ABSTRACT
Despite
concerted global efforts made towards infant-survival, infant death lingers as
a huge problem in developing countries. Environmental and personal-level
factors ranging from inadequacies of healthcare providers to poor support from
family members and poor practices by nursing mothers are assumed to have
accounted for this situation. This study aimed at considering predictors of
infant-survival practices among mothers whose infants attend paediatric clinics
in Ijebu-ode, Ogun state, Nigeria.
A
cross-sectional survey design was adopted. Data was collected from three
hundred and eighty-six nursing mothers attending paediatric clinics who were
selected through stratified sampling technique. Self-administered
questionnaires consisting of 38-items on demographic data, health-literacy
counsels and instructions received, social-support received, self-efficacy to
adhere to infant-survival instructions, and infant-survival practices were
developed for data collection. Responses from participants were transformed
into rating scales for each variable. Linear regression analysis was conducted
to give statistical responses to the research questions and hypotheses. Decision
rules for test of hypotheses were set at 5% level of significance.
Participants
had a mean age of 29.79±5.84years. Majority (81.6%) were married while 15.5%,
1.8%, 0.5% and 0.5% were single, separated widowed and divorced respectively.
Self-employed participants were 58.0%, 18.9% of them worked with either private
organisations or were civil servants while 14.8% were unemployed. Among
participants were 65.3% Christians, 31.6% Muslims and 3.1% traditional
believers. Although, 10.6% were Igbos, 3.1% were Hausas and 3.4% belonged to
other ethnic groups, participants were predominantly Yorubas (83.90%). Also,
42.5% of them had attained tertiary education, 42.5% had attained secondary
education, 9.6% had only primary education while 5.4% were uneducated.
One-third of respondents (33.4%) had more than two children, 34.5% had two
children and 32.1% had one child. It was also revealed that 11.90% of
participants had lost one or more infants at one point
in time before the survey was conducted. Participants had mean scores of 11.41±3.91 on level of
health-literacy counsels received which was measured on a 19-point rating
scale, 10.61± 3.67 on social-support received measured on a 17-point rating
scale, 16.61±4.56 on self-efficacy which was measured on a 24-point rating
scale, and 16.53±4.71 on self-reported infant-survival practices measured on a
21-point rating scale. The study found a significant relationshipbetween health-literacy and infant-survival
practices (R=0.320; R2=0.102; P˂0.05), and between social-support
received and infant-survival practices (R=0.401; R2=0.161; P˂0.05).
Self-efficacy to adhere to infant-survival instructions was the major predictor
variable of self-reported infant-survival practices (R=4.66; R2=0.217;
P˂0.05).
The study concluded that
participants had average levels of health-literacy, social-support,
self-efficacy and infant-survival practices. It suggests that efforts be made
by health care providers to instruct pregnant women and strengthen them on
activities required for the survival of their infants. Family members of
nursing mothers should also be informed about the benefits of giving support to
them.
CHAPTER ONE
INTRODUCTION
1.1 Background to
the Study
Global deaths among
infants recorded for a period of four years from 2012 to 2015 showed a marginal
improvement towards achieving the target for the Millennium Development
Goal-four with records of 35 to 32 deaths out of 1,000 live births (United
Nations Inter-Agency Group, 2015). In spite of efforts made towards
infant-survival all over the world, recent data on infant mortality shows a
rate of 56 deaths for every 1,000 births in regions in Africa. This is in
contrast to other regions such as East-Asia with 14 deaths per 1,000 live
births and the Middle East with 20 deaths for every 1,000 live births (Bado
& Appunni, 2015).
