Risk factors associated with under-five mortality in Northern Ghana between 2007 and 2012

Abstract

Introduction: Under-five mortality is still a critical issue globally, especially in Sub-Saharan Africa. The disparities between low- and high-income countries in respect to mortality in children continue to be high and persistent. According to WHO, under-five mortality rate was 73.1 per 1000 live births in low income countries compared to 5.3 per 1000 live births in high-income countries in 2016 – almost 14 times higher on average. The African region, being home to many low-income countries, is particularly affected. In fact, of all the WHO regions, the WHO African Region has the highest under-five mortality rate of 76.5 per 1000 live births. Objectives: This study assessed the risk factors associated with under-five deaths, described the leading causes of under-five deaths and examined the spatial variations of under-five deaths in northern Ghana between 2007 and 2012. Methodology: Data for this study came from the Navrongo Health and Demographic Surveillance System (NDSS) in the upper east region of Northern Ghana. Children born between 1st January 2007 and 31st December 2012 and resident in the HDSS area were included in the analyses. The children were followed up from first date of registration into the surveillance area till they were five years of age or censored depending on which comes first. Survival estimates were computed using Kaplan-Meier survival technique. Cox proportional hazards regression models were used to assess the risk factors associated with under-five deaths. Verbal autopsy data were used to ascertain causes of under-five deaths using InterVA4. Choropleth maps were used to depict the geographical distribution of under-five deaths across the study area. Findings: A total of 20,651 children were included in the analyses. Over the follow-up period, 1,010 under-five deaths were recorded with 51,783 person years of observation. Overall, under-five mortality rate was 19.5 per 1000-person years of observation (PYO). The risk factors whichwere significantly associated with under-five deaths were sex of child, marital status of the mother, maternal age, socio-economic status (SES), and birth place. Children born to mothers who were aged 20-34 years had 19% reduced risk of dying before age five compared to children born to mothers who were less than 20 years old (HR=0.81, p=0.034, 95% CI: 0.67, 0.98). Children from the richest households were less likely to die before their fifth birthday relative to those from the poorest households, after controlling for other covariates (HR=0.72, p=0.028, 95% CI: 0.54, 0.96). Children born at home had an increased risk of dying compared to those born at the health facility (HR=1.29, p<0.001, 95% CI: 1.12, 1.48) after adjusting for other covariates. The risk factors that were found to be associated with under-five deaths due to Non-Communicable Diseases (NCDs) were marital status, SES, birth place and mother’s level of education. On causes of death, 30% of all under-five deaths were due to malaria and 18% were attributed to Acute Respiratory Infections (ARI), including Pneumonia. The three leading causes of neonatal deaths in the study area were neonatal pneumonia (29%), prematurity (25%) and birth asphyxia (23%). Most of the neonatal deaths (71%) occurred in the early neonatal period of 0 to 6 days. Conclusion: Under-five mortality rates in the study area remain relatively high with marginal differences across clusters. Maternal age of less than 20 years, low socio-economic status of mother, being a male child, being a single mother, children born to mothers with no formal education and children delivered at home were at significantly increased risk of under-five deaths in the study area. Malaria and pneumonia are the leading causes of under-five deaths in the study area. To achieve the sustainable development target of reducing child mortality by 2030, it is important to identify the major risk factors which affect child mortality, as well as the major causes of child deaths at the district or local level in order to develop targeted interventions.