PROVISION, UTILIZATION LEVELS AND TRENDS OF CHILD HEALTH SERVICES IN PRIMARY HEALTH CARE CENTRES IN ENUGU URBAN OF ENUGU STATE

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ABSTRACT

This study was aimed at determining the provision, Utilization Levels and Trends of Child Health Services in the Primary Health Care Centres in Enugu Urban. The independent variables investigated were maternal age, parity, occupation and educational attainment. Other socio-economic factor(s) that could influence utilization of CHS were also considered in the study. The study was limited to eight components of CHS available in the area of study, while immunization service, which is one component of CHS, was used to trace the trend of CHS. Descriptive survey research design was used for the study. Four research questions and four hypothesis tested at .05 level of significance were formulated for the study. The population of study was 11,200 mothers of reproductive age on Enugu State and 310 mothers and their babies that utilize CHS in PHC facilities in Enugu Urban. Instrument for data collection were provision and utilization of CHS questionnaire and Trends in utilization of immunization inventory both designed by the investigator. Mean, frequencies, percentages and chi-squire statistical techniques were employed to analyze data collected. The findings of the study are as follows: CHS was available in the three PHC in Enugu Urban. All of the eight components of CHS except exclusive breast-feeding were utilized effectively. The trend of immunization services utilization over the years 2000 – 2007 was full of fluctuations. Maternal Demographic factors studied: Age, parity, occupation and educational attainment had no statistical relationship to the level of use of available CHS. Availability of medical personnel in the neighborhood 77.15 percent, ignorance of need of CHS, 40.06 percent, cultural belief 25.83 percent, bad attitude of health care provides 18.54 percent and procrastination of immunization/clinic days 13.58 percent were socio-economic factors that affected level of utilization of available CHS.


TABLE OF CONTENTS

Title page
Table of Contents
List of Acronyms and Abbreviations
List of Table
List of Figures
List of Appendices
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
Factors Associated With CHS
Theoretical Framework
Empirical studies on utilization level and trends of child Health Services
Summary of Literature Review

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

CHAPTER FOUR: Results and Discussion
Summary of findings
Discussion of major findings
Availability/provision of CHS
Utilization levels of CHS
Trends in utilization of immunization services from 2000 to 2007
Influence of maternal socio-demographic factors on Utilization level of CHS (age, parity, educational attainment and Occupational Status)
Socio-economic factor(s) that could influence level of utilization of CHS
Implications of the findings for health of the child and Childhood morbidity mortality rates

CHAPTER FIVE: Summary, Conclusion and Recommendations
Summary
Conclusions
Recommendations
Suggestions for Further Studies
Limitations of the study
References
Appendices

CHAPTER ONE

Introduction

Background to the Study
Children are the future of any nation or community. They are essential for the survival of any group of people. For this reason and more the focus of international public health concern has been on reducing child mortality and morbidity in order to propagate, preserve, nurture and ensure continuity of the human race. This is rightly so as WHO (2000) reported that recently in the mid 1980s, some fifteen million children under five years of age died each year, representing 30 per cent of all deaths in many countries. This evil trend was addressed through the provision of Child Health Services (CHS).

According to William (1984), CHS are that aspect of medical services that provide essential health services to protect, promote and maintain health and well-being for child bearing families as a unit and for each individual child within that family up to school age (from birth to five years). World Health Organization WHO (1993) stated that CHS is a channel through which medical and health services can be organized to improve the health of the child, prevent diseases and promote growth and development. Tabah (1987) had earlier noted that CHS is an integral part of community health services and has been adopted as Maternal and Child Health Services (MCH).


