Chapter One 1.1 Background To The Study

CHAPTER ONE
INTRODUCTION
1.1 Background to the study
Disparities in child health between and within countries have persisted and widened considerably
during the last few decades (Bryce, 2016; Moser, 2015). The reduction of these disparities is a key
goal of most developing countries’ public health policies, as outlined in the Millennium
Development Goals 2015 (Lawn, 2017). It is well recognized that disparities in child health
outcomes may arise not only from differences in the characteristics of the families that children are
born into but also from differences in the socioeconomic attributes of the communities where they
live (Fotso and Kuate-Defo (2015) and Griffiths, 2014). Indeed, the incorporation of community-
level factors in the analysis of child mortality provides an opportunity to identify the health risks
associated with particular social structures and community ecologies, which is a key policy tool for
the development of public health interventions (Pickett and Pearl 2001; Stephenson, 2016)
Childhood mortality has remained a major challenge to public health amongst families in Nigeria
and other developing countries. The menace of incessant childhood mortality has been a major
concern and this calls for studies to generate new scientific evidence to determine its prevalence
and explore predisposing factors associated with it in Nigeria. The risk of a child dying before the
age of one was highest in the World Health Organization African Region (51 per 1000 live births),
which is over six times higher than that in the WHO European Region (8 per 1000 live births).
Although sub-Saharan African (SSA) countries have achieved remarkable improvement in infant
survival rates since the introduction of the Millennium Development Goals (MDGs), infant
mortality in SSA continues to be the highest among all global regions. Different socioeconomic
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factors are considered responsible for the high rate of infant mortality in developing countries; the
most commonly sighted factors in previous studies have been the level of female education, per
capita income, general environmental cleanliness and expenditure on health, Worldwide, among
all maternal and child health indicators, infant mortality has been acknowledged as the one crucial
indicator that reflects the quality of the health care delivery system and progress of the country on
the health front. It has been 13 years since world leaders committed to Millennium Development
Goal-4, which sets out to reduce the under-five mortality rate by two-thirds between 1990 and
2015. Findings of a report released by the United Nation has estimated global infant mortality to be
37/1000 live births in 2011, amidst all the universal efforts and strengthening of the health care
infrastructure.(Moser, 2015).
Death of an infant is an event that is essentially preventable in current global scenario and results
mainly because of the socio-demographic profile of the community and deficiencies in the health
policies/healthcare delivery system. A wide range of heterogeneous parameters such as male child,
black race, young maternal age, low Apgar score, low birth weight, high parity, high birth order,
short inter-pregnancy interval, home delivery, unskilled delivery, social inequalities and inequities,
financial restraints, lack of quality antenatal care, access to healthcare services (diagnostic and
therapeutic) or trained and skilled health professionals, exclusive breastfeeding, inadequate
immunization, infections – diarrhea and acute respiratory tract infections, hand washing habits of
mothers with soap before preparation of food and feeding, and poor maternal education status have
been recognized as the potential risk determinants in the causation of infant mortality in different
settings. As already discussed, most of the potential determinants identified in the causation of
infant mortality are preventable and modifiable; nevertheless the scenario remains grim in
developing countries. (Moser, 2015). This is because of the obstacles that are prevalent either at
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the infrastructure level or at the community level such as healthcare delivery system (viz.
inequitable distribution of facilities, weak primary healthcare set-up, poor quality of offered
services, non-existing referral services, logistics barriers, timings of the government health
facilities, waiting time at the health center, and overburdened healthcare facilities), healthcare
personnel's (viz. scarcity in the number of healthcare professionals, untrained or questionable
training status of the staff, attitude of health workers towards community), and community
members (viz. local beliefs-customs-practices, poor knowledge, education status, not adopting any
contraceptive measures, and lack of affordability) as a result of which the maternal and child
health welfare services have not achieved the desired results. (Moser, 2015).
To counter the public health problem of infant mortality, solution exists in the essence to formulate
a comprehensive evidence-based policy based on the identified potential risk factors and/or
barriers. Additional strategies like sustained political commitment, involvement of the community,
supervision and monitoring of the health workers, strengthening of existing infrastructure, rapid
expansion of healthcare facilities, partnerships with non-governmental organization and
community-based organizations, collaboration with private sector physicians, quality-assured
antenatal care, advocating institutional delivery, training of healthcare staff in different aspects of
newborn care, ensuring universal immunization, increasing awareness among the outreach
workers/mothers about myths and misconceptions associated with pregnancy and infant
care/danger signals in newborn requiring immediate referral/importance of maintaining hand
hygiene/exclusive breastfeeding, and establishment of functional referral system, if implemented,
can reduce a major proportion of infant deaths. To conclude, planned implementation
supplemented with continuous monitoring and timely evaluation of the public health interventions
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at primary healthcare level can bridge the existing gap and thus the burden of infant mortality.
(Moser, 2015).
1.2 Statement of the problem
Looking at the society today the rate at which infant mortality is affecting the society is highly
demanding, the child tends to die before their age limit due to one or two causes of the child. The
health system in Nigeria centralized and rely on hospitals and government health centers, but
witnessing the reality of the health sector of the worsening deficit quantitative and qualitative
aspects of the physical and human resources is reflected in turn in determining access to health
services, in a result of this decline in the provision of health services, one of the major challenge of
public health is the inadequate of facility, the absent or lack of professional hospitalist and the poor
maintenance equipment used for reducing infant mortality rate.
The effects on the health and safety of individuals, which increased cases of illness and injury and
deprivation of basic options in the field of human development, and could lead to setbacks
catastrophic individuals, including death, and the death of man in general , which means the
erosion and the end of human capital investor in particular, mortality rate of children under five
years of age, despite the decline in this rate, but the decline was modest and did not accompany the
slow improvement continues as to decrease this rate requires more progress in the health, social
and economic and cultural center of the country addition to the decline in the level of service
provided in hospitals and health centers. In light of the above this problems triggers the
researchers attention to find out the role of public health in the prevention of infant mortality rate.
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1.3 Objectives of the study
The study focus on the role of Public health in the prevention of Infant mortality Rate in Jema’a
Local Government Area of Kaduna State
The specific objectives of the study are:
1. To Identify the causes leading to the death of children in Jema’a Local Government Area of
Kaduna state
2. To determine the role of Public Health Services providers on the community of Jema’a in
curtailing the rate of infant Mortality.
3. To examine propose solutions to lower the rate of infant mortality among children in Jema’a
Local Government Area of Kaduna state.
1.4 Research Questions
The following research questions are formulated to guide the study;
1. What are the causes leading to the death of children in Jema’a Local Government Area of
Kaduna state?
2. What are the role played by Public Health Services providers on the community of Jema’a in
curtailing the rate of infant Mortality?
3. What are the solutions in reducing the rate of infant mortality among children in Jema’a Local
Government Area of Kaduna state?
1.5 Significance of the study
The issue with regard to the role of public health on the prevention of infant mortality rate has
been stone on-turn in some community, this study will pave a way for researchers, Public health
workers and students being the beneficiaries to have ease access to information as to regard to the
effect of infant rate on the children in the school and community at large
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The Public Health Workers:
The study will be of profound importance to the health workers as it will serve as a gate way in
dealing with the challenges of infant mortality among children and also serve as a useful material
for individual consumption.
The researchers:
The researchers will benefit from this study as it will pave a way for them to further carry out
different research on the same or similar research and it will serve as a material for them to get
easy access of information.
The Students:
The student are not left out they will also benefit from this study in such a sense that they will have
more vast idea on the implication of infant mortality and the predicament concerning the ignorance
behind the scene.
1.6 Scope and limitation of the study
The scope of the study is on the role of public health in the prevention of infant mortality Rate in
Jema’a Local Government Area of Kaduna state. The study is limited to some selected
communities in Jema’a Local government area of Kaduna state. due to time frame the researcher
delimited himself to six (6) such as Gidan way community, Godogodo community, Anguwan
mailafiya community, Kanufi Community, Denji community and Nimbia communities which are
situated in Jema’a Local Government Area of Kaduna state
1.7 Operational definition of key terms
Role: A role is a set of connected behaviors, rights, obligations, beliefs, and norms as
conceptualized by people in a social situation. It is an expected or free or continuously
changing behavior and may have a given individual social status or social position.
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Public Health: "The science and art of preventing disease”, prolonging life and improving quality
of life through organized efforts and
Prevention: The act of avoidance, the act of preventing or hindering. How to use prevention in a
sentence.
Rate: The level at which certain occurrence, a measure, quantity, typically one measured against
another quantity or measure.
Infant: Use to descript young offspring, a child usually from 1-5 years
Mortality: The number of deaths in a particular population, scaled to the size of that population,
per unit of time
Infant mortality: The death of an infant before his or her first birthday
Infant mortality rate: The death of an infant with alarming number of death in limited time
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CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
