Introduction
For aeons, health has been human general objective. Our early parents looked forward for means to have good health as a means to acquiring other means of livelihood, so do everybody today. Little wonder why many persons have different views about their health. The present definition of health as defined by World Health Organization (WHO), they define health as a state of complete physical, mental and social well-being of an individual, not merely the absence of disease or infirmity. The National Primary Health Care Development Agency, (NPHCDA) in 2012, says that the current cumulative number of unimmunized children and the epidemiological pattern of disease transmission is showing the increasing proportion of cases in young infants, thus having plans to keep conducting routine immunization with hope that the disease affecting children 0–59 months of age, will be eradicated by the year 2020.
This idea speaks positively on our health, but the problem centre’s on utilization, Park (2008) emphasis more on utilization when he said “The test of any utilization is the measure of consideration and care, which it gives to its weaker members”. In this contest, the weaker members represent the aged (above 70 years of age) and children (0–59 months). Park asserted that 50 per cent of all deaths in the developed world are occurring among people over 70 years of age and the same proportion of death still occur among children during the five years of life in the developing world. According to the Global Health Observation [GHO] (2014), statistics taken from under five mortality ratio, they said 5.9 million children, under age is highest in WHO African region (81 per live births).
In addition, inequalities in child mortality between high income and low income countries remain large but especially in low income countries, where a record shows 76 deaths per 1000 birth. Reducing this inequity, across the countries and saving more children lies on ending preventable child deaths by curtailing the rate of morbidity and mortality which are important priorities.
Running down the memory lane, Ejebe (2006), emphasis that child’s health is the component of primary health care and its main objective is to remove child morbidity and mortality rate. Owning to these reasonable facts, it is therefore imperative that health workers should posses’ skills in the management of health and welfare of the target population, most especially the under-five (5) years of age, who are our future generation.
As affirmed by the World Health Organization (WHO), if we really want to achieve millennium development goal 4 & 5, it will mean reducing the child morbidity rate by three quarter (3 and child morbidity rate by two third ( by 2015. Although, the world is off track to meet these targets, but with leadership and commitment, from developing countries and community, the health of the children in the developing world can improve
Conceptual framework on health care services
Child health care as a component of primary health care has its main objectives and one of it, is to reduce the incidence of morbidity and mortality rate it is therefore imperative that all health workers must be actively involved in delivery of primary health care services and must be skilful and knowledgeable in rendering this services as part of primary health care services in management of health and welfare of the target population (Ejebe 2007).
As important as one’s health can be, it was glaring and well elucidated in Abed statement, the founding partner at Abed Graham Saudi Arabia in (2016) that “for the last five years I have witnessed at length, the bold predictions of how many start-ups focus companies will revolutionized health care as they did the consumers industries, I will indeed take health care start-up as a wishful thinking rather than based on other evidence” (Saif, 2016).
Even when every Dick and Harry accept the definition of world health organization of health as a state of complete, physical, mental and social well-being of an individual, not merely the absence of disease or infirmity. quest about our personal health still continues as it was stress in primary health by Peter Okereke in 2006 that primary health care is an essential health care, based on practical scientifically sound and social acceptable method, made universally acceptable to individual and families in a community, through their full participation and at a cost that the community and country can afford to maintain at every stage of their development, in the spirit of self-determination and self-reliance.
By this definition, Peter Okereke said that the World Health Organization (WHO) is trying to stress, unify and clarify the importance of health to the families, communities and countries at large and in this contest, 30% of the group are children under five (5) years of age. Though, there is a general phenomenon, by generation parents that children are less prone to disease than adult because their leukocytes (white blood cell or immunity) is still strong and well intact as a result of passive immunity from their before birth, but looking intently, into organogram of immunity, we find that there is no element of truth in that ideology. Comprehensively then, from the concept of health care we ascertain that it consist of coordinated parts and extend to certain maternal and infant mortality rate from 0-59months of age, with complication that may lead to their incidence. We can now use this medium to applauses to Delta State Government for stay-put such wonderful programme of free under 5 years medical services.
