Worldwide, nearly 6.6 million under-five children die yearly, translating to about 18,000 under-five deaths every day [
The 2007 State of the World’s Children Report documented that Nigeria is the country with the 14th highest under-five mortality rate in the world [
Earlier studies on childhood morbidity and mortality and child survival strategies in Nigeria presented some noteworthy findings. According to Policy Project/Nigeria office, the main causes of infant and child mortality in Nigeria include pneumonia, malaria, diarrhea, undernutrition, and vaccine-preventable diseases [
Malaria has been reported as the leading cause of childhood morbidity and mortality in Nigeria, accounting for 25% of infant and 30% of childhood mortality [
Inadequate knowledge and practice of child survival strategies by caregivers, as well as myths and misconceptions, contribute to child morbidity and mortality. A study by Tobin et al. found that 90.2% of respondents indicated that when a child is being weaned from breast milk, the child should continue with breastfeeding when diarrhea occurs with 9.8% indicating that breastfeeding should be discontinued with the onset of diarrhea [
Worried about the alarming under-five mortality rates in developing countries, the WHO in collaboration with UNICEF and the World Bank, developed a set of evidence-based interventions which, when properly implemented, would reduce under-five mortality. This package of interventions was named child survival strategies. Originally, there were four child survival strategies, namely, growth monitoring, oral rehydration therapy, breastfeeding, and immunization, giving the acronym “GOBI” [
Currently, child survival centers around newer strategies such as antenatal care attendance, skilled birth attendance at delivery, and commencement of breastfeeding within one hour of delivery. Others include use of insecticide treated bed nets, management of fever, and treatment of acute respiratory infections, amongst others. According to the NDHS 2013 and the National Bureau of Statistics 2014, the percentage of women who had four or more antenatal clinic visits in Cross River State, 58.7%, was lower than the regional figure of 62.7% but higher than the national figure of 51.1% [
The aim of this study was to determine the knowledge and practice of child survival strategies among rural community women in Cross River State, Nigeria.
The study was carried out in Cross River State of Nigeria. Cross River State is one of the six states in Nigeria’s South-South geopolitical zone. With a population of over 3 million, Cross River State is made up of 18 Local Government Areas which are further grouped into three senatorial districts. The low socioeconomic status of rural community dwellers in Cross River State influences the health-seeking behavior of the women both for themselves and for children in their care.
This was a descriptive cross-sectional study.
The sample size for the study was calculated using Leslie Kish formula:
Thus
The data for this study were collected in accordance with the Declaration of Helsinki. Informed consent was obtained from the respondents.
Twenty-six percent of the respondents were aged 45 and above while over 90% were Christians. Nearly 19% of the respondents were civil servants while only 8% were full-time housewives. Sixty-percent of the respondents were married. Fifty-four (36%) respondents had tertiary education. The Efiks constituted majority of the respondents, 77 (51.3%) (Table
Sociodemographic characteristics.
Variable | Frequency ( |
Percent |
---|---|---|
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15–19 | 12 | 8.0 |
20–24 | 18 | 12.0 |
25–29 | 18 | 12.0 |
30–34 | 18 | 12.0 |
35–39 | 28 | 18.7 |
40–44 | 17 | 11.3 |
45 and above | 39 | 26 |
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Christianity | 142 | 94.7 |
Others | 8 | 5.3 |
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Nonformal | 12 | 8.0 |
Primary | 22 | 14.7 |
Secondary | 62 | 41.3 |
Tertiary | 54 | 36.0 |
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Farming | 24 | 16.0 |
Trading | 27 | 18.0 |
Civil servant | 29 | 19.3 |
Student | 24 | 16 |
Full-time housewife | 12 | 8.0 |
Other | 34 | 22.7 |
As shown in Tables
Knowledge of child survival strategies.
Components of child survival strategies correctly indicated | Frequency |
Percent |
---|---|---|
Growth monitoring | 64 | 42.7 |
Oral rehydration therapy | 147 | 98 |
Breastfeeding | 94 | 62.7 |
Immunization | 101 | 67.3 |
Family planning | 65 | 43.3 |
Female education | 110 | 73.3 |
Food supplementation | 40 | 26.7 |
Essential drugs program | 34 | 22.7 |
Treatment of common ailments | 64 | 42.7 |
Source of information.
Source | Frequency |
Percent |
---|---|---|
Health talks in hospital/health center | 113 | 75.3 |
Personal advice by health worker | 77 | 51.3 |
Health books | 43 | 28.7 |
Radio/TV | 60 | 40 |
Village health worker | 41 | 27.3 |
Friends and relatives | 32 | 21.3 |
Patent medicine vendor | 7 | 4.7 |
Traditional birth attendant | 21 | 14 |
Adequacy of knowledge of child survival strategies.
Aspect of knowledge | Correct response | |
---|---|---|
Frequency ( |
Percent | |
Frequency of weighing of child | 30 | 20 |
Vitamin that prevents blindness | 110 | 73.3 |
Food that contains vitamin D | 67 | 44.7 |
When to commence breastfeeding | 114 | 76 |
Should a child be given first milk? | 119 | 79.3 |
Name of the first milk from mother’s breast after childbirth | 126 | 84 |
When should first polio vaccine be given? | 105 | 70 |
What is exclusive breastfeeding? | 117 | 78 |
Give salt sugar solution if child has diarrhea | 123 | 82 |
Continue breastfeeding if child has diarrhea | 49 | 32.7 |
As shown in Table
Practice of child survival strategies in the last pregnancy and childbirth.
