CHAPTER TWO

2.0 LITERATURE REVIEW

2.1 COMMUNITY
A community refers to a group of individuals residing in a specific area who share common
beliefs, traditions, customs, language, and more. It's characterized by stability, each having a
distinct name to identify its members. Communities can vary, ranging from families to villages,
with some having designated leaders chosen by the members. Ultimately, community embodies a
shared sense of coexistence among local residents.

2.1.1 TYPES OF COMMUNITIES

1. Communities based on interests consist of people who share similar passions or hobbies,
connecting through common pursuits (Smith, 2007).
2. Action-oriented communities form around a collective mission to enact change or improve
specific aspects of their environment (Davies, 2010).
3. Place-based communities are rooted in geographical boundaries, uniting individuals residing
in the same area (Porter & Shaw, 2017).
4. Practice-based communities are composed of professionals or individuals in similar fields,
bonding over shared expertise and common activities (Wenger, 1998).
5. Circumstance-based communities emerge from external events or situations, bringing
individuals together due to shared challenges or circumstances (Williams & Hall, 2000).

2.1.2 ORGANIZATION, FUNCTIONS AND ROLES OF THE COMMUNITY

Community organization, or Community-Based Organization (CBO), aims to positively impact a
community's social health, overall well-being, and functional efficiency. It can take various
forms, spanning geographical, psychosocial, cultural, spiritual, and digital realms.

Community organizing serves both immediate problem-solving and long-term engagement and
empowerment goals. Its objectives include enhancing community internal capacities and
boosting the decision-making authority and influence of marginalized groups (Hardcastle et al.,
2011; Minkler, 2013; Green & Haines, 2012; Horton & Freire, 1990; Warren, 2017).
Communities fulfill specific roles and functions for their members. Warren (1978) identified five
key functions carried out by locally relevant communities:

1. Economic Activities: Communities are vital in producing, distributing, and consuming goods
and services, meeting residents' various needs such as food, clothing, housing, employment,
transportation, medical services, and recreational opportunities.
2. Socialization: Communities act as important agents of socialization, especially for children
who learn societal role expectations within the community setting.
3. Social Control: The cohesion and bonds within a community influence its crime rates. Strong
communities often experience lower crime rates, while weaker ones may see higher levels of
criminal activity.
4. Community Engagement: Participating in communal activities provides opportunities for skill
acquisition, pursuing hobbies, and boosting self-confidence, fostering personal growth and
encouraging contributions to the community.
5. Mutual Support: Mutual support within teams leads to better outcomes, including fewer errors,
enhanced cooperation, self-correction abilities, efficient task distribution, and increased
resilience.
2.2 HEALTH
The World Health Organization (WHO) defines health as 'a state of complete physical, mental,
and social well-being and not merely the absence of disease or infirmity' (WHO, 1948). Widely
accepted among health professionals and researchers, this definition emphasizes that good health
goes beyond simply being free from illness—it entails functioning well across various aspects,
including biological, psychological, social, and spiritual dimensions. Achieving this
comprehensive well-being relies on factors like access to healthcare, nutrition, exercise, and
supportive relationships.

In contrast to the traditional medical model, which focuses solely on the absence of disease and
clinical intervention, this definition aligns with the biopsychosocial health model, which
considers physiological, psychological, and social factors.
However, some critics argue that this perspective may be impractical, suggesting that most
individuals remain in an unhealthy state for prolonged periods. Additionally, it may overlook the
growing population grappling with chronic illnesses and disabilities, potentially contributing to
overmedicalization. An alternative definition proposed by Huber et al. (2011) defines health as
'the ability to adapt and self-manage,' recognizing individuals' capacity to adapt to circumstances
as essential for health. This viewpoint acknowledges the subjective nature of health, which varies
depending on individual contexts and needs, although some see this subjectivity as a limitation
due to its lack of objectivity and measurability.

