Nurses’ Role In Prevention Of Infant And Under-Five Child Mortality In Africa

Project and Seminar Material for Nursing (Science)

Project and Seminar Material for Nursing (Science)


The under-five mortality rate remains unacceptably high with 6.3 million children dying before their fifth birthday in 2013. Research has, however, revealed that nurses are the means to reducing these untimely deaths. The aim of this research is to examine and identify the role nurses play in preventing and reducing infant and under-five mortality. The purpose of the study was to provide research based information of the position of nurses in consideration to childhood deaths.

Data for the research were obtained from PubMed and ScienceDirect search engines as well as manual data search. The accepted studies were published between the years 2000 and 2015. In total nine studies were analyzed. Inductive content analysis was the chosen method of data analysis.

The results of the study indicate there are challenge nurses face while trying to reduce and or prevent these early deaths. Nurses are challenged with inadequate medical care facilities, high maternal mortality rate as well as lack of training. Other challenges were also noted. The results also shows the role nurses are currently taking as well as some other roles nurses are suggested to play in order to lessen under-five mortality.

The findings of this study can be used by health care professionals especially nurses in developing countries. Research on the solutions needed to overcome the challenges faced as well as a study that focuses entirely on the nurses’ position is needed.

Chapter One

1.0 Introduction

In urban areas of Africa, Americas and Asia, statistics show that the poorest 20% population is twice as likely to die before their first birthday (Infant mortal-ity, WHO, 2013). In 2013, an estimated 6.3 million children under the age of five died (Children: Reducing Mortality, 2014). Child mortality is important as it is a pointer of the usage, accessibility, and availability of the health system by the inhabitants especially children. It is also a sign of the extent in which a society exercises the most basic human right: the right to life and health (GOAL 4: Reduce the under-five child mortality rate, 2010).

Although the rate of under-five deaths has decreased by 28 per cent between 1990 and 2008, it still remains high (Goal 4 Reduce Child Mortality, 2010). Research and experience has revealed that out of the almost 11 million children deaths per year, more than half could be saved by measures such as vaccines, antibiotics, micro-nutrient supplementation, insecticide-treated bed nets and improved family care and breastfeeding practices (Goal: Reduce Child mortality, Unicef). Therefore, the intensification of the health system to provide such interventions could save many lives (Children: reducing mortality, 2014). A report published by the United Nations (UN) claims that “nurses are key to achieving the United Nations Development Program’s Millennium Development Goals” which includes reducing child and infant mortality (Amieva and Ferguson, 2011). According to an article titled “The vital role of health care workers” published by the guardian (2012), a child is more likely to live till their fifth birthday if there are enough midwives, nurses and doctors. If the rate of under-five mortality is to reduce, nurses need to be knowledgeable and empowered in caring for children. Therefore, this study aims to examine and identify the role of nurses in reducing and or preventing infant and child mortality with a purpose of providing research based information that could be used by nurses.

1.1 Background of study

1.1.1 Infant and Child Mortality

Causes of infant and child mortality

Child mortality rate also known as under-five mortality rate is defined as the possibility that in every 1000 live births one baby will die before reaching age five: Whereas, the death of a child before his/her first birth day is termed infant death or infant mortality. Therefore, infant mortality rate is the number of children dying under a year of age by 1000 live births. Infant mortality rate is an important marker to measure the health and wellbeing of a population (Centre for disease control and prevention, 2014). This is because it is often linked to several factors such as maternal health, quality and access to medical care, socioeconomic conditions, and public health practices (Definition of Mortality, Infant, 2012).

In 2013, an estimated 6.3 million children under five years of age depart this life. An estimated 44% of these deaths occurred during the neonatal period. Neonatal period, which is the first 28 days of life, is considered to be the time where in a child is at the highest risk of dying. In addition, about 45% of all the under-five death has a connection with malnutrition. Although a child born in an already developed or a developing country can die before five years of age, he/she is, however, more likely to die if living in sub-Saharan Africa and Southern Asia compared to his/her counterparts in a developed country. About 50% of all under- five deaths occur in only five developing countries namely China, Democratic Republic of the Congo, India, Nigeria and Pakistan. (Children: Reducing Mortality, WHO, 2014). A large proportion of these deaths are caused by infectious yet preventable diseases (Niño-Zarazúa, 2013)
The main reasons of death in these regions are pneumonia (13%), diarrhea (9%), malaria (7%), measles, (2%), HIV/AIDS (3%), neonatal conditions like pre-term birth, birth asphyxia, and infections (46%).