The study will review the role o public health in the prevention of infant mortality rate the chapter
outline the conceptual framework, theoretical frame work linking the theory with infant mortality
and the empirical studies reviewing other work that might have been carried out related to the
present study.
2.2 Conceptual framework
2.2.1 Concept of Infant Mortality
Infant mortality is the death of young children under the age of 1. This death toll is measured by
the infant mortality rate (IMR), which is the probability of deaths of children under one year of age
per 1000 live births. The under-five mortality rate, which is referred to as the child mortality rate,
is also an important statistic, considering the infant mortality rate focuses only on children under
one year of age. In 2013, the leading cause of infant mortality in the United States was birth
defects. Other leading causes of infant mortality include birth asphyxia, pneumonia, congenital
malformations, term birth complications such as abnormal presentation of the fetus umbilical cord
prolapse, or prolonged labor, neonatal infection, diarrhea, malaria, measles and malnutrition. One
of the most common preventable causes of infant mortality is smoking during pregnancy. Lack of
prenatal care, alcohol consumption during pregnancy, and drug use also cause complications
which may result in infant mortality. Many environmental factors contribute to infant mortality,
such as the mother's level of education, environmental conditions, and political and medical
infrastructure. Improving sanitation, access to clean drinking water, immunization against
infectious diseases, and other public health measures can help reduce high rates of infant mortality.
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In 1990, 8.8 million infants younger than 1 year died globally Until 2015, this number has almost
halved to 4.6 million infant deaths. Over the same period, the infant mortality rate declined from
65 deaths per 1,000 live births to 29 deaths per 1,000. Globally, 5.4 million children died before
their fifth birthday in 2017. In 1990, the number of child deaths was 12.6 million. More than 60%
of these deaths are seen as being avoidable with low-cost measures such as continuous breast-
feeding, vaccinations and improved nutrition. The child mortality rate, but not the infant mortality
rate, was an indicator used to monitor progress towards the Fourth Goal of the Millennium
Development Goals of the United Nations for the year 2015. A reduction of the child mortality is
now a target in the Sustainable Development Goals—Goal Number 3: Ensure healthy lives and
promote well-being for all at all ages. Throughout the world, infant mortality rate (IMR) fluctuates
drastically, and according to Biotechnology and Health Sciences, education and life expectancy in
the country is the leading indicator of IMR. This study was conducted across 135 countries over
the course of 11 years, with the continent of Africa having the highest infant mortality rate of any
region studied with 68 deaths per 1,000 live births
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2.2.2 Concept of Public Health
The relationship between the infant and child mortality environment and human fertility has been
of considerable interest to social scientists primarily for two reasons: (1) The fertility and mortality
processes are the driving forces governing population change, so an understanding of the way they
are linked is crucial for the design of policies that attempt to influence the course of population
change. (2) The “demographic transition,” the change from a high fertility-high infant and child
mortality environment to a low fertility-low mortality environment, which has occurred in all
developed countries, has been conjectured to result from the fertility response to the improved
survival chances of offspring. Fundamental to either of these motivations is an understanding of
the micro foundations of fertility behavior in environments where there is significant infant and
child mortality risk. My purpose in this chapter is to clarify and summarize the current state of
knowledge. To that end, I survey and critically assess three decades of research that has sought to
understand and quantify the impact of infant and child mortality risk on childbearing behavior. To
do so requires the explication of theory, estimation methodology, and empirical findings.
2.3 Role of Public Health on Infant Mortality
Public health promotes the welfare of the entire population, ensures its security and protects it
from the spread of infectious disease and environmental hazards, and helps to ensure access to safe
and quality care to benefit the population. The earlier an infant is born, the more likely they are to
need intensive care and a long hospital stay, with higher medical costs. Premature infants are also
more likely to have lifelong health problems, like cerebral palsy, developmental delays, chronic
lung disease, and vision problems. Public health is one of the greatest things in which a
government can invest. Early prevention, which is relatively inexpensive, can prevent dire and
expensive health care problems later in life. Early in their development, both Minnesota and the
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United States recognized the role of the government in protecting the public's health, and each
entity makes reference to this in their constitutions as part of a "general welfare" clause. Public
health promotes the welfare of the entire population, ensures its security and protects it from the
spread of infectious disease and environmental hazards, and helps to ensure access to safe and
quality care to benefit the population. Governmental responsibilities for public health extend
beyond voluntary activities and services to include additional authorities such as quarantine,
mandatory immunization laws, and regulatory authorities. The state's partnership functions by
encouraging residents to do things that benefit their health (e.g., physical activity) or create
conditions to promote good health, and requiring certain actions (e.g., food safety). About 1 in 10
infants is born prematurely in the United States. The rate of preterm birth among African
American women is about 50% higher than that of white women, and infant death rates related to
preterm birth are about twice as high for black infants than for white infants. Some chronic
conditions—including high blood pressure and diabetes—increase the risk of preterm birth, and
the rates of these conditions in US women of reproductive age are increasing. CDC’s National
Center for Chronic Disease Prevention and Health Promotion works to prevent and control these
conditions among women of reproductive age through its nutrition, physical activity, and obesity
programs; its diabetes program; and its heart disease and stroke program. A key part of this work is
the effort to reduce health disparities, which are differences in health across different geographic,
racial, ethnic, and socioeconomic groups.
1. Assure an Adequate Local Public Health Infrastructure
Assuring an adequate local public health infrastructure means maintaining the basic capacities
foundational to a well-functioning public health system such as data analysis and utilization; health
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planning; partnership development and community mobilization; policy development, analysis and
decision support; communication; and public health research, evaluation and quality improvement.
2. Promote Healthy Communities and Healthy Behavior
Promoting healthy communities and healthy behaviors means activities that improve health in a
population, such as investing in healthy families; engaging communities to change policy, systems
or environments to promote positive health or prevent adverse health; providing information and
education about healthy communities or population health status; and addressing issues of health
equity, health disparities, and the social determinants of health.
3. Prevent the Spread of Communicable Disease
Preventing the spread of infectious disease means preventing diseases that are caused by infectious
agents, such as by detecting acute infectious diseases, assuring the reporting of infectious diseases,
preventing the transmission of disease, and implementing control measures during infectious
disease outbreaks.
4. Protect Against Environmental Health Hazards
Protecting against environmental health hazards means addressing aspects of the environment that
pose risks to human health, such as monitoring air and water quality, developing policies and
programs to reduce exposure to environmental health risks and promote healthy environments, and
identifying and mitigating environmental risks such as food borne and waterborne diseases,
radiation, occupational health hazards, and public health nuisances.
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5. Prepare and Respond To Emergencies
Preparing and responding to emergencies means engaging in activities that prepare public health
departments to respond to events and incidents and assist communities in recovery, such as
providing leadership for public health preparedness activities within a community; developing,
exercising and periodically reviewing response plans for public health threats; and developing and
maintaining a system of public health workforce readiness, deployment, and response.
6. Assure Health Services
Assuring health services means engaging in activities such as assessing the availability of health-
related services and health care providers in local communities; identifying gaps and barriers;
convening community partners to improve community health systems; and providing services
identified as priorities by the local assessment and planning process.
7. Encouraging women breast feeding
Breastfeeding is the best method for early infant feeding and the healthiest option for most mothers
and infants. Infants who are breastfed have reduced risks of ear and respiratory infections, asthma,
sudden infant death syndrome (SIDS), and obesity. In the United States, 84% of infants start out
being breastfed, but only 25% get solely breast milk until they are 6 months old, as recommended
by the American Academy of Pediatrics. Hospital practices in the first hours and days after birth
make the difference in whether and how long infants are breastfed. CDC works with partners to
help hospitals nationwide improve maternity care practices that support breastfeeding.
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8. Enlighten the parents on the importance of environmental hygiene
Two of the most important ways that parents can make their homes healthy and safe for their infant
are to make sure no one smokes in the home and that the infant has a safe sleep environment. To
keep the infant safe while sleeping (at night and during naps), parents and caregivers should:
 Place infants on their back at all sleep times, including naps and nighttime.
 Not allow infants to share their bed.
 Use a firm surface, such as a mattress in a safety-approved crib external icon, covered by a
fitted sheet.
 Remove all soft objects, such as pillows or loose bedding, in the sleep area.
2.4 The Causes of Infant Mortality Rate
Causes of infant mortality directly lead to the death. Environmental and social barriers prevent
access to basic medical resources and thus contribute to an increasing infant mortality rate; 99% of
infant deaths occur in developing countries, and 86% of these deaths are due to infections,
premature births, complications during delivery, and prenatal asphyxia and birth injuries. Greatest
percentage reduction of infant mortality occurs in countries that already have low rates of infant
mortality. Common causes are preventable with low-cost measures. In the United States, a primary
determinant of infant mortality risk is infant birth weight with lower birth weights increasing the
