Individual and community determinants of neonatal mortality in Ghana: a multilevel analysis

Abstract

BackgroundNeonatal mortality is a global challenge; identification of individual and community determinants associated with it are important for targeted interventions. However in most low and middle income countries (LMICs) including Ghana this problem has not been adequately investigated as the impact of contextual factors remains undetermined despite their significant influence on under-five mortality and morbidity.MethodsBased on a modified conceptual framework for child survival, hierarchical modelling was deployed to examine about 6,900 women, aged 15 – 49 years (level 1), nested within 412 communities (level 2) in Ghana by analysing combined data of the 2003 and 2008 Ghana Demographic and Health Survey. The aim was to identify individual (maternal, paternal, neonatal, antenatal, delivery and postnatal) and community (socioeconomic disadvantage communities) determinants associated with neonatal mortality.ResultsThe results showed both individual and community characteristics to be associated with neonatal mortality. Infants of multiple-gestation [OR 5.30; P-value < 0.001; 95% CI 2.81 – 10.00], neonates with inadequate birth spacing [OR 3.47; P-value < 0.01; 95% CI 1.60 – 7.57] and low birth weight [OR 2.01; P-value < 0.01; 95% CI 1.23 – 3.30] had a lower chance of surviving the neonatal period. Similarly, infants of grand multiparous mothers [OR 2.59; P-value < 0.05; 95% CI 1.03 – 6.49] and non-breastfed infants [OR 142.31; P-value < 0.001; 95% CI 80.19 – 252.54] were more likely to die during neonatal life, whereas adequate utilization of antenatal, delivery and postnatal health services [OR 0.25; P-value < 0.001; 95% CI 0.13 – 0.46] reduced the likelihood of neonatal mortality. Dwelling in a neighbourhood with high socioeconomic deprivation was associated with increased neonatal mortality [OR 3.38; P-value < 0.01; 95% CI 1.42 – 8.04].ConclusionBoth individual and community characteristics show a marked impact on neonatal survival. Implementation of community-based interventions addressing basic education, poverty alleviation, women empowerment and infrastructural development and an increased focus on the continuum-of-care approach in healthcare service will improve neonatal survival.

Determinants of neonatal mortality in rural and urban Nigeria: Evidence from a population‐based national survey

“…The finding, however, that mortality was significantly higher in rural neonates (NMR, 36 deaths per 1000 live births) compared with urban neonates (NMR, 28 deaths per 1000 live births) possibly reflects socioeconomic disparity. This urban advantage agrees with the general trend in the literature . For example, a previous UNICEF analysis has shown that birth in the rural areas is a significant risk factor for neonatal mortality .…”

Trends and risk factors of stillbirths and neonatal deaths in Eastern Uganda (1982–2011): a cross‐sectional, population‐based study

“…Advanced maternal age is a well‐established risk factor for stillbirths and it is linked with a higher prevalence of chronic hypertension and placental pathologies . Advanced maternal age was a risk factor for neonatal deaths regardless of parity, consistent with some previous findings but in contrast to several others . The association may be due to age‐related birth complications resulting in early neonatal deaths, or less health‐seeking behaviour and more observance of potentially harmful traditions among older generations.…”

“…Reviews suggest that stillbirths and neonatal deaths are linked to several biological and socio‐economic risk factors . While some studies set in sub‐Saharan Africa have been published, mostly from Ethiopia , and Ghana , a dearth of population‐level studies remains. An estimated 57% of deliveries in sub‐Saharan Africa take place outside health facilities , rendering hospital‐based studies unrepresentative.…”

Neonatal morbidity and mortality in the pediatric ward at the Ambohimiandra Antananarivo Madagascar hospital

“…[24][25] Lastly, low birth weight was identified as a risk factor for neonatal mortality; which was also highlighted in other studies. 2,8,14,15,[26][27][28][29] Newborns with low birth weight are likely to have multiple complications, ranging from metabolic disorders to neurological and sensory disorders, sometimes irreversible.…”