ABSTRACT
The study examined the infant care practices adopted by mothers in the rural communities of Udi Local Government Area of Enugu state. The objectives of the study were to determine the infant feeding, hygiene/cleanliness maintenance, umbilical cord care, warmth maintenance and health/care-seeking practices adopted by the mothers in the area as well as compare the adequacy of performances by the mothers across the different infant care practices and the association between their adoption of the practices and their demographic characteristics. The research design for the study was a descriptive survey design. The target population of the study were estimated to be 26,486 women of child bearing age of 15 -49 years. Ogebe-ogene, one of the development centres in Udi L.G.A was selected for the study using a simple random sampling technique. Proportionate sampling method was used to draw 12.5% of the sample size of 392 women of child –bearing age from each of the 8 villages in Ogebe-ogene for the study. Snowball method of sampling was used to reach the mothers who met the inclusion criteria. The instrument for data collection was researcher’s developed questionnaire. The collected data were subjected to simple descriptive statistical analysis of frequency and percentage.Chi-square was used to analyse the strength of association between the demographic data of mothers and their performances of the different infant care practices at 0.05 significant level. Major findings revealed that infant feeding was fairly practiced and was placed fourth in the adequacy of performances across the 5 determined infant care practices. Cord care practices were poor and was the least performed as less than average of the respondents adequately performed the optimal cord care practices as operationally defined. Warmth maintenance practices was the best adequately performed infant care and was followed by the hygiene care practices. Health care seeking practices was fairly practiced as a little above the average number of the mothers performed the practices adequately though a significant number (a little below the average) practiced self medication. There was a significant association between the maternal level of education and their adequacy of performance of all the infant care practices determined. Maternal age was significantly associated with their adoption of adequate infant feeding and health /care seeking practices. Occupations of the mothers were significantly associated with their adoption of adequate infant feeding, hygiene maintenance, warmth maintenance and health/care seeking practices. Maternal parity was significantly associated with their performance of adequate infant feeding, cord care, warmth maintenance and health /care seeking pattern. However, no significant difference was found between hygiene/ cleanliness maintenance practices and the maternal parity. Conclusion was drawn that cord care practices was poorly performed with infant feeding and health /care seeking practices only fairly /moderately practiced of all the examined infant care practices. Also, education, occupation, culture and experience (age and parity) were of significant association to the mothers’ practices. It was recommended that health workers and other stake –holders (particularly the public/ community –based nurses) should create more enlightenment/outreach programmes like health education and health visits to encourage improved adoption, and performances of cord care infant feeding and health/ care, seeking practices.
INFANT CARE PRACTICES ADOPTED BY MOTHERS IN THE RURALCOMMUNITIES OF UDI LOCAL GOVERNMENT AREA
OF ENUGUSTATE
M.Sc DISSERTATION
BY
UZOEGO CHINYERE M.
PG/MSc/06/45737
DEPARTMENT OF NURSING SCIENCES
FACULTY OF HEALTH SCIENCES AND TECHNOLOGY
UNIVERSITY OF NIGERIA, ENUGU CAMPUS
SEPTEMBER, 2014
CHAPTER ONE
INTRODUCTION
Background to the Study
Infancy, which is the period between zero (0) to two (2) years, is a very crucial period in ones life (World Health Organization (WHO), 2002). It is generally believed that once a child survives this period the child will successfully thrive through childhood. Being highly vulnerable, these infants need critical care from their care givers (that is, mothers, family members, health- practitioners etc). The objective of these care practices is to ensure the attainment of the infant’s health and survival.
Infant care practices are those practices or activities administered to the babies to ensure their health and survival. In other words, they can be those activities carried out by mothers and significant others, which help them go through the process of caring for their babies during this period of infancy so as to provide the children with suitable environment and conditions (physical, social and psychological) for proper growth and development (Yolanda, 2007). Emphasizing the importance of children’s right to survival and health, the Millennium Development Goals (MDGs) launched in 2005, has as its fourth (4th) goal, “the reduction of the under five mortality by two-third (2/3) by the year 2015”. To this effect, many countries have instituted programmes like Free Maternal and Child Health Care Services, Integrated Management of Childhood Illness (IMCI), Expanded Programme on Immunization (EPI), National Immunization Days (NIDs) etc. These efforts had only brought a sluggish decline in infant mortality rates (IMR) globally (Yolanda, 2007). UNICEF (2013) raised an alarm that Nigeria has only made a sluggish progress in checking the infant and child mortality between 2009 and 2011. According to the record, Nigeria was second next to India of the least successful countries in improving their infant survival. For instance, between 1990 and 2003 the infant mortality rate in Nigeria stood at 100 deaths per 1000 live births ( National population commission (NPC) 2008), while the statistical report by UNICEF (2013) indicated 88 deaths per 1000 live births. This figure is among the highest in the world.