2.3 COMMUNITY HEALTH

The development of public health has resulted in significant modifications to methods used to
enhance the health of community members. It is still difficult to adequately characterize
community health and to distinguish it from adjacent fields of public health practice, community
involvement, or other relevant community development initiatives.(Goodman et al., 2014)
The term "community health practice" describes the delivery of healthcare services with the
goals of early disease diagnosis, identification of occupational and environmental risks to health,
and disease prevention within the community. The goal of the Nigerian model of community
health practice is to enhance community health and well-being by using an all-encompassing and
inclusive strategy. It stresses the empowering of people and communities to take charge of their
own health and acknowledges the significance of community involvement in healthcare
decision-making (Dotimi et al., 2023).
Social determinants of health (SDOH) play a pivotal role in shaping the health outcomes of
communities. According to theWorld Health Organization, SDOH are "the conditions in which
people are born, grow, live, work, and age" (WHO, 2012). These factors include socioeconomic
status, education, physical environment, employment, social support networks, and access to
healthcare. Research by (Braveman and Gottlieb 2014) highlights the profound impact of these
determinants on health disparities, indicating that individuals from lower socioeconomic
backgrounds are more likely to experience poorer health outcomes due to limited access to
resources and opportunities.

2.3.1 MAJOR COMMUNITY HEALTH PROBLEMS

What defines a health concern?
- A health issue can be characterized as the gap between the current situation and the desired
state (Smith, 2007).
- The origins of community health problems may arise internally or externally to the community
itself (Brown et al., 2015).
- Health challenges can present with varying levels of seriousness (Johnson et al., 2020).
Examples of Community Health Concerns:
1. Child Abuse: Extending beyond physical harm, it encompasses any mistreatment by adults
threatening a child (Gilbert et al., 2009).
2. Domestic Violence: Acts of violence within a victim's domestic sphere, involving partners,
family members, or close relatives (García-Moreno et al., 2006).
3. Access to Nutritious Food: Ensuring individuals have the resources to obtain necessary food
for proper nutrition (FAO et al., 1996).
4. Accidental Injuries: Unintended incidents occurring without direct intent (World Health
Organization, 2008).
5. Teenage Pregnancy: A significant contributor to maternal and child mortality, with associated
health risks for pregnant adolescents (UNFPA et al., 2021).
6. Substance Abuse: Excessive consumption of psychoactive substances leading to physical,
social, or emotional harm (NIDA et al., 2021).
7. Depression: Conditions involving mood fluctuations, including bipolar disorder (World Health
Organization, 2021).
8. Sexually Transmitted Diseases: Infections transmitted through sexual contact (CDC et al.,
2021).
9. Access to Clean Drinking Water: Inadequate sanitation linked to the transmission of
waterborne diseases (WHO et al., 2018).
10. Illiteracy: Low health literacy associated with poorer health outcomes (Berkman et al., 2010).

2.3.2 FACTORS AFFECTING COMMUNITY HEALTH

Community health is influenced by various factors and faces numerous challenges that impact
the well-being of individuals and the community as a whole. This research work aims to delve
into the problems of community health and explore the key factors that contribute to these
challenges. By examining these factors and their implications, insights can be gain into
improvement of community health.
Community health in rural areas are challenging and therefore experience drawbacks as well as
problems. Below are some of them
Lack of Access to Healthcare:
- Limited availability of healthcare facilities in underserved areas (Adebayo et al., 2019).
- Shortage of healthcare professionals, particularly in rural communities (Ogunbode et al., 2020).
- Financial barriers and high healthcare costs (Onwujekwe et al., 2018). Socioeconomic Factors:
- Influence of socioeconomic status on health outcomes (Adebowale et al., 2017).
- Educational attainment and its impact on health knowledge and behaviors (Kabiru et al., 2016).
- Income inequality and its association with health disparities (Oyekale, 2019). Environmental
Factors:
- Exposure to environmental hazards, such as air pollution and inadequate sanitation (Akinbami
et al., 2021).
- Impact of climate change on community health (Oyekale, 2020). - Access to clean water and
sanitation facilities (Oyekale, 2018).
Lifestyle Choices and Behaviors:
- Unhealthy diet and sedentary lifestyle contributing to the rise of non-communicable diseases
(Oyekale, 2017).
- Substance abuse and addiction affecting community well-being (Adeloye et al., 2020).
- Mental health challenges and the need for improved mental healthcare services (Atilola et
al.,2019).

