well as high haemoglobin

concentration during pregnancy is associated with adverse

pregnancy outcomes. Maternal iron deficiency and anaemia

during pregnancy is a product of many factors, such as

maternal malaria, intestinal parasitic infection, recurrent

infection, reduced dietary intakes and many others.

Obstructed labour is one of the most common preventable

causes of perinatal morbidity and mortality in developing

countries. It accounted for 11% of maternal deaths in

Nigeria in 1999 (FMOH,2004). Its occurrence is regarded as a

sign of poor level of obstetric practice in any environment,

because obstructed labour is due to mechanical difficulties

in labour, which takes place where access to proper

obstetric care might not be available or utilized. In booked

patients obstructed labour is prevented by elective49

caesarean section where dyscocia is anticipated and the use

of partogram in labour management with early recourse to

emergency caesarean section.

Abortion is also a leading cause of maternal deaths in

Nigeria. Abortion is illegal in Nigeria except to save a

woman’s life. it is also common, and most procedures are

performed under unsafe, clandestine conditions. In 1996, an

estimated 610,00 abortions occurred (25 per 1,000 women of

childbearing age), of which 142,000 resulted in

complications severe enough to require hospitalization. The

number of abortions is estimated to have risen to 760,000 in

2006 (Bankole et al, 2006). Unsafe abortions are a major

reason Nigeria’s mortality rate – 1,100 deaths per 100,000

live births – is one of the world’s highest (WHO, 2005).

According to conservative estimates, more than 3,000 women

die annually in Nigeria as a result of unsafe abortion

(Henshaw et al, 2008). Many researchers have consistently

shown that high rates of abortion reflects levels of

unintended pregnancy, and that is certainly the case in

Nigeria. Of the estimated 6.8 million pregnancies that occur50

annually in Nigeria, one in five is unplanned, and half of

these ends in induce abortion (Guttmacher Institute, 2008).

Unsafe abortion impacts every level of Nigerian society. It

comprises the health and well-being of women, thereby

compromising the well-being of their families and

communities. Nigerian women experience a variety of

complications from unsafe procedures of abortion; these

include retained pregnancy tissue, infection, haemorrhage,

septic shock, anaemia, intra-abdominal injury (including

perforation of the uterus and damage to the cervix or

bowels) and reactions to chemicals or drugs used to induce

abortion.

Enclampsia also, remains a complication of pregnancy

and a leading contributor to maternal and perinatal

morbidity and mortality in Nigeria. Worldwide it accounts

for 50,000 maternal deaths annually. In spite of several

global and regional interventions and initiatives from

government and other concerned agencies, maternal mortality

continue to rise in Sub – Saharan Africa with enclampsia as

a major cause. Over the last decade it remained the leading51

cause of maternal mortality in Nigeria. This picture could

even be worse especially in the north-eastern part of

Nigeria with so far the worst case fatality rate of 11.6%

(11,600/100,000) as reports in Gombe by Dr. Abubakar Ali

Kullima et al, of the department of Obstetrics and

Gynecology, Federal Medical Center, Nguru, Yobe State. In

their studies of maternal mortality associated with

enclampsia in tertiary institutions in Northern Nigeria in

2009. According to the report, during the first five years

of study period, out of the 224 cases of enclampsia, 52

maternal deaths were recorded, giving case fatality rate of

22.3%. Enclampsia no doubt contributes significantly to

maternal mortality in Nigeria.

The situation of infant mortality is equally dire as

child malnutrition results in the underweight and the

stunting of up to 54 percent of under-five children (Alubo,

2012). There is a clear class character to the epidemiologic

profile in general and infant mortality in particular. There

is evidence that:

52

Infant and child mortality rates are high... Atpresent, one out of every 8 children dies beforehis fifth birthday...child mortality in thecountry is slightly higher than what its incomeper capita would suggest...in the case of infantmortality, ...it is still lower than countrieswith similar income (National Strategic HealthPlan, (2004:24).

The major causes of under-five mortality are;

malnutrition, neonatal tetanus, malaria, diarrhoea,

pneumonia, and measles. These causes are also briefly

discussed below.

In Nigeria, more than 50% of childhood deaths have

under-nutrition as underlying factor (NPC/UNICEF, 1998).

According to the National Strategic Health Plan,

malnutrition in Nigeria accounts for 53% of infant and child

mortality. Progress in nutrition is assessed from indicators

of malnutrition, breastfeeding, sail iodisation, and

vitamin-A supplementation for children under five. The World

Health Organization and the United nation Children

Children’s Fund (1989) recommends that children be

exclusively breastfed for the first four to six months of

life, and thereafter introduced to appropriate and adequate

53

complementary foods along with breast milk. According to the

1999 National Demographic Health Survey, 96 percent of

mothers admitted to breastfeeding babies, and 86 percent of

children ages 12-23 months were still being breastfed.

Despite the slight improvement in the practice of exclusive

breastfeeding, available literatures have shown that

Nigerian infants are not getting maximum benefits of

exclusive breastfeeding, given that about 40 percent of

infant’s ages 2 – 3 months were already receiving

supplements, thus putting them at risk of diarrhoeal

infections, an underlying factor in malnutrition. For older

children, the problem is lack of adequate complementary

feeding. Adequate complementary foods must contain the

recommended dietary allowances for energy, measured by

caloric intake and protein. Majority of young children

receive more cereal and root based carbohydrates as opposed

to protein-rich foods. Nutritional indices for children

under age three are equally poor. According to National

Demographic Health Survey, almost 50 percent are stunted

indicating chronic malnutrition. In addition to adequate

54

protein and energy, intake of micronutrients, especially

vitamin A deficiency contributes to 25 percent of infant,

child and maternal mortality in Nigeria because of reduce

resistance to protein-energy malnutrition, Acute Respiratory

Infection, measles, malaria, and diarrhoea (UNICEF, 2002).

Neonatal tetanus is highly debilitating disease with

high rate of mortality. Global efforts at eliminating the

disease in developing countries yielded results but slower

than expected. The high case of fatality of neonatal tetanus

remains a therapeutic challenge to physicians and requires

continues evaluation. According to the World Health

Organization (WHO), tetanus accounts for 7% of neonatal

deaths globally, and up to 20% in Nigeria. Although only 5%

of neonatal tetanus cases are actually reported to health

services, the indices, the incidence of neonatal tetanus in

Nigeria ranges between 14.6 and 20 per 1,000 live births

(Onalo et al, 2011). Recent data revealed that Nigeria

contributes 16% of global neonatal tetanus. While the WHO

had planned to eliminate neonatal tetanus from Africa by

2005 (WHO/UNICEF, 2001), there has been report on the impact55

of the organization’s neonatal tetanus elimination in

Nigeria. According to Onalo et al of the department of

paediatrics, Ahmadu Bello University Teaching Hospital,

Zaria, in a research conducted on the prevalence and outcome

of neonatal tetanus in Zaria, North-western Nigeria reports

that, in the present study, traditional ovulectomy was the

suspected portal of entry in about two-thirds of cases

followed by the umbilical cord in one-tenth of the patients.

The local practice of cutting the uvula between the third

and seventh days of life as well as the unhygienic handling

of the umbilical cord may be among the factors contributing

to the persistence of neonatal tetanus in this locality and

will definitely require urgent dissuasive efforts to be

controlled. In their studies, it shows patients presented

within the first week of life had higher mortality rate than

those seen in the second and third week of life. This

outcome may be related to the relationship between the

response of the immune system and the toxin load at this age

compared to the one of older infants with more matured

immunity, in that the relativity immature immune systems of

56

newborns in the first week of life could be easily

overwhelmed by the toxin load.

Malaria is also a leading cause of infant/child death

in Nigeria. According to the National Strategic Health Plan

(2010: 28). Malaria is by far the most important cause of

morbidity and mortality in infants and young children as it

accounts to 53% of mortality. It also accounts for maternal

deaths, especially for first-time mothers. It contributes

largely to neonatal and perinatal mortality as well as

anaemia in young children, thus undermining their growth and

development. It is estimated that 50 percent 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. In addition, malaria indirectly exacerbates

poverty by diminishing productivity and household income,

which further adversely affects child health and well-being.

Malaria has remained problematic because, like in most other

tropical countries, efforts to control malaria prior to Roll

Back Malaria (RBM) Initiative, failed to adopt and inter-

sectoral approach in considering the social and57

environmental factors sustaining disease. Victims were thus

dependent on home-based treatment and chloroquine.

Pneumonia is also a leading cause of infant mortality

in Nigeria. This has to do with Acute Respiratory Infection

which include a wide range of upper and lower respiratory

tract infections, commonly manifesting with cough, fever,

and rapid breathing. Pneumonia as another main cause of

infant and child mortality in Nigeria accounts for 20% of

mortality in infants and young children. Reports from the

1999 National Demographic Health Survey reveals that about

11 percent of infants less than three years of age had Acute

Respiratory Infections symptoms in two weeks of preceding

the survey; however, less than one-half were taken to health

facility for treatment. Although there was no urban – rural

differential in the prevalence of pneumonia, affected

children in urban areas were more likely to be taken to

health facility.

Diarrhoea is another most common cause of infant deaths

and under-five mortality as it accounts for 16% of infant

58

and child mortality (National Strategic Health Plan, 2010;

28). The World Bank (2001) reveals that Nigeria has lost 43

healthy years of life per 1,000 from diarrhoeal illnesses. A

comparison of data from the 1990 and 1999 National

Demographic Health Survey reveals appreciable improvement in

the treatment of diarrhoea by care-givers, indicating

significant progress in the past decades. The huge

investment of promoting Oral Rehydration Therapy (ORT),

embarked on in the 1980s by the government, has yielded

substantial results as depicted by an increase in the

proportion of children receiving ORT in the 1999 National

Demographic Health Survey compared with data from the 1990

NDHS. Hitherto, the response of parents and other care-

givers to diarrhoea have been to withhold fluids and foods.

The strategy employed to improve home based management of

diarrhoea placed heavy emphasis on the public education of

parents and caregivers vie commercial advertising and other

means of communication. These methods could be borrowed in

promoting other initiatives such as routine immunisation and

the use of insecticide treated nets for malaria control .

