Mapping knowledge management
resources of maternal, newborn and child health (MNCH) among people living in
rural and urban settings of Ilorin, Nigeria
Introduction: Lack of access to information and knowledge
about mother and child health was identified as a major contributor to poor
maternal and child health in Nigeria. The Partnership for Maternal, Newborn and
Child Health (PMNCH) has recognized mapping the knowledge management of
Maternal Newborn and Child Health (MNCH) as one of the major strategies to be
deployed in improving the health of these vulnerable groups. The main aim of
this study is to map the knowledge management resources of Maternal, Newborn
and Child Health (MNCH)in rural and urban settings of
Ilorin West LGA of Kwara state Nigeria.
Methods: It is a descriptive cross-sectional study
with a comparative analysis of findings from urban and rural settings. Epi-mapping was used to carve out the LGA and map
responses. The p-value of less than 0.05 was considered significant at 95%
Results: The study showed that traditional leader was
responsible for more than half of the traditional way of obtaining information
by rural (66.7%) and urban (56.2%) respondents while documentation accounts for
the main MNCH knowledge preservation for the rural (40.6%) and the urban (50%) dwellers.
Traditional leaders (32.2%) and elders (46.7%) were the main people responsible
for dissemination of knowledge in rural areas whereas elders (35.9%) and
Parents (19.9%) were the main people responsible in urban areas.
Conclusion: It was concluded that traditional and family
institutions are important in the knowledge management of MNCH in both rural
and urban settings of Nigeria.
The importance and
travail of mother and child was shown right from the creation of man and while
mother and child status were been relegated to household materials their health
status began to depreciate as well. Europe was the first to identify and address
the vulnerability of women and children. Developing countries were carried
along in the twentieth century when more international, local and non
governmental agencies began to address the challenges of the mother and child . The MDG declaration at the end of 20th century by the
heads of state of UN countries made health issues of mother and child the 4th
and 5th goals to stress the importance and vulnerability of the two
groups . In Nigeria the health situations of mother and
child are one of the worst in the world, aside the major causes of maternal,
newborn and child death in Nigeria, there are reinforcing risk factors that
further worsen the health and survival rate of women and children, parts of
which are poverty, low level of women education and gender inequalities,
inadequate coverage and low quality of essential obstetric care in the country
. Lack of access to information in all forms that will
cause delays of women to access quality health care is an important reinforcing
factor that MNCH attentions has not been paid to over the years. This has also
prevented adequate knowledge of the communities to the care of mother, newborn
For instance majority of newborn (66%) are
delivered by unskilled birth attendants at home by those who have poor
knowledge of how to manage newborn condition 2 while only 40% of pregnant women
in the country received two doses of tetanus toxoid
required to protect them and their babies. Only 32% of the babies are initiated
on breastfeeding within an hour of birth as required ,
while only 17% continued to be fed exclusively on breast milk for the first six
months of life, whereas all of these are due to inadequate knowledge of the
risks associated with these practices. Because these various factors are
related to knowledge gap, therefore there is need to consider the Knowledge
Management Systems (KMS) of the people in order to understand how knowledge
could be created, stored and disseminated and how to integrate this strategy
into Integrated Maternal Newborn and Child Health Strategies (IMNCH). Knowledge
Management System (KMS) offers integrated services to deploy information instruments
for networks of communities. KMS can be used for a wide range of cooperative,
collaborative, adhocracy and hierarchy communities [3,4].
The Partnership for Maternal, Newborn and Child
Health (PMNCH) was launched in September 2005 as merger of pre- existing
partnerships, with a focus on continuum care of MNCH and a main aim to
accelerate the achievements of MDGs 4 and 5. It has 6 constituency groups;
Developing country governments, Donors (bilateral and foundations), UN agencies
(WHO, UNICEF, UNFPA, World Bank), Health care professional associations,
Academic / training / research institutions and Non Governmental Organizations
. The strategic framework of PMNCH sets out six main
inter-linked areas of work. The first of these, knowledge management, will
establish a comprehensive knowledge management system which supports the
creation, capture, storage and dissemination of information on MNCH, in order
to provide readily-available robust knowledge summaries in a variety of
formats, and to identify and flag critical knowledge gaps. The knowledge
management system will include a web-based managed portal .
