Abstract
BackgroundGlobally, millions of children aged below 5 years die every year and some of these deaths could have been prevented. Though a global problem, under-five mortality is also a major public health problem in Ghana with a rate of 60 deaths per 1000 live births. Identification of drivers of mortality among children aged below 5 years is an important problem that needs to be addressed because it could help inform health policy and intervention strategies aimed at achieving the United Nations SDG Goal 3 target 2. The aim of this study is to develop a predictive model and to identify determinants of under-five mortality.MethodThe 2014 Ghana Demographic and Health Survey data was used in this study. Analyses were conducted on 5884 children. The outcome variable is child survival status (alive or dead). Single level binary logistic and multilevel logistic regression models were employed to investigate determinants of under-five mortality. The fit of the model was checked using Variance Inflation Factor and Likelihood Ratio tests. The Receiver Operating Characteristic curve was used to assess the predictive ability of the models. A p-value< 0.05 was used to declare statistical significance.ResultsThe study observed 289 (4.91%) deaths among children aged below 5 years. The study produced a good predictive model and identified increase in number of total children ever born, number of births in last 5 years, and mothers who did not intend to use contraceptive as critical risk factors that increase the odds of under-five mortality. Also, children who were born multiple and residing in certain geographical regions of Ghana is associated with increased odds of under-five mortality. Maternal education and being a female child decreased the odds of under-five mortality. No significant unobserved household-level variations in under-five mortality were found. The spatial map revealed regional differences in crude under-five mortality rate in the country.ConclusionThis study identified critical risk factors for under-five mortality and strongly highlights the need for family planning, improvement in maternal education and addressing regional disparities in child health which could help inform health policy and intervention strategies aimed at improving child survival.
Highlights
Millions of children aged below 5 years die every year and some of these deaths could have been prevented
This study identified critical risk factors for under-five mortality and strongly highlights the need for family planning, improvement in maternal education and addressing regional disparities in child health which could help inform health policy and intervention strategies aimed at improving child survival
Though there has been a significant reduction in Under-five mortality globally over the years, it is still a major public health problem in developing countries, especially in Sub-Saharan Africa where the rates have been persistently higher compared to other regions from 1990 to 2016
Summary
Millions of children aged below 5 years die every year and some of these deaths could have been prevented. Though there has been a significant reduction in Under-five mortality globally over the years, it is still a major public health problem in developing countries, especially in Sub-Saharan Africa where the rates have been persistently higher compared to other regions from 1990 to 2016. The global under-five mortality rate in the year 2016 was 41 deaths per 1000 live births, a decline over the previous rate of 93 deaths per 1000 live births in the year 1990. Despite the substantial decline in global under-five mortality, the rates remain high in Sub-Saharan Africa where many countries like Ghana in the region failed to meet the Goal 4 of the Millennium Development Goals (MDGs) targets which aimed at a two-thirds reduction in the under-five mortality rate by 2015. The under-five mortality rate in Ghana is still high with a rate of 60 deaths per 1000 live births in 2014 which fell short of the target set in the Ghana Under-five Child Health Policy 2007–2015 which targeted a reduction in under-five mortality to 40 deaths per 1000 live births by 2015 [4, 5]
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