Temporal trends in childhood mortality in Ghana: impacts and challenges of health policies and programs

Abstract

BackgroundFollowing the adoption of the Millennium Development Goal 4 (MDG 4) in Ghana to reduce under-five mortality by two-thirds between 1990 and 2015, efforts were made towards its attainment. However, impacts and challenges of implemented intervention programs have not been examined to inform implementation of Sustainable Development Goal 3.2 (SDG 3.2) that seeks to end preventable deaths of newborns and children aged under-five. Thus, this study aimed to compare trends in neonatal, infant, and under-five mortality over two decades and to highlight the impacts and challenges of health policies and intervention programs implemented.DesignGhana Demographic and Health Survey data (1988–2008) were analyzed using trend analysis. Poisson regression analysis was applied to quantify the incidence rate ratio of the trends. Implemented health policies and intervention programs to reduce childhood mortality in Ghana were reviewed to identify their impact and challenges.ResultsSince 1988, the annual average rate of decline in neonatal, infant, and under-five mortality in Ghana was 0.6, 1.0, and 1.2%, respectively. From 1988 to 1989, neonatal, infant, and under-five mortality declined from 48 to 33 per 1,000, 72 to 58 per 1,000, and 108 to 83 per 1,000, respectively, whereas from 1989 to 2008, neonatal mortality increased by 2 per 1,000 while infant and under-five mortality further declined by 6 per 1,000 and 17 per 1,000, respectively. However, the observed declines were not statistically significant except for under-five mortality; thus, the proportion of infant and under-five mortality attributed to neonatal death has increased. Most intervention programs implemented to address childhood mortality seem not to have been implemented comprehensively.ConclusionProgress towards attaining MDG 4 in Ghana was below the targeted rate, particularly for neonatal mortality as most health policies and programs targeted infant and under-five mortality. Implementing neonatal-specific interventions and improving existing programs will be essential to attain SDG 3.2 in Ghana and beyond.

Predictive model and determinants of under-five child mortality: evidence from the 2014 Ghana demographic and health survey

“…In Ghana, there is a persistent regional disparity in the distribution of socioeconomic resources, especially health care delivery, health services and wealth due to lack of political will to implement sound health and economic policies across the regions comprehensively. Also, the regional differences in the under-five mortality could partly be explained by variations in implementation of national health policies and programs coupled with inadequate health services and poor living conditions of households [14, 34–40].…”

Equity dimensions of the decline in under‐five mortality in Ghana: a joinpoint regression analysis

“…The role of targeted programmes and primary healthcare initiatives such as the Community Based Planning and Service (CHPS) which were rolled out in rural areas and allow for primary healthcare workers to provide basic services such as family planning, health education, skilled delivery and antenatal care might help explain the narrowing rural‐urban equity gap. However, such programmes have had their own setbacks such as unpredictability of funding, deviations from plans in the implementation process, and insufficient monitoring and evaluation [5]. The implication of these setbacks is that failure to support such initiatives and to continue to build a strong healthcare system undergirded by equally strong primary healthcare services could reverse the progress made.…”

“…Given its public health implications and economic significance, improving child survival has continued to be on Ghana's national agenda. In Ghana, several major interventions such as the National Health Insurance Scheme (NHIS), the Community Based Health Planning and Services (CHPS) programme and the free maternal health policy have contributed to the improvement of various child survival indicators [5].…”

Consistency of the determinants of achieving fertility desires in Ghana: insights from 2003, 2008 and 2014 Ghana Demographic and Health Survey data sets

“…Yeboah et al (2021) have earlier reported that women are more likely to attain underachieved fertility when their partner's fertility preference is lower. The increasing proportion of women with improvement in child survival may be attributed to maternal and child health policies and intervention programmes by the government and NGOs (Kayode et al, 2016). This consequently led to improvement in health care infrastructure, reduced inequality in healthcare uptake, eased financial challenge of healthcare service and drew government attention to meeting the MDG and SDG goals.…”