For the IMNCH interventions to be generally acceptable there would be need to
inform and educate the masses on the need to change their behaviours
and practices and this could only be possible if the Communities' general
knowledge acquisition, storage, sharing and transfer are identified. There
would be the need to map these knowledge resources, identify and institute
effective ways to utilize this for the purpose of managing the knowledge
resources for Maternal, Newborn and Child Health interventions in the Country .
This new concept that is recently just gaining
more recognition in health issues has been made use extensively in the last
decade by commercial industries and organizations to preserve the
organizational information, methods and technology [5-7].
It is mostly important in sharing of good practice and interventions on health
and the concept of Community of Practice (CoP) is
gaining more recognition everyday [8-10]. This is a concept
that if adequately utilized could be employed to drive many health
interventions, for community acceptability and ownerships of health programs
like IMNCH in Nigeria and importantly in the aspect of Social marketing of
reproductive commodities and MNCH care services [3,4].
The poor health situation of mother and child
health, led to a paradigm shift in 2007 to Integrated Maternal Newborn and
Child Health (IMNCH), changing the thinking, orientation and practice to foster
a continuum of care that will ensure survival of mothers and the children and
hence future prosperity of the nation. There would be evidence based
interventions that would be simple, cost effective and delivered to mothers and
children who need them , some of which are already being
implemented in other countries like Ghana, Mozambique, Tanzania, Uganda,
Eritrea, Mali and Malawi with considerable improvements in their Maternal,
Newborn and Child Health .
The rural and urban settings of the Country is important
because of the difference in the aspects of populations since quite a large
proportion of Nigerian population (70%) live in rural setting .
There are also differences in inequalities in access to health care, availability
of infrastructure for knowledge resources, literacy levels, socioeconomic
levels, perceived needs for Maternal, Newborn and Child Health, Cultural and
traditional values variations, acculturations and varying levels of Maternal,
Newborn and Child Health (MNCH) burdens. Therefore mapping the knowledge
management resources of the rural and urban would help the decision makers,
researchers and health workers to use the information in driving the Maternal,
Newborn and Child health interventions for proper community acceptance,
effectiveness of the programs therein and for a sustainable program. The main aim of this study however is to map the knowledge
management resources of Maternal, Newborn and Child Health (MNCH) among the
rural and urban settings of Ilorin West LGA of kwara
The study was a
cross-sectional study with comparative analysis of the observed pattern between
the rural and the urban clusters of adult populations in Ilorin, a
North-central state of Nigeria. There was a household enumeration of the
selected urban and rural communities. Household survey was carried out using a
pretested semi structured questionnaire. The data was collected by interviewing
a household head or most informed person per household. The minimum sample size
for the rural and urban cluster was calculated using the formula for comparison
of two proportions (comparing the rural with the urban respondents) . Multi stage random sampling method was used to select
respondents in the rural and urban communities.
For the purpose of this study a community with
population of over 20,000 and presence of some of electricity supply, tarred
road, Information technology (IT) facilities, industries and commercial firms,
secondary and tertiary educational institutions and media houses were regarded
as urban community. Analysis was done using Epi-info
software package while mapping of knowledge management resources of the 2
settings was created using Epi-mapping of World
Health Organization (WHO) to locate and carve out Ilorin west LGA from the
State. The simulated map of Ilorin west LGA was carved so as to indicate the
major areas of MNCH knowledge management like sources of general knowledge
acquisition, main people responsible for Maternal Newborn and Child Health
(MNCH) knowledge management in the communities and description of how
respondents would manage MNCH knowledge in terms of storage and transfer. The
p-value of less than 0.05 was considered significant at 95% confidence level.
The age distribution of
rural location is skewed towards elderly age group (44.1%) while the urban
population was predominantly young adults (34.6%) and middle age (35.4%), with
a p value of 0.00023169 (Table 1).