Child survival strategy practiced | Frequency | Percent |
---|---|---|
Antenatal clinic attendance | 93 | 62 |
Last child received all immunizations | 137 | 88 |
At least 2-year interval between last two deliveries | 111 | 74 |
Exclusively breastfed last child | 38 | 25 |
Given antimalarial in the last pregnancy | 126 | 84 |
Figure
False beliefs about colostrum by respondents.
Table
Association between level of education and knowledge of child survival strategies.
Independent variable | Dependent variable | Test statistic | df |
| |
---|---|---|---|---|---|
Yes | No | ||||
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Nonformal | 2 (16.7%) | 10 (83.3%) | |||
Primary | 7 (31.8%) | 15 (68.2%) | Chi square = |
3 | 0.022 |
Secondary | 24 (38.7%) | 38 (61.3%) | |||
Tertiary | 31 (57.4%) | 23 (42.6%) | |||
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Nonformal | 11 (91.7%) | 1 (8.3%) | |||
Primary | 21 (95.5%) | 1 (4.5%) | Fisher’s Exact Test | 3 | 0.1289 |
Secondary | 61 (98.4%) | 1 (1.6%) | |||
Tertiary | 54 (100%) | 0 (0%) | |||
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Nonformal | 6 (50%) | 6 (50%) | |||
Primary | 12 (54.5%) | 10 (45.5%) | Chi square = |
3 | 0.418 |
Secondary | 38 (61.3%) | 24 (38.7%) | |||
Tertiary | 38 (70.4%) | 16 (29.6%) | |||
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Nonformal | 6 (50%) | 6 (50%) | |||
Primary | 12 (54.5%) | 10 (45.5%) | Chi square = |
3 | 0.066 |
Secondary | 40 (64.5%) | 22 (35.5%) | |||
Tertiary | 43 (79.6%) | 11 (20.4%) | |||
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Nonformal | 4 (33.3%) | 8 (66.7%) | |||
Primary | 5 (22.7%) | 17 (77.3%) | Chi square = |
3 | 0.084 |
Secondary | 27 (43.5%) | 35 (56.5%) | |||
Tertiary | 29 (53.7%) | 25 (46.3%) |
Table
Association between level of education and practice of child survival strategies.
Independent variable | Dependent variable | Test statistic | df |
| |
---|---|---|---|---|---|
Yes | No | ||||
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Nonformal | 6 (50%) | 6 (50%) | |||
Primary | 13 (59.1%) | 9 (40.9%) | Chi square = |
3 | 0.734 |
Secondary | 38 (61.3%) | 24 (38.7%) | |||
Tertiary | 36 (66.7%) | 18 (33.3%) | |||
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Nonformal | 8 (66.7%) | 4 (33.3%) | |||
Primary | 17 (77.3%) | 5 (22.7%) | Fisher’s Exact Test | 3 | 0.001 |
Secondary | 58 (93.5%) | 4 (6.5%) | |||
Tertiary | 54 (100%) | 0 (0%) | |||
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Nonformal | 3 (25%) | 9 (75%) | |||
Primary | 12 (54.5%) | 10 (45.5%) | Chi square = |
3 | 0.000 |
Secondary | 49 (79%) | 13 (21%) | |||
Tertiary | 47 (87%) | 7 (13%) | |||
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Nonformal | 10 (83.3%) | 2 (16.7%) | |||
Primary | 17 (77.3%) | 5 (22.7%) | Chi square = |
3 | 0.884 |
Secondary | 46 (74.2%) | 16 (25.8%) | |||
Tertiary | 39 (72.2%) | 15 (27.8%) | |||
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Nonformal | 7 (58.3%) | 5 (41.7%) | |||
Primary | 16 (72.7%) | 6 (27.3%) | Fisher’s Exact Test | 3 | 0.023 |
Secondary | 55 (88.7%) | 7 (11.3%) | |||
Tertiary | 48 (88.9%) | 6 (11.1%) |
As shown in Table
Association between knowledge and practice of child survival strategies.
Knowledge variable | Practice variable | df | Chi square |
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Yes | 100 | 1 | 1 | 23.02 | 0.0000 |
No | 37 | 12 | |||
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Yes | 20 | 97 | 1 | 19.087 | 0.0000 |
No | 18 | 15 | |||
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Yes | 31 | 6 | 1 | 2.44 | 0.1180 |
No | 80 | 33 |
Only 32.7% of respondents knew that breastfeeding should be continued even when the child has diarrhea. This is comparable to the finding by Tobin et al. that 35.3% of respondents in a related study in a rural community in South-South Nigeria indicated that a child that has diarrhea should be given more breast milk than usual [
The majority of respondents, 79.3%, agreed that the baby should be given colostrum. This is contrary to the findings of Walia et al. where 66% of respondents withheld colostrums from neonates [
The proportion of respondents who had antenatal care in the last pregnancy (62%) is comparable to the national average of 61% reported by NDHS 2013 [
Education was found to be a determinant of knowledge and practice of some child survival strategies. It was a determinant of attendance of antenatal clinic although there was no statistically significant difference between the four levels of education (
There was an association between level of education and having received antimalarial medicine in the last pregnancy with a statistically significant difference,
Respondents demonstrated adequate knowledge and practice of most of the child survival strategies, especially with regard to oral rehydration therapy. However, there was evidence of some gaps like majority of respondents not knowing that breastfeeding should be continued even when the child has diarrhea. Such inadequate knowledge and practice, including evidence of myths and misconceptions demonstrated by the respondents, could mar efforts to reduce child morbidity and mortality in the state. Education was associated with knowledge and practice of most child survival strategies. This may be an indication that the advocacy for girl child education, which has been intensified within the past 15 years, is gradually making the desired impact and should be encouraged. It is recommended that health care providers should do more to educate caregivers about the basic facts regarding child survival strategies.
The authors declare that there is no conflict of interests regarding the publication of this paper.