AVAILABILITY, ADEQUACY AND UTILISATION OF CHILD HEALTH SERVICES IN PRIMARY HEALTH CARE CENTRES IN NSUKKA HEALTH DISTRICT, ENUGU STATE

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ABSTRACT


The purpose of the study was to find out the availability, adequacy and utilization of child health services in Primary Health Care Centres in Nsukka Health District, Enugu State. To achieve the purpose of the study, eight specific objectives with corresponding research questions were posed and five hypotheses postulated to guide the study. The Descriptive survey research design was used for the study. The population for the study consisted of 3882 mothers (3666) and health service provider (216). The multi-stage sampling procedure was used to draw a sample of 474 mothers (366) and health providers (108) for the study. The instrument for data collection was the availability, adequacy and utilization of child health services questionnaire (AAUCHSQ) designed by the researcher. Cronbach’ s Alpha statistic and Kuder Richardson 20 (KR-20) were used to establish the reliability of the instrument. Means and percentage were used to analyze descriptive data, while null hypotheses were tested using t- Test, Chi- Square and ANOVA statistics. The criterion mean for adequacy and utilization was 2.50. The major findings of the study were as follows: All the child health services were available in primary health centres, All the child health services were adequate ( X = 2.98, SD = .92). Mothers of different level of education utilized child health services effectively (no formal education ( X = 2.93) primary education ( X = 2.80), secondary school education ( X = 2.85) tertiary education ( X = 2.81)). Mothers of different occupation utilized child health services effectively farming ( X = 2.67), trading ( X = 2.81), public/civil servant ( X = 2.89), cloth weaving/hair dressing ( X = 2.82), house wives ( X = 2.81) and student ( X = 2.67). Mothers in both urban ( X = 2.96) and rural ( X = 2.65) utilized child health services effectively. All the components of child health services were available in both urban and rural primary health centres. All the child health services were adequate in both urban ( X = 3.14) and rural ( X = 2.96). There was no significant difference in the level of utilization of child health services according to level of education at .05. There was significant difference in the level of utilization of growth monitoring services and immunization services according to level of education. There was no significant difference in the level of utilization of; growth monitoring, curative services, ORT and immunization services while there was significant difference in the level of utilization of nutritional services according to mothers’ occupation. There was no significant difference in the level of utilization of growth monitoring, nutritional services, curative services and immunization service according to residential location of mothers. There were significant differences in the level of availability of growth monitoring, nutritional services, curative services, ORT and immunization services. There was also no significant difference in the level of adequacy of growth monitoring, nutritional services and immunization services according to mother’s residential location while there were significant difference in the level of utilization of curative services and ORT according to residential occupation of mothers. The researcher recommended that government should see that primary health centres are located equally in both urban and rural areas, and that health workers should strengthen their teaching on the utilization of all the components of CHs especially growth monitoring and curative services.


TABLE OF CONTENTS

Table of contents
List of Tables
List of Acronyms
Abstract

CHAPTER ONE: Introduction
Background to the Study
Statement of the Problem
Purpose of the Study
Research Questions
Hypotheses
Significance of the Study
Scope of the Study

CHAPTER TWO: Review of Related Literature
Conceptual framework
•  Child health services (CHs), objectives and components
•           Availability and adequacy of CHs
•           Utilization of CHs
•           Primary health centre
•  Factors associated with utilization of CHs
A diagrammatic schema showing conceptual frame work of availability, adequacy and utilization of child health services
Theoretical Framework
•  The three delays model (TDM)
•  Health belief model (HBM)
•           Health- Seeking behaviour model
Diagrammatic schema showing theoretical frame work of availability, adequacy and utilization of child health services
Empirical Studies on Availability, Adequacy and Utilization of CHs
Summary of Literature Review

CHAPTER THREE: Methods
Research Design
Area of the Study
Population for the Study
Sample and Sampling Techniques
Instrument for Data collection
Validity of the instrument
Reliability of the instrument
Method of data collection
Method of Data Analysis

CHAPTER FOUR: Results and Discussion           
Results
Summary of Major Findings
Discussion of Major Findings
Availability of child health services
Adequacy of child health services
Utilization of child health services
Differences in the availability, adequacy and level of utilization of CHs
Summary, Conclusions and Recommendations

CHAPTER FIVE: Summary, Conclusions and Recommendation
Summary
Conclusions
Recommendations
Limitation of the Study
Suggestions for Further Studies
References
Appendices

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....

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