This moderately high Infant Mortality Rate (IMR) in the country (an index of both medical and social standard) is attributed according to UNICEF (2013) and Adekunle (2007) mainly to the high neonatal and post-neonatal death rates. Darmstadt, Syed, Partel and Kabir (2006) noted that each year, approximately four million babies die during their first twenty-eight (28) days of life globally. Yolanda (2007) emphasized that ninety-nine percent (99%) of these deaths occur in the low and middle-income countries like Nigeria.
World Health Organization in Yolanda (2007) reported that these deaths occur at home where the infants are cared for by their mothers, relatives and traditional birth attendants (TBAs). (UNICEF 2013) and Yolanda (2007), emphasized that these deaths can be avoided through simple, affordable interventions, outreach and family/community care, health education to improve home- care practices, recognition of danger signs, generation of demand for skilled care and positive/increased health-seeking behaviour to appropriate health care facility.
Reducing infant mortality and morbidity, therefore, does not require only medical break through, expensive technology or the make-over of national health systems but major strides can be made by putting existing solutions into general practices (UNICEF 2013). As Martines, Paul, Bhutta, Koblinsky, Soucat and Walker (2005) noted, most infant survival programmes have focused too heavily on pneumonia, diarrhea, malaria and vaccine- preventable diseases which account for only thirty-six percent (36) of infant mortality. From the fore-going, it is deduced that most of these instituted programmes like free- Maternal and Child Health Care, Integrated Management of Childhood Illnesses, etc are objectively health-facility-based interventions while most deaths occur at home due to preventable causes which could be averted by simple methods such as house-hold hygiene practices, good nutritional practices and health/ care seeking behavior for these infants (Olatunji 2013).
The World Health Organization (WHO) in Peeyush and Pragti (2012) therefore, provided more comprehensive (hospital and home-based care) essential guidelines for newborn and infant care. These include: hygiene maintenance during and after delivery, keeping the infant warm, early initiation and exclusive breast-feeding, care of the cords, eyes, care during illness, immunization etc. These practices, according to Peeyush and Pragti (2012) meant “the mother and family preparing for birth, choosing a safe place for delivery, keeping the process of delivery clean, avoiding cold, breastfeeding early and exclusively, and understanding (and reacting to) potential danger signs.
Although mothers who access health care facilities are taught these infant care practices during their antenatal visits and the perinatal periods, they also get the influences of the family and community members in forms of suggestions, advices and contributions in caring for their babies. These may thus, create rooms for some controversial suggestions, ideas and practices, some of which might be harmful for the child’s health even though, they seem to be culturally acceptable. Worse still, mothers who habitually do not access health care facilities are more at risk to these dangers as they do not have prior knowledge of the proper essential newborn and infant care guidelines exposed to those that access health facilities.
Some of these practices which may still be in existence include, the introduction of coconut water (mmiri aku-oyibo in Igbo Language), as a pre-lacteal before initiation of breastfeeding of the infant. This is believed to help in reducing the severity of intestinal colicky (Afo-Mkughe “in Igbo Language”), which normally, most infants experience within their first three months of life. Other practices include; removal /expressing out of the colostrum which is believed to cause loose stool for the infant, massage of the infant’s abdomen and umbilical stump using hot-water, believing that it initiates stooling, increases peristaltic movement and speeds up the falling-off of the umbilical stump and its healing; rubbing of herbs/local concoctions like palm kernel oil (enu-aki) on the infant’s skin and body, even giving the child’s urine to the child with infantile conditions like fevers and convulsions believing that they drive the causative demons away, application of a poultice .on the parietal frontannelle of an infant to treat sunken frontannelle in a malnourished/dehydrated child etc. These practices even when objected to by these mothers might be forced on them by the families with the notion that they (the mothers) are inexperienced.
Based on the above considerations, it becomes necessary to look into the infant care practices adopted by mothers in rural communities, since research, as already indicated, has shown that most of the infant deaths occur at home where the infants are cared for by their mothers and relatives (WHO in Yolanda, 2007) and with little or no involvement of the formal health care system (Darmstadt et al, 2006). Besides, since these deaths can be avoided through simple affordable interventions like health education to improve home-care practices, (Yolanda, 2007), it becomes necessary to empirically ascertain the home-based care practices of these rural mothers. It is hoped that the information obtained from this study will assist in guiding the needed health education to improve the mothers’ home care practices.
