Risk factors of neonatal mortality in Navrongo DSS in Ghana between 2001 and 2005
Maraga, Seri Emily
Background Improvements in the health status of children have resulted in a substantive reduction in under-five mortality by two-thirds between 1960 and 1990. However this reduction is favourable for children after the first year in life, with little decrease in the neonatal period. Every year, about 4 million children die within the first 28 days of life, the first week (0-7 days) posing the highest risk. The Fourth Millennium Development Goal emphasises a reduction in child mortality by two-thirds by 2015, however this goal cannot be met because neonatal deaths continue to increase. It is therefore important to make available information on risk factors and the main causes of death that exist at a community level so that appropriate health policies are devised to reduce the mortality burden faced by neonates. Objective The study investigates the relationship between household and maternal socio-demographic characteristics with neonatal mortality in the Kassena-Nankana District from 2001 to 2005. The specific objectives were; (1) To calculate the neonatal mortality rates in the Kassena-Nankana District from 2001 to 2005, (2) To determine the causes of neonatal death for years 2003 to 2005, and (3) To assess the association of household characteristics and maternal socio-demographic characteristics with neonatal deaths in the Kassena-Nankana District from 2001 to 2005. Methods Data from Navrongo DSS in Ghana was used for the analysis. A total of 19 340 live births born from 15 224 households were registered between 1st January 2001 to 31st December 2005. Of these 551 died before the 28th day after birth. The outcome, neonatal mortality was coded as a binary variable and took values 1 if the child died and 0 if the child survived. Neonatal mortality rates were calculated by dividing the total number of deaths for a particular year by the total number of live births for that year, multiplied by 1000. Cause of death data were collected using neonatal specific verbal autopsies. Cause-specific neonatal mortality rates were calculated using physician coding to a list of cause of deaths based on the 9th International Classification for Diseases (ICD). Using the mother‟s household characteristics and assets ownership, a wealth index was constructed as proposed by Filmer and Pritchett to estimate socio-economic status. Chi-square (x2) test at 5% significant level was also done to compare the maternal socio-demographic and neonatal characteristics by neonatal mortality. Logistic regression models were fitted to assess the association between (i) neonatal mortality and socio-economic status (SES) and (ii) between neonatal mortality and maternal as well as neonatal risk factors, while adjusting for potential confounders. Health equity was measured using the concentration index (CI) and the poorest-poor ratio (PPR). Results: The overall neonatal mortality rate for the whole study period was 29 per 1000 live births. Most deaths (65.9%) occurred outside the health facility and most occurred in the early neonatal period (0-7 days). Infectious diseases (n=98, 33.2%), birth injuries (n=28, 9.5%) and prematurity (n=29, 9.8%) were the main causes of neonatal deaths. In the multivariate analysis maternal characteristic that showed an association with mortality were place of residence, SES, birth order and the type of birth outcome. Such that children who died were more often from the rural areas compared to in the urban areas (AOR=2.24 95% CI=1.16-4.34 P=0.016). Children who died were more often from a multiple birth outcome compared to those from a single birth outcome (AOR=0.20 95% CI=0.14-0.28 P<0.0001). SES was found to be protective against neonatal mortality (AOR=0.70 95% CI= 0.51–0.96 P=0.026). By birth order, children who died were more often from the 1st birth order compared to children of birth orders; 2-3 (AOR=0.60 95% CI=0.44-0.81 P=0.001), 4-5 (AOR=0.56 95% CI=0.38-0.84 P=0.005) and 6+ birth order (AOR=0.50 95% CI=0.31-0.8 P=0.005). A measure of health equity gave a C.I of -0.07 and PPR of 1.29 implying that neonatal mortality was high amongst the poorest households than the better ones. Conclusion The study showed that neonatal mortality was high in the rural areas and in the poorest households. Efforts to alleviate the burden of neonatal mortality at a community level should focus on improving living standards for poorest in the community. Also educating women on child health care and making them aware of high risk pregnancy age-groups will help minimize risky pregnancies which in turn will reduce neonatal deaths.
MSc (Med), Population-Based Field Epidemiology, Faculty of Health Sciences, University of the Witwatersrand
neonatal mortality, Navronogo DSS, Ghana