Studies to investigate infant survival should be geared towards understanding why infant mortality lingers in developing nations and how it can be significantly addressed. This study assessed ways by which health–literacy, social-support and self-efficacy of nursing mothers can determine infant-survival practices. The findings lucidly indicate that these factors are imperative in ensuring the survival of infants. Generally, results obtained showed positive associations between variables and older reproductive ages, better marital relationships, lucrative occupations, religion and tertiary learning. A significant proportion (11.90%) of the respondents had lost an infant or more at one time or the other before the survey was conducted.
Not Many participants were concerned about the fragility of an infant and how food should be prepared for them. Some denied that giving an infant herbal concoction will be harmful. Many disagreed that breastmilk is the best food for an infant less than six months. A good number of them did not take cleaning of the nipple before breastfeeding as an essential sanitary practice and could not carry-out all the instructions listed for infant-survival. Some reasons for these negative responses could be poor antenatal sessions or lack of support in carrying-out these practices when assistance was needed. Contrary to findings by Bolam and colleagues (1998) [23] which opined that health information and counselling had no positive impact on infant care practices, this study revealed a significant association between health-literacy of mothers and infant-survival practices (B = 0.385; β = 0.320; R2 = 0.102; P˂0.001). This result is however consistent with some studies that opine that behaviour-change geared towards infant care and reduction of infant mortality can be achieved by health education and counselling of caregivers of infants [14, 15]. These recent findings may be as a result of changes that have occurred in these domains over time.
Assistance from family members plays a pivotal role in the ability to decipher and perform health information received. Among participants, less than average (48.4%) always received assistance from their husbands to take their infants for immunization. Only a few participants always got assistance for self and infant care from family members while some were dissuaded to immunize their infants. The positive relationship between social-support and infant-survival practices (B = 0.514; β = 0.401; R2 = 0.161; P˂0.001) has been traced to relevant literature. A study [24] stated that involvement of men during pregnancy and childbirth is significant in the safety of the mother and child through emotional, physical and financial support, hence, men should equally receive health education for infant care. Mukuria et al (2016) [17] also resolved that key influencers such as fathers and grandmothers should be engaged in support for recommended infants care practices.
Although, 79.5% of participants agreed to comply with counsels on six months exclusive breastfeeding only a quarter (25.1%) exhibited confidence in taking infants for immunization while 41.2% claimed that it is inconvenient to sterilize infants’ items. About a third 120 (31.1%) reported not to attend antenatal sessions in the future because they are time consuming. Additionally, 99 (25.7%) exhibited lack of interest in cleaning the environment and claimed that it is tasking. Less than average agreed to attend antenatal sessions in the future (41.7%) and to practice exclusive breastfeeding for six months (39.1%) while only a few understood the importance of sterilizing infants’ objects. The relationship between self-efficacy and infant-survival practices (B = 0.481; β = 0.466; R2 = 0.217; P˂0.001) can be linked to access to health-literacy counsels, ability to understand instructions, availability of assistance in carrying-out these instructions and determinism.
Further analysis showed that Itamapako, the most rural setting scored poorest across all variables. Rural areas have less facilities, poor quality of healthcare, and are underprivileged. As portrayed in this study, similar studies have shown that higher infant mortality rates are predominant in rural areas due to poor facilities, low socioeconomic status and scarce attention from the few health attendants available [25, 26]. Furthermore, a probable reason for the poor scores of the young mothers between would be that most of them might have delivered outside wedlock and were neglected for promiscuity, leading to poor support. Other reasons could be physical immaturity, pregnancy complications, malnutrition and inadequate use of maternal and infant health services for the fear of shame. A similar study [16] revealed that infant mortalities are more associated with adolescent mothers than older mothers.
Married mothers scored highest means across all variables. The presence of a marital partner aids collective care. Husbands of such women will not only assist in catering for the infants but also encourage their wives to go for antenatal sessions, offer financial and tangible support and make them intentional to self-efficacy. The divorced and separated may not have such assistance. Likewise, participants engaged in lucrative jobs had better outcomes since they are more likely to be educated, empowered and funded than the unemployed, housewives and self-employed. The self-employed in this study referred to those who engaged in small scale businesses or petty trading. On examining the effects of employment on infant mortality, Ko and colleagues (2014) [27] showed related results to this and asserted that employment ensured tangible support for the mother and improved her self-efficacy to carry-out infant care counsels.
A possible justification for the high scores of Christians and low outcomes of those of the traditional religion could be that the traditional believers rely less on clinic instructions but more on herbs and may not have been consistently attending antenatal sessions. Social support was however independent of religious affiliation. From results on ethnicities of participants, the Yorubas may have scored high in social-support and self-efficacy because further analysis revealed through a cross-tabulation that of the 164 mothers who had attained tertiary learning, the Yorubas had the highest percentage (87.19%). There was also a positive correlation between higher educational attainment of participants and the variables.
Infant mortality is associated with poorer regions where women are hardly educated [28]. Children born to mothers without formal education are prone to early death. People who attain higher levels of academic learning are more likely to understand the depth of health-literacy instructions. They might be more able to tell their family the exact assistance needed for better support. Adebowale, Yusuf and Fagbamigbe (2012) [16] similarly discovered in a study that lower mortalities were observed among the Yorubas since they were more educated, engaged less in childhood marriage and engaged more in profitable jobs.
Another observation was that participants with higher parity had better scores than first timers in terms of health-literacy and infant-survival practices. This could be because those with only one child may not have been accustomed to childbearing and its rudiments. However, a possible explanation for the low scores of participants with greater parity in self-efficacy and social support could be that family members assumed they already had skills needed for infant-survival owing to their experience. Mothers with history of previous infant deaths had less social-support, had concerns with adherence to infant-survival instructions and scored poorest in health-literacy. Lack of these elements may have accounted for the previous infant mortalities.
This study is not without limitations. First, the nursing mothers considered for the survey were those whose infants were receiving immunization in health centres, those who were not attending immunization sessions were not considered, therefore, the results may not be generalized for all nursing mothers. Secondly, results based on ethnicity may be favorable to the Yorubas because they comprised the largest ethnic proportion of the location. Thirdly, respondents may have been bias in giving responses since the data retrieved were based on self-reported information.