Statement of the Problem
Infancy is a very crucial period in the life of every human being, since infants are highly vulnerable due to their total dependency on the adult humans for the provision of their basic needs and up keep (Yolanda, 2007). The infant mortality rates are a health and social index used globally for measuring a country’s Gross Population Rate (GPR). Globally, Nigeria is among the countries with the highest infant mortality rate with 88 deaths per 1000 live births (UNICEF 2013). Accordingly, the National Population Commission Demographic and Health survey (NPCDHS, 2008) indicated a substantial difference in the infant and childhood mortality rates between the urban and rural areas of 67 deaths / 1000 live births and 95 deaths /1000 live births respectively. The report also emphasized that these differences might be related to the qualities of the infant childhood care practices administered to these infant. Most of these deaths are recorded to occur in the homes even among the deliveries attended to in the health facilities by trained health personnel and may be attributed to the infant\ childcare practices at home (Chandrasekhar, Hari, Binu, Sabitri& Nenna 2006 & Yolanda 2007).
Indeed the traditional child care practices in the typical Nigerian society is always a collaborative effort involving the extended family members, friends and neighbours of the infants’ family with the notion that “the child belongs to all (nwa bu nwa ora). Though this may be slightly avoided in the urban settings due to the modern accommodation set ups but in the rural setting, the effort might be highly futile due to the social life style obtained there. Some of these practices as observed by the researcher include; the deprivation of colostrum cum delay of early initiation of breast feeding, the use of prelacteals like coconut water before initiating breast feeding, predominant breast feeding of the infant (that is, giving water in addition to breastfeeding of the infants and sometimes pap) at early ages of 2 to3 months as well as some traditional treatment\ care practices like rubbing of palm kerneal oil on the infants’ skin for convulsion, application of poultice/ clay on the infants’ frontannelle for sunken frontannelle which indicates dehydration/ malnutrition due to poor feeding practices etc.
The area of study, Udi Local Government Area is one of the rural settings of Enugu State and accommodates about 70% rural dwellers. According to the raw data of 2011 (January to October) from the district hospital (the Maternal and Child Health Centre, Udi) which is the headquarter of all the 5 health centres/ district hospitals the local government could boast of, out of the 180 infants aged 0- 1 year presented to the health centre for treatment, 60 of them presented with diarrhea/ gastroenteritis / dysentery with 40 of them within the age ranges of 2 weeks and 7 months. Other infections presented were acute upper respiratory tract infections (URTI) and omphalitis were reported at the rates of 102 and 20 respectively. These figures are alarmingly high giving credence to assertions by WHO, (2003) that acute respiratory infection (ARI), fever and dehydration from diarrheas are important causes of childhood morbidity and mortality in developing countries and that prompt medical attention when a child has symptom is therefore crucial in reducing these deaths. These are conditions that may arise from inadequate infant care practices. In view of these, there is need not only to empirically investigate into the infant care practices adopted by the mothers in the homes such as feeding practices, cleanliness, cord care practices, maintenance of warmth/ thermal regulations practices, health/ care seeking patterns when the child is sick, but also to ascertain the adequacy at which these are practiced.
Purpose of the Study
The purpose of the study is to determine the infant (one-year) care practices adopted by mothers in the rural communities of Udi Local Government Area of Enugu State.
Objectives of the Study
Specifically, the objectives are to:
1) Identify the infant feeding practices adopted by mothers.
2) Determine the hygiene/cleanliness practices employed by mothers in caring for the infants.
- Determine the umbilical cord care practices employed by mothers.
- Identify the practices related to maintenance of warmth employed by mothers in the care of the infants.
- Determine the health/ care-seeking patterns / practices employed by mothers while infants are sick.
- Compare the adequacy of performance by mothers across the different infant care practices.
- Determine the association between the adoption of the infant care practices and some maternal demographic data.
Research Questions
Based on the above set objectives, the following research questions were asked;
- What are the infant feeding practices employed by mothers in caring for their infants?
- What are the hygiene/ cleanliness practices adopted by mothers in caring for their infants?
- What are the cord-care practices employed by mothers while caring for their infants?
- What practices are employed by mothers in ensuring the maintenance of warmth for the infants?
- What health/care-seeking patterns/practices are employed by mothers during the infants’ Illness?
- What differences were there in the adequacy of performances by mothers across the different infant care practices?
- What was the association between the adoption of infant care practices and some maternal demographic data?
Significance of the Study
The study is significant in that it will highlight the different home-based infant care practices as adopted by mothers. The findings will be highly beneficial to the infants who are the receivers of the care practices, the mothers of infants as the administrators of the care practices and the heath care givers /workers.The findings will also be of help to other researchers who wish to work in this field.
