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NURSES' ROLE IN PREVENTION OF INFANT AND UNDER-FIVE CHILD MORTALITY IN AFRICA

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ABSTRACT
The under-five mortality rate remains unacceptably high with 6.3 million children dying before their fifth birthday in 2013. Research has, however, revealed that nurses are the means to reducing these untimely deaths. The aim of this research is to examine and identify the role nurses play in preventing and reducing infant and under-five mortality. The purpose of the study was to provide research based information of the position of nurses in consideration to childhood deaths.
Data for the research were obtained from PubMed and ScienceDirect search engines as well as manual data search. The accepted studies were published between the years 2000 and 2015. In total nine studies were analyzed. Inductive content analysis was the chosen method of data analysis.
The results of the study indicate there are challenge nurses face while trying to reduce and or prevent these early deaths. Nurses are challenged with inadequate medical care facilities, high maternal mortality rate as well as lack of training. Other challenges were also noted. The results also shows the role nurses are currently taking as well as some other roles nurses are suggested to play in order to lessen under-five mortality.

The findings of this study can be used by health care professionals especially nurses in developing countries. Research on the solutions needed to overcome the challenges faced as well as a study that focuses entirely on the nurses' position is needed.

   Introduction
In urban areas of Africa, Americas and Asia, statistics show that the poorest 20% population is twice as likely to die before their first birthday (Infant mortal-ity, WHO, 2013). In 2013, an estimated 6.3 million children under the age of five died (Children: Reducing Mortality, 2014). Child mortality is important as it is a pointer of the usage, accessibility, and availability of the health system by the inhabitants especially children. It is also a sign of the extent in which a society exercises the most basic human right: the right to life and health (GOAL 4: Reduce the under-five child mortality rate, 2010).
Although the rate of under-five deaths has decreased by 28 per cent between 1990 and 2008, it still remains high (Goal 4 Reduce Child Mortality, 2010). Research and experience has revealed that out of the almost 11 million chil-dren deaths per year, more than half could be saved by measures such as vaccines, antibiotics, micronutrient supplementation, insecticide-treated bed nets and improved family care and breastfeeding practices (Goal: Reduce Child mortality, Unicef). Therefore, the intensification of the health system to provide such interventions could save many lives (Children: reducing mortali-ty, 2014). A report published by the United Nations (UN) claims that "nurses are key to achieving the United Nations Development Program’s Millennium Development Goals" which includes reducing child and maternal mortality (Amieva and Ferguson, 2011). According to an article titled "The vital role of health care workers" published by the guardian (2012), a child is more likely to live till their fifth birthday if there are enough midwives, nurses and doctors. If the rate of under-five mortality is to reduce, nurses need to be knowledgeable and empowered in caring for children. Therefore, this study aims to examine and identify the role of nurses in reducing and or preventing infant and child mortality with a purpose of providing research based information that could be used by nurses.
2      Infant and Child Mortality
2.1  Causes of infant and child mortality
Child mortality rate also known as under-five mortality rate is defined as the possibility that in every 1000 live births one baby will die before reaching age five: Whereas, the death of a child before his/her first birth day is termed infant death or infant mortality. Therefore, infant mortality rate is the number of chil-dren dying under a year of age by 1000 live births. Infant mortality rate is an important marker to measure the health and wellbeing of a population (Centre for disease control and prevention, 2014). This is because it is often linked to several factors such as maternal health, quality and access to medical care, socioeconomic conditions, and public health practices (Definition of Mortality, Infant, 2012).
In 2013, an estimated 6.3 million children under five years of age depart this life. An estimated 44% of these deaths occurred during the neonatal period. Neonatal period, which is the first 28 days of life, is considered to be the time where in a child is at the highest risk of dying. In addition, about 45% of all the under-five death has a connection with malnutrition. Although a child born in an already developed or a developing country can die before five years of age, he/she is, however, more likely to die if living in sub-Saharan Africa and Southern Asia compared to his/her counterparts in a developed country. About 50% of all under- five deaths occur in only five developing countries namely China, Democratic Republic of the Congo, India, Nigeria and Pakistan. (Children: Reducing Mortality, WHO, 2014). A large proportion of these deaths are caused by infectious yet preventable diseases (Niño-Zarazúa, 2013)
The main reasons of death in these regions are pneumonia (13%), diarrhea (9%), malaria (7%), measles, (2%), HIV/AIDS (3%), neonatal conditions like pre-term birth, birth asphyxia, and infections (46%).

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