risk of infant mortality. The determinants of low birth weight include socio-economic,
psychological, behavioral and environmental factors.[
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1. Medicine and biology
Causes of infant mortality and deaths that are related to medical conditions include: low birth
weight, sudden infant death syndrome, malnutrition, congenital malformations, and infectious
diseases, low income for health care including neglected tropical diseases. The American
Academy of Pediatrics recommends that infants need multiple doses of vaccines such as
diphtheria-tetanus-acellular pertussis vaccine, Haemophilus influenzae type b (Hib) vaccine,
Hepatitis B (HepB) vaccine, inactivated polio vaccine (IPV), and pneumococcal vaccine (PCV).
Research was conducted by the Institute of Medicine's Immunization Safety Review Committee
concluded that there is no relationship between these vaccines and risk of SIDS in infants.
2. Premature birth
Premature, or preterm birth (PTB) is defined as birth before 37 weeks of gestation and can be
further sub-classified as extremely PTB (occurring at less than 28 weeks gestation), very preterm
birth (occurring between 28 and 32 weeks gestation), and moderate to late PTB (occurring from 32
through 36 weeks gestation). Lower gestational age increases the risk of infant mortality. Over the
last decade, prematurity has been the leading cause of worldwide mortality for neonates and
children under the age of five. The overall PTB mortality rate in 2010 was 11.1% (15 million
deaths) worldwide and was highest in low to middle income countries in sub-Saharan Africa and
south Asia (60% of all PTBs), compared with high income countries in Europe, or the United
States. Low income countries also have limited resources to care for the needs of preterm infants,
which increases the risk of infant mortality. The survival rate in these countries, for infants born
before 28 weeks of gestation is 10%, compared with a 90% survival rate in high income countries.
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Premature birth can be either spontaneous, or medically induced. The risk of spontaneous PTB
increases with "extremes of maternal age (both young and old), short interpregnancy interval,
multiple gestation, assisted reproductive technology, prior PTB, family history, substance abuse,
cigarette use, low maternal socioeconomic status, late or no prenatal care, low maternal
prepregnancy weight, bacterial vaginosis, periodontal disease, and poor pregnancy weight gain." [26]
Medically induced PTB are often conducted when continued pregnancy poses significant risks to
the mother, or fetus. The most common attributing factors for medically induced PTB include
preeclampsia, diabetes, maternal medical conditions, and fetal distress, or developmental
problems.[27] Despite these risk factors, the underlying causes of premature infant death are often
unknown and approximately 65% of all cases are not associated with any known risk factor.
Understanding the biological causes and predictors is important for identifying and preventing
premature birth and infant mortality. While the exact mechanisms responsible for inducing
premature birth are often unknown, many of the underlying risk factors are associated with
inflammation. Approximately "80% preterm births that occur at <1000 g or at <28 to 30 weeks of
gestation" have been associated with inflammation. Biomarkers of inflammation, including C-
reactive protein, ferritin, various interleukins, chemokines, cytokines, defensins and bacteria have
been shown to be associated with increased risks of infection or inflammation-related preterm
birth. Biological fluids have been utilized to analyze these markers in hopes of understand the
pathology of preterm birth, but are not always useful if not acquired at the appropriate gestational
time-frame. For example, biomarkers such as fibronectihn are accurate predictors of premature
birth at over 24 weeks gestation, but have a poor predictive values before then
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3. Sudden infant death syndrome
Sudden infant death syndrome (SIDS) is a syndrome where an infant dies in their sleep with no
reason behind it. Even with a complete autopsy, no one has been able to figure out what causes this
disease. This disease is more common in Western countries. So much so, the United States Center
for Disease Control reports Sudden Infant Death Syndrome to be the leading cause of death in
infants age 1 month to 1 year of life. Even though researchers are not sure what causes this disease,
they have discovered that it is healthier for babies to sleep on their backs instead of their stomachs.
This discovery saved many families from the tragedy that this disease causes. Scientists have also
discovered three causes within a model they created called "the contemporary triple risk model".
This model states that three conditions such as the mother smoking while pregnant, the age of the
infant, and stress referring to conditions such as overheating, prone sleeping, co-sleeping, and head
covering. In the early 1990s, it was argued immunizations could attribute to an increased risk of
Sudden Infant Death Syndrome; however, studies since then have proven otherwise and in fact
support the idea that vaccinations provide protective properties by reducing the risk of Sudden
Infant Death Syndrome.
4. Congenital malformations
Congenital malformations are birth defects that babies are born with, such as cleft lip and palate,
Down Syndrome, and heart defects. Some congenital malformations may be more likely when the
mother consumes alcohol, but can also be caused by genetics or unknown factors. Congenital
malformations have had a significant impact on infant mortality. Malnutrition and infectious
diseases were the main cause of death in more undeveloped countries. In the Caribbean and Latin
America, congenital malformations only accounted for 5% of infant deaths, while malnutrition and
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infectious diseases accounted for 7% to 27% of infants deaths in the 1980s. In more developed
countries such as the United States, there was a rise in infant deaths due to congenital
malformations. These birth defects were mostly due to heart and central nervous system problems.
In the 19th century, there was a decrease in the number of infant deaths from heart diseases. From
1979 to 1997, there was a 39% decline in infant mortality due to heart problems.
5. Low birth weight
Low birth weight makes up 60–80% of the infant mortality rate in developing countries. The New
England Journal of Medicine stated that "The lowest mortality rates occur among infants weighing
3,000 to 3,500 g (6.6 to 7.7 lb). For infants born weighing 2,500 g (5.5 lb) or less, the mortality
rate rapidly increases with decreasing weight, and most of the infants weighing 1,000 g (2.2 lb) or
less die. As compared with normal-birth-weight infants, those with low weight at birth are almost
40 times more likely to die in the neonatal period; for infants with very low weight at birth the
relative risk of neonatal death is almost 200 times greater." Infant mortality due to low birth weight
is usually a direct cause stemming from other medical complications such as preterm birth, poor
maternal nutritional status, lack of prenatal care, maternal sickness during pregnancy, and an
unhygienic home environments. Along with birth weight, period of gestation makes up the two
most important predictors of an infant's chances of survival and their overall health.
6. Malnutrition
Malnutrition or under nutrition is defined as inadequate intake of nourishment, such as proteins
and vitamins, which adversely affects the growth, energy and development of people all over the
world. It is especially prevalent in women and infants under 5 who live in developing countries
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within the poorer regions of Africa, Asia, and Latin America. Children are most vulnerable as they
have yet to fully develop a strong immune system, as well as being dependent upon parents to
provide the necessary food and nutritional intake. It is estimated that about 3.5 million children die
each year as a result of childhood or maternal malnutrition, with stunted growth, low body weight
and low birth weight accounting for about 2.2 million associated deaths. Factors which contribute
to malnutrition are socioeconomic, environmental, gender status, regional location, and
breastfeeding cultural practices. It is difficult to assess the most pressing factor as they can
intertwine and vary among regions.
7. Adverse effects of malnutrition
Children suffering from malnutrition face adverse physical effects such as stunting, wasting, or
being overweight. Such characteristics entail difference in weight-and-height ratios for age in
comparison to adequate standards. In Africa the number of stunted children has risen, while Asia
holds the most children under 5 suffering from wasting. The number of overweight children has
increased among all regions of the globe. Inadequate nutrients adversely effect physical and
cognitive developments, increasing susceptibility to severe health problems. Micronutrient
deficiency such as iron has been linked to children with anemia, fatigue, and poor brain
development. Similarly, the lack of Vitamin A is the leading cause of blindness among
malnourished children. The outcome of malnutrition in children results in decreased ability of the
immune system to fight infections, resulting in higher rates of death from diseases such as malaria,
respiratory disease and diarrhea.
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8. Infectious diseases
Babies born in low to middle income countries in sub-Saharan Africa and southern Asia are at the
highest risk of neonatal death. Bacterial infections of the bloodstream, lungs, and the brain's
covering (meningitis) are responsible for 25% of neonatal deaths. Newborns can acquire infections
during birth from bacteria that are present in their mother's reproductive tract. The mother may not
be aware of the infection, or she may have an untreated pelvic inflammatory disease or sexually
transmitted disease. These bacteria can move up the vaginal canal into the amniotic sac
surrounding the baby. Maternal blood-borne infection is another route of bacterial infection from
mother to baby. Neonatal infection is also more likely with the premature rupture of the
membranes (PROM) of the amniotic sac.
Seven out of ten childhood deaths are due to infectious diseases: acute respiratory infection,
diarrhea, measles, and malaria. Acute respiratory infection such as pneumonia, bronchitis, and
bronchiolitis account for 30% of childhood deaths; 95% of pneumonia cases occur in the
developing world. Diarrhea is the second-largest cause of childhood mortality in the world, while
malaria causes 11% of childhood deaths. Measles is the fifth-largest cause of childhood mortality.
Folic acid for mothers is one way to combat iron deficiency. A few public health measures used to
lower levels of iron deficiency anemia include iodize salt or drinking water, and include vitamin A
and multivitamin supplements into a mother's diet. A deficiency of this vitamin causes certain
types of anemia (low red blood cell count).
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9. Early childhood trauma
Early childhood trauma includes physical, sexual, and psychological abuse of a child ages zero to
five years-old. Trauma in early development has extreme impact over the course of a lifetime and
is a significant contributor to infant mortality. Developing organs are fragile. When an infant is
shaken, beaten, strangled, or raped the impact is exponentially more destructive than when the
same abuse occurs in a fully developed body. Studies estimate that 1–2 per 100,000 U.S. children
annually are fatally injured. Unfortunately, it is reasonable to assume that these statistics
underrepresent actual mortality. Three-quarters (70.6 percent) of child fatalities in FFY 2018
