CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

One of the most pressing global health issues is the high rate of death among children under the age of five. Every year, more than 10 million children under the age of five die around the world. Due to neonatal and child mortality, child health and survival in poor nations lag behind desired targets. Every year, over 29,000 children under the age of five die, mostly from preventable causes (UNICEF, 2008). According to WHO (2011), an estimated four million children die during their first 28 days of life, with the majority of deaths occurring during the first 24 hours, due to a lack of proper facilities and health personnel willing to do their tasks at the appropriate time. The situation is especially concerning in Sub-Saharan Africa, where infant and child mortality rates are ten times greater than in developed countries (Barbieri, 2004). Nigeria's under-five mortality rate was 157/1000 in 2008, according to the Nigerian Demographic and Health Survey (NDHS) (NPC & ICF Macro, 2009). When compared to the aim of 45/1000 that was set for 2015, this is concerning. The decrease of newborn and child mortality has become a significant priority in the development agendas of most developing countries (Ugweje, 2008). Eboh (2000), in a paper on the subject, stated that infant and child health are critical factors in ensuring a healthy nation and a prosperous future for the child and the entire society, as every child has the right to good health, to grow up and to develop happily into a productive and stimulating life. Furthermore, the United Nations General Assembly enacted the International Convention on the Rights of the Child in 1989, which requires governments to "guarantee, to the utmost degree feasible, the survival and development of the child." State parties were dedicated to the rights of children's survival, development, and protection. In terms of operations, it was advised that suitable efforts be made to reduce baby and child mortality, as well as to combat sickness and malnutrition" (Eboh, 2000:27). Child mortality was selected as a major indicator of development at a gathering of world leaders in 2000 to create global development goals for the millennium. As a result, it was designated as a key indicator of social, economic, and health progress for many countries and zones around the world. Goals for achieving the millennium development goals have been set (MDGs). For example, by 2015, the worldwide child death rate was predicted to drop to 45 per 1000. To meet this goal, global efforts were mobilized to develop technology that would secure global child health. The development and distribution of efficient vaccines and technology to protect children from known pediatric killer diseases were encouraged. Every country's primary health care (PHC) system has been highlighted as the fundamental driver in the successful fight against childhood fatalities. The PHC centers were supposed to serve as a hub for women's ante-natal and post-natal care, as well as immunizations for their children against childhood killer diseases. As a result, one of the health centers' principal functions was to increase access to health services and thereby minimize childhood mortality. The Inter-Agency Group for Child Mortality Estimation (IGME) was established by the United Nations in 2004 to advance the work of monitoring progress toward MDG4, which aims to reduce the under-five mortality rate by two-thirds between 1990 and 2015 as a global momentum and investment for accelerating child survival and growth (UNICEF, 2010). This has refocused attention on the issue of health intervention access. Bill Gates (2005), speaking at the World Health Assembly in 2005, urged world stakeholders in global health to commit more thought and investment to improving access to existing initiatives for improved health. Using data from the Orumba North Local Government Area (LGA) of Anambra State, the study described here aims to investigate the issue of access to PHC services in Nigerian rural communities.

1.2 STATEMENT OF THE PROBLEM

Effective access to health care services by women and children in Nigeria remains limited and problematic. Effective access to health care services by women and children is commonly defined as one's ability to obtain and appropriately use good quality health technologies and commodities as and when needed for good health (Ensor & Cooper, 2004). Only 23% of children aged 12-23 months, the age at which they should have had all immunizations, were fully vaccinated, according to the 2008 Nigerian Demographic and Health Survey (NDHS). BCG immunizations were given to 50% and measles vaccinations to 41%. DPT 3 (35%) and polio 3 (39%) vaccinations were given to fewer youngsters than DPT 1 (52%) and polio 1 (39%) vaccinations (68 percent ). Only 19% of children are fully immunized by the age of 12 months. Overall, only 29% of Nigerian children have got any vaccines. Insecticide-treated nets (ITNs) ownership and use also left a lot to be desired. Only 8% of homes surveyed in the 2008 NDHS owned at least one ITN, with only 3% owning several ITNs. Per household, the average number of ITNs was fewer than one. This is concerning, given the large size of Nigerian households. The widespread distribution and marketing of insecticide-treated nets (ITN) among pregnant women and children under the age of five has not resulted in the projected reduction in malaria cases, particularly among these populations. Only 8% of families have two or more mosquito nets. Worse, only 3% of ITN owners have more than one. Per household, the average number of ITNs is fewer than one. Despite remarkable improvement in net production and availability in Nigeria, this falls short of the aim of at least two ITNs per household.

People in different demographic groups have different levels of access to these life-saving technology. According to the 2008 NDHS, while more children (five years) in rural regions (12.6 percent) than those in urban areas slept beneath any net, only 5% of children (five years) in rural areas slept under ITNs compared to their counterparts (6.5 percent) in urban areas. ITN was used by 2.5 percent of children in the lowest quintile compared to 8.0 percent of children in the wealthiest quintile. When it comes to immunization, the situation is similar.

