TABLE OF CONTENTS

Title Page                –           –           –           –           –           –           –           i

Approval page –          –           –           –           –           –           –           –           ii

Certification    –      –           –           –           –           –           –           –           –           iii

Dedication      –          –           –           –           –           –           –           –           –           iv

Acknowledgements    –        –           –           –           –           –           –           –           v

Table of Contents            –           –           –           –           –           –           –           vi

List of tables     –           –           –           –           –           –           –           –           vii

Abstract          –           –           –           –           –           –           –           –           viii

CHAPTER ONE – INTRODUCTION

Background of the Study        –           –           –           –           –           –           1

Statement of the Problems         –           –           –           –           –           –           4

Purpose of the Study –               –           –           –           –           –           5

Objectives of the Study              –           –           –           –           –           –           5

Research Questions     –         –           –           –           –           –           –           6

Significance of the Study       –          –           –           –           –           –           6

Scope of the Study                 –           –           –            –           –           –           7

Operational Definition of Terms         –       –           –           –           –           7

Umbilical Cord Care Practices              –           –           –           –           –           8

Warmth Maintenance/Thermal Regulation Practices  –  –           –           –           9

Health/Care-Seeking Patterns/ Practices        –           –           –           –           9

Socio-demographic Data             –           –           –           –           –           –           9

CHAPTER TWO LITERATURE REVIEW

Concept of Infancy     –            –           –           –           –           –           –           10

Infant Care Practices and Related Concepts –     –           –           –           –           13

Theoretical Review     –           –   –           –           –           –           –           26

Empirical Studies on Infant Care Practices    –             –           –           –           33

Summary of Literature Review and Critical Analysis of Empirical Review              –           39

CHAPTER THREE – RESEARCH METHODOLOGY

Research Design         –      –           —          –           –           –           –           41

Area of Study             –       –           –           –           –           –           –           –           41

Popu1ation of Study   –                   –           –                       –           –           –           42

Sample            –               –           –           –           –           –           –           –           42

Sampling Procedure    –               –           –           –           –           –           43       

Instrument for Data Collection                     –           –           –           –           43

Validity of Instruments               –           –           –           –           –           44

Reliability of the instrument              –           –           –           –           –           44

Ethical Considerations     –           –           –           –           –           –           45       

Procedure for Data Collection       –           –           –           –           –           45

Methods of Data Analysis        –           –           –           –           –           46       

CHAPTER FOUR

PRESENTATION OF RESULTS

Research Question 1                –           –           –           –           –           –           47

Research Question 2. –                –           –           –           –           –           –           52

Research Question 3   –     –           –           –           –           –           –           –           56

Research Question 4   –     –           –           –           –           –           –           58

Research Question 5:- –          –           –           –           –           –           –           61

Research Question 6   –             –           –           –           –           –           –           62

Research Question 7   –            –           –           –           –           –           –           64

Summary of findings –          –           –           –           –           –           –           73

CHAPTER FIVE

DISCUSSION OF RESULTS

Discussion of findings              –           –           –           –           –           –           75

Implications of the study          –           –           –           –           –           –           84

Limitations of the study             –           –           –           –           –           –           85

Suggestions for further studies                –           –           –           –           –           85

Summary of the study       –           –           –           –           –           –           86

Conclusion      –         –           –           –           –           –           –           88

Recommendations          –           –           –           –           –           –           –           89

References      –           –           –           –           –           –           –           –           90

Appendix I: Questionnaire

Appendix II

LIST OF TABLES

Table 1: Demographic data of the respondents?          –                       47

Table 2; Initiation of infant feeding and practice of breastfeeding by respondents. –           49

Table 3:  Introduction of weaning feeds/ other adult feeds.   –           –           51

Table 4: Frequency of infants’ baths.   –           –           –           –           52

Table 5: Respondents care of infant clothing / diapers and beddings 54

Table 6: Showing the care of the infants’ cutlery and cockery.      56

Table 7 Respondents are intents off cord care      –           –           58

Table 8: Showing respondents’ maintenance of warmth for the infants by their mothers.    60

Table 9: Showing the respondents’ maintenance of warmth during infant baths and warmth in the room.   –           –           –           –           –           –           61

Table 10, Showing the health/care seeking practices of mothers for their sick infants.-       63

Table 11; Showing the respondent’s adequacy and inadequacy of practices of the different infant care practices in the order of adequacy.     –           64

Table 12: Showing the cross tabulation of maternal age against the respondents adoption of the infant care practices.               –           66