There was no significant difference between the sex distribution of the two
locations (p=0.65866). There was however difference in marital status of the
respondents in the rural and urban areas (p=0.00000234) with more unmarried
respondents in the urban (25.4%) than the rural (1.8%) areas. There was also
significant difference (p=0.00000000001) in the literacy level of both areas
with over 80% of illiteracy level observed in the rural area as opposed to
41.5% illiteracy level in the urban area. Traditional leader through the
traditional town announcer was responsible for more than half of the
traditional way of obtaining information by rural (66.7%) and urban (56.2%)
respondents. There is no difference in the traditional route of obtaining information
in both areas (p=0.13623331). Other routes recognized by the study as sources
of obtaining general health information in both settings were through elderly
members, religious routes and other family sources (Figure 1).
Traditional leaders (35.9%) and Elders (41.8%)
played major roles in knowledge storage in the rural areas while Elders
(35.3%), Parents (17.8%) and head of family (15.1%) were the main people
responsible for knowledge storage in urban areas. This difference was
significant (p=0.000000001). Similar pattern existed for the dissemination of
health knowledge. Traditional leaders (32.2%) and Elders (46.7%) are the main
people responsible for dissemination of knowledge in rural areas whereas Elders
(35.9%) and Parents (19.9%) were the main people responsible in urban areas.
Traditional leaders are the main cultural ways
of obtaining MNCH knowledge in all the rural and urban clusters with no
significant difference in all the clusters (Figure 1). Documentation
accounts for the main MNCH knowledge preservation for the rural (40.6%) and the
urban (50%) dwellers (Figure 2),
but significant proportion of the urban dwellers (17.7%) would use Computer and
other Information technology (IT).
Letter writing/Mailing is responsible for almost
half of the medium that respondents in rural (43.2%) and urban (48.4%) areas
would use to disseminate MNCH knowledge. However, Computer and other IT media
is significantly higher in urban (18.5%) than rural (3.6%) area. All the 4
clusters in the rural area would like to disseminate MNCH knowledge through
mail and letter writing while respondents in the 3 clusters in urban area would
like to disseminate MNCH knowledge mostly through letter writing or mailing and
computer (Figure 3).
More urban (80.8%) respondents had knowledge of Information Technology (IT) as
compared to their rural (63.1%) counterpart. This difference is significant
with p-value of 0.0021236. However, more than half of the respondents that
claimed knowledge of Information technology could not correctly described it
(p=0.615112). Only 4.5% of rural respondents had access to computer/internet
facilities as opposed to 70% of the urban respondents. There were high usage
rates among those respondents in the rural (60%) and urban (91.9%) area that
have the access.
There is high preference for modern mode of MNCH
knowledge management across all levels of education among respondents in both
rural (p = 0.7636) and urban (p=0.0974) areas. All the unmarried respondents in
rural setting have no knowledge of health problems of mothers and children
while 42.4% of those in urban setting had no knowledge of health problems of
mothers and children. These observations are significantly different in both
<0.005). Twenty five percent of Artisans in rural area and 41.2% in urban area have no knowledge management of MNCH as compared to other occupations. These observations were significantly different in the rural (p=0.0133) and urban (p=0.001) settings. >
The 61% of female in
rural and 58.5% of female in urban were similar to response pattern observed in
Nigeria demographic and health Surveys (NDHS) of 2008 
where 68% and 65% were proportions of female respondents in the rural and urban
settings respectively. Expectedly, while over 60% of the rural respondents were
illiterates, only 22.3% of the urban respondents were illiterates. One third of
both the rural and urban respondents were traders but the major difference was
that while Farmers and Artisans were more than another third of rural
respondents, Civil servants and students constitute more than one-third of
This study showed the relative knowledge
management difference between the rural and urban preferences on a simulated
map of Ilorin west LGA of kwara state, so as to
indicate the major areas of knowledge management where the main differences
lied like sources of general knowledge acquisition, main people responsible for
knowledge management in the communities and description of how respondents
would manage knowledge in terms of storage and transfer. This representation is
necessary so as to be able to show at a glance the knowledge management
preferences of both settings for evidence based decision making which is the
hallmark of IMNCH strategy .