59

Measles is one of the leading causes of deaths among

young children even though a safe and effective vaccine is

available. In 2010, there were 139,300 measles deaths

globally – nearly 380 deaths every day or 15 deaths every

hour (WHO, 2010). According to UNICEF, more than 95% of

measles deaths occur in low-income countries with weak

health infrastructures. Measles is a highly contagious,

serious disease caused by a virus in the paramyxovirus

family. The measles virus normally grows in the cells that

line the back of the throat and lungs. Measles is a human

disease and not known to occur in animals. The first sign of

measles is usually a high fever, which begins about 10 to 12

days after exposure to the virus, and last for seven days. A

runny nose, a cough, red and watery eyes, and small white

spots inside the cheeks can develop in the initial stage. In

1980, before widespread vaccination, measles caused an

estimated 2.6 million deaths each year. It remains one of

the leading causes of death among young children globally,

despite the availability of safe and effective vaccination.

Severe measles is more likely among poorly nourished young

60

children, especially those with insufficient vitamin A, or

whose immune systems have been weakened by HIV/AIDS or other

diseases.

Thus from all the health factors responsible for

infant/child and maternal mortality, it can be said that

they are chiefly influenced or informed by the non health

factors which will be discussed below.

2.3.2 Non Health factors responsible for infant and

maternal mortality.

There are other factors responsible for the prevalence

of infant and maternal mortality in Nigeria that are not

directly related to health issues but determines the health

and survival of infants and mothers, these factors also to a

large extend determine the access to health care delivery,

thus, this research tend to lay more emphasis on the non-

health factors. These include:

Socio-economic factors.

61

Socio economic condition of people in society has a

strong impact on infant/child and maternal mortality. Access

to medical and health care is a class issue. While some can

afford the best centres within Nigeria, including elaborated

private hospitals; many more can only afford General

Hospitals, in fact, others can’t even afford any of the two.

Others attend the informal medical sources. These combined

sources apparently add up to 50% of Nigerian’s recorded as

accessing medical care. Many other Nigerians travel abroad

for medical care.

There are regular reports of VIPs visits to these

destinations as well as missions which are unsuccessful.

There is little doubt that overseas remains the last port

for the rich while the poor continue to anguish with

different degrees of illnesses as a result of poor health

and medical care. The deplorable condition in the health

services is due to long military usurpation of political

power and long period of mismanagement of public fund made

for the health sectors. Although, Nigeria National Health

Policy (NHP) was formulated in 1988 and revised in 2004 to62

bring about a comprehensive health care system based on

primary health care that is protective, preventive,

restorative and rehabilitative to every citizen of the

country within the available resources so that individuals

and communities are assured of social well-being and

enjoyment of living.

Despite this, health system in Nigeria still boils down

with chronic problems, such as inappropriate budgetary

allocation, poor infrastructure in the public health

facilities, lack of drugs, uneven distribution of health

facilities and lack of qualified medical personnel. This has

resulted in the increase in the use of private health

facilities which made the private sector provides 65.7

percent of health care delivery in Nigeria (UNICEF, 2001).

Presently, continued economic difficulties in Nigeria

have undermined the public health system with the

introduction of payment schemes based on selling of

essential drugs. This is one of the main reason of the

Bamako Initiative, according to which the income generated

63

would ensure reliable supply of drugs and would improve

other aspects of the quality of the services rendered. Thus,

quality improvements would compensate for the financial

barrier and as a result the utilization of public health

services would be increased or at least maintained. But

this, has led to the rise in the ‘informal’ private sector

like the traditional medicine healers, itinerant drug

peddlers and hawkers, mixed-trade dispensers, unlicensed

patent medicine dealers and injection doctors.

This sector, offer very low quality treatment

(treatment without laboratory diagnosis, making wrong

diagnosis, sale of drugs with little regard for dosage or

treatment regimen and the use of fake and expired drugs), it

is a more important source of disease treatment and

prevention for the poor. The frequent media advertisement of

traditional medicine healers, who openly challenge the

utility of western medicine, makes them very popular,

especially among the poor. Also, doctors in public services

are allowed to operate private clinics. Some of these

facilities are below standard (unregistered, poorly64

equipped, lack of diagnostic facilities, dirty premises,

employing auxiliaries to work as registered nurses,

dispensing medicines and irrational prescription).

In plateau state for example, the government set up a

committee recently to weed out unqualified and unregistered

private medical institutions in the state, this committee

has been able to identify and close down no fewer than 40

private health care centres. Most of these health facilities

are death traps for the poor who patronize them.

There is a synergic interrelationship between poverty,

poor health, malnutrition, and reduced child and maternal

survival, which is worsened by social exclusion and

political marginalization. A child born to a financially

deprive family is at risk of dying perinatally or within the

first month of life, since the mother was probably poorly

nourished during pregnancy, had little or no ante natal

care, and is unlikely to have delivered at health facility.

On surviving the first month of life, the child is been

exposed to increased risks of illnesses, such as malaria and

65

diarrhoea, due to poor living conditions, limited access to

safe water and inadequate sanitation, malnutrition from

household food, insecurity, or ignorance about good child

feeding practices.

Large family size (ignorance of and lack of access to

family planning) puts pressure on the mother to work in

order to provide for the family, thus leaving the child

quite possibly inadequately cared for. All these factors are

further aggravated by limited access to health services due

to poor income and low level of maternal education, often

leading to no-immunization of the child. Recent estimates

place about 70 percent of Nigerian population below the

poverty line (UNDP, 2001). It also shows that persons

earning less than 1$ a day were 9 percent less likely to use

insecticide treated nets, less able to perceive malaria as a

preventable disease, and less likely to have adequate

sanitation (refuse disposal).

66

Educational factors.

Women’s education has been reported as a key factor in

reducing infant/child and maternal mortality. The higher a

woman’s level of education, the more likely it is that she

will marry later, play a greater role in decision making,

and exercise her reproductive rights. Her children will tend

to be better nourished and enjoy better health. Data from

both the 1999 NDHS and the 1999 MICS reveal that lower

education levels among females was related to higher infant

and under-five mortality.

Both surveys highlighted female illiteracy and under-

five mortality being twice as high in the northern zones

than in the south. Similarly, rural areas had lower levels

of female literacy and consequently higher under-five

mortality than the urban areas.

The relationship between female literacy and child

survival is also clearly demonstrated when looking at

immunization coverage rates and treatment of diarrhoeal

illnesses. Timely and appropriate use of Oral Rehydration

67

Therapy (ORT) in the treatment of diarrhoeal illnesses (the

second main cause of under-five mortality after malaria)

reduces mortality outcomes. The 1999 NDHS reports that the

proportion of caregivers that use ORT progressively rises

with levels of education.

The same survey data also show that the proportion of

children not immunized at all decreases from 60 percent

among illiterate mothers to 24 percent among mothers with

primary education, before dropping to 10 percent among

mothers with secondary education. Some scholars have argued

that education is the most influenced factor in

differentiating infant and maternal mortality levels within

all other factors. Mother’s education seems to be directly

related with the health of a child. There is no doubt that

an educated mother can provide better care of child than a

mother with no education or lower level of education.

Education makes a mother socially advanced, free from

traditional values and changes her pattern of behaving and

attitude. Caldwell (1976) argued that other things being

equal, children of educated mothers experienced lower68

mortality than the children of uneducated mothers. Of course

educational attainment of parents or mother to be precise

may determine the kind of occupation she does. Mother’s

occupation is also associated with nutritional status of her

child(ren) and also her nutritional status during pregnancy

and after delivery.

Other than the intrinsic importance of education and

its important role in economic growth, a causal link has

been established between education and range of health

outcomes. One of the most consistent and powerful findings

in public health is strong association between mother’s

education and child mortality. Results of previous studies

have shown that a 1-year increment in the mother’s education

7-9% reduction in mortality in children younger than five

years and that child mortality rates among mothers with at

least 7 years of schooling were 58% lower than among those

without any education (Cleland and Ginneken, 1988).

In the past 30 years, many hypothesis have been

proposed for the mechanisms through which increased

69

education could lead to reduction in child mortality rates,

including individual level effects through improved use of

health services, economic advantages, empowerment and

independence of women, and community-level affect. Increased

in educational attainment are also strongly linked to

reduction in fertility, which contributes to reduced child

and maternal mortality rates (ibid). The commission on

Social Determinants of Health reinforced the importance

increasing educational attainment to reduce disparities in

health.

Environmental factors.

Globally the number of deaths among under five has

reduced from 12.4 million in 1990 to 8.1 million in 2009

(UNICEF, 2010) majorly due to interventions targeted at

communicable diseases such as malaria, measles, diarrhoea,

respiratory infections and other immunizable childhood

infections which have been major causes of child mortality.

However, these health gains were short lived especially in

70

Africa because disease oriented vertical program alone were

not effective (Mutunga, 2007).

Environmental, maternal and socio-economic factors were

acknowledged as additional important determinants of child

survival (Espo, 2002). Child mortality rates still remain

unacceptably high in sub-Saharan Africa despite the region

having only one fifth of the world’s children population

(Smith, 2010). For instance, in sub-Saharan Africa, 1 child

in 8 dies before age five – nearly 20 times the average of 1

in 167 in developed parts of the world (Ojikutu, 2008).

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 and died from disease or a combination of disease

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 accounting for one third of the total number of under

71

five deaths worldwide. The report describes the declining

rate as disturbing and grossly insufficient to achieve the

MDG gaol by 2015 as only 9 out of the 64 countries with high

mortality rate are on track to meet the MDG goal. Though,

common causes of child mortality and morbidity include

diarrhoea, malaria, measles, and acute respiratory

infections, studies have shown that in Nigeria, many

children die mainly from malaria, diarrhoea, whooping cough,

tuberculosis and bronchopneumonia (Ogunlesi, 1961; Baxter-

Grillo & Leshi, 1964; Morley, 1973; Animashaun, 1977; Ayeni,

1980). Ogunjuyigbe (2004) viewed morbidity and mortality of

the child to be influenced by the underlying factors of both

biological and socio-economic that operates through

proximate determinants.

