CHAPTER ONE
INTRODUCTION
1.1 Background of the Study:
Child mortality defined as the likelihood for a child born alive to die between its first and fifth birthday is one of the most sensitive and commonly used indicators of the social and economic development of a population. Thus, it is frequently on the programme of public health and international development agencies and has received renewed attention as part of the United Nations Millennium Development Goals (MDG Espo 2002).
The MDG target is to reduce child mortality by two-thirds in the year 2015.This is pertinent as the progress and future of any country depends on how healthy the children are, which is reflected in their access to basic health care, nutritious food and a protective environment, and if these are not available the country's mortality rates would increase and economic potentials diminish "(WHO 2008)"
Globally according to the UN inter-agency group on child mortality estimation in 2011 a significant amount of progress has been made towards achieving the target of reducing mortality rate by two-third among children under-five. For instance the number of under-five deaths worldwide has declined from more than 12million in 1990 to 7.6million in 2010.
However the highest rates of child mortality are still in sub-Sahara Africa where close to 50percent of childhood deaths takes place even when the region accounts for only one-fifth of the world's child population (Mesike and Mojekwu 2012).
For instance 1 in 8 children die before the age of 5years, more than 20times the average for industrialised countries (1 in 167) and South Asia (1 in 15), despite action plans, interventions and broad approaches towards improving child's health in the region (WHO 2005), further West African countries in particular experienced mortality up to three times higher than neighbouring countries in Northern and Southern Africa and all the under five deaths which occur ,five countries namely: India, Nigeria, Democratic Republic of Congo, Pakistan and China account for about 50% with India(22%) and Nigeria(11%) together accounting for a third of all under-five deaths.
Where child mortality is high or when it's neo-natal component is low relatively to the probabilities of death at higher ages, economies tend to suffer because parental investments can best be measured in terms of time, especially mothers time. In unfavourable mortality regimes, a far greater part of a woman's activity is dedicated to children who eventually die, thus limiting the time and energy available for other productive activities. In this way, adverse infant mortality patterns can be seen as an independent variable, an important contributing factor to the vicious circle of poverty and under development.
Nigeria despite its wealth of human and natural resources, the Federal Ministry of Health's Integrated Maternal New-born and Child health strategy and the fact that it is one of the first African countries with an integrated plan to look after mothers, new born and children right through from conception to the child's fifth birthday is one of the least successful of African countries in achieving improvements in child survival in the past four decades (Nigeria Health Journal 2011). During the past two decades a considerable amount of information has become available from developing countries showing that maternal education has a strong impact on child mortality. On average each one year increment in mother’s education corresponds with about 7-9% decline in under 5's mortality.
Education exercises a stronger influence on early and later childhood than in infancy. This research would assess the various mechanisms or intervening factors which could explain how mother’s education influences the health and survivor ship of her child. Two of the possible intervening variables, namely reproductive health patterns and more equitable treatment of sons and daughters play a relatively minor role in the explanation of the relationship.
Economic advantages associated with education (i.e income, water and latrine facilities, housing quality etc) account for about one-half of the overall education-mortality relationship of intervening variables is complex and variable. There are countries whose primary health services are so weak that they have no effect on the health of mothers and children, there are also other countries whose health services may tend to accentuate educational disparities because of differential access, little is known about the intervening role of health beliefs and domestic practices, but it is hypothesise that they are important in the explanation of the education mortality relationship.
Data from the world fertility survey in ten third world countries are used to test the conclusion, based on a Nigerian study, that maternal education is important in reducing child mortality. The analysis confirms the major importance of parental education, the impact of which is probably greater than both income factors and access to health facilities combined. Rural/urban differentials are of small importance once parental education has been controlled. The findings of the Nigerian study are modified in that paternal education, and the step from primary to secondary schooling is more important than that from illiteracy to primary schooling.
The massive declines in child mortality during the last quarter of a century have been result not only of technological and economic change but also of social change of which the most important component for the survival of children through the first year of life has been parental education.
It is suggested that schooling introduces parents to a global culture of largely Western origin and loosens their ties to traditional cultures age and sex differentiation in power, decision making and benefits within the larger family are reduced while schooling brings about a new family system in which women and children are allocated higher priorities in terms of care and allocation of food and in which parents can make decisions about health and childcare without reference to their elders.
Hundreds of millions of children in less developed countries suffer from poor health and nutrition which increases child mortality. Children in most less developed countries also compete far fewer years of schooling, and learn less per year of schooling than do children in developed countries. Recent research has shown that poor health and nutrition among children reduces their time in school and their learning during that time because lack of health and nutrition leads to early death of these children.