In 1990, the
Millennium Development Goal-four was initiated as part of the eight millennium
goals with the aim of reducing child and infant mortality by two-thirds between
1990 and 2015 (Adegboye, Kotze, Adegboye, 2014; Diallo, Meda, Sommerfelt,
Traore, Cousens & Tylleskar, 2012). Reports have given the global
percentage reduction in infant and child mortality to be 53% over the 15-year
goal which was aimed at 75% reduction (Murray,
Wang, Fullman, Lopez & Murray, 2015). Also, in 2015, countries in
Sub-Saharan Africa recorded an achievement of 52% of the 75% target and remain
major contributors to the global mortality burden of infants (Adedini,
Odimegwu, Imasiku, Ononokpono & Ibisomi, 2015). This shows that the goal
was not attained. Recent data on infant mortality in Nigeria shows a prevalence
of 69 deaths per 1,000 live births which has ranked the country as one of the
top ten nations in infant mortality (Ezeh, Agho, Dibley, Hall & Page,
2015).
Infant death
lingers as a huge problem in developing countries (Fehling, Nelson, Ahn, Eckardt,
Tiernan, Purcell et al, 2013). In
June 2012, more than 80 countries represented by government officials, partners
from private sectors, civil societies, and religious organizations gathered for
the Child-Survival Call to Action. The forum was convened by the governments of
Ethiopia, India, and the United States, in collaboration with the United
Nations Children’s Fund (UNICEF) and challenged the world to lessen infant and
child mortality to 20 or lesser deaths per 1,000 live births in every country
by 2035 (Koffi, Mleme, Nsona, Banda, Amouzou & Kalter, 2015). Beyond the
challenges of establishing infant-survival in developing countries are
underlying reasons why these conditionscontinue to constitute the challenge (Chatterjee
& Paily, 2011) and these are the essential issues of concern.
A vast number of
studies have identified certain factors that put infants at risk of mortality.
Infections, vaccine-preventable diseases, nutritional inadequacies, sanitation
challenges and health status of the mother during pregnancy have been
documented (Cheraghi, Poorolajal, Hazavehi & Rezapur-Shahkolai, 2014;
Jarso, Workicho & Alemseged, 2015). Other factors contributory to infant
mortality from investigations include poor antenatal planning of mothers, poor
service provision by healthcare service providers, inadequate birthing
practices of care-givers and poor health-information dissemination to mothers
of infants (Atulomah & Atulomah, 2015). If these factors are not critically
attended to, infant mortality will continue to be an issue without lasting
solutions (Joshi, Sharma & Teijlingen, 2013).
Some of the requirements
of mothers include skill-building in preparation for enhancing the survival of
their infants, getting skills that will strengthen them to take their infants
for immunisation (Oyo-Ita, Wiysonge, Oringanje, Nwachukwu, Oduwole &
Meremikwu, 2016), practicing exclusive breastfeeding, imbibing positive
sanitary habits and preventing cases of diarrhoea and malaria (Fadnes, Engebretsen,
Moland, Nankunda, Tumwine & Tylleskär, 2010). These should be essential
components of health-literacy instructions communicatedto mothers of infants during
antenatal care sessions.
Also, behaviour-change
in mothers of infants to enhance their self-efficacy in ensuring that they
carry-out activities that will ascertain the survival of their infants will be as
a result of comprehensible health-instructions (Elder, Pequegnat, Ahmed,
Bachman, Bullock, Carlo et al, 2014).
Furthermore, programs with innovative approaches to engage key influencers such
as fathers and other family members around the mother to provide positive
social-support for her could be more successful in changing her behaviour to
improve maternal and infant care (Altrena, Martin, Egondi, Bingham and
Thuita,2016).
Infants are a group
of individuals who have neither control over themselves nor the power to cater
or care for themselves. They are delicate subgroup of a population. Their
survival is a fundamental pointer to the level of maternal and child health,
therefore, investigating their well-being is an investment for the development
of any nation (Sathiyasusuman & Hamisi, 2012).
1.2 Statement of the
Problem
About 353,000
births are reported to occur daily around the world, yet, infants are exposed
to the risk of mortality as these births occur (Ayele, Zewotir & Mwambi,
2016). One main challenge in attaining the target reduction in infant death is
that most infant health programs do not get to the mothers through tangible
programs (Lassi, Middleton, Crowther & Bhutta, 2015).