Jinadu et al. (1991), in a study, found dirty feeding

bottles and utensils, inadequate disposal of household

refuse and poor storage of drinking water to be

significantly related to the high incidence of diarrhoea.

Although, several studies by health actuaries exists on

child mortality, evidence on why the rates is still high in72

Nigeria in spite of various action plans and interventions

made remain sparse. Possibly, the cause of disease and death

over which not much controversies and uncertainties exists

is the total environment of man (Adeyemi et al. 2008).

Malaria, acute respiratory infections, measles, and

diarrhoea which are today major causes of mortality for

children under five are consequence of the built environment

of man. In developing countries like Nigeria, one in eight

children does not live to see their birthday due to

avoidable environmental threats, resulting into

approximately 11 million avoidable childhood deaths yearly

(WRI, 1999; World Bank, 2004).

According to World Bank (2001) in a recent study,

environmental risk factors were estimated to account for

about one-fifth of the total burden of disease in low income

countries. The WHO (2002) similarly, reported in Mutunga

(2007) that among the ten identified leading mortality risks

in high mortality developing countries, unsafe water,

sanitation and hygiene ranked second while smoke from solid

73

fuels ranked fourth. About 3% (1.7 million) of the resulting

deaths are attributable to environmental risk factors and

child deaths account for about 90% of the total. The

environmental burden of disease as noted by Listorti and

Douman (2001), in Adeyemi et al. (2008) was highest in sub-

Saharan Africa with 26.5% while the average for all less

developed countries was 18%.

Environmental health risks are broadly categorized into

two (Shyamsundar, 2002). The first are the traditional

hazard related to poverty and lack of development, such as

waste disposal, vector borne diseases, inadequate

sanitation, air pollution (indoor) and lack of safe water

while the second emanated from the modern hazards such as

rural air pollution and exposure to agro industrial chemical

and wastes, caused by development that lacks environmental

safeguards.

Many of the diseases that lead to increased morbidity

and mortality of children under five and their mothers are

largely related to the unavailability of safe water,

74

unhygienic behaviours, poor sanitary facilities, and poor

housing conditions. Acute Respiratory Infection (ARI), a

major killer of children under five, along with Vaccine

Preventable Diseases (VPD) such as measles, diphtheria, and

tuberculosis, are easily spread in poor overcrowded houses.

Also, increased prevalence of diarrhoeal disease, cholera,

and typhoid is seen in situations of unsanitary refuse,

excreta disposal, and use of unsafe drinking water. In

addition, inadequate drainage and accumulated waste water

encourage breeding of mosquitoes with increased malaria

attacks (the single most significant cause of death among

children). The 1999 MICS reports that 54 percent of the

population in Nigeria had access to safe drinking water (71%

and 48% in urban and rural areas, respectively). The

southeast is the worst hit region; only 39 percent of the

population get their drinking water from safe sources. Just

over one-half (53%) of the population live in households

with a sanitary means of excreta disposal (1999 MICS), a

situation which varies from 40 percent in the northeast to

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58 percent in the southwest, and from 44 percent in rural

areas to 75 percent in urban areas.

A comparison of data from the 1990 and 1999 NDHS shows

improvement in access to safe water, the proportion of the

population collecting water from surface sources declined

from 52 to 38 percent, while the proportion of obtaining

water from ground sources such as boreholes and wells rose

from 35 to 44 percent between the two surveys. Poor access

to safe drinking water encourages the spread of certain

vector-borne illnesses: onchocerciasis (river blindness) and

dracunlliasis (guinea worm), which are transmitted by

vectors associated with water, causing more debilitating

illnesses than those listed above. In the 1990s, remarkable

progress was made in reducing guinea worm cases from 394,082

in 1990 to 13,237 in 1999, representing a 97 percent

reduction from efforts of the Nigeria Guinea Worm

Eradication Programme (NIGEP).

In 1999, only about eight states were reporting

significant numbers of cases. Poor coverage for water supply

76

and sanitation is linked with insufficient funding of

operations and maintenance, lack of capital to complete and

initiate water projects, and inadequacy of skilled labour

and management capacity. Compounding the lack of safe water

in the lack of awareness of the health consequences of

unhygienic behaviours, such as defecating and urinating in

bushes outside houses, poor refuse disposal, and infrequent

hand washing. Another problem is the use of the same water

source for bathing, washing, and feeding cattle.

Faced with this environmental health threats, and

coupled with the world desire to reduce child and maternal

mortality worldwide as reflected in the MDG, understanding

the factors responsible for high incidence of mortality is

expedient and prudent.

2.4 THEORETICAL FRAMEWORK

Health is a cherished but often misunderstood concept.

In health discourse in Nigeria the primary concern is often

about hospitals and drugs and rarely about the conditions

which make drugs and hospitals necessary. The Medical and

77

Materialist perspective of health are two contending

paradigms which address these issues and what can be done

about them.

2.4.1 Medical Perspective

Much of what contemporary populations think about

health and illness, and much of the focus of research –

including sociological research – is strongly influenced by

the prevailing medical model. In public debate, the medical

approach remains central.

It is said that the medical perspective of health is a

negative one: that is, that health is essentially the

absence of disease. Despite bold attempts by bodies such as

the World Health Organization (WHO) to argue for a

definition of health as ‘a state of complete physical,

mental and social well-being, and not merely the absence of

disease or infirmity’, most medically related thought

remains concerned the disease and illness. This is hardly

surprising, given the fact that people turn to medicine in

times of trouble, not when they are feeling well. It has

78

also been found that promotion of positive health, whether

by doctors or ‘health promoters’, competes with other valued

goals, for individuals and for societies as a whole. Matters

become even more complicated when it is realized that the

presence of ‘disease or infirmity’ does not, in any event,

mean that people always regard themselves as unhealthy. The

phrase ‘complete well-being’ remains elusive as it is

positive, and health, illness and medicine are related in

complex ways. The medical model of health, though often

charged with ‘reductionism’, at least has the attraction of

cutting through some of these knots.

As historians such as the late Roy Porter (2002a) have

pointed out, the medical perspective, as we now know it,

took on its main characteristics in the eighteenth and

nineteenth centuries. Prior to this date most medicine in

Western countries was committed to observation and the

exhaustive classification of symptoms. Although this

attachment to observation and entailed a rejection of

existing authorities (represented especially in Galen’s

writings) and was linked to reformist view of science and79

society, developments were not straightforward. For many

physicians in the seventeenth and eighteenth centuries,

emerging views concerning the nature of disease were

anathema. Physiology in French and chemistry in Germany were

bringing the laboratory sciences to bear on human health and

disease, and many thought this undermined the doctor’s

traditional role at the patient’s bedside. However, during

the nineteenth century, the development of bacteriology and

anatomy marked a major change in both thought and practice.

Doctors now claimed exclusive jurisdiction over health

and illness, the warrant of medical model of disease as

their support. This situation meant that modern citizens

were increasingly encouraged to see their health as an

individual matter, and their health problems as in need of

attention of a doctor. It is this Foucault (1973) saw as

constituting the ‘medical gaze’ which focused on individual

and on processes on inside the body – its ‘volumes and

spaces’.

80

This ‘gaze’ (extended in due course to health-related

behaviours) underpinned the development of the modern

‘doctor-patient’ relationship, in which all authority over

health matters was seen to reside in the doctors’ expertise

and skill, especially as show in diagnosis. This meant that

the patient’s view of illness and alternative approaches to

health were excluded from serious consideration. Indeed, the

patient’s view was seen as contaminating the diagnostic

process, and it was better if the patient occupied a passive

role. It is for this reason that the ‘medical model’ of

disease has been regarded critically in many sociological

accounts.

Health is frequently conceived as a medical issue and

reduced to provision of medical care. This paradigm comes

from development of bacteriology, especially the work of

Louis Pasteur with anthrax and cholera. The medical model

conceives health as a biophysical malfunctioning which

disrupts the body’s equilibrium. Such malfunctioning is

caused by germs and other bacteria (Rossdale, 1965; Turshen,

81

1977a; McKeown, 1979). The model has a machinelike image of

the human body and,

In terms of both diagnostics and therapy, the bodywas considered to be analogue to the machine thusallowing for instrumentalist approach to the body.Individual parts could be examined and treatedwithout the rest of the body being affected(Berliner, 1975:576).

In accordance with this conception, specializations in

medicine (such as ophthalmology, urology, Ear, Nose and

Throat, etc) began to concentrate on individual systems and

organs to the exclusion of the rest of the body (Navarro,

1980; Powles, 1973).

This conception of health was further reinforced by

restructuring of the medical education in the USA and Canada

about 1910-1915 (Brown 1979; Starr 1982) which stipulated

training in the laboratory based on sciences to be followed

by supervised clinical tutelage of unspecific content and

duration. The utility of medical practice was then limited

as the capacity to cause harm and heal were equal (Brown

1979; Starr 1982). Heroic medicine, as it was then called,

used procedures like purging, blistering and bleeding with

82

an instrument called the lancet. It is not accident that the

oldest and most respected medical journal in the world took

that name. This restructuring of medical curriculum

radically changed the situation which turned medicine from

craft to the profession of high status and income (Alubo,

2010). It pushed medicine beyond the poor both in terms of

opportunity for medical education and access to doctors’

services. This is the brand of medical training that was

imported into Nigeria and other developing countries. As

Alubo (2010) noted, that the internalization of the

curriculum has contributed to the respect for Nigerian

trained doctors but has also facilitated the brain drain.

It must be noted that continued reference to

Hippocrates as the intellectual; ancestor of modern medicine

(there is for example the Hippocratic Oath) is, in some

sense, contradictory. This is because the current

individualistic-mechanic conception is different from

Hippocrates’ who viewed health as a relationship between the

individual and the environment, including the political

economic (Alubo, 2010). According to Hippocrates:83

Health means a healthy mind in a health body andcan be achieved only by governing daily life inaccordance with natural laws which ensures anequilibrium between the forces of the organism andthose of the environment (Dubos 1965:323).

