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 demographic attributes, health-literacy, social-support and self-efficacy of nursing mothers explain infant-survival practices. The findings lucidly indicate that these factors are imperative in ensuring the survival of infants. Results obtained showed greater mean scores between infant-survival practices and better marital relationships, lucrative occupations, religion, and tertiary learning. A considerable proportion (11.90%) of the respondents had lost an infant or more before the survey was conducted.
Some participants 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 respondents 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) [25] 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 (R2=0.101; P˂0.05). This result is however consistent with some studies that suggested 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 because of changes that have occurred in these domains over time.
Assistance from family members play a pivotal role in the ability to decipher and act on health information received. Among participants, less than average (48.4%) consistently received encouragement and assistance from their husbands to take their infants for immunisation. Only a few participants always got assistance for self and infant care from family members while some were dissuaded to immunise their infants. The positive relationship between social-support and infant-survival practices (R2=0.157; P˂0.05) has been traced to relevant literature. A study [26] 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. Similarly, Mukuria et al (2016) [17] resolved that key influencers such as fathers and grandmothers should be engaged in support for recommended infant care practices.
Reports on self-efficacy showed that an above average of the participants were willing to comply with the six months EBF practice. However, some reported finding it tasking to clean the environment regularly while some were not confident to take infants for immunisation, sterilise infant’s items or attend antenatal sessions during a future pregnancy because they are usually time consuming. The relationship between self-efficacy and infant-survival practices (R2=0.217; P˂0.001) can be linked to access to and comprehension of health-literacy counsels, availability of assistance in carrying-out health instructions, and determinism. For example, a nursing mother may find it tasking to always clean the environment if she has no assistance.
Further analysis showed that Itamapako, the most rural setting scored poorest on infant-survival. 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 [27, 28]. Furthermore, married, and single mothers scored high in infant-survival. 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, separated and widowed may not have such assistance. Single mothers may be accustomed to living alone and being able to cater for themselves without someone else being around.
Participants engaged in lucrative jobs reported better outcomes because 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 Muslims 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. From results on ethnicities of participants, other ethnic groups may have reported lower scores because they did not have their family members around and are the least likely to be educated or employed with a lucrative job.
This study also found a higher infant-survival score among participants who had attained tertiary education as compared to those of lower educational status. Infant mortality is associated with poorer regions where women are hardly educated [30]. People who attain higher levels of academic learning are more likely to understand the depth of health-literacy instructions and may be able to tell their family the exact assistance needed for better support and infant care. Adebowale, Yusuf and Fagbamigbe (2012) [16] similarly found in a study that lower mortalities were observed among individuals who were more educated and engaged more in profitable jobs.
Although, we found no difference in means scores of respondents regarding parity, mothers with history of previous infant deaths scored poorer in infant-survival practices. Lack of essential elements for infant care may have accounted for the previous infant mortalities. While 42.5% of participants had attained some form of tertiary education, other covariates may be responsible for low infant-survival practices. For example, traditional belief and employment status may negate positive outcomes. Similarly, mothers who have attained tertiary learning and who are also employed with better jobs may be hindered from dedicating adequate time to infant care practices such as EBF. This implies that infant-survival should be tackled from the multi-level perspective as it is not a function of one factor.
This study is not without limitations. First, the nursing mothers considered for the survey were those whose infants were attending health centres for immunisation. We were unable to do a closer community-based study, hence, those who were not attending immunisation sessions were not considered. The results may therefore not be generalized for all nursing mothers. Secondly, results based on ethnicity may be favourable 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. Despite these limitations, this study addresses key issues in a suburban setting and relates the findings to all personnel involved in the prevention of infant morbidity and mortality.