From the state mark of achievement, and Nigeria as a country, following the eradication of small pox, we have also been certified polio free country in (2015) with a certificate awarded. More are yet to be done as we look forward to total eradication of the six killer diseases that likely cause complication to children under-five years of age.
Incidence of child’s care morbidity and mortality
As a general incidence the number of morbidity and mortality in Nigeria is increasingly high in women of child bearing age and children 0-59 months of age. The infant mortality ratio is 704 per every 100, 000 babies that was born, which is one of the highest in the world and this occurs before they celebrate their 5th birthday, according to health report in 2011. A representative of UNICEF said that delta state has improved access and affordability of health care and this is a major factor for improving child’s health.
Report from UNICEF in March (2006) points to the infant that every minute a child dies as a result of one of the six killer diseases and 20% of these children died before reaching 5 years of age and this means that 20% of new born will not live to start school. Still noted, was that most of this death is from preventable cause, like:- infection, malnutrition, with some intrinsic and extrinsic abnormalities. The cause of child care is aimed at providing the health workers the necessary skills needed to provide services that will ensure that fewer babies and children will die and many will live to go to school as well as becoming future leaders.
Ejebe (2007), in her book maternal and child health care, mention some of the intrinsic and intrinsic abnormalities that may likely children of under 5 years of age.
Intrinsic abnormality: Abnormality condition before birth, these types of abnormality can either be as a result of accident, effect of drugs by the mother trying to terminate the pregnancy, or any other possible cause (personal factor). These drugs might have cause some damage to the unborn foetus and these groups of drugs are listed below:
- Quinine (overdose) at first trimester
- Antibiotic (overdose) at first trimester
- Alcohol at early pregnancy which can cause obstruction of foetus formation.
- Smoking of cigarette or taking of tobacco by pregnant mother which can lead to malformation etc.
These are personal factors caused by the mother to the unborn child to make the child abnormal or suffer some infections after birth.
As a result of accident: It can be as a result of blow on the protrude stomach that will affect the foetus or a fall that will show early signs of haemorrhage.
Intrinsic abnormality: These are abnormality condition during the process of delivery or after the baby have been born. Child suffer gonorrhoea through the birth canal if the mother is infected, the child can be HIV positive if the mother is diagnose positive and the baby is delivered through the normal process. It can also be as a result of paralyses which are other possible cause. Examples are Elbe paralysis as a result of force in the part of the shoulder which affects the other part of the hand during the process of delivery. All of these are known as extrinsic abnormality which can cause a big sum of money to handle the case, hence there is need for introduction of free medical under five years of age.
According to Nour (2008) some major cause of neonatal death is bacterial infection, maternal birth injury, lack of delivery kit to take care of the child during delivery and after delivery and the less privilege mothers cannot afford some of this material and they are left in painful contraction until complication sets in which might likely affect unborn child or lead to the death of the mother (maternal death), and this has never be part of government plan as to reduce child morbidity and mortality.
Shiffman (2010) in his book health for all noted that cause of child’s mortality is a result of low income, when he said over the last decade, new-born death have decreased by 17%, yet in 2010, an estimate of 3.1 million neonate 0-28 days died, mainly in low income countries so Shiffman has proved beyond reasonable doubt that child mortality rate can increase as a result of poverty, and from his research the only way to contain it to boast the economic development.
Daniels (2007) recommended the effective way to reduce child morbidity and mortality rate, when he said
- Access to family planning services
- Access to health care
- Through funding and inter-partum care
- Through general public health practices.
And only if we practice the above mention objectives can the infant and child mortality rate can be reduced.
Cause of child’s mortality
According to the World Health Organization [WHO] (2005) it outline the cause of child mortality to be as a result of complication in material morbidity such as bacterial infection, variant of gestational hypertension including eclampsia, help syndrome, obstetrical haemorrhage, ectopic pregnancy, puerperal sepsis (child bed fever) amniotic fluid embolism uterine rapture and complication of unsafe or this abortions.
