DEPARTMENT OF HEALTH AND PHYSICAL EDUCATION UNIVERSITY OF NIGERIA NSUKKA.

Abstract

This study was undertaken to determine the morbidity and mortality prevalence of six killer diseases among under five children in Enugu East Local Government Area of Enugu State  2006

– 2010.   Eight research questions were posited and six hypotheses were postulated to guide the

study.  The study adopted the descriptive method utilizing the expost – facto design.  The sample for the study consisted of 544 children who area exposed to these six killer diseases in various hospitals, maternities, health centres and health post in Enugu East Local Government Area from

2006 – 2010. The data were collected using the researcher designed morbidity and mortality

prevalence inventory profoma (MMPIP) which was used to gather information from folders of children under five years  hospital, informations concerning morbidity and mortality prevalence (55.56) of six killer diseases among under five children. The data collected were analyzed using percentages for the purpose of answering the research questions while chi-square (2) statistics was used to test the hypotheses at .05 level of significance.   The results of the study revealed that the highest morbidity prevalence of measles was recorded in 2006 (39.5%) while the lowest morbidity prevalence (6.7%) occurred in 2010 and the highest mortality prevalence (55.5%) of measles occurred in 2006 while the lowest mortality prevalence (5.6%) occurred in 2007, 2009 and 2010. The result also showed that the highest morbidity prevalence of poliomyelitis occurred in 2007 (52.5%) while the lowest morbidity prevalence poliomyelitis occurred in 2006 and 2008 and the mortality prevalence (1.6%) of poliomyelitis occurred only in 2006. The highest morbidity prevalence (42.2%) of tuberculosis occurred in 2010 and the lowest morbidity prevalence (7.7%) occurred in 2007 while the mortality prevalence (100%), of tuberculosis occurred in 2006 only morbidity prevalence of tetanus occurred (20%) in each year and the mortality prevalence of tetanus recorded highest in 2007 (62.5%) and lowest in 2008, 2009 and

2010 each.  The result also showed that diphtheria morbidity prevalence occurred once in each

year from 2006 – 2010 (20%) and the mortality prevalence of diphtheria (20%) occurred once in each year from 2006 – 2010. There was no record of morbidity and mortality prevalence of pertussis during the  period understudy.      There was  no  significant  difference  in  mortality prevalence of six killer diseases among under five children according to  mothers’ level of education.   There was no significant difference in morbidity prevalence of six killer diseases among under five children according to location. There was no significant difference in mortality prevalence of six killer diseases among under five children according to location. The results were extensively discussed and recommendations were made which were among others awareness about the six killer diseases should be created as it concern their signs and symptoms, prevention, treatment, and immunization schedules.

Background to the Study

CHAPTER ONE Introduction

Despite several programmes aimed at promoting child survival, childhood morbidity and mortality have been an issue of major public health concern in Nigeria. A recent analysis of global child survival points out that more than ten million children die each year, mostly from six killer diseases in developing countries of the world. Under five mortality is highest in Africa particularly in sub-Sahara region. This may be declining but the rate remains unacceptably high when compared with other regions of the world (Adeyemi, 2008).

Every year, over 2 million children continue to die from disease which could have been prevented, if they were adequately covered by protective measures (WHO 2003). Under five morbidity  and  mortality  prevalence  are  constantly  on  the  agenda  of  public  health  and international development agencies. This is part of United Nations Millennium Development Goals. United Nations (1995) and United Nation Children Fund-UNICEF (2000) noted that mortality prevalence among children under the age of five remains strikingly high through out the majority of the developing and the industrialized countries of the world. Although developed countries are experiencing decline in the prevalence of six killer diseases over the years, most developing countries like Nigeria still maintain relatively high rate irrespective of action plans and intervention programmes that are made available, (WHO, 2004).

