CHAPTER ONE
Introduction
Background to the Study
People seek to improve quality of life in both developed and developing countries. Unfortunately, most people in developing countries live in overcrowded houses with inadequate sanitation and unsafe water supply. Infectious disease and malnutrition are common especially among children. Death rate is high and life expectancy is low. World Health Organization – WHO (2002) estimated that ten million children under the age of five years die each year from complications arising from childhood diseases and 80 per cent of these deaths occur in Sub-Saharan Africa. The ratio of infant mortality in the region is one of the highest in the world reaching a proportion of 113 per 1000 live births (World Bank, 2004). In Nigeria, the Federal Ministry of Health-FMOH (2007) reported that about 5.3 million children are born annually that is 11.000 per day. One million of these children die before the age of 5 years. The ministry further submitted that Nigeria’s infant mortality rate (528 per day) is one of the highest in the world. Infant mortality and under five mortality are 100 and 201 per 1000 live births respectively, and these deaths are from preventable causes such as malaria, pneumonia, diarrhoea, measles and HIV & AIDS. One explanation for poor health outcome among children is the non-use of available child health services by sizable proportion of mothers. Haddad (2005) Stated that the cost and utilization of health services in developing countries clearly showed that the utilization of available child health services is very low in developing countries. This according to Haddad is influenced by culture, economics, access, perceptions and lack of knowledge of mothers on existing child health services.
Stanfield (2004) noted that child health services is an integral part of Primary Health Care, which is concerned with the provision of accessibly integrated biopsychological health care services by the health care personnel. The author maintained that the health care personnel are accountable for addressing a large majority of personal health needs, developing a sustained partnership with patients and participating in the context of family and community. Onuzulike (2005) asserted that child health services are the total care and services rendered to children 0-5 years in order to maintain healthy living. Turmen (2006) described child health services as the provision made to improve optimal growth and development in infancy and childhood through disease prevention, good nutrition and health supervision.
Health care has been defined by William (2003) as the prevention, treatment and management of illness and preservation of mental well-being through the services offered by the medical, nursing and allied health profession. Hatch and Shiel (2006) described child health activities as services which focus on the well-being of children from conception and is concerned with all aspects of children’s growth and development and with the unique opportunities that each child has to achieve his or her full potentials as a healthy adult. Child health services in this study refer to the efficient strategies provided by health workers in order to promote health of the child and prevent diseases, disabilities and deaths through simple cost-effective measures. They are services meant to ensure as much as possible that every child lives and grows healthy.
Services are defined as a system provided for by a government or official organisation for the need of the public (Rundel, 2005). Services are provisions made for the public to use as much as they need in order to benefit from them (Pelto, 2005). Pelto added that services help to improve the health of the public especially Health Care Services. Health care services which are provided for the children is referred to as child health services (CHs). According to Ama (2001), comprehensive child health services must encompass all the following: immunisation services, growth monitoring services, nutritional services, health education, oral rehydration therapy (ORT), curative services and outreach services. These are the components of CHs.
Child health services are meant to ensure as much as possible that every child live and grows up in a healthy environment and receives adequate nourishment for healthy living. To ensure effective child health services, each primary health centre must provide the components or activities of child health care services. Gabr (1985) outlined certain activities to be provided for children within the PHC centres. The activities include, immunisation of all children against the six preventable diseases such as measles, poliomyelitis, whooping cough, tetanus and diphtheria and pertusis; growth monitoring and development using a standardised chart aimed at assessing the physical development of the child; health education for mothers on general child’s health; using oral rehydration therapy (ORT) in treating diarrhoea of any aetiology; treatment of identified minor diseases in the family and community. The author also mentioned other activities to be provided outside the primary health centres. These activities include promotion of breast feeding in preventing malnutrition and diarrhoea in children; use of locally and culturally acceptable foods during weaning period; and outreach services which are planned and carried out. In the context of this study, the components of child health services to be carried along include; immunisation, growth monitoring, ORT, nutrition and curative services. These are chosen because they are the services provided within the health centers of which information can be accessed.
Brunner and Sadder (2002) described immunisation as intentional introduction of weakened micro-organism in a small dose into the body to stimulate sensitive reaction that brings about immunity against the invasion of such organism in larger amount. Ajayi (2005) pointed out that administering life attenuated micro-organism produces antigen – antibody reaction that gives the body active immunity to diseases. Lacus and Gilles (2006) stated that immunization of children is one of the most cost effective public health interventions and each child should be immunized against common communicable diseases which vaccine is available. Immunization is routinely offered against tuberculosis, tetanus, whooping cough, diphtheria, poliomyelitis and measles. The choice of vaccine and the immunization schedule should be selected on the basis of local epidemiological situations and on the most practicable routine. During child immunization the health workers perform other child health services such as growth monitoring.
Growth monitoring is an important indication of child health in health care facilities. Growth monitoring, according to UNICEF (2004), is aimed at observing the physical growth and development of the child. It helps to detect growth failure at early stage for proper management. Akinsola (2004) asserted that growth monitoring is important during the first five years of child’s life because it is during this period that the child grows rapidly, physically and its social behaviour and mental attitude are also formed. The foundations are formed mentally and physically for building up the personality of the child. Monitoring a child’s progress helps to compare it with a standard growth chart. When a child progress is observed over a period of time, it is quite possible to detect a disease or abnormality at an early stage and prompt treatment can be administered. This helps to prevent disabilities, diseases and malnutrition. Akinsola (2004) maintained that, weighing is the easiest and most accurate methods of monitoring the growth of a child if the child’s age is known; his weight can be compared with a standard weight of a normal child of his age and of the same group. Even when his age is not known his weight can still be recorded regularly, (monthly) on a chart. By measuring and recording a child’s weight regularly on a single card, a growth curve for that child can be made. This curve can quickly reveal any significant changes in the child’s pattern of growth and so appropriate action can be taken promptly. Growth monitoring helps the health worker to give professional advice on malnutrition in children, hence improvement in nutritional services are among the services children should receive.
Nutritional education is an integral part of CHs which is meant to give the mothers the opportunity of early development of insight into the nutritional requirements of children. Through nutritional education, mothers learnt how to promote good nutrition, prevent nutrition diseases and seek immediate medical attention (Bennette, 2004). Pelto (2005) described nutrition education as a process by which nutritional information is successfully imparted in such a way that the recipient is motivated to make use of the information for the promotion and maintenance of the family’s or community’s nutritional status. Nutrition in children may be categorized into four; intra-uterine nutrition, complementary feeding, post weaning and exclusive breast feeding. Improvement in nutrition will help to reduce the need for curative services among children.
Curative services are concerned with appropriate treatment of diseases and injuries. The aim is to prevent death and disability resulting from common childhood diseases and injuries so that all children can have the opportunity of healthy growth and development (Akinsola, 2004). In Nigeria, one major health problem which has been tackled with great success is diarrhoea which is a major killer of children. With the introduction of ORT, the high mortality rate which often accompanies diarrhoea among children has been drastically reduced. Today, nearly every Nigerian mother knows how to prepare and administer oral rehydration fluid.
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