Lesser known causes of maternal and child death includes – renal failure, cardiac failure and hyper-emesis gravidarum by their findings as rated in percentage haemorrhage was said to be major cause as it was rated 23% infection (12%), unsafe abortion (12%) eclampsia (convulsion as a result of acute toxaemia in pregnancy) (11%), obstructed labour(16%) other direct cause (7%) and indirect cause as (18%) with deep vein thrombosis (mass of coagulated blood in the vein that can lead to phloem thrombosis) which is (1%).
Ejebe (2007) stated various causes of maternal and child mortality with contributory factor for the direct causes these are:
- Haemorrhage
- Sepsis
- Unsafe abortion
- Obstructed labour
- Pregnancy induced hypertension (pre-eclampsia and eclampsia indirect causes such as:
- Malaria
- Diabetics mellitus
- Sickle cells
- Renal disease
- Cardiac disease
Contributory causes and these are:
- Poverty
- Low status of women
- Illiteracy
- Poor nutrition
- Ignorance–taboo and beliefs
- Harmful traditional practice
- Poor maternal and child health service
- Unemployment
- Uneven distribution of skill birth attendant
- Unavailability of emergency obstetric care
According to Nour (2008) 45% of postpartum death occurs within 24 hours and over 90% of maternal death occurring in developing countries. Pressat in his research in 2015 finds out the cause of child’s mortality is said to be as a result of accessibility (distance travelling to the nearest clinic to receive proper treatment or care and many will not have access to good health because of poverty and assumption that health care are expensive.
Owing to Pressat statement, the researcher in 2016 find out the cause of child’s mortality from his evaluation of the outpatient department record (OPD) attendant to be low income, cultural background or belief and attitude of health workers when at time these patient manage to visit the hospitals or the health facilities and this has led to serious complications and has also increase the number of child’s mortality recorded. Following the free under five medical services was introduced.
Prevention and control measure of child’s morbidity and mortality
Free maternal and child health programme has exposed every dick and harry to its objectives of child’s survival programme, which includes the following:
- To promote physical emotional, psychological and social growth and development of children in order to have a healthy and economically productive population.
- To reduce infant and childhood mortality and morbidity through preventive and early identification.
Akinsola (2006) stated that the objectives of maternal and child health service generally begins with solving the health problems of individual mothers and their children when he said” that the programme is meant to ensure that every pregnant women and nursing mothers maintain good health, learn the act of child care, have normal delivery and give birth healthy children, who should grow in a family unit, with love and security, in a healthy environment, well-nourished with adequate medical attention and socialization”
Health education in this aspect cannot be overemphasis. According to Obion (2001) he said health education provides opportunities, not only by which people voluntarily adapt to healthy behaviour, but also enable them to contribute to decision making that affect their health. He also said that health education motivate people as individuals or groups in the community settings to attain health as their own effort to make intelligent choices and use the available health services and medical product.
Ward in his current research in 2009 points out the important of health education when he said it helps to effect change in the community. He also said that health education answer the acceptance problem and it is the fundamental truth of all other component of primary health care services. Akinsola (2006) stated various factors (physical, biological and social), which can affect the health of a mother and children under 5 years of age. They are summarized as follows:
- Family size: The larger the size of the family, the lower the amount of nutritious food to be consumed due to poverty. Hence, family planning plays a key role here.
- Age of the mother: Ejebe (2005) states that woman under 16 years, who are pregnant are said to be women at risk and can face many complication during delivery, since their pelvic is too small or too miniature for the passage of the foetus during delivery. Also after delivery, these women cannot take proper care of themselves and their baby.
- Customs: Some African culture and traditions are detrimental to the health of the child e.g. food taboos, which denies the mother from intake of nutritional food.
- Child spacing: The more intervals between child spacing and pregnancies; the better the health status of the mother and child.
- Climate: In the tropical climates, the risk of infection and poor health is prone, due to poor environmental condition and lot humid tropical climate.
- Educational level of mothers: Illiterate mothers, lack the experience to take care of themselves and the unborn child when there are pregnant.
- Inherited chronic/congenital disease: Inherited disease can lead to disability in the child and can affect the social economic status of the mother and other members of the family.