As the world enters into the 21st century, under five morbidity and mortality prevalence

of the six killer diseases remain a big issue for developing countries. Many researchers have attempted to identify many factors that are contributing to the high morbidity and mortality of under five children. UNICEF (2008) was of the opinion that morbidity and mortality prevalence of under five will be used as a guide or as a yard stick for measuring the standard of living of any country in the world especially as they reflect the health status of the children and their mothers.

Morbidity as defined by Brailler (1986) is a state of being diseased. Lucas and Gilles (2006) defined it as information on the occurrence and severity of sickness in a community or in an  area.  Obionu  (2006)  was of the  opinion that  morbidity is  a  measure  of frequency the occurrence of diseases within a defined population during a specific period of time in an area or in a community. This may be used to assess the health status of the community. Morbidity as

used in the study refers to the occurrence and severity of sickness (that is the six killer diseases)

in the area of the study among the under five children.

The data on the occurrence of the six killer diseases within the community can provide more detailed assessment of the health of the community (Lucas & Gilles, 2006). The data on the morbidity of six killer diseases may be obtained from a number of sources, for example from previous records of health institutions, or from nursing mothers and health workers who are working in the primary health sectors. Morbidity prevalence can be calculated as the number of new and old cases of a disease over the population at risk at a given time multiplied by one thousand (Lucas & Gilles, 2006). Morbidity is usually linked to mortality if not adequately taking good care it leads to death.

Mortality is defined by Brailler (1986) as the state of being liable to die. Butterworths (1988) defined mortality as the condition or quality of liability to death. Obionu (2006) described mortality as the number of deaths among a given population in a community.  Mortality is the number of deaths in a particular situation or period of time (Hornby, 2006).  According to Park (2009), mortality is defined as the number of deaths in a given population annually. Mortality as used in the study refers to the number of deaths (by six killer diseases) recorded in an area annually per one thousand population of under five children. Morbidity and mortality prevalence of the six killer diseases are high among under five children.

Prevalence, is defined by Hornby (2006) as something which exists or is very common at a particular time and in a particular place. Park (2009), described prevalence as the total number of all individuals who have attributes or diseases at a particular time or during a particular period divided by the population at risk. Obionu (2006) maintained that prevalence is the number of people in a population who have the disease (both new and old cases) at a given point in time. Prevalence as used in this study refers to the number of under five children (both old and new cases) who have been diseased by these six killer disease and death of children from these six killer diseases during a particular time and during a particular period of the diseases. There are two types of prevalence: Point prevalence and period prevalence. Point prevalence as described by Park (2009) is the number of all current and old cases at one point in a time in relation to defined population. Butterworths (1986) defined period prevalence as the proportion of cases or manifestation  occurring  during  a  specific  period  of  time.  Prevalence  mathematically  is represented as P=1 X D where P is prevalence, I is incidence and D is disease.

Morbidity and mortality prevalence of six killer diseases among under five children have been an issue of global crisis especially in health sectors. (WHO 2002) Efforts have been made to reduce under five morbidity and mortality prevalence of these killer diseases. According to Park (2009), under five mortality is defined as number of deaths that occur in ages from one to five years in a given population. He also stated that under five morbidity is the number of sickness which occurs at ages one to five years in a given population.

Lucas and Gilles (2006) defined under five as the children at the ages of one to five years old. In  is the study, the under five refers to these children under one to five years of ages who are been exposed to these six killer diseases. They further maintained that under five morbidity and mortality serve as indicator related to the overall health status of children and are widely accepted as one of the  most  useful single  measure of the health status of the community. Morbidity and mortality prevalence of under five may be high in communities where health and social services are poorly developed. Under five morbidity and mortality account for approximately forty per cent of the total morbidity and mortality in most developing countries (Adeyemi, 2008). The situation may not be same with the developed countries where major health  interventions are  available to  improve the  life  of children especially the  under  five children. The under five children’s health is not only regarded as an important index of child health but it is a sensitive measure of the effectiveness of health services as well as the socio- economic progress of a country (Obionu, 2006). The under five morbidity and mortality prevalence are mostly from six killer diseases, which are mostly preventable.

