STATISTICAL ANALYSIS OF INFANT AND CHILD MORTALITY RATE

Despite modest improvements in child health outcomes during the 20th century, infant and child mortality rates remain unacceptably high in Nigeria. Infant and child mortality rate in Kaduna State is a major concern as the State recorded 88 deaths per 1,000 live births and 179 deaths per 1,000 live births in 2010. The aimed of this study is to analyze infant and child mortality trends and differentials in Kaduna State, Nigeria. The objectives were to determine the level and examine the trend of infant and child mortality rate from 2005 to 2014; examine the socio-economic and demographic differentials in infant and child mortality and the factors that determine infant and child mortality rate in the study area.  Data from the hospitals in the Local Government Areas from 2005 to 2014 were analyzed to assess the trends of infant and child mortality. A total of four hundred (400) copies of semi structured questionnaire were administered using purposive sampling technique, of which 386 were found useful for analysis. The data were analyzed using descriptive statistics, ANOVA and regression analysis using SPSS 20.0 version. The descriptive statistics showed that 66.3% of the respondents are between the ages of 20 and 34 years, 36.8% are Hausa/Fulani, 28.8% have attended secondary school, and most of the respondents (21.8%) have monthly income between ₦30,001-₦40,000. Malaria is the major cause of under-five deaths with 30.1%. Experience of under-five (U5) mortality was found to differ by education, income, and occupation. The result also shows that under-five mortality is higher between women within 15-24 than 25-34 years. Women that got married early (15-24 years) experience more under-five mortality than the adult (25-34 years). Women with no formal education were found to experience more under-five mortality than those with formal education. The level of under-five mortality in Kaduna State has remained high since the past 10 years with an estimated under-five mortality rate of 163/1,000 live births. The trends in under-five mortality in Kaduna State since 2005 has been on the decrease, although the decrease is small over the years in which 2011, 2012, 2013 and 2014 witnessed steady decline or no change in the trends of infant and child mortality. Six factors were significantly associated with under-5 mortality, namely, distance to health facility, age at first marriage, age of mothers, current marital status, level of education, and length of breast feeding. Logistic regression revealed that distance from the health facility had the most significant correlation (0.379), followed by age at first marriage (0.138), age of mother (0.118), marital status (0.064), level of education (0.064) and length of breast feeding contribute (0.054). On the basis of the findings, the study recommends that programme interventions need to focus on mothers with low socioeconomic status. Also, the adolescent girls should be encouraged to go to school to acquire at least secondary education. This will increase age at first birth and reduce child death at first birth. Health services should be brought nearer to the communities so that mothers can have access to health facilities during pregnancy postpartum services to reduce infant and child mortality in the State.
 