Okereke (2006) principles of primary health care, detailed the reason why antenatal and pre-natal care should be given priority by gravid (pregnant) mothers. Which he said is one of the ways we can combat child mobility and mortality and since the compliance, commitment and commencement of the programme, few mortality ration has been recorded and morbidity ration has been curtained from 60% of high rate to 10% of decrease. What a great relieve the maternal and child health medical service programme has brought as it is being rendered free.
Impact of free health services for child health care
Running down the memory lane, we all can ascertain the fact that effort from government and some individual running NGOs to combat the cause of child morbidity and mortality and this can be achieve when free medical service is being rendered. Statistics has shown that poverty and ignorant has been the major reason while people are not utilizing the health facilities. Such programmes that stay put to combat this conditions is:
- The National Programme on Immunization (NPI) which is rendered free to tackle the six killer disease such as diphtheria, pertusis, tuberculosis, poliomyelitis’s, tetanus and measles and this programme was kick off in Lagos on the 26th day of October 1984 and by the end of that programme, 60% showed high level of acceptance by the people.
In line with that, National Programme on Immunization (NPI), now continue in his effort to implement sustainable strategies and inventions in collaboration with the state local government areas (LGAs) and partners, with the vision of making immunization a community owned, community driven and community operated service. Furthermore, National Programme on Immunization, (NPI) has continue to ensure the provision of potent vaccines to states and LGAs with corresponding qualities of needles and syringes, they have also supported, by supplying the state LGAs with cold chain equipment and logistics.
Included also is human, technical and financial support, required for the programme. Kits and personal protective equipment (PPE) was also provided with aim of reducing adverse effect following immunization (AEFI). Advice from World Health Organization (WHO), points to the fact that there is need for everyone to support and sustain routine immunization coverage, in order to support the on-going accelerated disease control initiative. The available vaccine put in place to combat this diseases are as follows:
- Bacillus, Cametteand Guerin (BCG) vaccine
- Oral polio vaccine (OPV)
- Pentavalent vaccine (Penta)
- Hepatitis B vaccine (HBV)
- Measles vaccine
- Yellow fever vaccine
- Tetanus toxoid vaccine
- Inactivated polio vaccine (IPV)
All these are effort put in place to promote and rehabilitate the health of children/infant as a way to reduce infant and neonatal death. Also by means, of cold chain, that involve personnel and equipment, these vaccine are taken care of, since some of them are freeze sensitive attached with vaccine vial monitor (VVM) and all of these has their own temperature where are stored which ranges from +8°Cto 25°C the personal are there to manage the commodities, to maintain the appropriate temperature required for each vaccine and issued them out for use. Understandably, then, ever since the existence of the free under 5 years medical services, we have seen changes when it comes to combating the neonatal and infant morbidity and mortality.
Added to this, Artemisilin based combination therapy (ACT) drugs has really been utilized by mothers and parent to their children as a welcome development and statistics has shown how effective this free medical under 5 years of age programme has been helpful.
References
Akisola, H. A. (2005), A –Z of community health in medical, nursing and education practice.
Daine, T. & Myles textbook on Macmillan Publisher
Ejebe, A. (2007). Maternal and child health care in primary health care setting. Warri: Erigha Publishers
Federal Ministry of Health (2012).National health plan.
Federal Ministry of Health (2001).National reproductive health policy and strategy, Nigeria.
Global Health Observatory (GHO) (2014)
Okereke, P. (2005). Principles and practice of maternal and child health. A guide to community health officers. Warri: Noble publishers.
Margaret, C. (2003). Churchill Livingstone
National Primary Health Care Development Agency (NPHCDA) (2012)
Park, K. (2005). Preventive and social medicine. Jabalpur m/s Banarsida Bhanot Publishers.
Shaffman (2010).Health for all and analysis of human health. In KostenbauderM.D (1989) Maternal and newborn nursing. Spring house
UNFPA (2003) Training manual for reproductive health
World Health Organization (2012).Report of the International Conference on Primary Health care. Alma Ata, USSR, WHO for all series No. 1