More than half of the respondents from the rural
and urban settings obtained their knowledge traditionally through traditional
leader. This involved the use of "Town criers" now known as
"Town announcer" who relates information from the traditional leader
to his subjects. The role of traditional institution in Nigeria has been
severally emphasized in Health programs especially in community participation
and community ownership of health programs . The
traditional institution has culturally made use of town announcers to spread
announcements on health programs and this has been extensively used in
Immunizations . The implication of this
findings is that Knowledge management of IMNCH in Nigeria should take
into consideration active involvement of traditional institution in Nigeria in
storage and transfer of knowledge on IMNCH for the strategy to have success.
Other traditional ways that should be considered according to the findings from
this study are; the role of elderly people in the community, religious
institutions and the use of tales and music to manage knowledge resources on
The difference between the main people
responsible for knowledge storage in the rural and urban settings in this study
implies that while traditional institutions could be used to store knowledge on
IMNCH in the rural communities it would be more effective to use elders and
family institution in the urban setting and this also encourages the tacit
knowledge storage  and subsequent transfer through
coaching and mentoring . Similarly, this study revealed
that there is a difference in the particular persons responsible for knowledge
dissemination in rural and urban settings with a p-value of 0.0000001. Again
traditional leaders and elders were the main people in rural settings while
Elders, parents and head of family were the main people in the urban settings.
However, other relevant categories of people that are responsible for knowledge
dissemination in the two settings are; political leaders and opinion leader.
Documentation by writing the knowledge down in a
secured medium like books, diaries, audio recording and video recording were
the most common description of how the respondents in rural and urban areas
would like to store knowledge. The main significant difference in the two areas
was, while only few of the rural respondents would use Information Technology
(IT) to store knowledge, some significant proportion of urban respondents would
use IT. These findings implied that documentation in terms of keeping diaries
and media recording is important in knowledge storage and should be taken into
consideration while determining the knowledge management of IMNCH strategies.
Many of the evidence based interventions  that are
required to change the trends of maternal, newborn and under fives morbidity
and mortality required proper documentation in form of audio visual recordings
and literary as a form of Community of Practice (CoP)
When compared, IT usage is more pronounced in
urban settings than the rural setting because of social amenities and
infrastructural availability [19,20]. But notably, among the urban respondents, only few would
like to store knowledge through IT. This finding is worrisome because web-based
managed portal is the main strategy that the knowledge management of MNCH is
intended to use  and while this could be fairly
successful in urban settings the use in the rural setting may not be effective.
It was shown that the preferences of knowledge
management for MNCH are affected to a small extent by rural and urban settings.
This was evident from the fact that there is no statistical significance in the
observed traditional ways of knowledge acquisition in both settings, their
preferences for traditional and modern knowledge management for MNCH and
general perceptions to knowledge management of MNCH in the two settings.
However, the effect was more in the area of sources of general knowledge
acquisition, main people responsible for knowledge management, access and usage
of IT and awareness and knowledge of the mother and child health problems.
This study concluded that
traditional and family institutions were important in knowledge management of
maternal and child health in both the rural and urban settings of Nigeria while
IT is a potential source of strength for knowledge management of MNCH. It is
recommended that there is need to accommodate the traditional institution in
the knowledge management of MNCH by the IMNCH Core Technical Committee (CTC) of
both Federal Ministry of Health (FMoH) and State
Ministry of Health (SMoH). The health policy makers
at all the 3 tiers of government should endeavor to explore the traditional and
family routes of knowledge management to preserve good health practices as it
relates to mother and child.
The authors declare no
Oladimeji Akeem Bolarinwa: Main author,
responsible for the conception, design, data collection, data analysis and the
manuscript writing. Hafsat Abolore
Ameen: Responsible for design and manuscript review. Kabir Adekunle Durowade: Responsible for design, data collection and
manuscript review. Tanimola Makanjuola
Akande: Supervises the research work. All the authors
have read and approved the final version of the manuscript.
Table 1: socio-demographic distribution of
Figure 1: Map showing
cultural ways of obtaining MNCH knowledge in rural and urban clusters
Figure 2: Map showing
how MNCH knowledge is being preserved in rural and urban clusters
Figure 3: Map showing
how knowledge is being disseminated in rural and urban clusters
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