The information obtained will be used where applicable by the health care givers and other care givers (mothers and other family members) to plan or redirect health education strategies that will improve the infant care practices. These will assist, when properly applied in attainment of infants’ survival, growth and development. Consequently, the infant morbidity and mortality caused by faulty infant care practices will be reduced, thus assisting in achieving the fourth Millennium Development Goals (MDGs).
Scope of the Study
The study was delimited to finding the practices in the care of infants (0-1 year) adopted by mothers residing in the rural communities of Udi Local Government Area of Enugu State. The emphasis on the care practices was delimited to the variables in the stated objectives which include; the patterns of feedings, maintenance of warmth/thermal regulation, hygiene/cleanliness maintenance, care of the umbilical cord/stump, as well as the health/care-seeking patterns adopted by the mothers when the infants are sick. The maternal demographic factors affecting these practices were also determined.
Operational Definition of Terms
Infant Care Practices: As regards to this study, these are care practices/activities routinely administered to the infants to ensure their health growth and survival. These activities/practices include; infant feeding patterns; hygiene/cleanliness practices; warmth maintenance practices; cord care practices, as well as the health/care- seeking practices/patterns while the infant is sick.
Feeding Practices: This will entail the different feeding approaches by mothers for infants’ up-keep. They may be in forms of:
- Exclusive Breastfeeding (EBF): This, according to the study entails breastfeeding the infant with only breast milk starting from the first 30 minutes to 1 hour of birth without the introduction of water and prelacteals like honey, coconut water, herbs etc. and other infant formula/feeds until the fourth to sixth month of the infants’ life. It also involves breastfeeding the infant on demand. If the infant is given water in line with breast feeding, the practice is known as predominant breastfeeding and is inadequate.
- Supplementary Feeding Practices: This entails the use of infant formular and other breast milk substitutes in feeding the infant in place of breast-milk. These infant formula /feeds are purchased from the market/shops and they include, NAN, SMA Gold, etcetra. Also, some locally processed feeds like fura de nunu, used mainly by the fulani’s etc.
- Complementary Feeding: this encompasses the introduction of infant formular/feeds in combination with breastmilk. Also, the other weaning feeds like mashed yams, puddings like moi-moi and other adult/family feeds are considered.
Complementary feeding will be adequate when it is introduced at the 4th to 6th month of the infants’ life and breastfeeding continued until 2 years of infants’ life.
Cleanliness/ Hygiene Practices: These constitute the activities employed by the nursing mothers to ensure maintenance of hygiene for the infants’ welfare. The activities include, routine hand washing while handling the baby, its items and while carrying out procedures on and for the infants, (These procedures are preparation of baby’s feeds, breastfeeding the baby, cleaning of the cords etc)
Hygiene/cleanlines practices will be judged adequate when;
- The baby diapers/ clothes /beddings are changed and washed once they are soiled.
- Also the baby’s cutlery / cockery /feeding items are washed immediately and stored in tight container.
- Any other practice outside this will be considered inadequate.
Umbilical Cord Care Practices
These are routine practice/approaches adopted to ensure the drying, falling off of the umbilical stump and healing of the wound.
In this study, the idea of ‘optimal cord care practices’ will be measured by the
applications / medications administered to the stump viz:
- The practice will be judged ‘adequate’, if the drying agent/medications used on the stump is surgical (that is methylated spirit) only, and cleaned for up to 4 -6 times daily and also whenever the diaper/napkins are changed.
- Inadequate, if surgical spirit is used with other local applications like herbs, oil, etcetra, and
- Also inadequate, if local applications only like Lantern sooths, cow dung, earth, meshed herbs/leaves, heating with hot knives, palm kernel oil or other forms of applications were used.
Warmth Maintenance/Thermal Regulation Practices
This will be measured by the adoption of the following practices:
- Keeping the room warm through closing the windows and doors in cold weathers.
- This will be judged adequate when the whether changes are considered as regards to closing of the windows & doors, bathing the baby, and the wears the infants are clothed with.
- Ensuring that the infants clothing’s are always commensurate with the climatic changes.
Health/Care-Seeking Patterns/ Practices
These are practices/activities performed or employed by mothers to ensure the infants’ recovery from ill-health. In this study, these activities are in forms of:
- The activities carried out at home to institute care when the child is sick, these are remedies like herbs, orthodox drugs etc.
- Which health facilities are preferably sort for?
- When do they decide to seek for care givers?
- The health care seeking practice will be judged adequate when the mothers at least take the infant to the formal health sector / practitioner for appropriate diagnosis and treatment. Also does not practice self medication/ purchase drugs from the counter/chemist.
Socio-Demographic Data
The socio-demographic factors that were used in this study are: age, level of education, occupation and parity of the mothers.