Background: Despite concerted global efforts towards achieving infant-survival, infant mortality lingers as a problem in developing countries. Environmental and personal-level factors are assumed to account for this situation. This study was undertaken to provide better understanding of the dynamics of predictors of infant-survival practices among mothers with infants attending paediatric clinics. Methods: A cross-sectional survey design was adopted. Data was collected from 386 nursing mothers selected by convenience sampling. Interviewer-administered questionnaires were used for data collection. The questionnaire consisted of 38-items including demographic information of respondents, health-literacy counsels received during antenatal care, social-support from significant others, and self-efficacy to carry-out infant-survival instructions. Responses were transformed into rating scales for each variable and data analysis was conducted by linear regression analysis with test of hypotheses at 5% level of significance. Results: The mean age of respondents was 29.8 ± 5.8 years. Majority (81.6%) were married. Yorubas (83.90%) were predominant. Participants had mean scores of 10.50 ± 3.83, 10.56 ± 3.70 and 16.61 ± 4.56 respectively computed for levels of health-literacy, social-support, and self-efficacy. The dependent variable measured level of infant-survival practices and respondents scored 16.53 ± 4.71. The study found a significant association among variables. Self-efficacy was the major predictor variable of self-reported infant-survival practices (R = 0.466; R2 = 0.217; P<0.05). Conclusion: We conclude that participants had average levels of health-literacy, social-support, self-efficacy, and infant-survival practices. Healthcare providers should make efforts to empower pregnant women on activities essential for infant-survival. Family members of nursing mothers should as well be knowledgeable about the advantages of supporting them.
This study adopted the cross-sectional survey design. It was conducted in Ijebu-Ode local government situated in Ogun state, South-West Nigeria. The local government has twelve primary health centres and one tertiary health facility. We randomly selected nine primary healthcare centres that cut across all the wards in the local government. We then included the only tertiary health facility in the study location. The population was 2006 mothers whose infants were receiving postnatal care at the time of the study. We estimated the sample size to be 423 using Cochran’s formula for sample size computation [22]. We anticipated an attrition probability of 10%. Overall, from the ten health facilities, 386 consenting nursing mothers drawn by convenience sampling were enrolled into the study. Because the number of postnatal attendees for each health facility depends on the level of patronage and the population in the locality, none of the facilities recorded similar number of respondents. We adopted the educational and ecological assessment phase (Predisposing, Reinforcing, and Enabling factors) of the PRECEDE model [23], bearing in mind that these parts of the framework are causally linked to expected behaviour. We first developed the instrument in English and then translated it to Yoruba language because Ijebu-Ode is home to mostly people of the Yoruba ethnicity (a major Nigerian ethnic group inhabiting states in the Southwestern part of Nigeria). Thus, respondents could select the questionnaire written in the language option suitable for them. We initially conducted a pilot-test for internal consistency of the instrument using 40 nursing mothers from Ilishan primary health centre (25 km from study site), followed by a re-test for reliability of the instrument with the same participants. Data from the pilot-test was statistically analysed and a Cronbach alpha standard score of 0.738 was obtained with corrections made where necessary. We collected data from participants by interviewer-administered technique from the 27th of February 2017 to the 21st of March 2017. Predisposing factors are personal-level attributes that motivate behaviour prior to or during the occurrence of that behaviour. For this study, the predisposing factors we assessed were health-literacy and demographic characteristics of respondents. Reinforcing factors are environmental-level influences that stem from repetitive emphasis laid on the behaviour of interest. For this study, we assessed social-support from family members as the reinforcing factor. Enabling factors are the characteristics of the environment that facilitate action and any skill or resource required to attain the specific behaviour. These may be programs, services, availability and accessibility of resources, or new personal skills. The enabling factor for this study was self-efficacy. We described the behaviour of concern as infant-survival practices. Figure 1 describes the linkages between the variables as adopted from the PRECEDE Framework. Variables in the educational and ecological assessment phase of the PRECEDE meta-model expressed in the study objectives demonstrating linkages between predisposing, reinforcing, enabling factors and infant-survival practices Demographic data elicited information on age, marital status, occupational status, religion, ethnicity, educational attainment, parity, and number of infants ever lost. As Renkert and Nutbeam [24] previously described, we defined maternal health-literacy as cognitive and social skills that determine mother’s motivation and ability to gain access to, understand, and apply information in ways that promote and maintain their health and that of their children. The variable contained items such as instructions about sterilization of infants’ items, infant feeding, exclusive breastfeeding and use of Insecticide Treated Nets. Two items had the dichotomous response format (Yes/No) and were scored at a point each. Six items had multiple-choice response format and were scored at 16 points; each right response being scored at one point. Thus, health-literacy was measured on 18-points rating scale. The social-support variable included questions on the frequency of receiving assistance and encouragement to practice health counsels and assistance with infant health and care from family members. It consisted of five items with the Likert-type 4-response options (never, rarely, occasionally, and always; the least being 0 and the highest being 3) and 1-item with multiple-choice response pattern rated at two points. Thus, the social-support variable was measured on a 17-point rating scale. We measured self-efficacy as self-responsibility, confidence and willingness of mothers to adhere to infant-survival instructions. The variable consisted of eight items with the Likert-type 4-response option (strongly agree, agree, disagree, and strongly disagree; the least being 0 and highest being 3). Hence, we rated self-efficacy on a 24-point rating scale. The dependent variable was infant-survival practices which assessed mothers’ behavioural adherence to antenatal health instructions, prevention of malaria, practice of exclusive breastfeeding, and health appointment keeping. The variable included seven items with Likert-type 4-response options (never, rarely, occasionally and always; the least being 0 and the highest being 3) and was measured on a 21-point rating scale. The ratings of the variables provided responses to the research questions on the levels of health-literacy, social-support, self-efficacy and infant-survival practices of respondents. Data derived were computed and analysed using the Statistical Package for Social Sciences (SPSS) version 21. Responses from the variables were transformed into rating scales to derive standard measures. Correlation and linear regression analysis were conducted to give statistical responses to the research hypotheses. Analysis of Variance was evaluated to assess how demographic data influenced responses of participants on infant-survival. Decision rules for the test of null hypotheses were set at 5% level of significance. Therefore, P-Values greater than 5% were rejected.
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