Through the medical conception, health care has become

equated with medical care and policies have stressed the

intensification of curative medical services (Alubo 1985a,

Erinosho, 1982). Other aspects of health such as preventive

and rehabilitative dimensions are ignored. Politicians are

comfortable with medical perspective and the policy thrust

has revolved around the following initiatives:

1. The training of more personnel to achieve a better

practitioner-patient ration. Nigeria’s various

governments have been proud of increases in both the

ratio and absolutely number of various cadres of

personnel trained.

2. Building of more clinics, hospitals and treating

centres and expanding existing ones. Even a situation

where existing facilities are in crisis and most have

atrophied, new ones are being built.

84

3. Procurement and better distribution of drugs equipments

and other materials (Federal Government’s in Nigeria

1981, 2005).

This conception of health neatly fits modernization

path to health care development especially that it creates

markets for drugs and equipment manufacturers.

The modernization path appears to be a universal

phenomenon in underdeveloped countries as:

The poorer... countries have tended to copy bothphilosophy and development priorities of thedeveloped world, even though problems andpopulation structures are different. In followingthe health delivery trends of the technologicallysophisticated societies, African countries have sofar failed to make their health system effective,let alone efficient. Clearly, the system does notfit the population (Mburu 1981:17).

There are hardly questions about the impact of this

perspective on health problems. At issue is how medical care

can solve problem whose root causes are political and

economic. The common diseases in Nigeria are nutritional

such as kwashiorkor and marasmus; parasitic like malaria and

water borne such as cholera and guinea worm, all of these

85

diseases have accounted to the high prevalence of infant and

maternal mortality in Nigeria. How can cure to these

conditions be achieved without attending to the root causes?

Better understanding of the root causes of these illnesses

which has to do with environment and health care in general

need to be given attention. These are the factors that

causes the high rate of mortality in any given society

especially Nigeria and most especially among

infants/children and nursing mothers, hence, attention

should be given to health care delivery instead of medical

care.

Equally important is the distinction between cure and

care, there is a huge imbalance in health investment in

favour of cure. This is a deliberate ideological strategy

for as Navarro and others (Kelman 1972, Turshen 1999) long

argued, reducing problems of political and economic origins

to medical problems of political and economic origins to

medical problems serves an important legitimacy function for

the capitalist system:- makes people believe that structural

problems can be resolved through the individualist86

approaches of modern medicine. It diverts attention from

poverty and deprivation, the resolution of which will pose

threats to the accumulation process. This is because,

By situating the diagnosis and treatment ofdiagnosis and treatment of disease at the level ofthe individual, (medicine) provided the rulingclass with a means of social control: patientswould fail to make common cause with each other orto protest the external, underlying conditionsthat make them ill. The effect is to depoliticizemalnutrition, alcoholism, drug addiction andmental illness defining them as medical problems(Turshen 1977:57)

Furthermore, there is a trained class bias in medicine

which also reflects and reinforces the system. Curative

medicine is only useful to the affluent and others whose

basic needs are guaranteed. Under such circumstances, the

medical magic unveiled. But for the majority of the people

whose material condition of existence are not secure,

medicine serves little purpose. Indeed as Versayer, a

Russian writer and physician, once noted “medicine is the

science of dealing with the treatment of the rich only. In

relation to everybody else, it is merely a theoretical

science dealing with how they would be cured if they were

87

rich” (quoted in Navarro 1977:19). It is therefore correct

that the medical conception of disease and treatment

“meet(s) the health needs of the bourgeoisie, not the entire

population” (Navarro 1977:46). Thus from the above, it is

visible that medical care hardly benefits the poor, this is

because medical care lay more emphasis on the building of

hospitals, only the rich can afford to pay for the services

in the hospitals. But if government attention is centred on

the provision of health care facilities such as potable

drinking water, good sanitary environment and improve the

living standard of the poor, the y won’t need to visit the

medical facilities frequently as there won’t be any or

minimal cause of falling ill from preventable diseases

The medical paradigm remains the guiding principle of

health which has informed Nigeria’s health care policy and

practice. There are regular references to health care

delivery, as if, in the words of Aron Wildavsky, “the

welcome wagon was supposed to roll up to the door and

deliver health wrapped in a neat package” (Wildavsky

1977:112). In the illusionary pursuit of health care88

delivery over 80 percent of health budgets has consistently

gone into curative medicine (Alubo 1985a). Whether such huge

investments yielded the desired outcome is immaterial –

perhaps because of the under the table payment which

accompany the investments in contracts for hospital

construction and supply for drug equipment.

Thus from the medical approach to health, it can be seen

that more emphasis is been laid on the provision of medical

health care (which is curative in nature) instead of health

care delivery (which is preventive in nature). This makes

government forget the root causes or the major factors

responsible for illness and rather pay more attention on

curing these illnesses that should have preventable. All

factors responsible for infant and maternal mortality in

Nigeria have been proven to have a direct link with the

environmental or and living standard of the society, but

government have decided to concentrate its energy and

resources on the building of medical centres such as

hospitals and the training of doctors, nurses etc to attend

89

to infant maternal related issues instead of providing the

basic necessities for the prevention of such diseases.

2.4.2 The Materialist Perspective.

The materialist perspective of health care is anchored on

this fundamental assumption: health is part and parcel of

society within which individual lives, has a being;

reproduces him/her self and relates to other human beings in

these processes health is experimental and holistic, rather

than being a commodity which can be bought and sold.

From the outset, the focus is holistic, total and

socio-political rather than mechanistic, individualistic or

biophysical. According to Sander Kelman (1977:8), the

materialist conception of health:

Begin(s) with the axiom that human beings are thebasis of both forces of production (physicalingredients of production , such as labour,resources and equipment) and the relations ofproduction (division of labour, legal property andsocial institution and practices) in any societyand therefore appropriate human organismicconditions (i.e. ‘health’) can only be understoodin the correct text of the particular mode oforganization of production and the dialectical

90

relationship between the productive forces andrelations (quoted in Alubo, 2010:13)

So conceived, health is inseparable from the political

condition under which people live, meet (or fail to meet)

their daily needs and reproduces life (Turshen 1977a;

Navarro 1976). Nor is health separable from such processes

as the rate of capital and profit accumulation,

privatization and deregulation, and other super structural

aspects of materialist basis in which the individual has

relative control over his/her existence in a purposeful and

meaningful way, devoid of overarching structures of

oppression, alienated and exploitation. Such existence must,

at the same time, be conducive to material and spiritual

wellbeing.

For this material conception, bio-physical malfunctions

are important not in their own rights, but for the politic-

economic contradictions they symptomatize. Kwashiorkor, for

instance, is only the bio-physical manifestation of the

contradictions in the same social relations of production

which cannot guarantee adequate nutrition. Similarly, worm

91

related infections and water-borne conditions are not really

the disease. The real problem is the nature of the society

and individual’s location within it. The diseases arises

from the political economy of reward structure which

benefits some while placing others at a disadvantage. Those

place at a disadvantage are left at the mercy of the rich,

hence making them more prone to high risk of mortality.

The materialistic conception of health is not new, it

is only long ignored (Alubo 2010). As far back as the 12th

century, long before the discovery of bacteria and its

derivation, the germ theory, the relationship between low

socio-economic status and low life expectancy for all

courses was observed (Syme and Berkman 1981:35).

Furthermore, Karl Marx and Friedreich Engels, jointly and

individually discussed how poor material conditions

predisposed people to disease in works like the Communist

Manifesto and the Conditions of the Working class in

England. Because of the obvious ideological implications,

this conception has remained ignored. An illustration of the

material interpretation provides the explanations not only92

for susceptibility to disease but to individuals’ responses.

The last point is starkly brought home in Earl Koos’ classic

book, The Health Regionville, which is a community reaction

to sickness and illness. Koos quoted a woman as saying ‘how

I wished I knew what you mean about being sick. She said she

sometimes felt she would curl up and die but cannot afford

the luxury to be sick because there was no money for the

doctor’ (quoted in Alubo, 2010). Her experience is shared by

many much as the women making akara by the street corner,

the motorcycle, taxi operators and many more who live from

hand to mouth. So being sick is itself a luxury that cannot

be afford, as members of the underclass drag themselves

until they are at the point of dropping dead.

Class and class relations bear on who becomes sick and

types of sickness: diabetes and gout are found more among

the middle and upper classes, just as kwashiorkor and

stunting are common among lower classes. Even malaria has a

class character because the mosquito vector is egalitarian

in biting the rich and the poor but the latter succumb more

93

frequently to malaria (Alubo 2010). Class or socio economic

status also determines access to available care.

This perspective shows the power play in the access to

health care. According to the Strengthening Health System

document “children and infants among the poorest 20% of the

population are about three times more likely to die than

among the riches 20%. The disparity is even greater for

under 5 mortality where the mortality is 87 per 1,000 among

the wealthiest population and staggering 219 per 1,000 among

the poorest” (Federal Ministry of Health, 2009:1). The

situation is blamed on the increasing poverty and weakness

of the ‘health care system’. It is here observed that what

is described as the health care system is essentially the

various levels of medical care system (Alubo, 2012). Most of

the causes of deaths and serious illnesses, which occur

among Nigerians, can be treated with simple remedies...

communicable disease are... often compounded by malnutrition

(Health Policy, 2006). Thus, this shows the power play

between the upper class even in terms of who get ill and

what kind of illness.94

Access of health care or medical care as the case may

be is now determined by the ability to pay and where various

Nigerians fit in the stratification order. The situation

speaks to the nature of wealth, power and privileges in

modern Nigeria where the structures created these processes

have replaced cordon sanitaire (the philosophy of physical

separation of colonialist from natives as a way of guarding

against possible spread of disease from the latter) of the

colonial period (Alubo, 2010). The materialistic conception

of health is about how people live, what facilities they

have and what essentials they are denied. This to a large

extent also determine who gets ill and who does not.

The materialistic conception classically explain the

dire situation of infant and maternal mortality in Nigeria,

as many researchers have shown that infant and maternal

mortality is high among the lower class (poor) than among

the upper class (rich), this is largely because they (the

rich) have more access to both medical and health care

services than the poor who barely have enough to afford

95

three square meal a day, not to talk of affording a balance

diet.