Women's education has been reported as a key factor in reducing infant and child mortality. This is practical whereby the higher a woman's level of education the more likely it is that she will marry later which plays a key role in decision making and exercise her reproductive rights, her children will tend to be better nourished, and kept in a hygienic environment, also protected from killer diseases unlike an uneducated mother who is ignorant of healthy living and nutritional values which tend to pose a threat to the wellbeing of her children, making the children prone to diseases which can cost their lives thereby increasing the level of child mortality.
The lack of primary education and lack of access to health care contribute significantly to child and maternal mortality statistics. Women who complete secondary education are more likely to delay pregnancy, receive pre-natal and post-natal care and have their birth attended to by qualified medical personnel; data from the NDHS 2008 revealed that educational levels among females were related.
From birth through age four, the child has to be protected against childhood diseases and injuries; there is need for early detection and prevention of development problems and postnatal disabilities. Each child needs to be prevented and protected from burns, poisoning, drowning, bites, strangulation, suffocation, abuse and neglect.
Ages five (5) through fourteen (14) years pose a lot of challenges for health promotion agents in consolidating the gains of early years, these are ages in which to teach and personally demonstrate healthy eating habits, personal hygiene, avoidance of unsafe food, water and sources of parasites how to deal troubling feeding and troubling people, social amenities and problem solving in an equitable manner.
Health professionals are en joined to take initiative to work with local educators and parent groups to reach the public with the many small but important steps they can like to save children from trauma and disability. This period witnessed the planting of seeds including teaching children the high value of good health and how to build it through continuing health promotion and self-care, teaching them about hygiene (cleanliness to avoid infection), healthy eating, adequate exercise and sleep, keeping dangers out of households and play areas, avoiding careless and risky behaviours and respecting and esteeming others as well as oneself.
A woman’s education as a determinant in different demographic processes has been the subject of many studies during the last 30 years and it has been proven to have an impact on fertility, health, and mortality. In 1979, John Caldwell published an article that argued for a strong causal relationship between a mother’s education and child survival. Up to this point, the focus of research had been on the importance of economic, medical and technological progress as key factors in reducing child mortality in developing countries (Caldwell, 1979).
Caldwell’s article set the stage for a series of papers concerning the impact of a woman’s education on the survival and well-being of her children. In poor countries, education is (of course) a goal in itself as a way to increase the generation of income and raise living standards. However, this new awareness of the importance of women’s education as a way of reducing the mortality in developing countries has made investments in girls’ education an even more important part of development programs.
Several mechanisms and factors combined explain this causal relationship, one of which is the fact that young girls enrolled in schools obtain basic knowledge on subjects such as hygiene and sanitation. Education also makes the women more likely to have their children vaccinated; it will make them able to communicate better with health care workers and gives them a higher inclination to use contraceptives. In addition, education is thought to increase a woman’s autonomy within the household and in society in general.
This individual-level effect of education is found to be reduced when taking into consideration socio-economic status and community variables such as wealth and whether the woman lives in an urban or a rural area. The reason for this is that while education may be a determinant for wealth and place of residence, it may also be that the wealth and attitudes of a woman’s parents and where she grew up have an impact on her education.
Improvements in the health of pregnant women and new mothers will play an important role in generating further reductions in child mortality. Poor nutrition in women can lead to pre-term births and babies with low-birth weight. The evidence also shows that children who lose their mothers are more likely to die before their second birthday than those whose mothers survive. There has been progress here as well, notably in scaling up key interventions, such as skilled attendance during delivery. However, more than half a million women still die every year as a result of complications that arise during pregnancy and childbirth.
The focus must be on delivering key interventions at the community level as part of integrated efforts to support the development of stronger country-wide health systems. Widespread adoption of basic health interventions, including early and exclusive breastfeeding, immunisation, vitamin A supplementary and the use of insecticide-treated mosquito nets to prevent malaria, are essential to scaling up progress. Still, if the gains of recent years are to be sustained and increased, we must recognise that providing better health care and higher coverage of vital interventions to those who are most in need requires more than just new hospitals, better immunisations and more skilled health professionals. It requires good roads, reliable water supplies, and better nutrition and food security.
Without these, health workers face difficulties in reaching villages and homes, malnutrition undermines the impact of health interventions, contaminated water sources cause diarrhoea diseases, and unhygienic practices render children and mothers more vulnerable to disease. Economic growth, poverty reduction and access to skilled health workers all contribute to improving child survival and reducing maternal mortality.
Providing basic education especially to girls will also be crucial to building on the gains of the recent past. Improving access to education is an essential building block for increasing the number of trained health workers, particularly at the community level. And universal basic education reduces poverty and contributes to economic growth by increasing productivity. Education also helps build the kind of behaviours and habits that have a positive impact on an individual’s health.
