Abstract
ObjectivesTo determine the neonatal mortality rate in the Kassena-Nankana District (KND) of northern Ghana, and to identify the leading causes and timing of neonatal deaths.MethodsThe KND falls within the Navrongo Health Research Centre’s Health and Demographic Surveillance System (HDSS), which uses trained field workers to gather and update health and demographic information from community members every four months. We utilized HDSS data from 2003–2009 to examine patterns of neonatal mortality.ResultsA total of 17,751 live births between January 2003 and December 2009 were recorded, including 424 neonatal deaths 64.8%(275) of neonatal deaths occurred in the first week of life. The overall neonatal mortality rate was 24 per 1000 live births (95%CI 22 to 26) and early neonatal mortality rate was 16 per 1000 live births (95% CI 14 to 17). Neonatal mortality rates decreased over the period from 26 per 1000 live births in 2003 to 19 per 1000 live births in 2009. In all, 32%(137) of the neonatal deaths were from infections, 21%(88) from birth injury and asphyxia and 18%(76) from prematurity, making these three the leading causes of neonatal deaths in the area. Birth injury and asphyxia (31%) and prematurity (26%) were the leading causes of early neonatal deaths, while infection accounted for 59% of late neonatal deaths. Nearly 46% of all neonatal deaths occurred during the first three postnatal days. In multivariate analysis, multiple births, gestational age <32 weeks and first pregnancies conferred the highest odds of neonatal deaths.ConclusionsNeonatal mortality rates are declining in rural northern Ghana, with majority of deaths occurring within the first week of life. This has major policy, programmatic and research implications. Further research is needed to better understand the social, cultural, and logistical factors that drive high mortality in the early days following delivery.
Highlights
Child mortality is declining worldwide, an estimated 8.8 million children still die every year before their fifth birthday [1]
The neonatal mortality rate for the period was 24 per 1000 live births and the early neonatal mortality (ENM) rate was 16 per 1000 live births
32% (137) of the neonatal deaths were from infections, 21% (88) from birth injury and asphyxia and 18% (76) from prematurity, making these three the leading causes of neonatal deaths in this region of northern Ghana
Summary
Child mortality is declining worldwide, an estimated 8.8 million children still die every year before their fifth birthday [1]. More than 40% of these children die within 28 days after birth (considered the ‘‘neonatal period’’), [1] a burden borne disproportionately by low- and middle-income countries [2]. Sub-Saharan Africa has among the highest neonatal mortality rates in the world, yet some of the weakest health and vital registration systems[3,4,5,6]. Neonatal mortality rates are typically estimated using complex statistical modelling, small hospital-based studies, or nationally representative demographic and health surveys that use cluster-level sampling of live births [7]. Neonatal mortality rates are often underestimated in developing country settings [4,8,9]. Without a clear sense of the true burden of neonatal deaths and the aetiology of those deaths, planning appropriate interventions is extremely difficult
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