CHAPTER THREE

RESEARCH METHODOLOGY

96

3.1 INTRODUCTION

This chapter highlights how the researcher intends to

conduct the study by gathering necessary and valid data that

can be tasted and replicated. It specifies the method to be

used and way they are used in the study. Point of focus in

this chapter may include the method of data collection and

analysis, how the data will be analyzed and the instrument

that was employed and use in the study analysis. Finally,

these procedures will enable the researcher to make a fairly

convenient study from which readers can be assured of

reliability and validity.

3.2 METHOD OF DATA COLLECTION

The method of data collection used in this study is the

survey method. This is because of its explicit rules and

procedures in gathering information about a large

population. The primary source of data collection was use to

generate data from the study. The primary source of

collecting data involve a response from the respondents.

Questionnaires will be design especially for women and

97

health workers in a structured form, this is due to its

relative advantage in terms of time utilization, cost

involved in the gathering of information and its

reliability.

The questionnaire will consists of two parts. Part “A”

will consist of the socio-demographic characteristics or

bio-data of the respondents. Part “B” will consist of

questions that will be administered – the questionnaire is

structured in an open and close ended manner. An open ended

questions enable the respondents to give their own view

without options while in the close ended, options will be

given to the respondents to choose from them. It is believed

that responses from both women (who are/were mothers) and

health workers would guarantee effective representation of

their experiences and views on the research topic, journals

and textbooks will form part of the study as secondary

source of data.

3.3 POPULATION AND SAMPLING

98

According to Ibanga, (2006.11), a researcher would love

to study all cases he is confronted with in a given research

situation. However, certain constraints usually make such

design not more than a wish. In other words, it is quite

difficult to study every case in the population, thus, there

is the need for a researcher to use smaller proportion of

the population. For this research work however, the sample

size that will be use is two hundred (200) women or

respondents. Two hundred questionnaires will be administered

to respondents living within Jos metropolis. The

questionnaire will be administered in some of the private

hospitals within the area understudy. Private clinics and

hospitals will be used due to the fact that all the Primary

Health Care (PHC) centres in the state have been on strike

for a long time, thus have not been functioning. The

distribution of the questionnaires will be made during ante

natal days in those hospitals. The parts that will be

covered will include Tudun Wada, Angwan Rukuba, Nasarawa

Gwong, Jenta and other places. The respondents will cut

across the group comprising of the Hausa, Berom, Igbo,

99

Yoruba, Anagutas, among others. Their level of education and

age will also be considered in this research work. Random

sampling will be used for this purpose.

3.4 METHODS OF DATA ANALYSIS

The method that will be used in this research work will

be the statistical and arithmetic method. The use of simple

percentage will be used to calculate data and findings of

the research. Data will be assumed as the basis for making

deduction and reaching conclusions on one hand. Data on the

other hand will be referred to as actual figures or a body

of figures.

Statistical data are frequently arranged and presented

in form of tables to enable the reader have a good grasp of

the information which the researcher intends to convey with

a minimal effort.

Tabulation is the process of transferring data from

data gathering instruments to a tabular form. This makes it

possible to be systematically examined. Tabulations of data

also forms basis for reducing and simplifying the details

100

given in a mass data. It is for the above reason that the

tabulation method of data analysis shall be adopted in this

study.

3.5 PROBLEMS OF DATA COLLECTION

The researcher might encounter some problems during the

field work despite the benefits derived from adopting these

methods. The most prevailing among the problems that might

be encountered will be that of secrecy of the respondents.

Most of the respondents might feel that issues concerning

the death of children and their mothers should be kept

secret as any attempt to raise it up again may raise

emotions, most of the respondents may find it difficult in

providing information on infant/child and maternal mortality

especially those that concern them directly or indirectly,

this might made most of the respondents to hide some of the

important information required. Another problem that might

be encountered will be getting the attention of some of the

respondents who might perceived this process as time

consuming against their own activities as the questionnaires

101

will be administered during ante natal days in the hospitals

or health care centres as the case may be.

102

CHAPTER FOUR

DATA PRESENTATION AND ANALYSIS

4.1 INTRODUCTION

This chapter is mainly concerned with the presentation,

analysis and interpretation of research findings. This

chapter is designed in such a way that the presentation,

interpretation and analysis are guided by the research

problem and the objectives of the study.

Two hundred (200) questionnaires were administered

within the area coverage of the study, however, one hundred

and eighty four (184) questionnaires were filled and

returned, 84 of the other questionnaires were misplaced,

this was because the researcher distributed the

questionnaires in private health care centres during ante

natal, and some of the women forgot and left with the

questionnaires given to them. Therefore, the data

presentation, analysis and interpretation will be done base

103

on the number of questionnaires that were filled and

retrieved.

The responses from the questionnaires have been

tabulated showing the frequencies and percentage analysis.

The questionnaire is divided into two sections: Section ‘A’

is the bio data or socio-demographic characteristics of the

respondents, which is on the basis of age, education,

occupation monthly income, number of children, years of

marriage, age at which the respondents got married and the

number of children lost during or after delivery if any.

Section ‘B’ deals with the analysis of health care delivery

and the prevalence of infant and maternal mortality as

presented in the following tables.

4.2 PERSONAL DATA OF THE RESPONDENTS.

Table 4.1: Distribution Respondents by Age

Age in Years Frequency Percentage (%)18 – 24 35 1925 – 30 68 3731 – 35 44 2436 – 40 26 1440 – above 11 6Total 184 100Source: Field survey

104

Table 4.1: represents the distribution of respondents

by age. From the table above, it can be seen that most of

the respondents lies between age 25 – 30, with 37% of the

respondents (68) being within that range, this if followed

by those between age 31 – 35, accounting to 24% of the total

respondents. Others include those within the age range of 18

– 24, which are 35 and accounts to 19% of the total

respondents, those within the age range of 36 – 40 accounts

to 14% of the total respondents, and finally those within

the age range of 41 – above accounts to only 6% of the

total respondents. Thus, from the table, it can be seen that

a large percent of the total respondents and within child

bearing age.

Table 4.2: Distribution of Respondents by EducationalAttainment

Education Frequency Percentage (%)Primary 15 8Secondary 80 44Tertiary 85 46Non 4 2Total 184 100Source: Field survey

105

From table 4.2. above, it can be seen that an

impressive 46% of the total respondents are educated up to

the tertiary level, 80 respondents which accounts to 44% of

the total respondents have attain secondary education, 8% of

the respondents have just a primary school certificate and

only 4 of the respondents which accounts to only 2% of the

total respondents have no any form formal of education.

thus, generally, it can be said that a significant number of

the respondents have attain one level of formal education or

the other, with most of them having attain tertiary level of

formal education.

Table 4.3: Distribution of respondents by Occupation

Occupation Frequency Percentage (%)Housewife 52 28Petty Trader 36 19Business Woman 33 18Civil Servant 47 26Others 16 9Total 184 100Source: Field survey

From table 4.3, the occupation of the respondents was

also included with their frequencies and percentages. Thus,

it can be seen that a significant number of 52 respondents

106

which accounts to 28% are housewives, 47 respondents (26%)

are civil servants, 19% of the total respondents are petty

traders, 18% of the respondents are business women, while 16

respondents which accounts to 9% engage in other activities

for livelihood. However, despite the fact that an impressive

number of women (26%) from the above table are civil

servants, many more lies within the category of those who

are housewives (28%), business women (18%), and petty

traders ( 19%) who engage in petty trade to feed on in their

homes.

Table 4.4: Distribution of Respondents by Monthly Income

Income (N) Frequency Percentage (%)5,000 – 10,000 80 4411,000 – 20,000 48 2621,000 – 35,000 28 1536,000 – 50,000 15 850,000 – above 13 7Total 184 100Source: Field survey

107

Table 4.4 above shows the distribution of respondents

base on monthly income. It can be seen from the above table

that majority of the respondents (80) which accounts to 44%

of the total respondents earns a monthly income between

N5,000 – N10,000, this is largely due to the fact that most

of the respondents are either housewives or petty traders,

48 of the respondents which accounts to 26% of the total

respondents earns a monthly income ranging between N11,000 –

N20,000, 15% of the respondents earns a monthly income

between N21,000 – N35,000, 8% earns a monthly income of

between N36,000 – N50,000, and only a few 13 respondents

which accounts to 7% of the total respondents earns a

monthly income of between N51,000 – above. Thus, this

largely explains the poor socio-economic status of women

which to a large extend determines the prevalence of infant

and maternal mortality.

Table 4.5: Distribution of Respondents by Number of Children

Number of Children Frequency Percentage (%)1 – 3 86 444 – 6 66 36None 32 17Total 184 100

108

Source: Field survey

Table 4.5: shows the distribution of respondents by

number of children. Thus, it can be seen from the table

above that 47% of the total respondents have a number of

children that ranges between 1 – 3, this is due to the fact

that most of the respondents are at their early child

bearing, 66 of the respondents accounting to 36% of the

total respondents have a number of children ranging from 4 –

6, none of the respondents have children more than 6

children, and finally, 32 respondents which accounts to 17%

did not have any child or are yet to have children, probably

because they just had their first pregnancy and have not

delivered yet or have lost their child(ren).

Table 4.6: Distribution of Respondents by Years of Marriage

Years of Marriage Frequency Percentage (%)1 – 5 87 476 – 10 65 3511 – 15 20 1116 – above 12 7Total 184 100Source: Field survey

109

Table 4.6 shows the distribution of respondents by

years of marriage, thus form the above table, 47% of the

respondents have been married for about 1 – 5 years, 65

respondents which account for 35% have been married for

about 6 – 10 years, 11% of the total respondents have been

married for about 11 – 15 years, and on 7% of the total

respondents have been married for over 16years. Thus, the

number of years in marriage determines the number of

children a woman will/may have, and the more the number of

children with a corresponding low level of income may

increase the high prevalence of infant and maternal

mortality.