Children who complete basic education eventually become parents who are more capable of providing quality care for their own children and who make better use of health and other social services available to them. Evidence indicates that when girls with at least a basic education reach adulthood, they are more likely than those without an education to manage the size of their families according to their capacities, and are more likely to provide better care for their children and send them to school.
Achieving universal primary education is itself a Millennium Development Goal. The first measure of success in education is ensuring all children complete primary schooling. But simply completing school is not sufficient. The quality of knowledge and the level of competency that schools are able to successfully impart are equally important. An early start is vital to providing children with good health habits, responsible behaviour patterns and improved self-esteem.
However, focusing exclusively on primary education and young children will not guarantee the results that education should deliver, because these attributes are often only put into meaningful practice when girls and boys reach adolescence.
Therefore, quality education for children, adolescents and youth must be the focus of our attention. Quality education means good teaching methods and learning materials provided to those who are sufficiently healthy to benefit from what is offered to them, in an environment that is conducive to learning. Schools that cannot provide basic amenities, such as proper toilets, clean water supply and play areas, do not lend themselves to providing quality education, particularly for girls, whose educational prospects suffer. Faced with a lack of girl-friendly facilities, many parents withdraw their daughters from school when they reach adolescence. And evidence tells us that education, especially of girls, is critical for the development and empowerment of women. It raises economic productivity, reduces poverty, lowers child and maternal mortality, and helps improve nutritional status and health.
In addition, clean water and adequate sanitation in schools often trigger demand for clean water and good sanitation practices in the wider community. As the education and health levels of communities improve, so, by extension, do their prospects for decreased child and maternal mortality levels. Within classrooms, it is essential that the environment is one in which children can actively participate in the education process and in which resources are adequate to promote enthusiasm for learning.
Programmes like the Child Friendly School Initiative support the development of schools that offer a safe, high-quality, including education, tailored to the needs of the children they serve. Informal education for those not in schools can also contribute to the health and well-being of women, children and their communities.
Another initiative, the Child to-Child for School Readiness programme, provides training and materials that allow teachers to equip students to pass on the knowledge they gain to siblings who are either not or not yet, in school. This programme has been tested in many countries and has demonstrated that it successfully spreads healthy habits and practices beyond schools and into homes and communities.
The relationship between education and child and maternal health is clear. The larger lesson—that all the MDGs are interlinked and that success in any one will only be sustainable with success across all of the Goals.
1.2 Statement of the Research Problem:
A very important determinant of child mortality is the age and education of mothers. Analysis of mortality rates by education reveals that death rates are higher among illiterate and young mothers.
A high incidence of childhood diseases particularly tuberculosis and diarrhoea is prevalent among pre-school and children in Northern Nigeria. The mothers of these children associated with these diseases are predominantly uneducated and rural, making them ignorant of adequate nutrition and poor hygiene.
If all this problems aren't tackled and they prevail, high rates of mortality will be experienced which will have repercussion on the welfare of a very large segment of the population especially mothers and their children. This would also continue to suppress the development of the state and the amount of resources channelled towards health services which will affect the total income of family, state income and foreign reserve of the state.
This study therefore is aimed at investigating if there exist a relationship between education and child mortality.
1.3 Objective of the Study:
(1) To investigate if education has any significant effect on child mortality.
(2) To find out how much effort Nasarawa state government has put in place in achieving the MDG goal 4.
(3) To find out what rate is child mortality increasing in Nasarawa state (geometrically or arithmetically)?
1.4 Significance of the Study:
In a study of this nature, apart from determining the level of child mortality in Nasarawa State, it will also attempt to examine the nature and cause of child mortality. Child mortality rate correlate very strongly with and is among the best predictors of a state failure as child mortality rate is also a use full indicator of a country's level of health or development.
A search through literature revealed that education is viewed as one of the important determining factor of child mortality. In view of that, the contribution of education towards understanding child care and proper hygiene in the study are is of great significance to this study.
This study is also an attempt to fill the gaps existing on knowledge in this field in the study area which will be of benefit to Nasarawa State Government, the public and further researchers who will find this important.
1.5 Research Question
(1) To what extent has education impacted on child mortality?
(2) What positive measures has Nasarawa State Government put in place to achieve goal 4 of the MDG?
(3) At what rate is infant mortality increasing in the state?
1.6 Statement of Hypothesis
This research is designed to test the following hypothesis:
H0: Education has no significant impact on child mortality in Nasarawa State.
H1: Education has a significant impact on child mortality in Nasarawa State.
1.7 Scope of the Study
This research work covers parents especially women who have given birth to children between the ages of 0-5 years in Keffi, Nasarawa State.
This study is limited to Keffi, Nasarawa state. It analyses two basic issues: education and child mortality as they concern Nasarawa state. It also examines other issue which are either directly or indirectly causes of child mortality.
Call 07032879723 or send mail to michaelonjewu@yahoo.com for the complete project
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