Abstract
BackgroundUnder-five mortality (U5M) rates are among the health indicators of utmost importance globally. It is the goal 3 target 2.1 of the Sustainable Development Goals that is expected to be reduced to at least 25 per 1000 livebirths by 2030. Despite a considerable reduction in U5M observed globally, several countries especially those in sub-Saharan Africa (SSA) like Ghana are struggling to meet this target. Evidence-based targeting and utilization of the available limited public health resources are critical for effective design of intervention strategies that will enhance under-five child survival. We aimed to estimate and map U5M risk, with the ultimate goal of identifying communities at high risk where interventions and further research can be targeted.MethodsThe 2014 Ghana Demographic and Health Survey data was used in this study. Geostatistical analyses were conducted on 5884 children residing in 423 geographical clusters. The outcome variable is child survival status (alive or dead). We employed a geostatistical generalised linear mixed model to investigate both measured and unmeasured child specific and spatial risk factors for child survival. We then visualise child mortality by mapping the predictive probability of survival.ResultsOf the total sampled under 5 children, 289 (4.91%) experienced the outcome of interest. Children born as multiple births were at increased risk of mortality with an adjusted odds ratio (aOR) (aOR: 8.2532, 95% CI: [5.2608–12.9477]) compared to singletons. Maternal age increased risk of mortality (aOR: 1.0325, 95% CI: [1.0128–1.0527]). Child’s age (aOR: 0.2277, 95% CI: [0.1870–0.2771]) and number of children under 5 within each household (aOR: 0.3166, 95% CI: [0.2614–0.3835]) were shown to have a protective effect. Additionally, mothers with secondary education level (aOR: 0.6258, 95% CI: [0.4298–0.9114]) decreased the risk of U5M. The predicted U5M risk in 2014 was at 5.98%. Substantial residual spatial variations were observed in U5M.ConclusionThe analysis found that multiple births is highly associated with increased U5M in Ghana. The high-resolution maps show areas and communities where interventions and further research for U5M can be prioritised to have health impact.
Highlights
Under 5 Mortality (U5M) rates are among the health indicators of utmost importance globally
About 1886 (32.1%) of the children came from poorest households and 728 (12.4%) of the children came from well-endowed households
Among the covariates adjusted for in the model, the study found that maternal educational level and age, number of children under five in the household, type of birth, and child’s age were associated with U5M in the spatial model (i.e. Generalised Linear Geostatistical Model (GLGM)) while maternal educational level and age, number of children under five in the household, child’s age, household wealth, elevation, and type of birth were associated with U5M in the nonspatial model
Summary
Under-five mortality (U5M) rates are among the health indicators of utmost importance globally It is the goal 3 target 2.1 of the Sustainable Development Goals that is expected to be reduced to at least 25 per 1000 livebirths by 2030. U5M rates are among the health indicators of utmost importance globally It is the goal 3 target 2.1 of the Sustainable Development Goals (SDG) that is expected to be reduced to at least 25 per 1000 livebirths by 2030 [1]. Despite a considerable reduction in U5M observed globally over the past two decades, several countries especially those in sub-Saharan Africa (SSA) like Ghana are struggling to meet this target [2, 3]. The Global Burden of Disease (GBD) 2017 SDG Collaborators reported that several countries are on track to meet the minimum target of 25 deaths per 1000 livebirths by 2030 but noted that about 31 countries/territories need to meet yearly rates of reduction from 2015 to 2030 that are between 2 to 10 times higher than what was recorded for 1990–2015 to be able to achieve this goal [2, 3]
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