Table 4.7: Distribution of Respondents on the Age they gotMarried

Age Range Frequency Percentage (%)18 – 24 116 6325 – 30 56 3031 – 35 7 4

110

36 – above 5 3Total 184 100Source: Field survey

The table above also shows the distribution of

respondents on the age they got married, table 4.7: shows

that 116 respondents which represents a whopping 63%

accounts for those that got married between ages 18 – 24,

30% of the respondents got married between ages 25 – 30, 4%

of the respondents got married between ages 31 – 35, and

only 3% of the respondents got married between the ages of

36 – above. Thus, it can be seen that those that got married

between ages 18 – 24 has the highest number of respondent

(63%), this is largely because in Nigeria and other parts of

the country, the more conventional age of getting married

lies between that range, however, the early an individual

gets married, the more number of children he may have and

vice versa. Also, the situation can be explained because a

considerable number of the respondents have only a secondary

level of education, and this may push them into early

marriage between the age range of 18 – 24.

111

Table 4.8: Distribution of Respondents on the Number ofChildren lost during or after delivery

Number of Children Frequency Percentage (%)1 40 222 10 5Non 134 73Total 184 100Source: Field survey

Lastly in the table above, there is the distribution of

respondents on the number of children lost during or after

delivery. The table shows that 22% of the respondents have

lost a child during or after delivery, 5% have lost two

children during or after delivery, and whopping 73% have

lost none of their child or children during birth or after

delivery. This is largely due to the fact that most of the

respondents are educated up to tertiary level, and a quite

number of them are civil servants or business women who earn

a considerable high income monthly.

4.3 QUESTIONS ON INFANT AND MATERNAL MORTALITY

This section analyses all the questions on infant and

maternal mortality asked and the responses of the

112

respondents. The analysis of the data obtained is presented

below.

Infant mortality

Table 4.9: Infant/Children born in poor families are athigher risk of mortality than those in rich families.

Responses Frequency Percentage (%)Strongly Agree 89 48.4Agree 77 41.8Disagree 14 7.6Strongly Disagree 4 2.2Total 184 100Source: Field Survey

Table 4.9 above shows responses of respondents on the

question ‘infant/children born in a poor family are at a

higher risk of mortality than those from rich families’.

From the table, it can be seen that 48.4% which accounts for

89 of the total respondents strongly agree with the

statement or question, 41.8% agree, 7.6% of the total

respondents disagree, while 2.2% representing 4 of the total

number of respondents strongly disagreeing. Thus, to a large

extent, it can be said that infant/children born in a poor

family are at a higher risk of mortality than those born in

113

well-to-do families or rich families, this is because a

considerable number of the total respondents either strongly

agree or agree to this fact.

Table 4.10: Socio-economic status of parents influencesaccess to health care and infant/child nutrition.

Responses Frequency Percentage (%)Strongly Agree 112 61Agree 64 35Disagree 8 4Total 184 100Source: Field survey

From table 4.10 above, it shows that most of the

respondents strongly agreed that there is a relationship

between socio-economic status of parents on infant/child

mortality as seen from the table above, 61% of the

respondents strongly agreed of this relationship, 64

respondents which account for 35% of the total respondents

agree of the relationship, as only 8% of the total

respondents disagree of this relationship and none of the

respondents strongly disagree of the relationship.

Thus from the table, it shows that a strong

relationship exist between socio-economic status of parents

114

on infant/child mortality especially in Jos North, this is

because a mothers income or socio-economic status determines

the kind of nutrition she gets during pregnancy and even

after delivery, it also informs a choice of quality health

care.

Table 4.11: Educational attainment of a mother determinesaccess and quality of health care her child(ren) get.

Responses Frequency Percentage (%)Strongly Agree 89 48.4Agree 42 22.8Disagree 29 15.8Strongly Disagree 24 13Total 184 100Source: Field survey

Table 4.11: shows that educational attainment of mother

determines access and quality health care delivery for her

child or children. From the table, it can be seen that 48.4%

of the total respondents strongly agreed that there is a

relationship between the educational attainment of mother

and quality health care delivery her child(ren), 42 of the

respondents (22.8%) agreed to this relationship, 15.8%

115

disagree to this relationship while 13% of the total

respondents strongly disagree to the relationship between

educational attainment of parents and quality health care

delivery.

Thus, it can also be seen from the table presented

above that a relatively strong relationship exist between

educational attainment of parents and health care delivery,

this is because educated parents are not ignorant, and are

likely to attain ante natal during pregnancy and post natal

care even after delivery, as can also be seen in table 4.1

above, most educated women has a good occupation and a

considerable amount of higher monthly income than those with

little or no form of education, thus, this determines access

to health care services. Educated parents also know what to

do and what not to do during pregnancy and are likely to

give their infant or young children a good nutrition and an

exclusive breast feeding compared to those with little or no

form of education whom may be ignorant of those things.

116

Table 4.12: A poor sanitary environment with non or poorsocial amenities increases the risk of infant/childillnesses and death.

Responses Frequency Percentage (%)Strongly Agree 53 28.8Agree 102 55.4Disagree 18 9.8Strongly Disagree 11 6Total 184 100Source: Field survey

Table 4.12 shows the responses, frequency and

percentages of respondents on the impact of environmental

conditions on infant/child illnesses and mortality. From the

table above, 28.8% of the respondents strongly agree that a

poor sanitary environment have a great impact on infant

health and mortality in Jos North, 102 respondents which

accounts for 55.4% of the total respondents Agree to the

impact of environmental conditions on infant and maternal

mortality, 9.8 percent of the respondents Disagree, while 6%

of the total respondents strongly disagree that that a poor

sanitary environment can increase the risk of infant/child

illnesses and death .

117

Thus from the above table, it can be seen that a quiet

number of the respondents either strongly agreed or agreed

to the fact that environmental conditions such as unhealthy

environment with no or little social amenities such as

potable drinking water, stagnated water which breeds

mosquitoes that in turn becomes a major cause of infant

morbidity and mortality.

Table 4.13: How effective is the service been rendered inthis hospital or health care centre with regards toantenatal, natal and post natal care?

Cost Frequency Percentage (%)Very Costly 38 20.7Costly 83 45.1Not Costly 63 34.2Total 184 100Source: Field survey

The above table 4.14: shows one of the findings of this

study, from the table, 20.7% of the total respondents

believe that the cost of service (ante-natal, natal and

post-natal care) in the private hospitals is very costly, 83

118

respondents which represents 45.1% of the total respondents

are of the view that the service is costly, while 63

respondents (34.2%) believed that the service is not costly.

Thus, from the table, it can be seen that those who said the

services been rendered in the private clinics of health care

centres are higher compared to those of the view that the

services are not costly.

Table 4.14: How will you rate the cost of service beenprovided in the hospital or health care centre?

Effectiveness Frequency Percentage (%)Very Effective 56 30Effective 97 53Not Costly 31 17Total 184 100Source: Field survey

Also, concerning the effectiveness of the service, 30%

of the respondents said the service rendered in the private

health care centres is very effective, 53% of the

respondents argued that the service is effective, while 31

respondents (17%) are of the view that the service is not

effective. However, generally, it can be seen that a

significant number of respondents are of the view that the

119

service is either very effective or effective, this may be

due to the fact that the cost of service is high which may

correspond to the effectiveness of the service been

rendered, another explanation to this may be that the

questionnaires were only distributed in private health care

centres whose services over the years have been effective

but costly.

Maternal Mortality

Table 4.15: Women from poor families are at a high riskof mortality during pregnancy, child birth and afterdelivery.

Responses Frequency Percentage (%)Strongly Agree 104 56.5Agree 73 39.7Disagree 7 3.8Total 184 100Source: Field survey

From the table above, 104 of the total respondents

strongly agree to the fact that women from poor families are

at a high risk of mortality during pregnancy, child birth

and after delivery, 39.7% of the respondents agreed to this

fact, 3.8& disagree while none of the respondents strongly

disagreed. Thus, this indicates that most of the respondents

120

strongly agree or agreed to the fact that women from poor

families are at a high risk of mortality during pregnancy,

child birth and after delivery.

Table 4.16: Mother’s socio-economic status is likely goingto determine the kind of health care and nutrition she getsduring pregnancy and after delivery.

Responses Frequency Percentage (%)Strongly Agree 115 62.5Agree 61 33.2Disagree 8 4.3Total 184 100Source: Field survey

Table 4.16 shows the response, frequency and percentage

of respondents. 62.5% of the respondents strongly agree that

mother’s socio-economic status is likely going to determine

the kind of health care and nutrition she gets during

pregnancy and after delivery, 33.2% of the total respondents

agree, 8 of the total respondents which accounts for 4.3%

disagree while none of the respondents strongly agreed to

this fact. The above table thereby indicates that mothers

socio-economic status largely determine the kind of health

care and nutrition she gets during pregnancy and after

delivery.

121

Table 4.17: Educational Attainment of a mother is morelikely going to influence her decision to seek properhealth care during pregnancy, child birth and afterdelivery.

Responses Frequency Percentage (%)Strongly Agree 111 60Agree 70 38Disagree 2 1Strongly Disagree 1 1Total 184 100Source: Field survey

Table 4.17 above shows that educational attainment of a

mother is more likely going to influence her decision to

seek proper health care during pregnancy, child birth and

after delivery. This is because 111 of the total respondents

(60%) strongly agree to this fact, 38% of the respondents

agree, 1% of the respondents disagreed as well as 1%

strongly disagreed to this fact.

Table 4.18: A dirty or poor sanitary environment with non orpoor social amenities increases the high risk of maternalillness and death.

122

Responses Frequency Percentage (%)Strongly Agree 93 50.5Agree 87 47.3Disagree 4 2.2Total 184 100Source: Field survey

The above table shows that 50.5% of the total

respondents strongly agreed that a dirty or poor sanitary

environment with non or poor social amenities increases the

high risk of maternal morbidity and mortality, 87

respondents which represents 47.3% of the total respondents

agree, 2.2% disagree while none of the respondents strongly

disagreed.

Thus, this indicates that a dirty or poor sanitary

environment with non or poor social amenities increases the

high risk of maternal morbidity and mortality, some of the

social amenities may include clean and potable drinking

water, and a clean environment free of stagnant water.