2.4 INTRODUCTION TO COMMUNITY DIAGNOSIS

A community represents a group of individuals who share common characteristics such as
geographic location, occupation, ethnicity, or housing conditions, residing together within
society. Community diagnosis involves a thorough assessment of the community's health status,
considering its social, physical, and biological environments. The goal is to identify health
issues, assess available resources, and establish priorities for health initiatives in collaboration
with the community.
Community diagnosis typically involves identifying and quantifying health problems affecting
the entire community, including mortality and morbidity rates. It also aims to pinpoint factors
associated with these issues, identifying those at risk or in need of healthcare services. This
process combines aggregate and social statistics with a deep understanding of the local context to
determine healthcare needs, with several implications:

1. Identification of Common Issues: Reveals prevalent problems amenable to preventive

measures.
2. Pioneering Rural Community Health Improvement: Advances rural community health
enhancement efforts.
3. Uncovering Hidden Problems: Exposes issues not readily apparent to community members but
significantly affecting their lives.
4. Reaching the Underprivileged: Facilitates access to healthcare for marginalized groups facing
barriers.
5. Recognizing Real Community Problems: Highlights genuine concerns community members
may not recognize on their own.
6. Empowering Communities: Provides knowledge and fosters problem-solving attitudes for
meaningful solutions.

2.4.1 COMMUNITY HEALTH DIAGNOSIS

Community health focuses on the well-being of community members and is often assessed
through an examination of social determinants of health (SDOH). These determinants, defined
by Health.gov, include the conditions where individuals are born, live, learn, work, play,
worship, and age, significantly impacting health outcomes and risks.

Communities typically comprise individuals sharing common characteristics like language,

socio-economic status, and ethnicity, leading to similar healthcare challenges. Factors such as
geographical location, environment, genetics, income, education, and social relationships, as
highlighted by the World Health Organization, greatly influence individual health outcomes.
Key components defining a healthy community include:
1. Economic Stability: Stable incomes reduce poverty and provide consistent access to health
insurance, yet challenges in accessing health-promoting resources persist.
2. Education Accessibility and Quality: Higher education levels correlate with improved health
outcomes, emphasizing the importance of quality educational resources.
3. Healthcare Accessibility and Quality: Limited health insurance access affects healthcare
utilization, emphasizing the need for accessible healthcare services.
4. Neighborhood and Physical Environment: Community design impacts health, with efforts to
improve infrastructure promoting physical activity and safety.
5. Social and Community Context: Positive community relationships enhance mental health and
overall well-being, especially crucial during the pandemic.

These social determinants collectively shape our understanding of a healthy community.

2.4.2 METHODS USED IN COMMUNITY DIAGNOSIS

The following are four commonly used methods in community diagnosis:
1. Data Collection:
Data collection involves gathering information about prevailing health issues in the community.
This process is crucial for gaining insights into the nature of problems in the surveyed area.
Various sources of data can be utilized:
- Engagement with Community Members: Actively discussing primary health concerns with
community members to gain firsthand knowledge.
- Review of Health Service Records: Examining records from healthcare services accessed by
the community to understand prevalent health problems.
- Community Surveys or Small-Scale Projects: Conducting surveys or initiating projects to
systematically collect health-related data from community members.
- Observational Assessment: Directly observing health hazards and risks within the community
to identify contributing factors.
2. Data Analysis:
Data analysis involves categorizing collected data into specific groups to extract meaningful
insights. For instance, computing disease prevalence and incidence rates based on recorded cases
and population size within the community provides valuable information.
Prevalence and incidence rates can be expressed as 'per 10,000' or 'per 100,000' in larger
populations. Prevalence refers to the total number of cases within the population during a
specific period, while incidence accounts for new cases occurring within a given timeframe.
3. Prioritizing Health Problems:
Prioritization involves arranging health issues based on their significance, considering factors
such as scale, severity, feasibility of resolution, and community/government concern. Health
problems with high magnitude, severity, feasibility of resolution, and significant
community/government concern should be prioritized.
4. Developing an Action Plan:
An action plan outlines strategies for implementing interventions aimed at disease prevention
and control. It includes objectives, corresponding interventions, responsible entities, timeline,
and necessary equipment for implementation.