involved children younger than 3 years, and children younger than 1 year accounted for 49.4
percent of all fatalities. In particular, correctly identifying deaths due to neglect is problematic, and
children with sudden unexpected death or those with what appear to be unintentional causes on the
surface often have preventable risk factors which are substantially similar to those in families with
maltreatment. There is a direct relationship between age of maltreatment/injury and risk for death.
The younger an infant is, the more dangerous the maltreatment.
2.5 Prevention of Infant Mortality rate
To reduce infant mortality rates across the world, health practitioners, governments, and non-
governmental organizations have worked to create institutions, programs and policies to generate
better health outcomes. Current efforts focus on development of human resources, strengthening
health information systems, health services delivery, etc. Improvements in such areas aim to
increase regional health systems and aided in efforts to reduce mortality rates.
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1. Policy formulation
Reductions in infant mortality are possible in any stage of a country's development. Rate
reductions are evidence that a country is advancing in human knowledge, social institutions and
physical capital. Governments can reduce the mortality rates by addressing the combined need for
education (such as universal primary education), nutrition, and access to basic maternal and infant
health services. A policy focus has the potential to aid those most at risk for infant and childhood
mortality allows rural, poor and migrant populations.
Reducing chances of babies being born at low birth weights and contracting pneumonia can be
accomplished by improving air quality. Improving hygiene can prevent infant mortality. Home-
based technology to chlorinate, filter, and solar disinfection for organic water pollution could
reduce cases of diarrhea in children by up to 48%.
According to UNICEF, hand washing with soap before eating and after using the toilet can save
more lives of children by cutting deaths from diarrhea and acute respiratory infections. Focusing
on preventing preterm and low birth weight deliveries throughout all populations can help to
eliminate cases of infant mortality and decrease health care disparities within communities. In the
United States, these two goals have decreased infant mortality rates on a regional population, it has
yet to see further progress on a national level.
2. Prenatal care and maternal health
When a woman becomes pregnant, certain steps can help to reduce the chance of complications
during the pregnancy. Attending regular prenatal care check-ups will help improve the baby's
chances of being delivered in safer conditions and surviving. Additionally, taking supplementation,
22
including folic acid, can help reduce the chances of birth defects, a leading cause of infant
mortality.[88] Many countries have instituted mandatory folic acid supplementation in their food
supply, which has significantly reduced the occurrence of spina bifida, a birth defect, in newborns.
Similarly, the fortification of salt with iodine, salt iodization, has helped reduce adverse birth
outcomes associated with low iodine levels during pregnancy.
3. Nutrition
Appropriate nutrition for newborns and infants can help keep them healthy and avoid health
complications during early childhood. The American Academy of Pediatrics recommends
exclusively breastfeeding infants for the first 6 months of life, following by a combination of
breastfeeding and other sources of food through the next 6 months of life, up to 1 year of age.
Infants under 6 months of age who are exclusively breastfed have a lower risk of mortality
compared to infants who receive a combination of breast milk and other food, as well as no breast
milk at all. For this reason, breast feeding is favored over formula feeding by healthcare
professionals.
4. Vaccinations
The Centers for Disease Control and Prevention (CDC) defines infants as those 1 month of age to
1 year of age.[96] For these infants, the CDC recommends the following vaccinations: Hepatitis B
(HepB), Rotavirus (RV), Haemophilus Influenzae type B (HIB), Pneumococcal Conjugate
(PCV13), Inactivated Poliovirus (IPV < 18 yrs), Influenza, Varicella, Measles, Mumps, Rubella
(MMR), and Diphtheria, tetanus, acellular pertussis (DTapP < 7yrs).[97] Each of these vaccinations
23
are given at particular age ranges depending on the vaccination and are required to be done in a
series of 1 to 3 doses over time depending on the vaccination.
The efficacy of these vaccinations can be seen immediately following their introduction to
society Following the advent of the Pneumococcal Conjugate vaccine (PCV13) in the United
States in the year 2000, the World Health Organization (WHO) reports studies done in 2004 had
shown a 57% decline invasive penicillin-resistant strains of diseases and a 59% reduction in
multiple antibiotic resistant strains that could lead to mortality among infants. This reduction was
even greater for children under 2 years of age with studies finding an 81% reduction in those same
strains. As aforementioned in a previous section, Sudden Infant Death Syndrome is the leading
cause of infant mortality for those 1 month of age to 1 year of age. Immunizations, when given in
accordance to proper guidelines, have shown to reduce the risk of Sudden Infant Death Syndrome
by 50%. For this reason, the American Academy of Pediatrics (AAP) and the Center for Disease
Control (CDC) both recommend immunizations in accordance to their guidelines.
5. Socio-economic factors
It has been well documented that increased education among mothers, communities, and local
health workers results in better family planning, improvement on children's health, and lower rates
of children's deaths. High-risk areas, such as Sub-Saharan Africa, have demonstrated that an
increase in women's education attainment leads to a reduction in infant mortality by about 35%.
Similarly, coordinated efforts to train community health workers in diagnosis, treatment,
malnutrition prevention, reporting and referral services has reduced infant mortality in children
under 5 as much as 38%. Public health campaigns centered around the "First 1,000 Days" of
24
conception have been successful in providing cost-effective supplemental nutrition programs, as
well as assisting young mothers in sanitation, hygiene and breastfeeding promotion.
Increased intake of nutrients and better sanitation habits have a positive impact on health,
especially developing children. Educational attainment and public health campaigns provide the
knowledge and means to practice better habits and leads to better outcomes against infant mortality
rates. Awareness of health services, education, and economic opportunities provide means to
sustain and increase chance of development and survival. A decrease on GPD, for example, results
in increased rates of infant mortality. Negative effects on household income reduces amount being
spent on food and healthcare, affecting the quality of life and access to medical services to ensure
full development and survival.
2.6 Theoretical framework of the study
The four perspectives informing most of the extant cross-national infant mortality research can be
referred to as gender stratification, modernization, dependency/world- systems, and developmental
state theories. Each is discussed in turn.
2.6.1 Gender Stratification Theory
Proponents of gender stratification theory argue that the enhancement of women's status, especially
through education and other means, will greatly increase women's ability to access the
socioeconomic resources and knowledge required for proper infant nutrition and care, resulting in
reduced infant deaths (Wang 2014). Educated mothers are not only more likely to delay and space
births but they are more likely to have fewer children, which reduces infant mortality (York and
Ergas 2011). Existing cross-national and sub-national research indicates a strong negative
relationship between gender equity measures such as female education and infant and child
mortality (see, e.g., Caldwell 1990; Frey and Field 2000; Gakidou et al. 2009; Schell et al. 2007;
25
Shandra et al. 2011; Shen and Williamson 1997, 2001; Wang 2014; York and Ergas 2011, but see
Fuse and Crenshaw 2006).
2.6.2 Modernization Theory
Modernization theory is used to explain the process of modernization within societies.
Modernization refers to a model of a progressive transition from a 'pre-modern' or 'traditional' to a
'modern' society. Modernization theory originated from the ideas of German sociologist Max
Weber (1864–1920), which provided the basis for the modernization paradigm developed by
Harvard sociologist Talcott Parsons (1902–1979). The theory looks at the internal factors of a
country while assuming that with assistance, "traditional" countries can be brought to development
in the same manner more developed countries have been. Modernization theory was a dominant
paradigm in the social sciences in the 1950s and 1960s, then went into a deep eclipse. It made a
comeback after 1991 but remains a controversial model. Industrialization is an important
component of the modernization process and it is central to the modernization perspective (see,
e.g., Rostow 1990). Modernization theorists contend that industrialization and the attendant
economic development reduce infant mortality through improvements in health care, education,
nutrition, and the like. A number of cross-national researchers have confirmed the validity of
modernization theory, reporting that infant and child mortality (as well as gender imbalances in
infant mortality) vary in a negative fashion with the level of industrialization and alternative
measures of economic development (e.g., Babones 2008; Fuse and Crenshaw 2006; Jorgenson and
Rice 2010; Moore et al. 2006; O'Hare et al. 2013; Pamuk et al. 2011; Shandra et al. 2004, 2005,
2011; Shen and Williamson 1997, 2001; Wang 2014), but re-search exists questioning this
relationship (e.g., Amand and Ravallion 1993; Frey and Field 2000). Modernization theory both
attempts to identify the social variables that contribute to social progress and development of
26
societies and seeks to explain the process of social evolution. Modernization theory is subject to
criticism originating among socialist and free-market ideologies, world-systems theorists,
globalization theorists and dependency theorists among others. Modernization theory stresses not
only the process of change but also the responses to that change. It also looks at internal dynamics
while referring to social and cultural structures and the adaptation of new technologies.
Modernization theory suggests that traditional societies will develop as they adopt more modern
practices. Proponents of modernization theory claim that modern states are wealthier and more
powerful and that their citizens are freer to enjoy a higher standard of living. Developments such
as new data technology and the need to update traditional methods in transport, communication
and production make modernization necessary or at least preferable to the status quo. That view
makes critique difficult since it implies that such developments control the limits of human
interaction, not vice versa. And yet, seemingly paradoxically, it also implies that human agency
controls the speed and severity of modernization. Supposedly, instead of being dominated by
tradition, societies undergoing the process of modernization typically arrive at forms of
governance dictated by abstract principles. Traditional religious beliefs and cultural traits,
according to the theory, usually become less important as modernization takes hold. Today, the
concept of modernization is understood in three different meanings: 1) as the internal development
of Western Europe and North America relating to the European New Era; 2) as a process by which