Few studies have
recognised components leading to lack of infant care and poor survival of
infants. Issues involving the personal-level predisposition of mothers stem
from factors such as health-literacy instructions and counsels communicated to
mothers at antenatal sessions. Most of these counsels have either not been
strategically delivered to mothers or have not been adequately delivered to
them in ways by which they are empowered, encouraged and willing to ensure the
survival of their infants (Lu & Johnson, 2014; Owor, Matovu, Murokora,
Wanyenze & Waiswa, 2010; Rosato, Lewycka, Mwansambo, Kazembe, Phiri &
Chapota, 2014).
Also,
environmental-level factors have posed a challenge in ensuring infant-survival.
Such deficienciescome from lack of social-support from family members and
significant others in the lives of nursing mothers. Nursing mothers should
receive reinforcements in terms of encouragements to carry-out instructions
received for infant care, positive advises and assistancefrom those around them
in order to enable them carry-out activities that will strengthen the survival
chances of their infants (Fry-Bowers, Maliski, Lewis, Connell & DiMatteo,
2014).
Mothers should
receive health instructions and counsels during preconception and antenatal
periods, and support in the many ways they will require assistance in order to
practice skills that will prolong the lives of infants (Berglund &
Lindmark, 2016; McInnes, Hoddinott, Britten, Darwent & Craig, 2013). If
they are not adequately equipped with skills regarding what to do during the
period preceding delivery, after delivery and how to respond to emerging situations
that threaten the lives of their infants, they will be weak in ensuring the
survival of their infants.It will therefore be of immense benefit to
investigate into how these personal and environmental-level factors can
collectively be predictors of infant-survival practices among mothers.The aim
of this study was to consider the predictors of infant-survival practices among
mothers whose infants attend paediatric clinics in Ijebu-ode, Ogun state,
Nigeria.
1.3 Objective of
the Study
The main objective
of this study is to assess factors associated with self-reported infant-survival
practices among mothers with infants attending paediatric clinics in Ijebu-Ode,
Ogun state, Nigeria. The specific objectives are to:
1.
assess the level of personal-level predisposing factors (health-literacy
and demographic characteristics)of the respondents;
2.
measure the level of environmental-level reinforcing factors in terms of
social-support received by respondents from significant others in ensuring
infant-survival;
3.
assess the level of personal-level enabling factors in terms of
self-efficacy to adhere to infant-survival instructions received among
respondents;
4.
measure the level of self-reported infant-survival practices among respondents;
5.
determine if there is a relationship between personal-level predisposing
factors (health-literacy and demographic characteristics) and self-reported
infant-survival practices among respondents;
6.
determine if there is a relationship between environmental-level
reinforcing factors in terms of social-support received by respondents and their
self-reported infant-survival practices;
7.
determine if there will be an association between personal-level
enabling factors in terms of self-efficacy to adhere to infant-survival
instructions received and self-reported infant-survival practices among the
respondents and
8.
identify which of these personal and environmental-level factors will
predict infant-survival practices most significantly among the respondents.
1.4 Research
Questions
The questions for
this research are as follows:
1.
What is the level of personal-level predisposing factors (health-literacy
and demographic characteristics)of the respondents?
2.
What is the level of environmental-level reinforcing factors in terms of
social-support received by respondents from significant others in ensuring
infant-survival?
3.
What is the level of personal-level enabling factors in terms ofself-efficacy
toadhere to infant-survivalinstructions received among respondents?
4.
What is the level of self-reported infant-survival practices among respondents?
5.
Is there a relationship between the personal-level predisposing factors (health-literacy
and demographic characteristics) and self-reported infant-survival practices
among respondents?
6.
Is there a relationship betweenenvironmental-level reinforcing factors
in terms of social-support received byrespondents and their self-reported infant-survival
practices?
7.
Will there be an association between personal-level enabling factors in
terms of self-efficacy to adhere to infant-survival instructions received andself-reported
infant-survival practices among respondents?
8.
Which of these personal and environmental-level factorswill predictself-reported
infant-survival practices most significantly among respondents?