Starfeiled (2002) asserted that CHS is an integral part of Primary Health Care (PHC) which is concerned with the provision of accessible, integrated, bio-psychosocial health care service by the health care personnel who 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. According to Guagilardo (2004) PHC is recognized as the most important form of health care delivery system for maintaining populations health including child health, because it is relatively in-expensive, can be more easily delivered than specialty an in-patient care (if properly distributed) and most effective in preventing disease progression in a large scale.
The health of the child and services offered to protect it are influenced by factors classified by Cleason, Edward, Mawiji, and Pathmanathan (2000) as proximate factors (such as non-medical and medical care during the antenatal period, care at birth, preventive and curative care in the post-natal periods) and non-proximate factors such as maternal factors (age, parity and birth intervals). Household and community level factors (such as water supply, sanitation, and housing) then socio-economic development and health services. Diamond (2000) pointed out that there is little doubt that high child mortality rates are associated with high rates of child bearing early child bearing, short birth spacing and high-parity birth. He suggested that effort to reduce high child mortality should not only end in health intervention but should include improvement in women’s education.

Gabr (1985) identified the components of child health care services as follows: immunization services, growth monitoring, oral re-hydration therapy, promotion of breastfeeding, treatment of minor illness and outreach services. These activities are aimed at protecting child health and preventing ill health. Immunizations are given to protect the child against childhood killer diseases. The Federal Ministry of Health of FMOH (2004) identified these diseases as: whooping cough, measles, tuberculosis, tetanus, poliomyelitis, diphtheria and the additional package namely hepatics B and cerebrospinal meningitis. United Nations Children Fund) UNICEF (2002), reported that although most of these childhood killer diseases have been reduced in the developed countries, other diseases and conditions such as malaria, human immunodeficiency virus (HIV), cerebro-spinal meningitis, diarrhea, hepatitis B virus and malnutrition are now topping the lead as childhood killer diseases.
Other CHS includes; growth monitoring, using a standardized chart aimed at assessing the physical development of the child. Oral re-hydration therapy given for the treatment of diarrhea of any aetiology, promotion of breastfeeding to prevent malnutrition, health education on nutrition and the use of locally and culturally accepted foods during weaning periods to introduce children under the age of one year to the family food without creating nutritional gap that would result to malnutrition, treatment of prevalent illness such as malaria and outreach health services. In outreach services, trained health personnel go out to reach children in schools and churches or mosque to delivery child health services such as immunization, health screening and inspection, identification and referral of children with physical or psychological impediments for proper management.

The objective of child health care services according to Nelson (2000) is to reduce child morbidity and mortality to enhance mental, physical and psychological well being of the children to permit them to come to adulthood at their optimal stage of development as to complete with life struggle at their affective level. It is worth noting, however that not withstanding the provision of all these services, their utilization are essential for accomplishing of the objective of child health care services. In other words, the provision of the services is considered a necessary factor for the accomplishment of the objective of the child health care services, while the utilization is also another factor.

Child health services among other health services are provided by the government at all levels: federal, state and local government levels. Each has her responsibilities in turn for providing these services either single-handedly or in collaboration with non-governmental agencies such as UNICEF, United State Affair for International Development (USAID), World Bank, WHO, DFID. According to Cleason and Waldman (2000), health care services are provided at government levels, community levels and family levels. It is the responsibility of the government to provide some of these health services, while it is the responsibility of the community to make them accessible, bearing in mind the cultural health practices and attitudes of the families to health issues.

The CHS provided at home/family level includes: Breast-feeding, good nutrition by good weaning practices, hygiene and other health promoting behaviours. Clearson and Waldman (2002) maintained that the ability of the mother to recognize illness, provide appropriate and quality care and seek medical help early in sickness, goes a long way to save and keep the child alive.
WHO (2000) reported that at the community level, the extent of utilization of child health services will depend on community factors such as culture, values, beliefs norms, ecology and geography among other things. Factors such as availability of those services, accessibility, quality of other health services (private and public) around, food, energy, water supply and sanitation will determine and influence the extent of use of CHS. Similarly at government level, factors such as government policies and actions on health, nutrition, population, health financing and expenditure, provision, stewardship, inter-sectorial linkages, evaluation and monitoring will make a way for availability and accessibility of CHS. Other governmental policies such as infrastructure, transport, energy, agriculture, water supply and sanitation can also influence the extent of use of CHS.
Child health services as part of maternal and child health services evolved through ages and is noted in the bible (Exodus 1:15 – 22). According to Nelson (2000), it reached......

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