2.4.4 TYPES OF DATA TO BE COLLECTED IN COMMUNITY DIAGNOSIS

The project should gather both quantitative and qualitative data. Additionally, Population Census
and statistical data such as population size, sex and age structure, medical services, public health,
social services, education, housing, public security, and transportation are crucial.
Below are the types of data collected in a comprehensive community diagnosis:

1. DEMOGRAPHIC DATA:
Demography involves the study of characteristics and changes within the human population,
including births, deaths, age, income, education, gender, occupation, family size, housing,
ethnicity, language, and religious affiliation. These metrics are fundamental for segmenting
population groups.

2. EPIDEMIOLOGICAL DATA:
Epidemiology quantitatively explores the prevalence, distribution, determinants, and mitigation
strategies of diseases and impairments within human populations. It covers morbidity and
mortality data, risk factors, and health-promoting factors, providing insights into population
health status.

3. HEALTH SERVICE DATA:

Health service data offers insights into healthcare resources available within a community and
how the population engages with them. It includes client interactions with healthcare providers,
service locations, nature of interventions, and patterns of healthcare-seeking behaviors, aiming to
improve access to effective healthcare for all community members.

4. DATA ON KNOWLEDGE, ATTITUDES, AND PRACTICE (BEHAVIORAL DATA):

Collecting data on behaviors, habits, perceptions, knowledge, attitudes, beliefs, and opinions
regarding public health issues informs health education and promotion initiatives. Understanding
community perceptions about disease transmission guides efforts to address areas of ignorance or
necessity.

A community profile may also include environmental data such as water points, housing
conditions, distribution of latrines, presence of breeding sites for mosquitoes, transportation links
with health centers, and communication infrastructure.

2.5 SEGMENTS OF COMMUNITY DIAGNOSIS

Aligned with the goals and objectives of our community diagnosis program, this literature review
will consist of eight primary sections. These segments will serve as the focal points of our
questionnaires and will enable us to accomplish the objectives established by our team for the
community health assessment of the Ibido community.
These segments are:
1. Housing, water and environmental health
2. Family planning
3. Pregnancy and maternal health care
4. Children immunization
5. Prevalent disease
6. Availability of health care facilities
7. Nutritional health

2.5.1 HOUSING, WATER AND ENVIRONMENTAL HEALTH

A house serves as a vital space where people carry out their daily activities, and water is essential
for life itself, emphasizing its crucial role in health. Environmental health encompasses various
factors like physical, chemical, and social elements that influence human well-being. Ensuring a
clean and healthy environment is essential for preventing the spread of diseases.

Access to clean water and safe housing is fundamental for human survival and welfare,
especially in developing nations like Nigeria. Promoting awareness and positive practices
regarding environmental health is crucial for maintaining a healthy living environment. Lack of
access to clean water and proper sanitation leads to numerous deaths globally and affects
productivity and livelihoods.

