Abstract
BackgroundCommunities and their composition have an impact on neonatal mortality. However, considering the smallest health administrative units as communities and investigating the impact of these communities and their composition on neonatal mortality in Ghana have not been studied. Therefore, this study aimed to investigate the effect of community-, household- and individual-level factors on the risk of neonatal mortality in two districts in Ghana.MethodsThis was a longitudinal study that used the Kintampo Health and Demographic Surveillance System as a platform to select 30,132 neonatal singletons with 634 deaths. Multilevel cox frailty model was used to examine the effect of community-, household- and individual-level factors on the risk of neonatal mortality.ResultsRegarding individual-level factors, neonates born to mothers with previous adverse pregnancy (aHR = 1.38, 95% CI: 1.05–1.83), neonates whose mothers did not receive tetanus toxoid vaccine (aHR = 1.32, 95% CI: 1.08–1.60) and neonates of mothers with Middle, Junior High School or Junior Secondary School education (aHR = 1.30, 95% CI: 1.02–1.65) compared to mothers without formal education, had a higher risk of neonatal mortality. However, female neonates (aHR = 0.61, 95% CI: 0.51–0.73) and neonates whose mother had secondary education or higher (aHR = 0.37, 95% CI: 0.18–0.75) compared to those with no formal education had a lower risk of mortality. Neonates with longer gestation period (aHR = 0.95, 95% CI: 0.94–0.97) and those who were delivered at home (aHR = 0.56, 95% CI: 0.45–0.70), private maternity home (aHR = 0.45, 95% CI: 0.30–0.68) or health centre/clinic (aHR = 0.40, 95% CI: 0.26–0.60) compared to hospital delivery had lower risk of mortality. Regarding the household-level, neonates belonging to third quintile of the household wealth (aHR = 0.70, 95% CI: 0.52–0.94) and neonates belonging to households with crowded sleeping rooms (aHR = 0.91, 95% CI: 0.85–0.97) had lower risk of mortality.ConclusionThe findings of the study suggest the risk of neonatal mortality at the individual- and household-levels in the Kintampo Districts. Interventions and strategies should be tailored towards the high-risk groups identified in the study.
Highlights
Communities and their composition have an impact on neonatal mortality
In model IV, sex of neonates had a significant impact on neonatal mortality with females having 39% less risk of mortality as compared to males
Neonates whose mothers had no tetanus toxoid vaccine during pregnancy had 32% excess risk of mortality as compared to neonates whose mothers received the vaccine during pregnancy
Summary
Communities and their composition have an impact on neonatal mortality. considering the smallest health administrative units as communities and investigating the impact of these communities and their composition on neonatal mortality in Ghana have not been studied. It is projected that if the current trends continue, approximately half of the projected 69 million under-five deaths from 2016 to 2030 will occur during the neonatal period [4] This makes neonatal mortality a threat to under-five survival and the need to study its risk factors. Over the past two decades, the region has been experiencing the phenomenon of slower decline in neonatal mortality [6]; making it one of the regions which require huge resources to reducing neonatal mortality significantly. Ghana was not able to achieve MDG 4 due to huge burden of neonatal mortality This suggests that unless concerted efforts are made, Ghana will not be able to achieve the Sustainable Development Goal (SDG) 3 of reducing under-five and neonatal mortality rates to 25 and 12 per 1000 live births respectively [9]
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