Table 4.19: Women awareness and empowerment and animprovement in their living standard will reduce the highrisk or prevalence of infant and maternal mortality.

Responses Frequency Percentage (%)Strongly Agree 162 88

123

Agree 22 12Total 184 100Source: Field survey

In table 4.19, most of the respondents (88%) strongly

agreed that women awareness and an improvement in their

living standard will reduce the high risk or prevalence of

infant and maternal mortality, 12% of the respondents agreed

and none of the respondents either disagree or strongly

disagree. Thus this indicates that the high risk and

prevalence of infant and maternal mortality can be reduced

to the barest minimum only if women awareness and

empowerment and an improvement in their living standard is

ensured.

Thus, the above shows that women awareness and

empowerment and also an improvement in their living standard

will reduce the high risk or prevalence of infant and

maternal mortality.

Table 4.20: A clean and healthy environment with theprovision of basic social amenities will ensure safetyinfanthood and motherhood.

Responses Frequency Percentage (%)Strongly Agree 107 58

124

Agree 73 40Disagree 4 2Total 184 100Source: Field survey

Table 4.20 shows that 58% of the respondent strongly

agreed that a clean and healthy environment with the

provision of basic social amenities will ensure safety

infanthood and motherhood, 40% of the respondents which

accounts for 73 of the total respondents agree to this fact,

2% of the total respondents disagree while none of the

respondents strongly disagreed. This means that, to ensure

safety infanthood and motherhood, a clean and healthy

environment must be ensured.

Solutions to the Problems Identified

This study was able to get some possible solutions to

the problems of infant and maternal mortality in Jos North

from the respondents, table 4.6 below provide some of the

possible solutions.

Table 4.21: Ways to reduce the causes and prevalence ofinfant and maternal mortality.

Responses Frequency Percentage (%)

125

Free ante-natal andpost-natal care

76 41.3

Women Empowermentand Education

59 32.1

Building of Newhealth care centresand training ofpersonnel

23 12.5

Provision of BasicSocial Amenities.

26 14.1

Total 184 100Source: Field survey

From the above table 4.21, 76 respondents which

represents 41.3% of the total respondents are of the opinion

that if ante-natal and post-natal care is been made free in

all hospitals and clinics, it will go a long way in reducing

the prevalence of infant and maternal mortality in Jos

North, 32.1% of the total respondents advocate for women

empowerment and education, 12.5% of the respondents believed

that building new health care centres and the training of

health personnel like midwives will go a long way in curbing

the prevalence of infant and maternal mortality in Jos

North, however, 26 respondents (14.1%) are of the view that

the provision of basic social amenities will reduce the much

cases of infant and maternal mortality.126

From the above, it can be seen that a significant

number of the respondents are of the view that infant and

maternal mortality can be reduced if both private and public

hospitals render such services free to enable all women have

access to it.

CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1 SUMMARY OF MAJOR FINDINGS

Infant and maternal mortality are one of the very dark

spots in Nigeria’s health profile. Major causes of death

among women in Nigeria are pregnancy-related. Information on

the extent to which women in Nigeria receive care during

pregnancy, during delivery, and a few weeks after delivery

presents a picture of the health care available to mothers

127

and the new born. Such care is also critical for the

survival and well-being of both mother and child.

The research work is carried out in Jos North Local

Government Area of Plateau State, it is aimed at looking at

health care delivery and the prevalence of infant and

maternal mortality in Nigeria, with this, the research

looked at the prevalence, factors, causes and possible

solutions of infant and maternal mortality.

The research finds out that most of the women or

respondent are either petty traders or housewives, hence

most of them have a monthly income of N5,000 – N10,000,

thus, this income is barely enough to enable them get

quality access to health care delivery and good nutrition

during pregnancy and after delivery, this in turn leave

their children malnourished and more prone to morbidity and

subsequent mortality.

In this study, it is seen that socio-economic status of

parents influence access to health care delivery and also

the type of nutrition a mother and her child get. This is

because of the cost involve in quality health care delivery

128

as argued by the respondents, thus it said that children

born in poor families are at high risk of morbidity and

mortality than those born in rich homes or families, also

mothers whose socio-economic status is high can afford the

basic nutrition needed during pregnancy and even after

delivery.

Another outstanding findings of this study is that the

educational attainment of a mother determines health care of

the mother and her child, this is because she is not

ignorant of what she ought to do during pregnancy and after

delivery. Educated mothers are more likely to visit the

hospital during pregnancy for ante natal, natal and post

natal care than those without any form of education. It is

also seen that the educational attainment of a mother to a

large extent determines her occupation and also her monthly

income. Therefore, the educational attainment of a mother is

a major factor in infant and maternal mortality.

Another finding of this study is that though the theirs

effectiveness in health care delivery, the cost implication

of such health care services is also high, thus most women

129

who are financially incapacitated prefer to deliver at home

than in the hospital, they only resort to the hospital when

there are complications during delivery and most of the time

becomes too late. However, the effectiveness and cost of

this health care services can be explained due to the fact

that the study centred in the private hospitals or health

care facilities.

Finally, this study was able to find out also the fact

that environmental factors also affects or influence infant

and maternal mortality. It is found out that a poor and

unhealthy environment with little or no access to social

amenities like potable drinking water will to a large extent

affect infant and maternal survival, this is because a dirty

and unhealthy environment is likely going to breed

mosquitoes, and malaria which is caused by mosquitoes have

been identified as one of the killer disease in

infant/children.

5.2 CONCLUSION

High infant and maternal mortality is a manifestation

of gross underdevelopment. Hence, permanent reduction

130

requires societal transformation. The prevalence of infant

and maternal mortality in Nigeria cannot be overemphasized,

hence this study is meant to help identify the causes and

factors responsible for infant and maternal mortality and

how those causes can be minimize to reduce the prevalent

cases of this menace which has become a national

embarrassment.

Infant and maternal mortality can be attributed to

factors such as educational, socio-economic and

environmental factors. This factors have been found to be

major causes of infant and maternal mortality in Jos North

and Nigeria in general, the study shows that most of the

women only have a secondary school certificate and most of

them are either housewives or petty traders, hence don’t

have the financial capacity to seek better health care

during pregnancy and after delivery and also cannot afford

the required nutrition needed for their children and

themselves after delivery.

Lack of access to available and better health care at a

cheaper rate have been identified as a factor that also

131

increases the high prevalence of infant and maternal

mortality in Nigeria. Women continue to become victims of

poor and dilapidated health facilities in the health care

centres that ordinary should have been created by any

responsible government, clean and healthy environment with

available of social amenities which ordinarily should be

provided by government has become an illusion, that is why a

women in Nigeria has 1-in-8 risk of dying in child birth or

from pregnancy related causes during her lifetime, which is

higher than the overall 1-in-22 risk for women in Sub

Saharan Africa.

The number of mothers in Nigeria who die in the cause

of pregnancy and childbirth is unacceptably high, as is the

number of infants born in Nigeria who do not live to their

first birthday. For the majority of these deaths, the

medical causes are well understood and there are effective

preventive strategies available. Urgent health system and

socio-economic interventions should therefore be put in

place to reduce maternal and infant mortality in Nigeria.

5.3 RECOMMENDATIONS

132

The following recommendations are derived from the

findings of this work and also from the responses of

respondents. The following are recommendation that if taken

into consideration, will reduce the prevalence of infant and

maternal mortality in Jos North and Nigeria at large.

i) Government should provide financial and technical

support for NGOs working on infant and maternal

mortality. Education programmes that stress the

prevention of infant and maternal mortality should be

introduced in schools, workplaces, churches/mosques,

and community groups.

ii) Women should be empowered economically in terms of

employment opportunities and also and material

empowerment to help them be able to seek quality

antenatal and post natal care during pregnancy and

after delivery.

iii) Both government and the NGOs should embark on media

campaigns using the print and electronic media to raise

awareness on the issues of infant and maternal

133

mortality, also public campaigns should be carried out

using posters, stickers, rallies and drama, etc.

iv) The Mother-Newborn-Child Continuum of care should be

adopted, this has to do with the core principle

underlying the strategies to develop maternal, newborn

and child care programmes. Care has to be provided as a

continuum throughout the lifecycle and in a seamless

continuum that spans the home, the community, the

health centre and the hospital. This will save lives of

many women, newborns and children.

v) There should be Increase effectiveness and utilization

of antenatal care, this is due to the importance of

Antenatal and post natal care which is a variable

package of screening (through clinical evaluation and

investigations) and treatment for pregnant women with

the prime objective of prevention, early detection and

treatment of complications in the mother and fetus, and

the ultimate goal of optimizing maternal and perinatal

health.

134

vi) It is however important to note that antennal and post

natal care as identified above should be made free of

charge in both private and public health care centres

and hospitals, and such services should also be

accessible to the general public or to all pregnant

women.

vii) Malaria in pregnancy is an important and critical

health concern in Sub-Saharan Africa, therefore, cost

effective interventions should be made available to

reduce the burden of malaria in pregnancy. Intense

public health education, advocacy and political will

are needed to scale up malaria in pregnancy.

viii) Government should provide a clean and healthy

environment, and also be able to provide basic social

amenities in all communities in country such as potable

drinking water, and also creating awareness on keeping

the environment clean and free from stagnated water

which may breed mosquitoes leading to other diseases.

ix) The presence of midwives and skilled birth attendant at

childbirths is a very effective intervention for

135

reducing maternal mortality and newborn mortality,

therefore, government should make a deliberate effort

in training and retraining of midwives and traditional

birth attendants which should be posted to every nook

and cranny of the country including rural areas for

effective delivery.

x) The need to address childhood and motherhood

malnutrition in a holistic sense, to positively affect

child and maternal survival and development as well as

eradicate childhood disease in a sustainable manner

cannot be overemphasized. Adequate childhood and

maternal nutrition should be seen as an outcome of

several related factors in the family, community and

society, not just a process in the child’s body. The

nutrition of the mother is also of utmost importance

for her

xi) If the 4th and 5th Millennium Development Goal are to be

attained and sustained, the structures on the

successful immunization programmes depend, chiefly the

primary health care system must be revitalized. There

136

is also a need to promote local research into the

demand-side of immunization services such as missed

opportunities, factors that affect uptake knowledge and

attitudes of community members to immunization.

xii) Maternal mortality cannot be reduced without some

degree of financial investment to bring the standard of

care to a minimum level. The issue of budgetary

allocation to health should be addressed. Strong

political will and commitment is required to sustain

the flow of financial resources in the long term.

xiii) A strong advocacy and awareness should be made on the

need for exclusive breastfeeding by mothers. Early

initiation and sustained exclusive breastfeeding are

proven, almost cost-free child survival strategies

whose benefits begin in the neonatal period and extend

well beyond infancy. Breastfeeding alone can save the

lives of thousands of babies.

