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CAUSES OF UNDER-FIVE MORBIDITY AND MORTALITY IN KATH, MOTHER AND BABY UNIT (MBU)

SUMMARY The causes of under-five morbidity and mortality are diarrhea, mal-nutrition, malaria, acute respiration infection, asphyxia, sepsis, anemia, injuries. Factors contributing to the prevalence of the disease include illiteracy, ignorance, and poor hygiene, failure to exclusive breastfeeding, socio-economical factors and cultural factors. Hospital records of under-five morbidity and mortality will be studied and in addition some mothers will be interview. Most common sources of water are stream, spring, pipe-borne, well and pond. Most mothers do not boil or filter the water they give to their children to drink. Toilet facilities are latrine, WC, whiles refuse dumps are the open type situated at various parts. The above named factors contribute to morbidity and mortality in under-five. With effective health education programmes on environmental sanitation and exclusive breastfeeding, morbidity and mortality rate can be reduced.

INTRODUCTION AND LITERATURE REVIEW Approximately children under 5 years of age die throughout the world each year in developing countries of every 1000 children born in sub-Sahara Africa, approximately 170 die, comparing with less than 10 of those who are born in developed countries. The 4th Millennium Development Goal is to reduce child and infant mortality in the world by the year 2015. According to Mortality country facts sheet 2006, the distribution of causes of death among children less than 5 years of age in Ghana, between the years 2000-2003 were HIV infection, neonatal asphyxia, pneumonia, malaria and measles. The Millennium Development Goals (MDGs) were adopted in 2000 with the aim of reducing the severe gaps between rich and poor populations. Most countries have endorsed Goal 4 of the MDGs to “reduce by two thirds [between 1990 and 2015] the mortality rate among children under-five”. Reliable information on the magnitude, patterns and trends of causes of death of children aged less than 5 years helps decision-makers to assess programmatic needs, prioritize interventions and monitor progress. It is also crucial for planning and evaluating effectiveness of health services and interventions. Yet, data are very scarce in low-income settings where they are most needed and estimations are necessary for these areas. This is also exacerbated by the high prevalence and episodes of malaria in this age group. It sad to realize that sub Sahara Africa is leading morbidity and mortality rate in the world. In light of the priority to achieve the fourth Millennium Development Goal by 2015, reductions in child mortality through improved health care access will benefit from a focus on additional measures.

The strengthening of social support networks for children’s caregivers might be achieved through community group development and implementation of community systems that can provide them with the support they need when seeking health care. It is important to also improve their access to financial resources through tools such as micro financing. The effect of detecting clustering of all cause and cause specific mortality and underlying factors is crucial for timely public health interventions. In a study done in western Tanzania, under-five malaria attributable deaths accounts for 45% of the annual estimated mortality of 100, 000. Blanke C.H. et al (2008).

In Ghana the picture is not different with malaria leading the pack of major causes of morbidity and mortality in children under five- years of age. Because of enormous burden the malaria menace present the Ghana government vision 2020 program, has through the medium term health strategy, adapted the roll back malaria program developed by the health organization which is aimed at reducing the menace of malaria.

The most common cause under-five morbidity and mortality is malnutrition, either alone or in combination with an infection. Recent research has suggested that, less than 1 year of age, children born of educated mothers have the highest chances of survival, followed by children in rural areas; those most at risk of infant mortality are from urban slums.

This finding underscores the contribution of poor sanitation, inadequate water supply, overcrowding, and underlying poverty to child mortality. Low birth weight, due to maternal deprivation and workload, has a direct relationship to survival in the neonatal period, as well as breastfeeding. Inadequate supplementation of solid foods and unsanitary faeces disposal leads to a high incidence of anemia in children under 5 years of age. To reverse high levels of morbidity and mortality in these children, measures are suggested at the national, community, and family levels.

Preventive measures at the national level currently underway include: Integrated Child Development service program, Vitamin A prophylaxis program, national anemia prophylaxis program, Development of Women and Children for Rural Areas program, national goiter control program, diarrheal diseases control program, the Extended Program of Immunization.

Most of these programs have been implemented at the community level, and organized village structures and groups have worked to enhance community participation. At the family level, knowledge, attitudes, and practices of mothers regarding available government health services and appropriate child care practices are essential and can be strengthened by community health workers.

Responding to international demand and to the need for better evidence-based cause-specific mortality, the Child Health Epidemiology Reference Group (CHERG) – an independent group of technical experts jointly coordinated by WHO and the United Nations Children's Fund (UNICEF) – was established in 2001. CHERG has undertaken a systematic, extensive and comprehensive literature review of published information and developed a methodological approach that is transparent and consistent across different diseases and conditions to produce estimates of the major causes of childhood deaths. This study is an essential part of the overall CHERG efforts. Its main objective is to provide estimates of deaths from diarrhea in 2004 at all levels, mainly for countries with incomplete or non-existing civil registration data.