According to Frost and Reich (2008), the current child death rate in developing nations is due to a lack of health care services for many individuals, particularly rural dwellers. Poor prenatal care (ANC) practices, lack of access to, and weak health systems are largely to blame for Nigeria's low child health status and limited uptake of interventions aimed to improve child health. Poverty and ignorance exacerbate the situation, preventing women from receiving crucial ANC treatments and counseling on important safety measures, medications, and other interventions such as ITN use (Onokerhoraye, 2000). Medical facilities are often scarce and sparsely distributed. In remote rural locations with challenging terrain and insufficient infrastructure.

Having a good road network and sophisticated health facilities are luxuries that most residents cannot afford, even if they want them (Okonofua, 2010). Due to a variety of personal and logistical challenges that women face, such as location, mode of transportation, and occasionally the attitude of health care providers, attendance at antenatal clinics (ANC) is quite low. Nigeria is a signatory to many international accords reached in 1993 to address the global problems of poverty, hunger, malnutrition, and child survival. However, it is a sobering observation to realize that 18 years after the start of this historic campaign, millions of children have been left behind (Ogundipe, 2008). According to Ojanuga (2009), the child mortality rate is still rising, fueled by sociocultural factors that negatively impact physical well-being and access to proper health care services. There is also the issue of low education, particularly in the area of health education, among rural dwellers. This has hampered community members' ability to make sensible decisions (Federal Ministry of Health and Social Services, 1998). Education, according to Ugwueje (2008), is a critical component because it affects other aspects of home living conditions such as knowledge of appropriate health facilities, perceptions of illness and disease causation, and personal illness control strategies. Furthermore, according to the World Bank (2002), one of the key causes of increased child death rates in Africa is economic hardship. Most families' ability to purchase adequate and high-quality foods has dwindled, affecting children's eating practices (Rokx & Brown, 2002). Onyeneho (2005) highlighted in her study that failure to access child health programs in underdeveloped countries is dependent on bridging gaps in service delivery and community utilization. The aforementioned challenges and problems point to a link between growing child mortality in the country and limited access to primary health care services. While the problem may be the same in most Nigerian communities, the actual expression and explanatory elements may vary from one region to the next, even within the same civilization. This is in line with Frost and Reich's conclusion (2008:xi) that "simply because an excellent health technology exists, does not ensure it will be provided, used, or reach its potential to produce good health."

1.3 OBJECTIVE OF THE STUDY

The following objective questions are established to guide this investigation based on the foregoing:

I.       to assess thestate of infant and child health in Rivers State's Port Harcourt Local Government Area?

II.    to assessthe level of adoption of child survival technologies in Rivers State's Port Harcourt Local Government Area?

III. to determine the cultural variables that influencesaccess to primary health care services in Rivers State's Port Harcourt Local Government Area?

1.4 RESEARCH QUESTIONS

The following research questions are established to guide this investigation based on the foregoing:

I.       What is the state of infant and child health in Rivers State's Port Harcourt Local Government Area?

II.    What is the level of adoption of child survival technologies in Rivers State's Port Harcourt Local Government Area?

III. What cultural variables influence access to primary health care services in Rivers State's Port Harcourt Local Government Area?

1.5 SIGNIFICANCE OF THE STUDY

Nigeria's population status reveals that mortality, particularly baby and child mortality, remains high. As a result, this research has both theoretical and practical implications. Theoretically, this research will add to the corpus of information on child health in Nigeria and other developing countries, with a focus on rural areas. The findings of this study will serve as a good foundation or guidance for future research, as well as inspire more research on the health of children in rural areas, which now need special attention. In addition, this research will give useful information on the factors that influence childhood mortality and inadequate usage of primary health care services, particularly in developing nations. The research will give empirical data to examine the validity of several existing child health theories in rural Nigeria. In practice, the outcomes of this study will indicate the variables that impede proper usage of primary health care services, as well as the consequences for child mortality. The findings of this study will also aid planners in developing appropriate, persuasive health messaging that will improve people's attitudes toward using primary health care services and raise knowledge of the country's child mortality crisis. More importantly, the interviewing procedure and the provision of replies to the questions will provide people in the study communities with the chance to improve their child health practices.

1.6 SCOPE OF THE STUDY

The focus of this study is limited to an evaluation of access to Primary Health Care Services and Child Mortality in Rivers state. The local government of Port Harcourt was used as the case study.

1.7 LIMITATION OF STUDY

The study was limited given the short duration of the study and the budget.

1.8 DEFINITION OF TERMS

Childhood Mortality: "Mortality refers to decrement process by which living members of a population gradually die out" (Preston, Heuveline, & Guillot, 2001:92). Childhood mortality refers to death of persons under-5 years (WHO, 2011). It is measure by the number of deaths occurring between the first year of birth and the fifth birthday in a given population.

Infant Mortality: This is the death occurring during the first year of life (UNICEF, 2010). In this study it will refer to the death of person aged 12 months or less.

Primary Health Care: According to WHO (1978), Primary health care is defined as essential health care based on practical, scientifically sound, and socially acceptable methods and technology made accessible to individual and families in the community through their full participation and at a cost that the community and country can afford to maintain in the spirit of self-reliance and self-determination.

Primary Health Care Services: This refers to the provision of primary health care, including preventive health services and education (Texas Department of Health Services, 2007). In this study, it will include provision of the first course of health management, especially education and preventive services. It entails basic curative, preventive and promotional health services. In this study focus will be on the provision of basic curative, preventive and promotional health services in government established health care centres.

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