In the Ibido community, this study aims to assess housing conditions, water safety, and
environmental health. Key objectives include understanding water purification methods,
proximity to water sources, community involvement in sanitation, and waste disposal practices.
Ultimately, the study seeks to determine if existing health issues among residents are linked to
water quality and sanitation practices.
2.5.2 FAMILY PLANNING
Family planning is a critical component of reproductive health programs aimed at promoting
maternal and child health, reducing unwanted pregnancies, and empowering individuals and
couples to make informed decisions about their reproductive lives. In Nigeria, family planning
initiatives have gained momentum in recent years, yet significant challenges persist.
Nigeria, as the most populous country in Africa, faces substantial challenges related to
population growth, maternal mortality, and limited access to reproductive health services.
According to Okigbo et al. (2017), Nigeria's population is projected to double by 2050,
exacerbating pressure on already strained health systems and resources. Addressing these
challenges necessitates comprehensive family planning programs that cater to diverse socio-
cultural contexts and population groups.
Socio-cultural factors significantly influence family planning practices in Nigeria. Traditional
beliefs, religious norms, and gender dynamics often shape attitudes towards contraception and
family size preferences (Oye-Adeniran et al., 2014). For instance, misconceptions about
contraceptive methods, fear of side effects, and opposition from religious leaders can hinder
contraceptive uptake among women and couples (Ijadunola et al., 2015). Understanding and
addressing these socio-cultural barriers are crucial for designing effective family planning
interventions tailored to local contexts.
Barriers to Family Planning Access and Utilization
Despite efforts to expand access to family planning services, significant barriers persist in
Nigeria. Supply-side challenges, including stockouts of contraceptive commodities, inadequate
healthcare infrastructure, and limited skilled personnel, hinder service delivery and uptake
(Ahanonu et al., 2018). Furthermore, demand-side barriers such as low awareness,
misconceptions, and socio-economic disparities contribute to low contraceptive prevalence rates,
particularly among marginalized populations (Sedgh et al., 2016). Overcoming these barriers
requires multi-faceted approaches that address both supply and demand-side factors.
Role of Government and Policy Initiatives
The Nigerian government has made significant strides in prioritizing family planning within the
national health agenda, evidenced by the development of strategic frameworks, policies, and
guidelines to guide program implementation (FMOH, 2017). However, translating policy
commitments into tangible outcomes requires sustained political will, adequate resource
allocation, and effective coordination among stakeholders at all levels (Izugbara et al., 2017).
Community-Based Approaches and Innovative Interventions
Community-based approaches play a vital role in increasing family planning uptake and
addressing local needs and preferences. Initiatives such as community health outreach programs,
mobile clinics, and peer education have been effective in raising awareness, dispelling myths,
and increasing contraceptive acceptance (Adebowale et al., 2019). Moreover, innovative
interventions leveraging technology, such as mobile health platforms and social media
campaigns, hold promise for reaching remote populations and engaging young people in family
planning discussions (Adam et al., 2020).
Reaching its family planning goals has been a slow process for Nigeria. Funding for family
planning services is uneven and inconsistent due to its significant reliance on outside donors.
Therefore, increased domestic resource mobilization through government funding is required.
(Mbachu et al. 2023). By prioritizing investments in family planning and adopting a multi-
sectoral approach, Nigeria can empower individuals and couples to make informed choices about
their reproductive health, leading to healthier families and communities.

2.5.3 PREGNANCY AND MATERNAL HEALTH CARE

Mothers and children make up over 2/3 of the whole population, hence there is an increasing
concern and interest in maternal and child health care, that is, health service provided to mothers
(women in their child bearing age) and children. The focus of Maternal and Child Health Care is
the reduction of maternal, infant and childhood mortality and morbidity and the promotion of
reproductive health and the physical and psychosocial development of the child and adolescent
within the family. (Dash 2017)
Pregnancy and maternal health care are fundamental components of public health systems and in
ensuring the well-being of both the mother and the child, we examine dynamics of pregnancy,
maternal health care, and the role of local communities in ensuring positive outcomes for
mothers and newborns.