countries that do not belong to the first group of countries, aim to catch up with them; 3) as
processes of evolutionary development of the most modernized societies (Western Europe and
North America), i.e. modernization as a permanent process, carried out through reform and
innovation, which today means a transition to a postindustrial society. [3] Historians link
modernization to the processes of urbanization and industrialization and the spread of education.
27
As Kendall (2007) notes, "Urbanization accompanied modernization and the rapid process of
industrialization."[4] In sociological critical theory, modernization is linked to an overarching
process of rationalisation. When modernization increases within a society, the individual becomes
increasingly important, eventually replacing the family or community as the fundamental unit of
society. It is also a subject taught in traditional Advanced Placement World History classes.
2.6.3 Dependency/World-Systems Theory
Proponents of dependency/world-systems theory contend that dependent relations between core
and peripheral countries foster resource and surplus extraction, resulting in limited resources for
investment in public health, family planning, nutrition, education, pre-natal and post-natal care
programs, and other factors that reduce infant and child mortality (see, e.g., Shandra et al. 2011).
Research results are mixed on the link between various measures of dependence (including foreign
investment, trade dependence, debt dependence and structural adjustment, and export commodity
concentration) and infant and child mortality (see, e.g., Frey and Field 2000; Jorgenson and Burns
2004; Jorgenson and Rice 2010; Moore et al. 2006; Ragin and Bradshaw 1992; Shandra et al.
2004, 2005, 2011; Shen and Williamson 1997, 2001; York and Ergas 2011).
2.6.4 Developmental State Theory
Developmental state theorists contend that strong states can act in ways that promote human well-
being and reduce infant mortality (Evans 1995). State actions may include direct efforts to reduce
infant mortality through pre-natal and post-natal care programs, as well as indirect programs such
as investment in public health and welfare programs that reduce inequalities in access to proper
nutrition, health care, and the like. Results of the existing cross-national research are mixed,
ranging from support to no support (Dal-ton and Springer 2001; Frey and Field 2000; Gruber et al.
2014; Schell et al. 2007; Shandra et al. 2011; Shen and Williamson 1997, 2001; Wang 2014).
28
2.7 Empirical Studies
According To Sah (1991) Carried out a research work on the considered case of an expected utility
maximizing family choosing the number of discrete births to have. He showed that if there is no ex
ante birth cost (a cost that is incurred regardless of whether or not the child survives), then the
number of births must be a nonincreasing function of the survival risk (as is true of the previous
model). Consider the case in which the choice is between having two, one, or no children. In that
case, the difference in expected utilities associated with having one versus no child is the survival
risk s times the difference in utilities (i.e., s[U(1) − U(0)]. Similarly, the difference in expected
utilities between having two children versus having one child is s2{[U(2) − U(1)] − [U(1) − U(0)]}
+ s[U(1) − U(0)]. Now suppose that for a given s, it is optimal to have one child but not two, a
result that requires satiation at one surviving offspring [U(2) − U(1) < 0]. Clearly, at a higher s, it
will be optimal to have at least one child. However, at the higher value of s it will still not be
optimal to have a second child, and indeed the difference in expected utilities between having two
and having one cannot increase. As Sah demonstrates, the argument generalizes beyond a feasible
set of two children to any discrete number of children.
This result, that increasing the mortality risk of children cannot reduce fertility (except in the
neighborhood of certain mortality, s = 0), is the obvious analog to the target fertility result.
However, unlike the target fertility model, it does not imply that the number of surviving children
will be invariant to the survival rate. The reason is due to the discreteness (and the uncertainty). An
example may be helpful. Suppose that U(1) − U(0) = 2 and U(2) − U(1) = −1. Now, assuming s is
nonzero, it will always be optimal to have at least one child, s[U(1) − U(0)] = s > 0. However, in
this example, for any survival rate less than two-thirds, it will be optimal to have two children. At a
29
survival rate just below two-thirds, the expected number of surviving children is close to 1.33,
whereas at a survival rate just above two-thirds, the expected number of surviving children is close
to 0.67. There is, thus, a decline in the expected number of surviving children as the survival rate
increases in the neighborhood of two-thirds. However, the relationship is not monotonic; the
higher the survival rate within the zero to two-thirds range, and again within the two-thirds to unity
range, the more surviving children there will be on average because the number of births is
constant within each range.
According to Sah (2015) carried out a survey research design on the implication on public health
in the prevention of infant mortality rate in kaduna however, that adding a cost of childbearing, as
before, leads to ambiguity in the effect of the survival rate on fertility. He develops two sets of
sufficient conditions for fertility (in the general case of any finite number of children) to decline
with the survival rate (for hoarding to be optimal) that depend on properties of the utility function:
that the utility function is sufficiently concave (in discrete numbers of children), or that for any
degree of concavity the marginal utility of the last optimally chosen birth be nonpositive, that is,
that the marginal utility of the last child be nonpositive if all of the optimally chosen children were
to survive. Obviously, this second condition will fail to hold if there is no target fertility level, that
is, if children always have positive marginal utility. Sah shows that these conditions are weaker
than those that would be required if fertility were treated as a continuous choice within the same
expected utility framework, and it is in that sense that discreteness reduces ambiguity.
According to Wolpin (2016) illustrates structural estimation. The model has the following
characteristics: (1) Per-period utility is quadratic in the number of surviving children in that period
and in a composite consumption good, (2) fertility control is costless and perfect, (3) there is a
fixed cost of bearing a child and a cost of maintaining a child in its first period of life (if it survives
30
infancy), (4) children can die in only their first period of life subject to an exogenous time-varying
(and perfectly forecasted) infant mortality rate, (5) the household has stochastic income and
consumption net of the cost of children that is equal to income in each period, and (6) the
household's marginal utility of surviving children varies stochastically over time according
to a known (to the household) probability distribution. Given this framework, the
household chooses in each period whether or not to have a child.
For the purpose of estimation, Wolpin assumes that the time-varying preference parameter
is drawn independently over both time and across households from a normal distribution.
The mortality rate faced by the household is assumed known to the researcher, measured
by the state-level mortality rate in each period, and the researcher is assumed to forecast
future mortality rates exactly as the household is assumed to do, namely based on the
extrapolated trend in the mortality rate at the state level. Future income is forecasted from
the time series of observed household income, again under the assumption that the
household uses the same forecasting method.
31
CHAPTER THREE
RESEARCH METHODOLOGY
3.1 Introduction
The research set out fundamentally to study the role of public health on the prevention of infant
mortality in Jema’a Local Government Area Kaduna sate. The chapter covers the following sub-
headings; Research design, Population of the study, Sample and sampling techniques,
Instrumentation, Validity of the instrument, Reliability of the instrument, Method of data
collection, Method of data Analysis are described in this chapter
3.2 Population of the study
In this study the target population is a precisely specified group of cases from which a researcher
studies a sample and to which the results from the sample are generalized (Neumann, 2006).
Creswell (2005) defines the term population as a group of people having common characteristics
for instance all public health workers situated in Jema’a Local Government Area. In this study, the
target population are public health workers, the private health community workers and the medical
personal in Clinic centers in Jema’a Local Government Area of Kaduna state.
3.3 Sample and sampling procedure
According to Kombo and Tromp (2016), a sample is the set of respondent selected from a larger
population for the purpose of a survey. In this study, purposive random sample techniques is used
to select specifically the health workers in Jema’a community. According to Fraenkel and Wallen
(2000), purposive sampling is an occasion based on previous knowledge of a population and
specific purpose of the research investigators for use in personal judgments to select a sample. The
use of this techniques enable the researcher to achieve a sample size of two hundred and fifty
32
(250); these participant are public health workers, the private health community workers and the
medical personal in Clinic centers.
3.4 Research Instrument
The major instruments used for this study is questionnaire. The structured questionnaire used was
provided with an option of strongly agreed (SA), Agreed (A), Strongly disagree (SD) and disagree
(D) for the respondent to fill in. The researcher also made use of observation, textbook,
periodicals, dictionaries, unpublished thesis, encyclopedia, etc, in obtaining data for the study.
There are two major sources of data used by researchers in any study. These are the primary and
secondary sources.
Section A: Demographic characteristics of the respondents which contained Sex, Age, and Marital
Status etc.
Section B: Was on the role of public health on prevention of infant mortality
The administered to the selected respondent using questionnaire which is sub –divided into two (2)
session which are A and B the section A comprises of the bio-data while second B is based on the
research question generating twenty five (25) statement item that will be answered and will be
used to ascertain the level of significant of the study.
3.5 Administration of research instrument
In this study, questionnaires were employed to collect information Cohen (2006). A questionnaire
consists of a mixture of open ended and closed ended questions. Open-ended questions offer more
freedom to the respondents to answer the questions, whereas closed ended questions limit the
respondents to specificity of the responses for the purpose of quantification and approximation of
magnitude Kothari (2004).
33
3.6 Method of data Analysis
The study will make use of simple percentage and frequency to analyzed the role of health workers
on the prevention of infant mortality among children. The result of the analysis is further
proceeded with editing, coding, classification and tabulation of collected data.
34
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
4.0 Introduction
This chapter present the data analysis and present the responses of the data in tabular form using
the simple frequency distribution table
4.1 Data Presentation
From the data generated from the questionnaire distributed to the respondents is presented as
follows:
Section A: Analysis Of Bio Data
Table 1: Age of respondents
Age No of respondents Percentages %