THE SIGNIFICANTS OF THE STUDY Though research has been done to find out about the causes of illness and death in under -5 but the rate is still high and this calls for more study in this area. According to the report by the mother and baby unit (MBU) at KATH from the period of May to September 2009, a total of 1406 babies were admitted to the MBU and 255 died from conditions like sepsis, diarrhea, birth asphyxia, respiratory tract infection, malaria, malnutrition, severe anemia while as others were preterm babies and significant number were light for date babies accounted for the mortality and morbidity rate. Moreover some of the cases admitted from this period are still on admission though some have been discharged. Those still on admission might add up to the number of death cases. The study is aimed at finding the high mortality and morbidity rate and then finds possible solutions to the causes. Africa may not achieve the 4th millennium development goals if we do not strategies our intervention method which is six years ahead (2015). However South Africa and Morocco and few others are almost there, Ghana as a nation has a lot to do. In spite of the Ghana vision 2020 recommendations the rate is unacceptable. According to Ghana web report on 11th November, 2009, Ghana ranks high in child mortality and morbidity rate and most of the diseases are preventable. According to the report about 80,000 children less than five years die each year mostly from preventable diseases (the Source Ghana news agency and Ghana Television). It is hoped that this study will equip anyone ready to tackle the conditions causing childhood morbidity and mortality in MBU to effectively institute preventive measures. AIMS AND OBJECTIVES To find out the high causes of morbidity and mortality rate in children under five years in MBU. Objective (General) To determine the high causes of morbidity and mortality in children under five years in KATH, MBU Specific objectives 1. To find out the relationship between high morbidity and mortality rate in children under five years and literacy level of parents. 2. To find out the impact of access to health care and high mortality and morbidity rate in children under five years in ward MBU. 3. To find out the relationship between poor sanitation and diarrhea in children under five years in ward MBU. 4. To determine the relationship between malnutrition and high rate of morbidity and mortality in children under five years in ward MBU.

CAUSES OF UNDER – FIVE MORBIDITY AND MORTALITY IN MBU CONSCENT FORM Permission will be obtained from the hospital management before the study will be carried out. Because children are involved in the study, we intend to seek consent of the primary care givers. Name of Parent / Guardian……………………………………………… Number of children………………………………………………………….. Address…………………………………………………. Detail explanation will be given to the primary care given in simple, clear, concise and in a local language. Participation is voluntary and can be withdrawn at anytime without negative consequences. I understand the study is aimed at finding the causes of morbidity and mortality in under-5 years of age. During the study, I will answer questionnaire to enable the study to be successful. I have been assured that the information given will be confidential and used for the research only and that my name will not be link to any information given. METHODS AND DESIGN The existing data, observation and interview. It will take two months. Data will be collected by personal interviews, observation & use of existing/review of hospital record. Mothers will be interviewed through the use of questionnaires. National census data will be useful to establish relationship between children born and those who do not reach the fifth birthday. At biostatistics dept of KATH, we will compare OPD attendances, admissions and deaths as well as the causes of disease from the folders. STUDY POPULATION AND SAMPLING The study population will be children under-five. Probability sampling (systematic) will be used to collect data from primary care givers. SAMPLE SIZE All deaths of children less than five years old that occur in MBU, KATH as well as morbidity data will be used in the period of study. The sample size for this study is the total number of under-five children who will be at the unit. About 200 subjects will participate in the study. Still births will not be included in estimates of deaths. Neonatal mortality form part of the mortality rates. DATA MANAGEMENT PROCEDURES All-cause mortality data for under-five for this study extract from the KATH. Database, using Structured and unstructured interview through the use of questionnaire DATA ANALYSIS Statistical methods will be used to analyze the data collected.

DISCUSSION Estimating all-cause under-five mortality and morbidity of cause-specific deaths provide timely and update data collected at regular intervals within months. A number of studies have already been published on the pattern of causes of children fewer than five years of age morbidity and mortality in Ghana. But this is the first study to be carried out on the ward but mortality meetings are held most times. This pattern is consistent with other studies in the sub-region. The observed high mortality rate in infants compared to children. Some of the diseases associated with death are pneumonia, sepsis, measles, diarrhea, preterm birth and malnutrition. Distribution of c EXPECTED OUTCOME At the end of the study; 	To estimate under-five mortality and systematic studies of all cause and malaria specific mortality among under five children in MBU in KATH. (2009).

	Findings from the study will be communicated to the parents and the hospital management.

DISSERMINATION OF RESULTS Findings from the study will be communicated to the hospital authority and published in the national papers (as well as KATH journal and reports in the abstracts.)

TIME SCHEDULE Time schedule for this research will take 3 months. WORK PLAN Title of the project and Abstract 2 weeks Background and Statement of the problem 2 weeks Significant of study and Aims and objectives 2 weeks Related search and Methods and design 2 weeks Resources and budget 3 weeks

RESOURCES Human resources; I will seek help from experience health personal like doctors and nurse as well as specialist on the various ward. Back-up facilities like computer search, libraries, space and good secretariat will be used. The above measures will in no doubt strengthen the research.

BUDGET Research staff salary -                       GH 300 CEDIS Secretariat staff -                               GH 200 CEDIS Data-collection costs-                       GH 300 CEDIS Data-processing cost-                       GH 100 CEDIS Book purchases\library cost            GH 100 CEDIS Use of the internet-                           GH 200 CEDIS Total cost is                                         GH 1200 CEDIS REFERENCES

Adjuik M, Smith T, Clarke S, Todd J, Garrib A, Kinfu Y, et al. Cause Specific mortality rates in sub-Saharan Africa and Bangladesh; Bulletin of the World Health Organization 2006; 84:181-188.

Ghana statistical service/ demographic and health service (1998) Ghana demographic and health survey. Calverton, Maryland, USA, Macro international incorporation. 3:81-89.