Obionu (2006) defined the six killer diseases as the six specific infectious diseases which most children develop (especially in the tropical countries) and which are usually preventable through immunization and adequate utilization of health intervention programme for children. Six killer diseases as used in the study refers to the immunizable or preventable disease which have  high morbidity and  mortality prevalence among under  five children in area of study. Preventable diseases are measles, tuberculosis, whooping cough, poliomyelitis, diphtheria and tetanus (Park, 2009). With adequate immunization coverage and provision of health care services to the rural areas, the prevalence of six killer diseases will be adequately reduced (Park, 2009).

Poliomyelitis, according to Obionu (2006), is a disease caused by the poliovirus (an enterovirus). It is an acute infectious disease which involves the motor neurons of the spinal cord and brain resulting in asymmetric flaccid paralysis of the involuntary muscles. Type one has

been the most frequent cause of endemic and epidemic paralytic  diseases and its clinical picture ranges from one specific mild febrile illness to severe and potentially fatal paralytic diseases (Sofofumwe, Scheram & Ogunmedan, 1999). World Health Organization-WHO (2004) emphasized  that  the  goal  of  poliomyelitis  eradication  would  be  pursued  in  ways  which strengthen National programme on Immunization – (NPI) as a whole, fostering the development of primary health care.

Obionu (2006) stated that poliovirus is mostly contacted through oral route and it occurs in a very poor sanitary condition. The two types of polio virus vaccine (sack) and live attenuated oral polio vaccine (sabin) found in the three strains of polio virus which induce a protective anti body response against the various strains of the virus.

Another preventable killer disease is  measles, this  is an acute highly communicable diseases caused by measles virus, (Sofoluwe, et. al., 1999). Measles has well been documented as  the  prominent  causes  of  under  five  morbidity  and  mortality  in  African  children.  The endemicity is mostly in the tropics and the incidence is higher in children under two years of age. The mode of transmission is by person to person, by droplet spread or direct contact with nasal or pharyngeal secretion. Prevention of the disease is by adequate immunization coverage with measles at nine months, good nutrition, prompts medical attention especially when the child has reached nine months (Lucas & Gilles, 2006). Greatest complication occurring in infants include otitis media, encephalitis and blindness (Obionu, 2006).

Diphtheria is caused by corynebacterium, it is a non spore forming gram positive rod organism. It is a bacterial infection, where humans are the only natural host. The organism resides in the upper respiratory tract and is transmitted by air borne droplets (Lucas & Gilles

2006, & Obionu, 2006). The organism can also infect the skin at a site of pre-existing skin lesion. It has been observed that overcrowded living conditions in the tropics favour the spread of the disease among family members (Duff & Duff, 1999). Active immunization with diphtheria toxoid Diptheria Pertusis and Tetaus (DPT). vaccine has been proved to be a reliable measure for the control of this infection at six weeks, ten weeks and fourteen weeks of birth (Anion 2004).

Pertusis or whooping cough is one of the six killer diseases that contribute to high morbidity and  mortality prevalence among under  five children. The  infection is  caused by bordertella pertusis, a small encapsulated gram negative rod organism. The organism attaches to the  ciliated  epithelium of the  upper  respiratory tract  but  do  not  invade  underlying  tissues

(Obionu, 2006). Nicholas and Peter (2008) described pertusis as disease exclusively of human pathogen and its signs and symptoms are catarrhal, which last from one week to two weeks during which the child has mild to progressive cough, and feverish condition. This stage is followed by prolonged sudden inspiration whoop (whooping cough) which according to Park (2009) is followed by final covalence that lasts for two weeks. Mode of transmission of pertusis is primarily by droplet infection spread from respiratory tract of the infected persons.  Severe cases could lead to prolapsed of the rectum and herina arising from excessive cough. Obionu (2006) maintained that adequate immunization coverage with DPT vaccines at six weeks, ten weeks and fourteen weeks will reduce the morbidity and mortality prevalence of the disease.