Table 13: Showing cross tabulation of the determination of the respondents’ adoption of adequate infant are practices by their occupation.             69

Table 14: Cross tabulation for the determination of performance of infant care practices by mother’s level of education.             –           71

ABSTRACT

The study examined the infant care practices adopted by mothers in the rural communities of Udi Local Government Area of Enugu state. The objectives of the study were to determine the infant feeding, hygiene/cleanliness maintenance, umbilical cord care, warmth maintenance and health/care-seeking practices adopted by the mothers in the area as well as compare the adequacy of performances by the mothers across the different infant care practices and the association between their adoption of the practices and  their demographic characteristics. The research design for the study was a descriptive survey design. The target population of the study were estimated to be 26,486 women of child bearing age of 15 -49 years. Ogebe-ogene, one of the development centres in Udi L.G.A was selected for the study using a simple random sampling technique. Proportionate sampling method was used to draw 12.5% of the sample size of 392 women of child –bearing age from each of the 8 villages in Ogebe-ogene for the study. Snowball method of sampling was used to reach the mothers who met the inclusion criteria. The instrument for data collection was  researcher’s  developed questionnaire. The collected data were subjected to simple descriptive statistical analysis of frequency and percentage.Chi-square was used to analyse the strength of association between the demographic data of mothers and their performances of the different infant care practices at 0.05 significant level. Major findings revealed that infant feeding was fairly practiced and was placed fourth in the adequacy of performances across the 5 determined infant care practices. Cord care practices were poor and was the least performed as less than average of the respondents adequately performed the optimal cord care practices as operationally defined. Warmth maintenance practices was the best adequately performed infant care and was followed by the hygiene care practices.  Health care seeking practices was fairly practiced as a little above the average number of the mothers performed the practices adequately though a significant number (a little below the average) practiced self medication. There was a significant association between the maternal level of education and their adequacy of performance of all the infant care practices determined. Maternal age was significantly associated with their adoption of adequate infant feeding and health /care seeking practices. Occupations of the mothers were significantly associated with their adoption of adequate infant feeding, hygiene maintenance, warmth maintenance and health/care seeking practices. Maternal parity was significantly associated with their performance of adequate  infant feeding, cord care, warmth maintenance and health /care seeking pattern. However, no significant difference was found between hygiene/ cleanliness maintenance practices and the maternal parity. Conclusion was drawn that cord care practices was poorly performed with infant feeding and health /care seeking practices only fairly /moderately practiced of all the examined infant care practices. Also, education, occupation, culture and experience (age and parity) were of significant association to the mothers’ practices. It was recommended that health workers and other stake –holders (particularly the public/ community –based nurses) should create more enlightenment/outreach programmes like health education and health visits to encourage improved adoption, and performances of cord care infant feeding and health/ care, seeking practices. 

CHAPTER ONE

INTRODUCTION

Background to the Study

Infancy, which is the period between zero (0) to two (2) years, is a very crucial period in ones life (World Health Organization (WHO), 2002). It is generally believed that once a child survives this period the child will successfully thrive through childhood. Being highly vulnerable, these infants need critical care from their care givers (that is, mothers, family members, health- practitioners etc). The objective of these care practices is to ensure the attainment of the infant’s health and survival.

Infant care practices are those practices or activities administered to the babies to ensure their health and survival. In other words, they can be those activities carried out by mothers and significant others, which help them go through the process of caring for their babies during this period of infancy so as to provide the children with suitable environment and conditions (physical, social and psychological) for proper growth and development (Yolanda, 2007). Emphasizing the importance of children’s right to survival and health, the Millennium Development Goals (MDGs) launched in 2005, has as its fourth (4th) goal, “the reduction of the under five mortality by two-third (2/3) by the year 2015”. To this effect, many countries have instituted programmes like Free Maternal and Child Health Care Services, Integrated Management of Childhood Illness (IMCI), Expanded Programme on Immunization (EPI), National Immunization Days (NIDs) etc. These efforts had only brought a sluggish decline in infant mortality rates (IMR) globally (Yolanda, 2007). UNICEF (2013) raised an alarm that Nigeria has only made a sluggish progress in checking the infant and child mortality between 2009 and 2011. According to the record, Nigeria was second next to India of the least successful countries in improving their infant survival. For instance, between  1990 and 2003 the infant  mortality  rate  in Nigeria stood  at 100 deaths  per 1000 live births  ( National  population commission (NPC) 2008), while the statistical report by UNICEF (2013) indicated 88 deaths per 1000 live births. This figure is among the highest in the world.

