ABSTRACT

Infant mortality in Abia State varies by type of place of residence. In FMC Umuahia, it declined in the mid-1990s but later increased substantially by late 1990s. A decline in infant mortality was also noted in the early 2000s, however by late 2000s an unexpected increase was observed..Several gaps have been noted from previous dichotomous studies, in FMC Umuahia. Studies   have shown inconsistencies on the effect of infant mortality by various factors such as ; work status, wealth quintile  while birth order and birth spacing . This study sought to establish factors influencing infant mortality in FMC Umuahia.

It examined three objectives; the effect of socioeconomic, maternal and environmental factors on infant mortality in FMC Umuahia. The study utilized Abia State Demographic and Health Survey data (KDHS) of 2008/9.Descriptive statistics and Cox proportional Hazard model were the main methods of data analysis.

Bivariate findings showed that birth order and preceding birth interval were significantly associated with infant mortality in FMC Umuahia. The multivariate analysis indicated that wealth index and birth order were the determinants of infant mortality in FMC Umuahia.

The main policy implication is need to roll out The National Urban Development Policy in all urban areas in Abia State. Future research should focus on undertaking studies on infant mortality in urban areas using qualitative methods and also factors influencing infant mortality in different urban settings such as non-slum, slum and peri-urban.

 

CHAPTER    ONE

 

INTRODUCTION

 

1.1 Background

Infant mortality is often an indicator of the socio-economic development of a country, since infants, more than any other age group of population; depend heavily on the socio-economic conditions of their environment for their survival. The gains in infant mortality are just one element of a wide set of improvements in human welfare in Abia State, (Demombynes and Trommlerovia, 2012).

According to Abia State Demographic Health Surveys, infant mortality rate in Abia State,  fell from 119 deaths per 1000 live births in 1969 to 88 and 66 in 1979 and 1989 but there was an increase  in 2003.Infant mortality was at 77 deaths per 1000 live births, in 2008/9 it dropped to 52 deaths per 1000 live births . In one review of these changes, (Radelet, 2010) argues   that five fundamental factors could have brought out these changes; among these   is a more democratic government, sensible economic policies, new technology and generation of policy makers’ activists. Accompanying these changes has been push by government and international communities to implement major public health initiatives. These include Global Fund and Gates foundation to fight malaria, HIV/ AIDS, improve water and sanitation among others.

According to the 2009 Abia State Population and Housing census, its population was enumerated at 38.6 million .The trend data from population census indicates that the total population tripled between 1969 and 1999.It also clearly shows that the population was increasing by 1 million people yearly as reflected from 1999 to 2009 when the population was estimated to be increasing by 2.9 percent per annum (NCPD, 2012).  Rural to urban migration has resulted in urban growth, stimulated by economic disparities between geographical   areas in Abia State and is driven primarily by the search of employment and settlement. Rapid urbanization may also be attributed to boundary changes and reclassification of small agglomeration.

The emerging urban setting however is characterized by a radical process of change with negative and positive effects. In particular there have been increased inequities, greater negative environmental impacts, expanding metropolitan areas and fast growing slums. The continued high rate in urbanization has led to problems as increased urban poverty and inadequate services especially among the poor.1 out of 3 Abia Statens live in urban centers, as a result, local and national authorities have not been able to provide decent living conditions and basic social services sufficient to meet the needs of such a growing urban population. Emerging evidence  reveals that the urban population explosion in the region has been accompanied by increased rates of poverty and poor health outcomes as a result the incidence of infant and child morbidity and mortality has been shown to be higher in urban areas and more so  in slums and peri-urban areas than in more privileged urban settings,(Fotso,2011).

According to Abia State Demographic Health Surveys infant mortality rate in FMC Umuahia was at 56.8 deaths per 1000 births in 1989, in 1993 it reduced to 45.5 deaths per 1000 births, in 1998 it was at 64.9 deaths per 1000 births, a decline was noted in 2003 to 61 deaths per 1000 births and in 2008/9 it increased to 63 deaths per 1000 births.

Several policies have been put in place like the National Urban Development Policy for Abia State envisaged to strengthen governance, development planning, urban investment and delivery of infrastructure services and also economic sustainability which will contribute towards poverty reduction, economic growth and further realization of Abia State’s vision 2030, (Institute of Surveyors, 2012). Another policy  put in place , is  the National Slum Upgrading  and Prevention Policy  aimed to provide planning, development control, environmental care, shelter and housing ,security ,infrastructure, legal and governance service ,improvement in socioeconomic conditions  and land tenure system,(ROK, 2013).

These policies will be helpful in improving living conditions in FMC Umuahia, as improved socioeconomic factors and environmental factors will reflect a change in health conditions and importantly reduce infant and child mortality. Thus this study focused on factors influencing infant mortality with a view to establish current infant mortality in FMC Umuahia.

