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Access to Primary Health Care Services and Child Mortality in Orumba North Local Government Area, Anambra State, Nigeria

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TABLE OF CONTENTS
TITLE PAGE ………………………………………………………………………………………………………………………… I
CERTIFICATION ………………………………………………………………………………………………………………… II
DEDICATION ……………………………………………………………………………………………………………………… III
ACKNOWLEDGMENTS ……………………………………………………………………………………………………… IV
ABSTRACT ………………………………………………………………………………………………………………………….. V
TABLE OF CONTENTS ……………………………………………………………………………………………………….. VI
LIST OF ACRONYMS ……………………………………………………………………………………………………….. VIII
LIST OF TABLES …………………………………………………………………………………………………………………. X
LIST OF FIGURES …………………………………………………………………………………………………………….. XIV
LIST OF MAPS …………………………………………………………………………………………………………………… XV
LIST OF PICTURES ………………………………………………………………………………………………………….. XVI
CHAPTER ONE: INTRODUCTION ………………………………………………………………………………………. 1
1.1 BACKGROUND TO THE STUDY ………………………………………………………………………………………………… 1
1.2 STATEMENT OF THE PROBLEM ……………………………………………………………………………………………….. 3
1.3 RESEARCH QUESTIONS ………………………………………………………………………………………………………….. 6
1.4 OBJECTIVES OF THE STUDY ……………………………………………………………………………………………………. 7
1.5 SIGNIFICANCE OF THE STUDY …………………………………………………………………………………………………. 7
1.6 DEFINITION OF CONCEPTS ……………………………………………………………………………………………………… 8
CHAPTER TWO: LITERATURE REVIEW ………………………………………………………………………….. 12
2.1 REVIEW OF EMPIRICAL LITERATURE ……………………………………………………………………………………… 12
2.1.1 Global Trends in Child Mortality ………………………………………………………………………………….. 12
2.1.2 Child Mortality in Nigeria ……………………………………………………………………………………………. 13
2.1.3 Factors associated with child mortality in Nigeria …………………………………………………………… 14
2.1.4 Access to Primary Health Care Services in Nigeria …………………………………………………………. 16
2.1.5 Factors Affecting Access to Health Care Services in Nigeria ……………………………………………. 17
2.1.6 Efforts to Improve Access to Health Care Services in Nigeria …………………………………………… 21
2.2 REVIEW OF RELEVANT THEORIES …………………………………………………………………………………………. 22
2.2.1 Individual or Intrapersonal Health Behavior Models/Theories………………………………………….. 22
2.2.2 Interpersonal Health Behavior Model/Theories ………………………………………………………………. 25
2.2.3 Community level model/theory ……………………………………………………………………………………… 27
2.3 THEORETICAL FRAMEWORK ………………………………………………………………………………………………… 28
2.4 STUDY HYPOTHESIS ……………………………………………………………………………………………………………. 29
CHAPTER THREE: RESEARCH METHODOLOGY ……………………………………………………………. 30
3.1 RESEARCH DESIGN ……………………………………………………………………………………………………………… 30
ACCESS TO PRIMARY HEALTH CARE SERVICES AND CHILD MORTALITY vii
University of Nigeria, Nsukka
3.2 AREA OF STUDY …………………………………………………………………………………………………………………. 30
3.3 STUDY POPULATION …………………………………………………………………………………………………………… 31
3.4 SAMPLE SIZE ……………………………………………………………………………………………………………………… 32
3.5 SAMPLING PROCEDURE ……………………………………………………………………………………………………….. 33
3.6 INSTRUMENT FOR DATA COLLECTION …………………………………………………………………………………….. 34
3.7 METHODS OF DATA COLLECTION …………………………………………………………………………………………. 35
3.8 METHODS OF DATA ANALYSIS ………………………………………………………………………………………………. 36
3.9 LIMITATIONS OF THE STUDY…………………………………………………………………………………………………. 37
CHAPTER FOUR: ANALYSIS AND PRESENTATION OF DATA …………………………………………. 39
4.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS …………………………………………………….. 39
4.2 ISSUES ON CHILD HEALTH: COMMON HEALTH PROBLEMS AMONG CHILDREN …………………………….. 44
4.3 SITUATION OF PRIMARY HEALTH CARE SERVICES …………………………………………………………………… 54
4.4 ISSUES ON IMMUNIZATION AND USE OF INSECTICIDE TREATED NETS …………………………………………. 68
4.5 MULTIPLE REGRESSION ANALYSIS ……………………………………………………………………………………….. 77
4.6 TEST OF HYPOTHESES …………………………………………………………………………………………………………. 79
4.7 SUMMARY OF FINDINGS ………………………………………………………………………………………………………. 86
CHAPTER FIVE: DISCUSSIONS, CONCLUSION AND RECOMMENDATIONS …………………… 88
5.1 DISCUSSIONS ……………………………………………………………………………………………………………………… 88
5.1.1 Options Taken in Child Health Care ……………………………………………………………………………… 88
5.1.2 Problems in Accessing PHC Services …………………………………………………………………………….. 89
5.1.3 Common Health Problems among Children in the LGA……………………………………………………. 90
5.1.4 Awareness of Health Interventions like Immunization and ITNs ………………………………………… 91
5.3 RECOMMENDATIONS …………………………………………………………………………………………………………… 92
REFERENCES ……………………………………………………………………………………………………………………. 94
APPENDIX 1: STUDY QUESTIONNAIRE ………………………………………………………………………….. 101
APPENDIX II: IN-DEPT INTERVIEW GUIDE WITH HEALTH WORKERS ……………………….. 115
APPENDIX III: FOCUS GROUP DISCUSSION GUIDE ……………………….

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