This moderately high Infant Mortality Rate (IMR) in the country (an index of both medical and social standard) is attributed according to UNICEF (2013) and Adekunle (2007) mainly to the high neonatal and post-neonatal death rates. Darmstadt, Syed, Partel and Kabir (2006) noted that each year, approximately four million babies die during their first twenty-eight (28) days of life globally. Yolanda (2007) emphasized that ninety-nine percent (99%) of these deaths occur in the low and middle-income countries like Nigeria.

 World Health Organization in Yolanda (2007) reported that these deaths occur at home where the infants are cared for by their mothers, relatives and traditional birth attendants (TBAs). (UNICEF 2013) and Yolanda (2007), emphasized that these deaths can be avoided through simple, affordable interventions, outreach and family/community care, health education to improve home- care practices, recognition of danger signs, generation of demand for skilled care and positive/increased health-seeking behaviour to appropriate health care facility.

Reducing infant mortality and morbidity, therefore, does not require only medical break through, expensive technology or the make-over of national health systems but major strides can be made by putting existing solutions into general practices (UNICEF 2013). As Martines, Paul, Bhutta, Koblinsky, Soucat and Walker (2005) noted, most infant survival programmes have focused too heavily on pneumonia, diarrhea, malaria and vaccine- preventable diseases which account for only thirty-six percent (36) of infant mortality. From the fore-going, it is deduced that most of these instituted programmes like free- Maternal and Child Health Care, Integrated Management of Childhood Illnesses, etc are objectively health-facility-based interventions while most deaths occur at home due to preventable causes which could be averted by simple methods such as house-hold hygiene practices, good nutritional practices and health/ care seeking behavior for these infants (Olatunji 2013).

The World Health Organization (WHO) in Peeyush and Pragti (2012) therefore, provided more comprehensive (hospital and home-based care) essential guidelines for newborn and infant care. These include: hygiene maintenance during and after delivery, keeping the infant warm, early initiation and exclusive breast-feeding, care of the cords, eyes, care during illness, immunization etc. These practices, according to Peeyush and Pragti (2012) meant “the mother and family preparing for birth, choosing a safe place for delivery, keeping the process of delivery clean, avoiding cold, breastfeeding early and exclusively, and understanding (and reacting to) potential danger signs.

Although mothers who access health care facilities are taught these infant care practices during their antenatal visits and the perinatal periods, they also get the influences of the family and community members in forms of suggestions, advices and contributions in caring for their babies. These may thus, create rooms for some controversial suggestions, ideas and practices, some of which might be harmful for the child’s health even though, they seem to be culturally acceptable. Worse still, mothers who habitually do not access health care facilities are more at risk to these dangers as they do not have prior knowledge of the proper essential newborn and infant care guidelines exposed to those that access health facilities.

Some of these practices which may still be in existence include, the introduction of coconut water (mmiri aku-oyibo in Igbo Language), as a pre-lacteal before initiation of breastfeeding of the infant. This is believed to help in reducing the severity of intestinal colicky (Afo-Mkughe “in Igbo Language”), which normally, most infants experience within their first three months of life. Other practices include; removal /expressing out of the colostrum which is believed to cause loose stool for the infant, massage of the infant’s abdomen and umbilical stump using hot-water, believing that it initiates stooling, increases peristaltic movement and speeds up the falling-off of the umbilical stump and its healing; rubbing of herbs/local concoctions like palm kernel oil (enu-aki) on the infant’s skin and body, even giving the child’s urine to the child with infantile conditions like fevers and convulsions believing that they drive the causative demons away, application of a poultice .on the parietal frontannelle of an infant to treat sunken frontannelle in a malnourished/dehydrated child etc. These practices even when objected to by these mothers might be forced on them by the families with the notion that they (the mothers) are inexperienced.

Based on the above considerations, it becomes necessary to look into the infant care practices adopted by mothers in rural communities, since research, as already indicated, has shown that most of the infant deaths occur at home where the infants are cared for by their mothers and relatives (WHO in Yolanda, 2007) and with little or no involvement of the formal health care system (Darmstadt et al, 2006). Besides, since these deaths can be avoided through simple affordable interventions like health education to improve home-care practices, (Yolanda, 2007), it becomes necessary to empirically ascertain the home-based care practices of these rural mothers. It is hoped that the information obtained from this study will assist in guiding the needed health education to improve the mothers’ home care practices.

Statement of the Problem