1.2 Statement Of The Problem

Skilled care during child birth is important because it saves lives of millions of women and newborns and prevent serious and hard to predict complications during or immediately after delivery. Skilled attendance by health professionals with midwifery skills is very important because it recognizes pregnancy-related emergencies and possible complications, and either treat them or refer the women to health centers or hospitals immediately when there is need for advanced medical care. As trained nurses have national outlook, most communities and various arms of government of the country regarded their acquisition as worthwhile (Adeyemi, et al; 2005). Hence, the skills have potential for drastically reducing the infant mortality at various levels of the government and the communities in Africa. skilled care has been in practice by nurses since 1992, to address infant mortality and morbidity. However, it is not clear as to what extent the training of nurses in skilled care has contributed to the reduction of under-five mortality in Africa.This study was therefore conducted to find out the role ofnurses trained in skilled carein preventing under-five mortality in Africa.

1.3 Objectives Of Study

  1. To examine if nurses in Bauchi State provide effective ante natal care.
  2. To examine if nurses in Bauchi State improve care for women in labour satisfactorily.
  3. To examine if nurses in Bauchi State treat obstetrics emergency satisfactorily.
  4. To examine if nurses in Bauchi State provide care for women at pueperium satisfactorily.

1.4 Research Questions

  1. Do nurses in Bauchi State provide effective ante natal care?
  2. Do nurses in Bauchi State improve care for women in labour satisfactorily?
  3. Do nurses in Bauchi State treat obstetrics emergency satisfactorily?
  4. Do nurses in Bauchi State provide care for women at pueperium satisfactorily?

1.5 Significance Of The Study

The findings of this study brought to limelight the role ofnurses on infant mortality in Bauchi State. The result of this study showed that nurses are adequate to provide effective ante natal care, satisfactory obstetrics emergency care, skilled attendance at birth, care for women at pueperium and prevent maternal death and whether the commitment of the nurses toward the skilled care program is satisfactory and thus the study serves as a base line data for the followings:

  1. Governments of decision making in matters relating to maternal health.
  2. Health planners at governmental and non governmental levels in planning programs on maternal health.
  3. The study will serves as a means of assessing skilled care implementation in Bauchi state in particular and Nigeria in general to international organizations like WHO, UNICEF, UNDP etc because, skilled care is an international program under safe mother hood initiative.
  4. The maternity clients would understand the benefit of skilled care better when this study is made public e.g. through publishing in a reputable national and international journals.
  5. Stimulate further research in maternal care services.
  6. Serve as source of future reference in studies related to infant mortality.

1.6 Delimitations

This study was delimited to the role ofnurses on infant mortality in Bauchi state.

All nurses employed at the local government health centers, maternity homes, general hospitals, and specialist hospitals in Bauchi as well as women receiving maternity care in those health facilities would serve as respondents for this research.

1.7 Limitations

The study had the following limitations which would be considered in the interpretation of the results:

There are many factors that affect the utilization of the acquired skilled care, which in turn might affect its influence on infant mortality. It was not possible to control these factors. However, it was assumed that such influence would be minimal as the respondents were trained in the same institutions, lived and practiced under similar conditions.

Some of the terms used in the study were translated to some respondents due to their low literacy status and this may affect the actual meaning of these terms and may affect their responses to the questionnaire.

Chapter Five

Conclusion And Recommendations

5.1 Conclusion

The conduct of nurses contribute significantly to the provision of effective ante natal care, which results in the reduction of infant mortality.

The nurses provide significant skilled attendance at birth which ensures safe delivery and prevents delivery complications and thus directly reduces infant mortality.

The nurses provide obstetric emergency care which significantly prevents ante natal, natal, and post natal morbidity that may result in infant mortality.

The nurses provide care to women at pueperium, including puerperal sepsis, which put into controls puerperal complications that may result in women’s death, which is a positive influence in the reduction of infant mortality.

5.2 Recommendations

On the basis of the findings of this study, the following recommendations are made for effective and efficient provision of maternity care by nurses in Bauchi State.

The State governments and local government, whose responsibility is to provide facilities and equipment for the efficient and effective running of skilled care acquired by nurses, should do so adequately and timely based on WHO recommendations to help reduce infant mortality.

The State and local governments should ensure adequate provision of nurses to cater for the needs of the citizens.

The State and local governments should ensure staff remunerations that will prevent the attrition of the skilled care trained nurse and midwives, as their contribution to the prevention of under-five mortality are very positive.

The State and local governments should ensure retraining of the already trained midwives and nurses on a continuous basis.

The State and local governments should ensure adequate and constant supervision; monitoring and evaluation of the activities of nurses to make their work more efficient.

Communities should be mobilize through community leaders/traditional rulers, such village heads, district heads, and clergy men and women, school teachers, students, village health committees In order for women reap the benefits of skilled care.

The State and local governments should ensure health education and public enlightment to the communities about the contribution of nurses to maternity services.

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