CHAPTER ONE
INTRODUCTION
1.1       BACKGROUND OF THE STUDY 
Health is a state of human well being which in 1948, the United Nations (UN) declared as a right (United Nations, 2008). Thus, striving for improvement in health is a moral obligation for policy-makers at all levels of governance (National and International). In addition to being a goal, scholars have posited the significance of health to human development. This represents a shift in development strategy; earlier, health has been viewed as an end of development, but now the general tenet is that improvement of health standards is a means to achieve other aspects of development (Mamman, 1992; Kumar and File, 2010; World Health Organization (WHO), 2013; Bello and Joseph, 2014). Death of children under five is a factor that defines the wellbeing of a population and it is usually taken as one of the development indicators of health and socioeconomic status which indicate the quality of life of a given population, as measured by life expectancy (Buwembo, 2010).
Infant mortality is defined as the death of a live born child between the day of birth and span of 12 months United Nation International Children Fund (UNICEF), 2008). The mortality rate among infants is the measure of probability of children dying before reaching the age of one year. Child mortality includes deaths that occur at ages 1 to 5 years. The reduction of infant and child mortality is a worldwide target and one of the most important key indices among Sustainable Development Goals (SDGs) of reducing infant and under-five child mortality rates by two-thirds from the 1990 levels by 2015 (Desta, 2011). As a result of this, in October 2008, the Nigerian government„s National Health Insurance Scheme (NHIS) launched a pilot health project, titled the NHIS/SDG Maternal and Child Health Project (Bello and Joseph, 2014). The Project focuses on reducing maternal and child mortality and is assisted by the World Bank„s Heavily Indebted Poor Countries Initiative funds (HIPC).
Cases of infant and child mortality are largely under-reported and seldom documented in developing countries (Nigeria inclusive). Survival efforts can be effective only if they are based on accurate information of the cause of morbidity (Abhulimhen and Iyoha, 2012). The environment where the child is born and raised is increasingly becoming so unhealthy so that the life of the child is continually threatened by diseases (Chaudhari, Srirastava, Maitra and Desai, 2009). Another factor that is affecting the survival of infants and children has been identified to be the increasing devastating effect of Human Immunodeficiency Virus / Acquire Immune deficiency Syndrome (HIV/AIDS). This threat has become a major concern affecting the lives of families and thereby reducing the survival chances of the child (Baingana and Bos, 2009).
Many countries have shown considerable progress in tackling child mortality rate and it has been more than halved in Northern Africa, Eastern Asia, Western Asia, Latin America the Caribbean and Europe. It has placed them on track to achieving the (SDG) in contrast to many countries with unacceptably high rates of child mortality. Sub-Saharan Africa which accounts for 1/5th of the population of children under 5years, also accounts for half (8.8 million) of deaths in 2008 indicating insufficient progress to meet the SDG 2020 target world health organization (WHO, 2014).
Smith (2010), posited that infant and child mortality rate is high in Sub-Saharan Africa. Despite the region having only one fifth of the world’s infants population, it habours half of childhood deaths globally. Worldwide, mortality in children younger than 5 years has dropped from 11.9 million deaths in 1990 to 7.7 million in 2010. About 33.0 percent of deaths of children younger than 5 years occur in South Asia and 49.6% occur in Sub-Sahara Africa with less than one (1) percent of deaths occurring in high income countries (Rajaratnam, Tran, Lopez, and Murray, 2010).
In Nigeria, an examination of mortality levels across three successive five-year periods show that under-five mortality decreased from 199 deaths per 1,000 births during the middle to late 1990s (1993-1998) to 157 deaths per 1,000 births in the middle part of this decade (2003-2008) and 128 deaths per 1, 000 births in 2013 (NPC and ICF Macro, 2013).  Infant mortality rates have remained steady at 75 deaths per 1,000 births for 1999 and 2008 while under-five mortality rates show increase between 1999 and 2008. Under-five mortality rates increased from 140 deaths per 1,000 live births in 1999 to 157 deaths in 2008 (Buwembo, 2010). 
 
Socio-demographic and economic factors play important roles in determining child survival all over the world (Shawky and Milaat, 2011). For instance mothers‟ education has an implicit effect on the health of children (Abuqamar, Coomans and Louckx, 2011). Early marriage has also been identified in several studies to have affected both the socioeconomic condition and infant mortality (Othman and Saadat, 2009). A study conducted by Raj, Saggurti, Micheal, Alan, Michele, Decker, Balaiah and Jay (2010) in India showed that children born to mothers who were married before attaining the age of 18 were at a higher risk of stunting and underweight compared to children of women who had married at age 18 or older.
According to National Population Commission (NPC) and ICF Macro (2009), at the geopolitical level, the northwest zone has very high prevalence rate of 91 and 139 deaths per 1000 live birth for infant and child mortality respectively. Similarly, Bello and Joseph (2011) reported that the zone has mortality rate of 188 per 1000 for age 0-5 followed by the north east with 175.2 death while the lowest rate was recorded in the central region of Nigeria. 
The above portends the complex scenario experienced from each of the components of Nigerian State; the proportion coming from each component cannot be assumed as equal, since the differences in child mortality across states and regions are overwhelmingly explained by economic and social factors therein given the different approaches employed by various governments. This present situation notwithstanding, may not mean that there was no improvement in the child mortality situation as a result of different public and donor interventions, but, the pace still remains too slow to achieving the Millennium Development Goals of reducing child mortality by a third by 2020 in Kaduna State.  
In Kaduna state, both infant and child mortality have been unstably declining at gradual rates over the years at a high prevalence rate  of 115 deaths per 1,000 live births and  205 deaths per 1000 live births for infant and child mortality respectively  in 2003, 91 deaths per 1,000 live births and 189 deaths per 1,000 live births for infant and child mortality respectively in 2007, and 88 deaths per 1,000 live births and 179 deaths per 1,000 live births for infant and child mortality respectively  in 2010 (NPC and ICF  Macro, 2009; Partnership for Transformation of Health System (PATHS), 2010; PATHS, 2010). This slope sluggishly and still a far cry from Sustainable Development Goal (SDGs) of a reduction in infant and child mortality rate by about two third within 1990 to 2020.
The increase in mortality rates in Kaduna State seem to be firmly established and this would appear as the most striking demographic phenomenon of the last seven years. While, the pattern of mortality increase in Kaduna State bears similarities to the observed pattern in the early stage of the demographic transition, it is occurring now under quite different social, economic, and medical conditions. Child mortality rates are rapidly increasing as more infants are born with HIV and antropogenic factors such as internal crises, malnutrition and climate change (KMOH, 2014).