Obionu (2006) described tuberculosis as a preventable disease caused by bacterium. The disease is primarily from human beings and some came from cattle, mycobacterium tuberculosis is from human being while bovine tuberculosis is from cattle.

According to Park (2009), tuberculosis is a chronic inflammatory disease caused by mycobacterium tuberculosis which can affect any tissue or organ of the body but the most common site is the lungs This disease is still high in developing countries especially where there is over crowding and where standard of living is still very low (Lucas & Gilles, 2006). The mode of transmission of tuberculosis is from human being is by droplet, through air borne droplet and from cattle by drinking infected unpasturized milk, eating meat from (TB) tuberculosis  infected cattle (Sofoluwe, et al 1999). The clinical features include weight loss, profuse sweating in the night, low grade fever, loss of appetite, cough, with haemoptysis and generalized lymphadenopathy.  Lucas  and  Gilles  (2006)  stated  that  general  improvement  in  housing, nutrition, personal hygiene, adequate immunization coverage with BCG and chemoprophylaxis will reduce the morbidity and mortality of tuberculosis of under five children.

Among the six killer diseases is tetanus which is described by Sofoluwe et al (1999) as an acute neurological disease caused by toxin of tetanus bacilli. The disease occurs in all ages especially among under five children. The clostridium tetani is organism for causing tetanus infection.   Sofoluwe et al (1999) described the modes of transmission through cutting of the umbilical cord with contaminated instruments and the use of contaminated circumcision of males and females, piercing the ear of female children and open wound on any part of the body. Other entering points are surgical wound, extensive burns and infected needles and sites of injection (WHO, 2003). Lucas and Gilles (2006) described clinical features of tetanus to include truisms

(lock jaw), muscles spasm, fever, muscle rigidity and high fatality rate in untreated cases. In neonate the first symptom is failure to suck in child who has started sucking normally for the few days after delivery (Lucas & Gilles 2006). The reservoir is soil and the faces of various animal including man. Control and treatment  according to Lucas and Gilles (2006) are mostly by immunization of pregnant  mothers, clean delivery and  management of umbilical cords and adequate immunization control with DPT at six weeks, ten weeks and fourteen weeks.

Certain factors may contribute to the prevalence of the six killer diseases among under five children. One of the factors that is associated with the morbidity and mortality prevalence of the six killer diseases is mothers educational level. The influence of maternal education on morbidity and mortality prevalence of six killer diseases among under five children has been identified by (Manksch 1981) According to him the educational status of child bearing mothers is an influence determinant in the effective utilization of MCH services. When mothers are educated, they will follow the correct schedules of immunization, undertake antenatal visit till postnatal and take prompt actions when the children are sick. They will join in the campaign and various health education that have been on these six killer diseases. Educated mothers will like to deliver their children in the hospital where there are qualified health personnel to handle children during the course of the pregnancy and post natal periods. Illiterate mothers may not know the actual schedules for these vaccines to be administered to their children. Many illiterate mothers may go home with their babies after delivery till three to four months before taking the children to clinic for immunization of BCG which the babies are supposed to have immediately after

birth.

Millennium Development Goals-MDG (2004) stated that major challenges that contribute immensely to high under five mortality are poverty in Nigeria, which manifests itself in various ways. This is more pronounced in the rural areas where there is no access to good health care services and the population is predominately poor and unable to afford better services from the secondary and tertiary institutions.

Another major factor capable of influencing morbidity and mortality is the insufficient health  personnel  in  the  health  facilities,  especially  in  rural  areas  where  there  are  no infrastructures  to attract the health personnel to live in the villages to attend to health needs of these children. The under five children and mothers are left in the hands of quacks to handle (MDG, 2004).

Community practices is another factor that affect the morbidity and mortality prevalence of six killer diseases (MDG, 2004). In most communities due to their backwardness, they do not allow mothers to go to hospital for treatment when they are pregnant or allow the health workers to give their children vaccines, either because of their belief or out dated cultural practices. For example in Northern part of Nigeria many of the mothers do not go to hospital for antenatal care during pregnancy.