Access to Maternal Health Care: Access to maternal health care services remains a significant
challenge in many parts of the world, particularly in low-resource settings. According to Ahmed
et al. (2020), barriers to access include geographical distance, lack of transportation, financial
constraints, and cultural beliefs. Ensuring equitable access to maternal health care services is
crucial for reducing maternal mortality and improving maternal and neonatal outcomes
(Gabrysch & Campbell, 2009).
Quality of Maternal Health Care: Quality of care during pregnancy and childbirth significantly
impacts maternal and neonatal outcomes. A study by Bohren et al. (2015) highlights the
importance of respectful maternity care, emphasizing the need for dignified and compassionate
treatment of women during childbirth. Quality improvement initiatives, such as the WHO Safe
Childbirth Checklist (Spector et al., 2018), have shown promise in enhancing the quality of
maternal health care services and reducing adverse outcomes.
Maternal Health Care Infrastructure in Africa: Africa faces significant challenges in providing
adequate maternal health care infrastructure, including access to skilled birth attendants, health
facilities, and essential medical supplies. According to Ahmed et al. (2020), many African
countries lack sufficient healthcare facilities and skilled personnel, leading to high maternal
mortality rates. Limited infrastructure exacerbates the risks associated with pregnancy and
childbirth, particularly in rural areas where access to healthcare services is scarce (Yaya et al.,
2020).
Socio-cultural Factors Impacting Maternal Health: Traditional beliefs, practices, and societal
norms often influence women's decisions regarding pregnancy and childbirth (Adjiwanou &
Legrand, 2013). For instance, cultural preferences for home births and reliance on traditional
birth attendants can hinder access to skilled maternal health services (Chimatiro et al., 2018).
Additionally, socio-economic disparities and gender inequalities contribute to disparities in
maternal health care utilization, with marginalized women facing greater barriers to accessing
essential services (Tarekegn et al., 2019).
Community-Based Interventions: Recognizing the importance of community involvement,
several initiatives have focused on improving maternal health outcomes through community-
based interventions. These interventions leverage existing community structures, such as
women's groups, community health workers (CHWs), and traditional leaders, to promote
maternal health education, antenatal care, and skilled birth attendance (Colbournet al., 2013).
Studies have shown that community-based approaches can significantly improve maternal health
knowledge, increase antenatal care attendance, and reduce maternal mortality rates in resource-
limited settings (Lewycka et al., 2013).
Role of Technology in Maternal Health: The advent of technology has also revolutionized
maternal health care delivery in Africa. Mobile health interventions, such as text messaging
services and mobile applications, have been utilized to disseminate maternal health information,
provide appointment reminders, and facilitate communication between healthcare providers and
pregnant women (Owusu-Addo et al., 2020). Additionally, telemedicine platforms have enabled
remote consultations and medical support for expectant mothers in underserved areas, improving
access to skilled maternal health services (Baker et al., 2019).
Challenges and Future Directions: Despite progress in maternal health care delivery, significant
challenges persist in ensuring universal access to quality services in African communities. These
challenges include inadequate funding, weak health systems, cultural barriers, and limited human
resources (Amoakoh-Coleman et al., 2016). Addressing these challenges requires a multi-faceted
approach, involving increased investment in healthcare infrastructure, targeted community-based
interventions, and strengthened partnerships between governments, NGOs, and local
communities.
Pregnancy and maternal health care in African communities are influenced by a complex
interplay of socio-economic, cultural, and infrastructural factors. While challenges remain,
community-based interventions, technological innovations, and collaborative efforts hold
promise for improving maternal health outcomes and reducing maternal mortality rates across
the continent. By leveraging local resources and community networks, stakeholders can work
towards achieving equitable access to quality maternal health services for women in even local
communities.

