NURSES' ROLE IN PREVENTION OF INFANT AND UNDER-FIVE CHILD MORTALITY IN AFRICA

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 mortality, 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).
Child mortality has been at the hub of health discourse since time immemorial. Governments, health professionals, and policymakers have reserved an exclusive interest in reducing the prevalence of childhood deaths globally (Fox, 2011). This interest has not only extended into the international scene, it has led to the development of sound interventions to reducing child mortality among children under the age of five between 1990 and 2015, and between 2015 and 2030 as tagged in the United Nation’s Millennium Development Goals (MDGs) (Fox, 2011), and Sustainable Development Goals (SDGs) respectively (United Nations, 2015).
As recommended by different United Nations (UN) organisations, most countries use the reduction in under-five and maternal mortalities as bases for key development (Lander, 2006). It’s also pertinent for countries to estimate their neonatal and infant mortalities so as develop appropriate intervention programs to reduce preventable child deaths. Neonatal mortality remains a significant public health problem worldwide. In the year 2015, 2.7 million deaths occurred in the first 28 days of life; representing a significant reduction to 19 deaths per 1,000 live births from the previously 36 deaths per 1000 live births in 1990 (UNICEF/WHO/World Bank/UN, 2015). Though there was a decline in neonatal rates in some sub-Sahara African countries, such as Ghana and Uganda (Lawn et al., 2014), the Nigerian Neonatal Mortality Rate (NMR) reduced by 20.4%, from 49 deaths per 1000 live births in 1990 to 39 in 2011 (UNICEF/WHO/Word Bank/UN, 2012), 37 in 2013 (Oestergaard et al, 2009) and to 34 deaths per 1000 live births in 2015 (UNICEF, 2015). Globally, Nigeria ranks second to India with the highest number of neonatal deaths (UNICEF/WHO/World Bank/UN, 2012).
Similarly, Under-Five Mortality Rates (U5M) remain high in Nigeria despite recent interventions. A U5M of 128 deaths per 1000 live births as evidenced in the year 2013 Nigeria Demographic Health Survey suggests that about one in every eight children in Nigeria dies before their fifth birthday—approximately 21 times the average rate in developed countries (UNICEF/WHO/World Bank/UN, 2013). Spanning a period of over two decades (1990 to 2015) in Nigeria, Infant Mortality Rates (IMR) have reduced by 57% (from 126 to 69 deaths per 1000 births); U5M fell by approximately 49% (from 213 to 109 deaths) (UNICEF, 2015).
Child deaths commonly result from several risk factors and preventable diseases. Acute Respiratory Infections (ARIs), diarrhoea, malaria and chronic malnutrition contribute largely to disease morbidity and mortality among children (Adeyele et al., 2015). Deaths in the first 28 days of life has been linked to the endogenous (genetically-induced malfunctions, premature births) status of a child, quality of antenatal care, whether assistance was given during delivery and post-partum care (Adebayo et al., 2014). However, deaths in the succeeding 11 months are often tied to the wealth status of the households, environmental factors, health behaviour and nutritional practices (Adebayo et al., 2014). Several other factors have been linked with infant and child deaths. Such factors among others include maternal education, early marriage, place of residence, regional variations, short birth intervals, fertility behaviour, breastfeeding practices, use of health services by mother and or child, child’s sex, ethnicity and religion (Adebowale, 2012).
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, micronutrient 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 maternal 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.
Notwithstanding the considerable gains achieved in reducing childhood deaths globally, the recorded progress was insufficient in meeting the MDG 4 target. The recommended SDG target for child mortality signifies a renewed commitment to the world’s children. Achieving this renewed commitment is dependent on monitoring the drivers of preventable deaths among children. In spite of the significant progress made in recent years to reduce under-five mortality, significant inequities between and within countries continue to exist. These are not only driven by poverty, but are intrinsically linked to social exclusion and de jure and de facto discrimination. The outcome of this study would serve as a bedrock for planning suitable interventions for halting preventable deaths of newborns and under-fives. Therefore, this study tends to identify the role of nurses in reducing and or preventing infant and child mortality.
This study aims to find out the nurses’ role in infant and under-five mortality prevention. The purpose is to provide researched information to increase nurses’ knowledge of child mortality prevention by the findings of this research.  Specifically, the study sought to;
1.   examine the relationship between nurse and prevention of infant and under-five mortality.
2.   examine what nurses are doing to prevent infant and under-five mortality in Africa.
3.   examine the challenges nurses face in dealing with child mortality.
1.4   Research Questions
In order to reach the aims and purpose of the study, the following questions should be addressed: 
1.       What is the relationship between nurse and prevention of infant and under-five mortality?
2.       What are nurses' doing to prevent infant and under-five mortality in Africa?
3.       What challenges do nurses face in dealing with child mortality?
1.5   Research Hypothesis
Ho: There is no relationship between nurse and prevention of infant and under-five mortality.
Hi: There is a relationship between nurse and prevention of infant and under-five mortality. 
1.6   Significance of the Study
This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study will contribute to knowledge and could serve as a guide for other study.
1.7   Scope/Limitations of the Study
This study is on nurses' role in prevention of infant and under-five child mortality in Africa.
Limitations of study
Financial constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
Time constraint: The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.
1.8  Definition of Terms
Nursing: Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life.
Nurse: A nurse is a person who is trained to give care to people who are sick or injured. Nurses work with [doctors] and other health care workers to make patients well and to keep them fit and healthy. Nurses also help with end-of-life needs and assist other family members with grieving.
Infant: A very young child or baby.
Mortality Rate: Mortality rate, or death rate, is a measure of the number of deaths in a particular population, scaled to the size of that population, per unit of time.