Another major factor that can affect the morbidity and mortality prevalence of six killer diseases among under five is the non acceptability of health care services by the community members. This attitude of the community members may lead to non utilization of health facilities and services available  in the community, members may prefer patronizing the Quacks and traditional birth attendants. Government will built health centres, well furnished with equipments and staff, but the communities members will not make use of the health facility rather they will prefer quacks and traditional healers. Some of the factors may be non availability of health services. (Obionu, 2006)

Another major factor is the location of the mothers, whether they are in the urban or in the rural areas. There are inadequate road network for easier transfer of vaccines from urban to rural  areas.  Some  times  the  health  workers  may give  vaccines  whose  potency  have  been destroyed. The children receiving these vaccines are likely to have the diseases or die because there is no potency in the vaccines given to them. One of the major challenges of MDG (2004) is to reduce under five morbidity and mortality by the year 2015. It should be noted that survival of a child depends largely on events that are associated with pregnancy and child birth and under five children.

Age of the child is another factor that affect morbidity and mortality prevalence of six killer diseases campaign on the proper age limit for each immunization antigen is important, if a child is not immunized from birth to one year, the vaccines especially BCG vaccine may not have effect on the child and that may increase morbidity and mortality prevalence of the disease.

This study is anchored on the theory of demographic transition and was propounded by Coale (1973).The theory describing a possible transition from high birth rate and high death rate to low birth rate and low death rate when the economy of the country is good, that is when the industrialization, urbanization and other socio economics factors are available, there will be low morbidity and mortality of children especially under five children. Another theory used in the

study is the precede model which was developed by Green Kireuter, Deedss and Patridge (1980) The theory diagnosised the human behaviour and the factors that influence human behaviour. When the human behaviour is been influence by these factors positively it will lead to low morbidity and mortality prevalence of six killer diseases among under five children.

According to FMOH (2005) Under five morbidity and mortality prevalence of six killer diseases is one of the greatest public health problems confronting the country and this needs urgent intervention. This according to the report is affecting the socio-economic growth and development of the country and required immediate attention to remedy the situation. This however explains why the present study decided to determine the prevalence of these diseases among under five children because they are the group that are more vulnerable to these diseases than other groups. The efforts have not been established in Enugu East LGA. This study is an attempt to do this from 2006 to 2010.

Statement of the Problem

Diseases like tuberculosis, tetanus, poliomyelitis, pertussis, diphtheria and measles can be prevented if there are adequate immunization coverage. Mothers are taught how to prevent their occurrence by maintaining healthy life style, neat environment, good housing, making use of the available health facilities around, attending antenatal during pregnancy and prompt actions when there is out break of these diseases. These may reduce the prevalence of morbidity and mortality of six killer diseases among under five children. Efforts at reducing the scourge such as mass campaign against the six killer diseases include creating awareness on the causes, prevention and measures such as ensuring that children are properly immunized. Encouraging female education to increase mothers level of education are all directed to reducing the morbidity and mortality prevalence of six killer diseases among under five children.

Despite all these, children under five years still become sick and even die from these diseases. The  evidenced by WHO (2003) statistics indicated that about five million deaths and five million residual disability occur annually as a result inadequate immunization courage from the six killer diseases. The situation is very worrisome, therefore the investigator, feels that a study to determine the morbidity and mortality prevalence of six killer diseases among under five children in Enugu East LGA from 2006-2010 with the associated factors, that affect them.

Purpose of the Study

The purpose of the study to find out the morbidity and mortality prevalence of the six killer disease among the under five children in Enugu East Local Government Area of Enugu State from 2006-2010. Specifically, the study seeks to find out the:

1.        Morbidity prevalence of the six killer diseases among under five children in Enugu East

LGA of Enugu State from 2006-2010.