1.5 Justification for the Study
To reduce infant mortality, previous
investigations have recognized the need for effective behaviour-change
interventions targeting mothers (Elder, Pequegnat, Ahmed, Bachman, Bullock,
Carlo et al, 2014). Past studies have
indicated that behaviour-change on the part of mothers is critical in averting
infant death and improving child development (Fishbein, Bandura, Triandis,
Kanfer, Becker, & Middlestadt, 1992; Sulzer-Azaroff & Mayer, 1992).
However,
behaviour-change approaches should focus on improving information and
comprehension of it towards mothers in order to enhance infant care (McInnes,
Hoddinott, Britten, Darwent & Craig, 2013).
A number of studies
have suggested that health-literacy, social-support and self-efficacy may play
significant roles as personal and environmental-level predictors of
infant-survival practices (Fry-Bowers, Maliski, Lewis, Connell & DiMatteo,
2014; Lars, Engebretsen, Moland, Nankunda, Tumwine & Tylleskär, 2010).
However, these studies did not apply behaviour-change theories, hence, they did
not provide the needed empirical evidence to support their claims. Most of
these studies did not also link health-literacy, social-support and
self-efficacy together as a combination of components that will improve and
predict infant-survival practices of mothers.
In this study, an
ecological model was adapted to assess the personal and environmental-level
factors affecting infant-survival practices. The PRECEDE (Predisposing
Reinforcing and Enabling Construct in Educational/Environmental Diagnosis and
Evaluation) Model (Green, Kreuter, Deeds & Patridge, 1980) which suits the
diagnosis of concern was used as the conceptual guide to give the study an ecological
outlook. This study therefore investigated how health-literacy, social-support
and self-efficacy serve as collective predictors of infant-survival. The
outcomes derived will provide a conceptual understanding of determinants
essential in predicting infant-survival practices among mothers in paediatric
clinics. It may also lessen the rate of infant mortality in Ijebu-Ode, Ogun
State to rational extent and will therefore be extensively beneficial in
enhancing the health of infants in Nigeria as a nation.
1.6 Hypotheses
This study hypothesized the following:
1.
There
will be a significant relationship between personal-level predisposing factors
(health-literacy and demographic characteristics) and self-reported infant-survival
practices among respondents.
2.
There
will be a significant relationship between environmental-level reinforcing factors
in terms of social-support received and self-reported infant-survival practices
among respondents.
3.
There
will be a significant association between personal-level enabling factors in
terms of self-efficacy to adhere to infant-survival instructions received and
self-reported infant-survival practices among the respondents.
4.
One
of these personal and environmental-level factors will predict infant-survival practices
most significantly among the respondents.
1.7 Operational Definition of Terms
Health-Literacy
Nutbeam (2008), describes
health-literacy as the cognitive and social skills that determine the
motivation and ability of individuals to gain access to, comprehend and use
information in ways which promote and maintain health. In this study, it
involved the possession of health counsels and instructions by mothers of
infants and their ability to understand and carry-out these instructions for
the survival of their infants as received by healthcare providers.
Social-Support
Social-support is the perception and certainty that
one is cared for and can be measured as the availability of assistance or
degree to which a person is included into a social network (Nausheen, 2009).
Support can be emotional (encouragement or affection), informational (advice or
instruction) tangible (financial assistance, running errands), and
companionship (sense of belonging, presence of companions). In this study,
social-support included emotional-support, informational-support,
tangible-support and companionship from family members of nursing mothers.
Self-Efficacy
Self-efficacy is an individual
impression that focuses on a person’s absolute utilization of his or her
cognitive skill to produce beneficial outcomes (Htay, 2010). For this study,
self-efficacy was measured by self-responsibility, skills, abilities,
self-determination, confidence and willingness of the mothers to adhere to
infant-survival instructions and counsels.
Infant-Survival Practices
Infant-survival practices were described
as actions to support the existence of infants to keep to them without
disability, morbidity or anything that will lead to mortality beyond the age of
infancy (zero to two years). It also the ability of the nursing mothers to
carry-out practical actions regarding infant-survival.
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