15-20 55 22
21-30 50 20
31-40 100 40
41 and above 45 18
Total 250 100
Source: field survey, 2021
Table above table indicates that 40% of the respondents fall within the age of 31-40 years which is
the highest, while 15-20 years constitutes 22%, while 20% of the respondents fall within the age of
21-30, while 18% respondents fall within the age range of 41 and above. Therefore, majority of the
respondents are within the age range of 31-40years.
Table 2: Gender of the respondents
Sex No of respondents Percentages %

Male 130 52
Female 120 48
Total 250 100
35
Table one shows that male respondents are more than the female which constitute 130% of male
while female constitute 120% respectively. This tells that, the majority of the are male.
Table 3: Occupation/Post of the respondents
Occupation No of respondents Percentages %

Clinic center personal 50 20
Medical personal 120 48
Community health workers 80 32
Total 250 100
The above table shows that the medical personal respondents representing 48% is the highest
number of respondents, while community health workers respondents representing 80%, while
clinic center personal respondents representing 20% is the lowest of the respondents. Therefore
this shows that majority of the respondents are medical personal.
Table 4: Qualification of respondents
Qualification No of respondents Percentages %

NCE/ND/OND 55 22
HND/DEGREE 100 40
Masters 50 20
Ph.d 45 18
Total 250 100
Table above table indicates that 40% of the respondents fall within HND/Degree holders which is
the highest, while NCE/ND/OND holders constitutes 22%, while 20% of the respondents fall
within Master holders, while 18% respondents fall at Ph.d holders. Therefore, majority of the
respondents are the HND/DEGREE holders.
36
Table 5: Marital Status of the respondents
Status No of respondents Percentages %

Single 50 20
Married 120 48
Divorce 80 32
Total 250 100
The above table shows that 48% of the respondents were married which is the highest number of
respondents, while 80% of the respondents were divorce, while 20% of the respondents are single
which is the lowest of the respondents. Therefore this shows that majority of the respondents are
married.
Section B; Analysis Of Research Question
Table 6: Poor health awareness and ignorance by methods of health care, especially when the
family disease pneumonia, blood poisoning and diarrhea are among the causes of the death of
children
Option Frequency Percentage %

Agree 65 26
Strongly Agree 100 40
Disagree 50 20
Strongly Disagree 35 14
Total 250 100
The table above shows the frequency 65 representing 26% of the respondents agree, while 100
representing 40% of the respondents strongly agree, while 50 representing 20% of the respondents
disagree, while 35 representing 14% of the respondents strongly disagree. This shows that the
majority of the respondents strongly agree that poor health awareness and ignorance by methods of
health care, especially when the family disease pneumonia, blood poisoning and diarrhea are
among the causes of the death of children.
37
Table 7: Adoption of traditional methods of some families in Bioremediation Pediatric herbs as a
case or treatment of the child without going to the hospital contribute to causes of the death of
children

Agree 55 22
Disagree 80 32
Total 250 100
majority of the respondents disagree that adoption of traditional methods of some families in
Bioremediation Pediatric herbs as a case or treatment of the child without going to the hospital
contribute to causes of the death of children.
Table 8: Among other causes of death of children is Lack of awareness programs sponsored by
private health development of the child and the mother by the state , which is working to develop
the health status of the family and a few of these programs make the family depends on the bad
habits in child health care

Agree 65 26
Disagree 50 20
Total 250 100
38
majority of the respondents strongly agree that among other causes of death of children is Lack of
awareness programs sponsored by private health development of the child and the mother by the
state , which is working to develop the health status of the family and a few of these programs
make the family depends on the bad habits in child health care.
Table 9: The causes of death again is the declining in the standard of living for some children
dietary intakes which the family cannot provide quantitative and qualitative food for the child ,
leading to the injury of children's diseases, malnutrition and anemia.