2.        Mortality prevalence of the six killer diseases among under five children in Enugu East

LGA of Enugu State from 2006-2010.

3.        Morbidity prevalence of the six killer diseases among under five children in Enugu East

LGA according to age of the child from 2006 – 2010.

4.         Mortality prevalence of the six killer diseases among under five children according to age of the child from 2006 – 2010.

5.         Morbidity prevalence of the six killer diseases among under five children according to mother’s level of education from 2006 – 2010.

6.         Mortality prevalence of the six killer diseases among under five children according to mother’s level of education from 2006 – 2010.

7.         Morbidity prevalence of the six killer diseases among under five children according to location from 2006 – 2010.

8.         Mortality prevalence of the six killer diseases among under five children according to location from 2006 – 2010.

Research Questions

To guide this study the following research questions are posed:

1.        What is the morbidity prevalence of the six killer diseases among under five children in

Enugu East LGA from 2006 – 2010?

2.        What is the mortality prevalence of the six killer diseases among under five children in

Enugu East LGA from 2006 – 2010?

3.         What is the morbidity prevalence of the six killer diseases among under five children according to the age of the child from 2006 – 2010?

4.         What is the mortality prevalence of the six killer diseases among under five children according to age of the child from 2006 – 2010?

5.         What is the morbidity prevalence of the six killer diseases among under five children according to level of mother’s education from 2006 – 2010?

6.         What is the mortality prevalence of the six killer diseases among under five children according to mother’s level of education from 2006 – 2010?

7.         What is the morbidity prevalence of the six killer diseases among under five children according to location from 2006 – 2010?

8.         What is the mortality prevalence of the six killer diseases among under five children according to location from 2006 – 2010?

Hypotheses

The following null hypotheses were postulated to guide the study, and were be tested at

.05 level of significance at the appropriate degree of freedom.

1.         There is no significant difference of morbidity prevalence of six killer diseases among under five children according to age of the child in Enugu East LGA.

2.         There is significant difference in mortality prevalence of six killer diseases among under five children according to age of the child.

3.         There is no significant difference of morbidity prevalence of six diseases among under five children according to age of the mother’s level of education.

4.         There is no significant difference of the morbidity prevalence of six killer diseases among under five children according to mother’s level of education.

5.         There is  no  significant difference of the  morbidity prevalence of six killer diseases according to location.

6.         There is no significant difference of mortality prevalence of six killer diseases among under five children according to mother’s level of education in Enugu East LGA.

Significance of the Study

The study determines the morbidity and mortality prevalence of six killer diseases among under five children in Enugu East LGA of Enugu State from 2006 – 2010. The study generated data from morbidity and mortality prevalence of measles among under five children for period of five years, the information or data on causes, signs and symptoms, treatment, prevention and complication of measles may be beneficial to mothers of child bearing age, health workers, health educators, epidemiologists and both state and Federal Ministry of Health to enable them carry out grassroots campaign for the prevention of measles.

Data generated from the morbidity and  mortality prevalence of poliomyelitis among under five children in Enugu East within the period of five years. The data generated from the study  may  be  useful  to  the  mothers  to  encourage  adequate  immunization  courage  on poliomyelitis and these will help the doctors and nurses to make sure that polio vaccine with adequate potency gets to every child in that locality. To the epidemiologist, health statisticians health educators may benefit from the study, they may use the informations for proper utilization of health facilities and prompt action to prevent further occurrences.

The data generated from morbidity and mortality prevalence of diphtheria among under five children in Enugu East LGA from period of five years, on the causes and prevention of the disease may benefit the child bearing mothers to Immunization on time to avoid high morbidity and mortality prevalence of the diseases. The data generated may benefit the federal and state ministries of health to embark on the campaign for proper utilization of the maternal and child health services.

The data generated from morbidity and mortality prevalence of pertussis among under five children in Enugu East LGA from 2006 – 2010 covering the period of five years. The data that  be generated on the causes, signs and symptoms, prevention and complications of pertussis may benefit to the health workers, Nurses, Doctors, Health Educators and health statisticians to

plan strategies to prevent the out break of the disease and organize seminars and workshop for child bearing mothers.

