Understanding the care for sick children in rural North
Central Nigeria: epidemiology and anthropology interface
Bolanle Ola, Gillian Hundt & Nick Spencer
School of Health and Social Studies, University of Warwick, Coventry, UK
Introduction
Nigeria:
• One of the 6 countries worldwide that accounts for half of the world’s total
under-5 mortality.
• The country is ranked 2nd in total number of child deaths and 8th in under-5 mortality
rates
• Huge variations rates in different parts of the country.
To achieve the MDGs in 2015, under-5 mortality would have to reduce to 30 or less per
1000 live births.
Under-five mortality estimated trend and MDG goal Nigeria (19802004)
Findings
1. Interface of anthropology/epidemiology: multidimensional nuanced picture
experienced by carers at the household/community level
a) DHS showed mothers of children living in rural areas with little/no education, poor or
middle wealth were more likely to use surface /rain water, well and bore hole than the
urban. The field work showed that sources of water in this village is well, 1 functional
bore hole and spring. With Limited access to clean water, households are faced with
complex choices and decision e.g. domestic use/sale
b) Herbal remedies/traditional healer : important aspect of care giving at the household/
community levels, but underreported/missing data in the NDHS.
c) Yoruba taxonomies: absent in the NDHS and health seeking is sought at the traditional
healers e.g. ile tutu, abiku. Yourba explanatory model(folk) different from the
professional model e.g. SCA/Failure to thrive
Research Questions
Theoretical questions
• How does interfacing anthropology with epidemiology extend understandings of care
giving?
2. Human agency is shaped by cultural behavioural understanding of medical & social
diagnostics of health and illness manifested in plural heath seeking behaviour
e.g Diarrhoea and teething, itageri and so la ta
• How do medical and social diagnostics interface to affect health seeking behaviour of care
givers?
• How is structural violence experienced at the household and community levels and what is
the scope for agency
Empirical Questions
 What are the socio-economic, community and household factors affecting the health of
children and health seeking behaviour of mothers and caregivers in the village?
 How do mothers and caregivers keep their children healthy?
3. Materialistic and neo-materialistic factors shapes circumstances with daily lives &
within Nigerian society-example of structural violence
 How do mothers and caregivers deal with children’s illnesses ?
Research Methodology
The research used a secondary quantitative data (2008 Nigeria Demographic health Surveys)
and Primary data gathered through rapid ethnography assessment using a combination of
qualitative methods-participatory techniques e.g transect walks, ethnography.
Methods
Number
Total Number of
Respondents
Focus group interview
9
Household interviews
12
27
Verbal account of child mortalities
7
15
Health care providers
3
3
Headman
1
1
Ethnographic Field work
Observation in village clinic
TOTAL
63
72 days
15 sessions
7 month period
32 interviews
109 people
a) Over depending on food like cassava, potatoes with high carbohydrate and
starch and withdrawing foods like milk and eggs because they can not afford
them.
b) Delaying health seeking at the health centre because of poverty
c) Usage of herbs and visiting healers which offers credit facilities and payment in kind
d) Government provision of an electrically pump bole hole in a village with erratic
electricity supply denying the villagers of a stable water supply
e) User fees paid as the health centre and hospitals in general in Nigeria as a result of
SAP imposed policies.
References
1. United Nations (2009) ‘Under-5 mortality rates’ The state of the world children. Retrieved on May 12, 2009 from
http://dat.un.org/Data.un.org/Data.aspx?d=SOWC&f=inID%3A17
2 Black, R.E., Morris, S.S. and Bryce, J(2003)’Where and why are 10 million children dying every year? ‘ Lancet, 361,
2226-2234
3 Kleinman, A. (1980) Patients and healers in the context of culture :an exploration of the border land between
anthropology, medicine and psychiatry, Berkeley,: University of California Press