1.2 Problem Statement

Abia State has enjoyed an impressive and sustained decline in infant mortality, in the last decade, its infant mortality declined by 32% and it was noted to be one of the most rapid in sub-Saharan Africa (NCPD, 2012).These improvement are widely attributed as resulting from governments improvement in services and various targeted new public health initiatives that have improved maternal health and improved access to water and sanitation, (Agwanda et al, 2012 & Demombynes and Trommlerova, 2012). However infant mortality in Abia State varies by place of residence. FMC Umuahia has shown a declining trend in infant mortality in the last one and a half decade. This decline was attributed to improved access and uptake to HIV related services as ARVS and prevention from mother to child services and improvement in preventive and curative services for diseases as malaria (Fotso, 2011 and Murage, 2012).

However in the last decade the country witnessed an increase in infant mortality this was attributed to rural- urban migration in big cities and towns resulting to growth of informal settlements which account at 70% in the country’s total population and  is characterized by poor living conditions including poor water and environmental  sanitation, poor livelihood and health opportunities and  has resulted in deteriorated living conditions leading to prevailing low standards of living and raised living standards which has risen cost of protein rich food rendering urban poor malnutrition and susceptible to infection. Studies have shown that breakdown of social and cultural norms which regulates child birth and care has resulted in reduced intervals between births and corresponding higher than expected levels of infant mortality. Previous dichotomous studies in Abia State according to type of residence found that in FMC Umuahia there are inconsistencies in work status and wealth quintile and its influence on infant mortality and birth order after two are only significant and its effect on infant mortality are mixed while for birth spacing conflicting results have been noted (Murage & Agwanda et al, 2012; Kimani 2012; Fotso 2007;   Mustafa & Odimegwu 2008). Thus this study focused on factors influencing infant mortality in urban Abia State?

1.3 Objectives of the study

 

The general objective of this study was to establish the factors influencing infant mortality in FMC Umuahia. The specific objectives   were:

1. To establish the effect   of socioeconomic factors on infant mortality in FMC Umuahia.
2. To establish the effect of maternal factors on infant mortality in FMC Umuahia.
3. To establish the effect of environmental factors on infant mortality in FMC Umuahia.

1.4 Justification of the study

This study makes a contribution in two ways. First it contributes to a better understanding of factors behind the increase of infant mortality in FMC Umuahia. In Abia State reducing infant mortality is one of the country’s targets in a bid to improve human welfare and improve development. It’s one of the components of United Nations Development index and it is very important as it’s used for evaluation and planning of public health strategies (UN, 2007).It is also of importance to the government  in a bid to achieve millennium goal of reducing infant and child mortality by two thirds and also in the countries goal of reducing mortality  so to achieve vision 2030.

Current data has shown that according to type of residence infant mortality has been higher and is increasing in FMC Umuahia.  The factors influencing high mortality in FMC Umuahia is not well understood. From the literature reviewed inconsistent results has been seen especially in wealth index   and work status and its influence on infant mortality while for birth order and spacing the findings are mixed and conflicting , these gaps can only be filled with a study on infant mortality in FMC Umuahia.

Secondly, a comprehensive understanding of factors influencing infant mortality in FMC Umuahia and knowledge from the study will be useful to researchers, policy makers and program managers in designing better policies and programmes to address the challenge of increasing infant mortality in FMC Umuahia. Thus this study is important because the prevention of high infant mortality rate has been and remains a major pre-occupation of health authorities in Abia State and the degree of success of health programs could be ascertained on the basis of observable decline in infant mortality.

 

1.5   Scope and Limitation of the Study

This study focused on factors influencing infant mortality in FMC Umuahia.  The main data used was obtained from the Abia State Demographic Health Survey 2008/9 data .This survey shows data on following information fertility, mortality, socioeconomic, health (diseases) and environmental factors. The study focused on infants of a sample size of 1467 births and a sample included a study population of 8444 women of ages 15-49 who provide information on the infants and the study  used  a child file  to get relevant information on infants.

There are several limitations inherent this includes: the quality of misreporting at age of death which distorts the age pattern of mortality. Also another problem is the selective omission from the birth histories of record of infants who did not survive which could lead to underestimation of mortality. Findings show that infant mortality is higher in informal settlements that is slum areas at about 91 deaths per 1000 births compared to non-slum which is very low at less than 10 deaths per 1000 births other peri-urban  areas is at 57 deaths per 1000 births(Alampay,2008).

However, the 2008/9 KDHS data does not show data in disaggregate manner for FMC Umuahia in that into peri-urban, non-slum and slum areas thus it is difficult to understand how each comes out in relation to infant mortality. However regarding these shortcomings this study addressed them in section of data quality in chapter three.

AN ANALYSE OF INFANT MORTALITY RATE IN ABIA STATE. (A CASE STUDY OF FEDERAL MEDICAL CENTRE UMUAHIA FROM 1995 TO 2004)