2.5.4 CHILDREN IMMUNIZATION

Children in Sub-saharan African countries are at risk of being exposed to various vaccine
preventable diseases such as: whooping cough, chicken pox, measles, mumps, rubella,
diphtheria, polio e.t.c. Therefore, immunization of children at specific periods according to a
standard immunization schedule is of utmost importance to fortify their immune system against
these diseases.
But in different Sub-saharan African countries, complete and effective immunization is
sometimes not achieved particularly in rural areas.
In an analysis of demographic and health survey data in 25 Sub Saharan African countries to
examine child vaccination by (Firew Tekle Bobo et al. 2022), it was discovered that 56.5% of
children received full vaccination, 35.1% received incomplete vaccination, while 8.4% of
children remained unvaccinated.
Our country, Nigeria in particular, suffers from low immunization coverage. According to a
systematic search conducted by (Davies Adeloye et al 2017) on a selected 26,960 children, it was
revealed that an estimated percentage of fully vaccinated children was 34.4% with south-south
zone having the highest at 51.5% and North West zone having the lowest at 9.5%..
According to (A de Figueiredo et al. 2023), current WHO/UNICEF estimates of routine
childhood immunization coverage reveal the largest sustained decline in the uptake of vaccines
in the past three decades with pronounced setbacks across Africa. The study hinted at a decrease
in the level of confidence of people in the effectiveness of vaccines.
Factors such as parent/caretaker's barriers which include: lack of knowledge of immunization,
distance to access point, financial deprivation, lack of partner's support, and distrust in vaccines
and immunization programs hinder full immunization coverage. (Joseph Benjamin Bangura et al.
2020).
Availability of human resources can also be a factor influencing immunization coverage. In a
study conducted by ( S Anand, T Barnighausen, 2007) to test whether health worker density
affects vaccination coverage in developing countries, it was discovered that a higher density of
health care workers improves access to vaccination services thereby increasing vaccination
coverage.
Appropriate measures have to be put in place to increase the rate of immunization in children in
order to bring child mortality to the the barest minimum.
Therefore, awareness about the effectiveness of vaccines through appropriate
channels( Television, radio, news articles, community health programs), improvement on health
worker to patient ratio, and regular immunization outreaches to rural communities can improve
immunization coverage in children in Africa.