137

REFERENCES

Alubo, S. O. (1985a). Underdevelopment and Health Care Crisis inNigeria. Medical Anthropology 9 (4): 319-335

Alubo, S. O. (1987). Power and Privileges in Medical Care: An Analysis of

Medical Care in Post-Colonial Nigeria. Social Science and

Medicine 24-5: 453-462138

Alubo, S. O (2010). In Sickness and in Health: Issues in the Sociology of

Health in Nigeria, University of Jos Inaugural Lecture

Series No. 41

Alubo, S. O, and Ibanga, A. (1994). Household Reactions to

Diarrhoea in Plateau State. Nigerian Journal of Pediatrics 21

(Suppl): 111-120

Alubo, S .O. and Franklin Vivekananda (1995). Beyond the

Illusion of Primary Health Care in an African Society, Stockholm:

Bethany Books.

Akpala, C. O. (1993). Perinatal Mortality in a Northern

Nigerian Rural Community”. Journal of the Royal Society for

Health 113(3).

Caldwell, J. C. (1979). Education as a Factor in Mortality Decline: An

Examination of Nigerian Data. Population Studies, 33(3),

395-413. http.//dx.doi.org/10.2307/2173888.

Erinosho, O. (1982). Health Planning in Nigeria, Nigerian

Journal of Sociology and Anthropology.

Espo, M. (2002). Infant Mortality and its Underlying Determinants of Rural

Malawi (Dissertation). University of Tampere Medical

School.

Federal Government of Nigeria. (1986). The National Policy and

Strategy to Achieve Health for All in Nigeria, Lagos Federal Ministry

of National Planning

139

Harrison, K. (1997). Maternal Mortality in Nigeria: The Real

Issues, African Journal of Reproductive Health, 1(1): 7-13.

HERFON. (2006). Nigeria Health Review 2006 Abuja: HERFON

Ibanga, U. A. (1992). Statistics for Social Sciences, Jos. Centre for

Development Studies University of Jos.

Jinadu, M. K., Olusi, S. O., Agun, J. I., & Fabiyi, A. K.

(1991). Childhood Diarrhoea in rural Nigeria:

Studies on Prevalence, Mortality and Socio-environmental

Factors. Journal of Diarrhoea Diseases Research, 9 (4), 323-327.

Koos, E. (1954). The Health of Regionville, What the people did about it,

New York: University Press

Mckeown, T. (1979). The Role of Medicine: Dream, Mirage or Nemesis New

Jersey: Princeton University Press.

Mutunga, C. J. (2007). Environmental Determinants of Child Mortality in

Kenya. UNU- WIDER Research Paper No. 2007/83. Helsinki:

United Nations University World Institute for

Development Economic Research.

NDHS. (2008). Nigerian Demographic and Health Survey.

Shiffman, J. (2007). Generating Political Priority for

Maternal Mortality Reduction in 5 Developing countries,

American Journal of Public Health 97(5): 796-803.

140

Strong, M. A. (1992). The Health of Adults in the Developing World: The

View from Bangladesh, Health Transition Review

2(2):215-224.

Starr, P. (1982), The Social Transformation of American Medicine, New

York: Basic Books

Turshen, M. (1977). The Political Ecology of Disease. Review of

Radical Political Economy 9(1): 45-60

UNICEF (2009). Maternal and Child Health: The Social Protection Dividends

in West and Central Africa, Briefing Paper/Social Policies,

UNICEF West and Central Africa Regional Office.

UNICEF. (2010). Levels and Trends in Child Mortality, Report 2010,

New York: UNICEF.

Wall, L. (1998). Death Mothers and Injured Wives: The Social Context of

Maternal Mortality in Northern Nigeria. Studies in Family

Planning.

Wildavsky, A. (1977). Doing Better and Feeling Worse: The Political

Pathology of Health Policy. P105-123 John Knowles (ed) Doing

Better and Feeling Worse New York: WW Nortion

William, G. H. (1984). The Determinant of Health: Structure, Context

and agency. School of Social Science, Cardiff University,

Wales.

World Bank. (2004). Health and Environment. Background paper for the

World Bank Environment Strategy, Washington, DC: World Bank.

141

World Health Organization. ( 2006). WHO Proposes Survival

For African Children. Retrieved from Wikipedia, the free

encyclopedia, 07/04/2010.

Yahya, M. (2007). Polio Vaccines – No, Thank you! Barriers to Polio

Eradication in Northern Nigeria. African Affairs.

APPENDIX A

QUESTIONNAIRE

Department ofSociology,

University of Jos,Nigeria

142

P.M.B. 2084,

Jos.

Dear Respondent,

I am a final year student of Sociology Department,

University of Jos, conducting a research on ‘healthcare

delivery and the prevalence of Infant and maternal mortality in Jos North

Local Government Area of Plateau State, Nigeria’. Your cooperation

in answering these questions is highly solicited. This

is purely an academic exercise; hence any information

given will be treated with utmost confidentiality and

respect.

Thanks for your cooperation.

Yours faithfully,

Nuhu, Kefas

Dalyop

143

SECTION A: SOCIO-DEMOGRAPHIC CHARACTERISTICS/BIO DATA

1. Age. A)18 – 24 ( ), B) 25 – 30 ( ), C) 31 – 35 (

), D) 36 – 40 ( ), E) 41 and above ( )

2. Level of education. A) Primary ( ), B) Secondary ( ),

C) Tertiary ( ), D) Non ( )

3. Occupation. A) Housewife ( ), B) Petty Trader ( )

C) Business woman ( ), D) Civil servant ( ), E)

Others ( )

4. Monthly Income. A) N5,000 – N10,000 ( ), B) N11,000 –

N20,000 ( ), C) N21,000 – N35,000 ( ), D) N36,000

– N50,000 ( ), E) N51,000 and above ( )

5. Number of children. A) 1 – 3 ( ), B) 4 – 6 ( ), C)

7 – 9 ( ), D) 10 and above ( ), E) None ( )

6. Years of marriage. A) 1 – 5 ( ), B) 6 – 10 ( ), C)

11 – 15 ( ), D) 16 and above ( )

7. At what age did you get married? A) 18 – 24 ( ), B)

25 – 30 ( ), C) 31 – 35 ( ), D) 36 – above

( )

8. How many children have you lost during birth or after

delivery? A) 1 ( ), B) 2 ( ), C) 3 ( ), D)

NON ( ), E) Others specify ( )

SECTION B:

144

INFANT/CHILD MORTALITY

9. Infants/children born in a poor family are at a higher

risk of mortality than those in rich families. A)

Strongly Agree ( ), B) Agree ( ), C) Neutral

( ), D) Disagree ( ), E) Strongly

Disagree ( )

10.Socio-economic status of parents influence access to

health care and infant/child nutrition. A) Strongly

Agree ( ), B) Agree ( ), C) Neutral ( ), D)

Disagree ( ), E) Strongly Disagree ( )

11.Educational attainment of determine access and quality of

health care her child(ren) get. A) Strongly Agree (

), B) Agree ( ), C) Neutral ( ), D) Disagree (

), E) Strongly Disagree ( )

12.A poor sanitary environment with non or poor social

amenities such as safe and potable water increases the

risk of infant/child illness and death. A) Strongly

Agree ( ), B) Agree ( ), C) Neutral ( ), D)

Disagree ( ), E) Strongly Disagree ( )

13.How effective is the services been rendered in this

hospital or health care centre with regards to Ante

natal, natal and post natal care. A) Very Effective (

), B) Effective ( ), C) Neutral ( ),

D) Not Effective ( )

14.How will you rate the cost of service been provided in

this hospital or health care centre. A) Very Costly (

145

), B) Costly ( ), C) Neutral ( ), D) Not Costly (

)

MATERNAL MORTALITY

15.Women from poor families are at a high risk of mortality

during pregnancy, child birth and after birth. A)

Strongly Agree ( ), B) Agree ( ), C) Neutral (

), D) Disagree ( ), E) Strongly Disagree ( )

16.Mother’s socio-economic status is likely going to

determine the kind of health care and nutrition she gets

during pregnancy and after delivery A) Strongly Agree (

), B) Disagree ( ), C) Neutral ( ), D) Disagree

( ), E) Strongly Disagree ( )

17.Educational attainment of a mother is more likely going

to influence her decision to seek proper health care

during pregnancy, child birth and after delivery. A)

Strongly Agree ( ), B) Agree ( ), C) Neutral (

), D) Disagree ( ), Strongly Disagree ( )

18.A dirty or poor sanitary environment with non or poor

social amenities such as safe and potable water increases

the high risk of maternal illness and death. A) Strongly

Agree ( ), B) Agree ( ), C) Neutral ( ), D)

Disagree ( ), E) Strongly Disagreed ( )

19.Women awareness and empowerment and an improvement in

their living standard will reduce the high risk or

prevalence of infant and maternal mortality? A) Strongly

146

Agree, ( ), B) Agree ( ), C) Neutral ( ), D)

Disagree ( ), E) Strongly Agree ( )

20.A clean and healthy environment with the provision of

basic social amenities such as clean and potable water

will ensure safety infanthood and motherhood. A) Strongly

Agree ( ), B) Agree ( ), C) Neutral ( ), D)

Disagree ( ), Strongly Disagree ( )

21.What in your own opinion are some of the ways to reduce

the causes and prevalence of infant and maternal

mortality?

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