Agree 100 40
Disagree 35 14
Total 250 100
majority of the respondents agree that the causes of death again is the declining in the standard of
living for some children dietary intakes which the family cannot provide quantitative and
qualitative food for the child , leading to the injury of children's diseases, malnutrition and anemia.
39
Table 10: The spread of diseases and ease of infection among children , and sometimes other
infectious diseases are the causes of death among children.

Agree 55 22
Disagree 80 32
Total 250 100
majority of the respondents disagree that the spread of diseases and ease of infection among
children, and sometimes other infectious diseases are the causes of death among children.
Table 11:The educational level of the mother to the infant mortality rate mothers uneducated
increased exposure of their children to die before reaching the age of five

Agree 80 32
Disagree 55 22
Total 250 100
majority of the respondents agree that the educational level of the mother to the infant mortality
rate mothers uneducated increased exposure of their children to die before reaching the age of five
40
Table 12: The educational level of the mother to the infant mortality rate mothers uneducated
increased exposure of their children to die before reaching the age of five

Agree 80 32
Disagree 55 22
Total 250 100
majority of the respondents agree that the educational level of the mother to the infant mortality
rate mothers uneducated increased exposure of their children to die before reaching the age of five
Table 13:The health services will ensure that children receive adequate amounts of micronutrients
(Vitamin A and Iron, in particular either in the diet or through supplementation) as well as
consummation of iodized salt at the household level.

Agree 43 17
Disagree 65 26
Total 250 100
majority of the respondents strongly agree that the health services will ensure that children receive
41
adequate amounts of micronutrients (Vitamin A and Iron, in particular either in the diet or through
supplementation) as well as consummation of iodized salt at the household level.
Table 14:The health services should encourage mothers to take children as scheduled to complete
the full course of immunization before their first birthday

Agree 57 23
Disagree 85 34
Total 250 100
majority of the respondents disagree that the health services should encourage mothers to take
children as scheduled to complete the full course of immunization before their first birthday
Table 15:The health services should give guiding lines to mothers on how to protect children in
malaria endemic areas by ensuring that they sleep under insecticide treated bed nets

Agree 100 40
Disagree 35 14
Total 250 100
majority of the respondents agree that the health services should give guiding lines to mothers on
42
how to protect children in malaria endemic areas by ensuring that they sleep under insecticide
treated bed nets
Table 16: There should be orientation by the health services workers on the importance of
breastfeeding to make such lactating mothers practices exclusive breastfeeding for at least four
month

Agree 50 20
Disagree 65 26
Total 250 100
majority of the respondents strongly disagree that there should be orientation by the health services
workers on the importance of breastfeeding to make such lactating mothers practices exclusive
breastfeeding for at least four month
Table 17:The health services provide the children with immediate medicine to curtail the infant
mortality rate

Agree 55 22
Disagree 80 32
Total 250 100
43
majority of the respondents disagree that The health services provide the children with immediate
medicine to curtail the infant mortality rate
Table 18: The health services workers should entrust their services with less expensive demand
from the victims to reach the hand of individuals.

Agree 45 18
Disagree 70 28
Total 250 100
majority of the respondents strongly agree that the health services workers should entrust their
services with less expensive demand from the victims to reach the hand of individuals.
Table 19:The health services workers should provide self inform knowledge of the importance and
implication of dietary nutrients to individuals

Agree 50 20
Disagree 65 26
Total 250 100
44
majority of the respondents strongly disagree that the health services workers should provide self-
inform knowledge of the importance and implication of dietary nutrients to individuals
Table 20:Family knowledge of danger signs in a child's health will also help in managing the
challenges of infant mortality among children.

Agree 80 32
Disagree 55 22
Total 250 100
majority of the respondents agree that Family knowledge of danger signs in a child's health will
also help in managing the challenges of infant mortality among children.
Table 21:Improved access to water, sanitation, and hygiene is important to reducing infant
mortality.

Agree 57 23
Disagree 85 34
Total 250 100
45
majority of the respondents disagree that improved access to water, sanitation, and hygiene is
important to reducing infant mortality.
Table 22: The application of Skilled attendants for antenatal, birth, and postnatal care will also
serve as a possible method in reducing infant mortality rate among children.

Agree 65 26
Disagree 80 32
Total 250 100
majority of the respondents disagree that the application of Skilled attendants for antenatal, birth,
and postnatal care will also serve as a possible method in reducing infant mortality rate among
children.
46
Table 23:Maternal Immunizations is another sure way in reducing infant mortality among children

Agree 85 34
Disagree 43 17
Total 250 100
majority of the respondents agree that maternal Immunizations is another sure way in reducing
infant mortality among children
Table 24: The encouragement among the Immediate and exclusive breastfeeding will help in
reducing infant mortality among children.

Agree 50 20
Disagree 65 26
Total 250 100
majority of the respondents strongly disagree that the encouragement among the Immediate and
exclusive breastfeeding will help in reducing infant mortality among children.
47
Table 25:Using Newborn Screening to Detect Hidden Conditions is another way in reducing
infant mortality among children

Agree 55 22
Disagree 80 32
Total 250 100
majority of the respondents disagree that Using Newborn Screening to Detect Hidden Conditions
is another way in reducing infant mortality among children.
48
CHAPTER FIVE
SUMMARY CONCLUSION AND RECOMMENDATION
5.1 Introduction
This chapter contains the summary, conclusion and recommendations of the study. The
conclusions were based on the results of the research findings. Recommendations were made on
how to determine role of public health in the prevention of infant mortality Rate in Jema’a Local
Government Area of Kaduna state.
5.2 Summary
The research investigate the role of public health in the prevention of infant mortality Rate in
Jema’a Local Government Area of Kaduna state. The research work present the chapter one which
comprises of the background of the study, statement of the problem, highlighting the objectives of
the study, research questions, scope and limitation of the study and also operational definition of
key as used in the research study. Chapter two of this research review the literature that are
related to the study. The next chapter which is chapter three is the research methodology where the
researchers design their main purpose. The researchers made use of this survey research design due
to the fact that, it attempts to study a group of people or items by way of collecting and analyzing
data from a few samples of a population considered to be true representative of the entire group.
Chapter three is primarily based on descriptive survey research design, the population, sample size,
method of data collection and method of data analysis. Chapter four present the result of the
analysis in tabular form and further explain the result. Chapter five shows the summary,
conclusion and recommendations of the study.
49
5.3 Conclusion
From the analysis, it is concluded that the role of public health in the prevention of infant mortality
Rate in Jema’a Local Government Area of Kaduna stateby logistics revealed that infant and child
mortality significantly decreased as a result ``of unit change in educational level(No education,
Primary education, Secondary education and Higher education) by 17%, household
income(Starved, Poor, Middle, Rich and Very Rich) by 15%, residence(urban and rural) by 20%
and mother age by 10%.
However, infant and child mortality significantly increased as a result of unit change in place of
delivery(Delivery at home, Delivery at health centre and Others) by 46%. Cox proportional also
revealed that educational level at 17%, household income at 16%, residence type at 13%
significantly decreased risk, and residence type at 13% significantly decreased risk, while place of
delivery at 42% significantly increased risk (with hazard ratio of one, indicating the chance of
infant and child not being alive) of not infant and child mortality as mother’s age increases
This study investigates the predictors of child mortality in Nigeria. It utilized the nationally
representative data from the National Demographic Health Survey(NDHS, 2013. Cox Proportional
and Logistic regression technique were used to ascertain the effect of predictors of infant and child
mortality. From these analyses several interesting observation can be made, although the analysis
itself was subject to various types of problem. Sometimes, it is observed that logical or theoretical
hypothesis is supported by the results of fitted hazard and logistic response function
50
5.4 Recommendations
The following recommendations;
1. The government should give urgent attention should be given to place of delivery and other
factors in order to further reduce the risk of infant and child mortality in Nigeria.
2. The Government, Non-Governmental organizations, and the rich individuals should help
provide and maintain existing of the challenges as to regard to hygiene in the community this
will enable the rate at which death of children is massive will be minimize
3. The community should be educated on the effect of infant mortality among the people living in
the rural and urban community to avoid premature death
51
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54
APPENDIX
Department of Human Kinetics and Health Education,