The study generated data on the morbidity and mortality prevalence of tetanus among under five children in Enugu East Local Government Area of Enugu from 2006 – 2010. The information   cover  a  period of five  years,  on the  causes of tetanus,  signs and  symptoms, prevention and complications of tetanus. The data generated on the study may help the mothers especially the child bearing mothers to utilize all the health services especially as it concerns Maternal and Child Health (MCH), The data may also benefit the federal and state ministries of health to plan and make sure that number of health personnel’s should be increase especially in the rural areas where they MCH care are left in the hands TBAs and Quacks. The data may also benefit the public health sectors, to intensifying their duties by adequate immunization coverage especially in the rural areas.

The study also generated data on the morbidity and mortality prevalence of tuberculosis among under five children, the information on the causes, signs and symptoms, treatment, and complications of the tuberculosis which covered a period of five years, the data generated may be beneficial to the mothers of child bearing age for they will see the need for prompt immunization coverage especially BCG at birth. Nurses, Doctors and Health educators to plan prompt supply maintaining and monitor the potency of this BCC vaccines for children to receive the antigen at the appropriate time, and by appropriate health personnel. The study generated data from the factors associated with morbidity and mortality prevalence of six killer disease among under five children in Enugu East LGA from 2006-2010. The data generated on age of the child will enable the health workers, nurses, doctors and community health workers to educate the mothers on the importance of receiving these vaccines at the right schedules.

The data generated on the level of maternal education may be useful to child bearing mothers (CBMs) to motivate them to increase their attendance on seminars on six killer disease and the importance to utilize MCH services. The information may also help health educators, Nurses, midwives and community health practitioners to design health education programmes that  may enable these  illiterate  CBMs to  benefit  from Maternal and  Child  Health (MCH) instructions. The data may sensitize the government to appreciate the need for improving MCH services through the provision of essential teaching and learning experiences to help make the

concept presented by health educators, nurse educators and midwives tutors easier and very meaningful to the child bearing mothers.

The data generated on the influence of location on morbidity and mortality prevalence of six killer disease among under five children  which of the location the urban and rural which has the highest morbidity and mortality prevalence of six killer diseases. The information is useful for  mothers to  appreciate the  importance of using  available  MCH services in  view of the influence of location on the prevalence of six killer diseases. The information may help the health workers to educate all CMBs and increase efforts to mobilize urban rural CBMs to effectively utilize MCH centres. The information may also serve as base line information as this may assist the government to extend MCH services to the rural areas of the state and improve the existing health facilities.

Scope of the study

The study was delimited to the morbidity and mortality prevalence of six killer diseases among under five children in Enugu East Local Government Area of Enugu State. The study will examine the prevalence of six killer diseases among under five children. (tuberculosis, tetanus, whooping cough, measles diphtheria and poliomyelitis). The study   cover records on the morbidity and mortality prevalence of six killer diseases among under five children in various hospitals, health centres and maternities from 2006 – 2010.

The study also covered the factors associated with the morbidity and mortality prevalence of six killer disease, which include the age of the child, the mothers’ level of education and the location of the mother. (rural or urban) and as these effect the morbidity and prevalence of six killer diseases.

Factors associated with the morbidity and mortality age of the child mother’s level of education and location (both rural and urban) as they affect the morbidity and mortality prevalence of these six killer diseases among under five children in Enugu East LGA of Enugu state. The study was also anchored on two theories, the demographic transition theory which was explained possible transition from high death rate to low death rate and has highlights factors if carefully manipulated, can be used to reduce morbidity and mortality. The precede model theory which classified factors that influence human behaviour into three and when these factors are properly applied, they may lead to prevention and promotion of healthy behaviour which will

also reduce the morbidity and mortality of six killer diseases among under five children in Enugu

East LGA of Enugu state.

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