2.5.5 PREVALENT DISEASES

Community diagnosis is a very important tool in assessing the prevalence of diseases in
communities, proposing the causative factors of the disease and providing ways of stopping or
reducing the incidence of disease in that community.
A study done in Tigray, Ethiopia to show the prevalence and environmental determinants of
cutaneous leishmaniasis by Yohannes Mekman et al in 2019 found that the disease was
predominantly zoonotic and integrated interventions was recommended to stop the disease.
Another study done in nine communities in Nigeria by Owolabi Lukman et al in 2019 showed
the prevalence of epilepsy in Nigeria with its incidence being higher in rural areas than urban
centers.
One study done in Hausa Communities in Kano State Nigeria identified the prevalence of
malaria in the communities. It also showed that even with the high level of education and good
attitude of the study population towards the disease, there were still gaps in their knowledge
about the use of appropriate preventive practices. Therefore, awareness programs towards the
good preventive practices against malaria was recommended.( Dawaki Salin et al 2016)
A study was done in Umum Orlu Local Government in Imo State Nigeria by Nwaneri A et al in
2017. This study showed that the knowledge and awareness of the respondents about breast
cancer was very low with some of the women believing the disease was caused by ancestral
forces, therefore there is a need to improve health education programs to dispel the myths about
the disease and improve positive health seeking behavior among the women.
From these findings, we can infer that the cause of the prevalence of a disease in a community
could range from low education to the disease being zoonotic.
One of our goals in Ibido community is to identify if there is any prevalent disease among the
members of the community, propose a cause and educate them on methods to stop or reduce the
occurrence of the disease.
2.5.6 AVAILABILITY OF HEALTH CARE FACILITIES
The availability of health facilities in Nigeria is a critical issue that influences the overall health
outcomes of its population. Adequate infrastructure, medications, medical staff with the
necessary training, and diagnostic medical equipment are necessary for the efficient provision of
healthcare services. The delivery of healthcare services in Nigeria is frequently marred by
inadequate funding and bad management, which has an impact on the scope and caliber of
healthcare provided.(Oyekale 2017)
The geographic distribution of health facilities in Nigeria is uneven, with a significant disparity
between urban and rural areas. Rural areas are particularly underserved, resulting in limited
access to healthcare services for a large portion of the population. According to a study by
Abimbola et al. (2015), rural regions in Nigeria suffer from a shortage of health facilities, which
exacerbates health disparities and contributes to poorer health outcomes. The authors emphasize
that many rural communities are more than 10 kilometers away from the nearest health facility,
creating substantial barriers to accessing essential healthcare services.
The quality of infrastructure in Nigerian health facilities varies widely, with many facilities
lacking basic amenities and adequate resources. A comprehensive assessment by Adeloye et al.
(2017) found that a significant number of health facilities in Nigeria are in a state of disrepair,
with issues such as inadequate water supply, unreliable electricity, and poor sanitation. These
deficiencies not only compromise the quality of care but also pose significant risks to patient
safety.
In their study, Adeloye et al. (2017) highlighted the need for substantial investments in health
infrastructure to improve service delivery and health outcomes. The authors argue that without
addressing the infrastructure challenges, efforts to improve healthcare access and quality will be
severely hampered.
The distribution of healthcare workers is a critical factor influencing the availability and
functionality of health facilities in Nigeria. There is a marked imbalance in the distribution of
healthcare professionals, with a higher concentration in urban areas compared to rural regions.
According to a report by the Federal Ministry of Health (FMOH, 2018), about 70% of Nigeria's
healthcare workforce is located in urban areas, where only 30% of the population resides. This
disparity results in a significant shortage of healthcare workers in rural areas, limiting the
capacity of health facilities to provide adequate care.
Efforts to address this imbalance include policies aimed at incentivizing healthcare workers to
practice in underserved areas. The FMOH has implemented several initiatives, such as providing
financial incentives and career development opportunities, to attract and retain healthcare
workers in rural and remote areas (FMOH, 2018).
Effective health policies can enhance the distribution and quality of health facilities, while
ineffective policies can exacerbate existing disparities. According to a study by Okpaniand
Abimbola (2015), the Nigerian government's Primary Health Care (PHC) Under One Roof
policy, which aims to integrate and streamline primary healthcare services, has the potential to
improve the availability of health facilities across the country.
The PHC Under One Roof policy seeks to ensure that primary healthcare services are delivered
in an integrated manner, with adequate funding and resources allocated to health facilities at the
local level. Okpani and Abimbola (2015) argue that successful implementation of this policy
could significantly improve access to healthcare services, particularly in underserved rural areas.

2.5.7 NUTRITION
Nutrition is an integral part of a community's health and well being. The community nutritional
need is important as it affects its mortality, birth rate and risks of non-communicable diseases
(blood pressure, diabetes ) - as either healthy or malnourished. Nutrition is a crucial aspect of
human rights and progress, with undernutrition posing significant threats to children's well-being
and hindering national development goals. Despite often being unseen, its impact is profound.
Ensuring adequate healthcare and nutrition for children is essential for securing the future of our
nations. Undernutrition, as defined by UNICEF, arises from insufficient food intake exacerbated
by recurrent illnesses, leading to indicators like underweight, stunted growth, and nutrient
deficiencies. Studies also emphasize the role of poor nutrition and infectious diseases in
exacerbating undernutrition.
Malnutrition can stem from various factors including inadequate nutrient intake, limited
healthcare access, and socio-economic disparities. Poverty, in particular, plays a significant role
in shaping nutritional status by restricting access to nutritious foods and healthcare services.
Additionally, cultural practices, gender dynamics, and educational attainment, especially among
women, influence dietary habits and health outcomes within communities.

Furthermore, environmental factors such as poor sanitation and overcrowding in urban slums can
exacerbate malnutrition by increasing susceptibility to infections and limiting access to clean
water and proper waste disposal facilities. Addressing these multifaceted determinants through
community-focused programs and interventions is crucial for achieving sustainable
improvements in nutritional status. Recognizing the complex interplay of social, economic, and
environmental factors is essential for effective intervention strategies aimed at promoting better
nutrition and health outcomes for all.