Faculty of Education,
Ahmadu Bello University, Zaria
Kaduna state.
Dear Respondent,
The researcher is student of the above University undertaking a research work on “The role
of public health in the prevention of infant mortality Rate in Jema’a Local Government Area of
Kaduna state” in partial fulfillment of the requirements for the award of Bachelor in Education
B.Sc. (Ed). The information received will be strictly used only for this purpose and will be treated
confidentially.
Thanks for your cooperation.
Yours faithfully
(Researcher)
55
Instruction: Please Kindly Tick (√) your answer in the appropriate space provided against each
number of questions.
SECTION A (DEMOGRAPHIC INFORMATION OF RESPONDENTS)
1. AGE OF RESPONDENTS
b. 15-20years [ ]
c. 21-30 years [ ]
d. 31-40 years [ ]
e. 41 and above [ ]
2. GENDER
a. Male [ ]
b. Female [ ]
3. OCCUPATION / POST
a. Clinic center personal [ ]
b. medical personal [ ]
c. Community health Workers [ ]
d. Other specific ____________
4. QUALIFICATION
a. NCE/ND/ OND [ ]
b. HND/DEGREE [ ]
c. Masters [ ]
d. Ph.d [ ]
5. MARITAL STATUS
a. Single [ ]
b. Married [ ]
c. Divorce [ ]
56
SECTION B
THE MAIN QUESTIONNAIRE:
Rating Scale: SA for strongly Agreed [ ]

A for Agreed [ ]
D for Disagreed [ ]
SD for Strongly Disagreed [ ]
INSTRUCTION:
Please tick one box (√) only
RESEARCH QUESTION ONE: THE CAUSES LEADING TO THE DEATH OF

CHILDREN IN JEMA’A LOCAL GOVERNMENT AREA OF KADUNA STATE.
S/NO ITEM STATEMENT SA A D SD
1. Poor health awareness and ignorance by methods of health care,
especially when the family disease pneumonia , blood poisoning
and diarrhea are among the causes of the death of children
2. Adoption of traditional methods of some families in

Bioremediation Pediatric herbs as a case or treatment of the
child without going to the hospital contribute to causes of the
death of children
3. Among other causes of death of children is Lack of awareness

programs sponsored by private health development of the child
and the mother by the state , which is working to develop the
health status of the family and a few of these programs make
the family depends on the bad habits in child health care
4. The causes of death again is the declining in the standard of

living for some children dietary intakes which the family cannot
provide quantitative and qualitative food for the child , leading
to the injury of children's diseases, malnutrition and anemia.
5. The spread of diseases and ease of infection among children ,
and sometimes other infectious diseases are the causes of death
among children.
6. The educational level of the mother to the infant mortality rate
mothers uneducated increased exposure of their children to die
before reaching the age of five
57
RESEARCH QUESTION TWO : THE ROLE PLAYED BY PUBLIC HEALTH SERVICES
PROVIDERS ON THE COMMUNITY OF JEMA’A IN CURTAILING THE RATE OF
INFANT MORTALITY.
7. The health services will ensure that children receive adequate
amounts of micronutrients (Vitamin A and Iron, in particular
either in the diet or through supplementation) as well as
consummation of iodized salt at the household level.
8. The health services should encourage mothers to take children as

scheduled to complete the full course of immunization before
their first birthday
9. The health services should give guiding lines to mothers on how

to protect children in malaria endemic areas by ensuring that
they sleep under insecticide treated bed nets
10. There should be orientation by the health services workers on

the importance of breastfeeding to make such lactating mothers
practices exclusive breastfeeding for at least four month
11. The health services provide the children with immediate
medicine to curtail the infant mortality rate
12. The health services workers should entrust their services with
less expensive demand from the victims to reach the hand of
individuals.
13. The health services workers should provide self inform
knowledge of the importance and implication of dietary nutrients
to individuals
58
RESEARCH QUESTION THREE: THE SOLUTIONS IN REDUCING THE RATE OF
INFANT MORTALITY AMONG CHILDREN IN JEMA’A LOCAL GOVERNMENT
AREA OF KADUNA STATE.
14. Family knowledge of danger signs in a child's health will also
help in managing the challenges of infant mortality among
children.
15. Improved access to water, sanitation, and hygiene is important to

reducing infant mortality.
16. The application of Skilled attendants for antenatal, birth, and

postnatal care will also serve as a possible method in reducing
infant mortality rate among children.
17. the use of access to nutrition and micronutrients will go along

way in reducing the infant mortality among children.
18. Maternal Immunizations is another sure way in reducing infant
mortality among children
19. The encouragement among the Immediate and exclusive
breastfeeding will help in reducing infant mortality among
children.
20. Using Newborn Screening to Detect Hidden Conditions is
another way in reducing infant mortality among children
59

Chapter One 1.1 Background To The Study

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Chapter One 1.1 Background To The Study

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CHAPTER ONE

1.1 Background to the study

therapeutic) or trained and skilled health professionals, exclusive breastfeeding, inadequate

personnel's (viz. scarcity in the number of healthcare professionals, untrained or questionable

expansion of healthcare facilities, partnerships with non-governmental organization and

community-based organizations, collaboration with private sector physicians, quality-assured

care/danger signals in newborn requiring immediate referral/importance of maintaining hand

hygiene/exclusive breastfeeding, and establishment of functional referral system, if implemented,

can reduce a major proportion of infant deaths. To conclude, planned implementation

1.2 Statement of the problem

maintenance equipment used for reducing infant mortality rate.

Local Government Area of Kaduna State

The specific objectives of the study are:

curtailing the rate of infant Mortality.

Local Government Area of Kaduna state.

1.4 Research Questions

The following research questions are formulated to guide the study;

curtailing the rate of infant Mortality?

Government Area of Kaduna state?

1.5 Significance of the study

for individual consumption.

easy access of information.

behind the scene.

1.6 Scope and limitation of the study

situated in Jema’a Local Government Area of Kaduna state

1.7 Operational definition of key terms

conceptualized by people in a social situation. It is an expected or free or continuously

of life through organized efforts and

another quantity or measure.

per unit of time

2.2 Conceptual framework

2.2.1 Concept of Infant Mortality

infrastructure. Improving sanitation, access to clean drinking water, immunization against

region studied with 68 deaths per 1,000 live births

survival chances of offspring. Fundamental to either of these motivations is an understanding of

do so requires the explication of theory, estimation methodology, and empirical findings.

2.3 Role of Public Health on Infant Mortality

racial, ethnic, and socioeconomic groups.

1. Assure an Adequate Local Public Health Infrastructure

2. Promote Healthy Communities and Healthy Behavior

equity, health disparities, and the social determinants of health.

3. Prevent the Spread of Communicable Disease

4. Protect Against Environmental Health Hazards

radiation, occupational health hazards, and public health nuisances.

maintaining a system of public health workforce readiness, deployment, and response.

6. Assure Health Services

identified as priorities by the local assessment and planning process.

7. Encouraging women breast feeding

 Not allow infants to share their bed.

2.4 The Causes of Infant Mortality Rate

psychological, behavioral and environmental factors.[

diphtheria-tetanus-acellular pertussis vaccine, Haemophilus influenzae type b (Hib) vaccine,

preeclampsia, diabetes, maternal medical conditions, and fetal distress, or developmental

gestation" have been associated with inflammation. Biomarkers of inflammation, including C-

been shown to be associated with increased risks of infection or inflammation-related preterm

Infant Death Syndrome.

5. Low birth weight

Malnutrition or under nutrition is defined as inadequate intake of nourishment, such as proteins

to malnutrition are socioeconomic, environmental, gender status, regional location, and

intertwine and vary among regions.

7. Adverse effects of malnutrition

cognitive developments, increasing susceptibility to severe health problems. Micronutrient