Kassena-Nankana West District Research Articles

Gender vulnerability and coping strategies to changing provisioning ecosystem services in Bongo and Kassena-Nankana West districts in the Upper East Region of Ghana

ABSTRACT Ecosystems provide a wide variety of life-sustaining services but are currently facing severe degradation due to changing land use and cover. Women are presumed to be more affected by declines in provisioning ecosystem services (PES). These claims have not been empirically proven across all contexts and have been contested by recent studies. Few studies in Ghana have attempted to examine this gendered environmental change phenomenon. Underpinned by the vulnerability theory, this paper employed an eclectic methodological approach to examine gender differences in vulnerability and coping with changing PES in Ghana. The findings reveal that both males and females depend highly on agricultural and woodland ecosystems for their livelihood needs. The deterioration in the total areas of the major ecosystems has resulted in significant declines in vital PES such as wild edible fruits and vegetables, medicinal plants and building materials for both men and women over the past decade. The study further reveals that the decreases in fuelwood supply affect women more than men because the former group mostly cooks food in their households, using fuelwood. As adaptation mechanisms, male farmers mostly planted trees on their farms to reclaim unfertile land and conserve forests, while female farmers engage in fruits and vegetable trade in the markets, as well as used non-indigenous spices to enhance the taste of food. Both males and females have also resorted to relying on orthodox medicines contrary to the past. To increase ecosystem resilience, the mainstreaming of ecosystem integrity adaptation practices into national adaptation plans is paramount.

Population-based cross-sectional study of factors influencing full vaccination status of children aged 12- 23 months in a rural district of the Upper East Region, Ghana

BackgroundAchieving universal health coverage includes ensuring that children have access to vaccines that are of high quality, safe, efficacious, and affordable. The Immunisation Agenda 2030 aims to expand services to zero-dose and incompletely vaccinated children and reduce immunisation rate disparities as a contribution to vaccination equity. This study explored the factors influencing full vaccination status among children aged 12 – 23 months in a rural district of the Upper East Region of Ghana.MethodsA population-based cross-sectional study was conducted among carers of children aged 12 -23 months in the Kassena Nankana West district. A multistage sampling technique was used to select 360 carers. Information regarding the vaccination status of children was gathered through a combination of children’s health record books and carers’ recollections. Information on potential determinants was also systematically collected for analysis in Stata version 15.0.ResultsThe results showed that 76.9% (95% CI: 72.3 – 81.0) of children had full vaccinations per the national schedule. All children received at least one vaccination. A higher percentage of carers with incompletely vaccinated children reported that they had travelled with their children as the primary reason for missing certain vaccine doses. Full vaccination status was significantly associated with secondary (aOR = 2.60; 95% CI: 1.20—5.63) and tertiary (aOR = 3.98, 95% CI: 1.34—11.84) maternal educational level, being in a partnership relationship (aOR = 2.09, 95% CI: 1.03—4.25), and residing in close proximity to healthcare facilities (aOR = 0.41, 95% CI: 0.21—0.80).ConclusionsOur study found that nearly one-quarter of children aged 12—23 months in the study setting are underserved with vaccination services for a variety of reasons. Effectively reaching these children will require strengthening health systems, including eliminating vaccine shortages, addressing the unique challenges faced by unmarried women with children aged 12–23 months, and improving accessibility to vaccination services.

LEADERSHIP ROLES AND CHALLENGES AT THE JUNIOR HIGH SCHOOL LEVEL: THE PERCEPTION OF HEAD TEACHERS IN THE KASSENA NANKANA WEST DISTRICT OF THE UPPER EAST REGION OF GHANA

The purpose of the study was to find out the leadership roles and challenges facing Junior High School head teachers, as perceived by the head teachers in the Kassena Nankana West District of the Upper East Region of Ghana. The study used a quantitative research approach and a descriptive survey design. The population included all Junior High School Headteachers in the Kassena Nankana West District. A purposive sampling technique was employed to include all 34 Headteachers in the 34 Junior High Schools in the District. Structured questionnaire was the main instrument for data collection. The data was analysed using frequencies, percentages, means and standard deviations. The study found that Junior High School Headteachers were not properly prepared before and after their appointments. It emerged from the study that Headteachers’ were generally satisfied with the performance of their roles and responsibilities, though these responsibilities were considered to be numerous. The study revealed some particular challenges that affected head teachers. Most prominent among these were: performing administrative work and teaching at the same time; inadequate infrastructure; lack of offices for heads and store rooms; late payment of capitation grant; late submission of teaching lesson notes for vetting; misuse of instructional time; lack of teachers’ accommodation; indiscipline among students; non-payment of responsibility allowance and lack of motivation. Based on the findings, it was recommended among others that the procedures employed by Ghana Education Service in appointing head teachers should be reviewed and clearly defined procedures be followed in appointing professionals with relevant knowledge and experience as head teachers and not merely those who have achieved academic success or are in the system for long years. The government and GES should supply teaching and learning resources as well as other incentives before the beginning of the academic year.

Traditional and Western knowledge systems used by smallholders: Harnessing synergies for improved household food security in rural Ghana

ABSTRACT The discourse on knowledge integration persists in research and development practice. The need for traditional and Western knowledge systems to work together to achieve sustainable agricultural development in Ghana’s rural areas has become evermore relevant to achieve household food security in the context of changing climate, declining soil fertility, and labour challenges. The authors examined the role of knowledge integration in shaping the food security outcomes of socially differentiated smallholders’ households in Kassena-Nankana Municipal District and the Kassena-Nankana West District in the Upper East Region of Ghana, where food insecurity prevalence is very high. Using mixed methods approach, they found that most low resource endowed households that were unable to combine traditional and Western farming methods were more likely to experience food insecurity than were other households. Farmers with higher resource endowments integrated knowledges from both traditional and Western systems leading to better yield outcomes. However, combining both knowledge systems did not guarantee automatic success due to intervening factors. The authors conclude that different categories of smallholders’ resource endowment significantly impacts the smallholders’ food security status, and recommend that policy and development programming should promote integration of traditional and Western farming knowledge systems to achieve sustainable food crop production.

Land use and land cover change detection and prediction based on CA-Markov chain in the savannah ecological zone of Ghana

Environmental problems have accompanied the accelerated land use and land cover change (LULCC), yet few local level studies make an attempt to assess the dynamics of LULCC. This work employed GIS and remote sensing to quantify the past and predict future dynamics of LULCC based on the synergy Cellular Automata (CA) - Markov Chain Model (MCM). The results revealed that agricultural land in the Bongo district witnessed the greatest expansion from 10.03% to 27.17% of total area from 1990 to 2019, while wooded savannah area witnessed the greatest decline from a share of 42.26% to 15.51% of total area from 1990 to 2019. In the Kassena-Nankana West (KNW) district, shrub and tree savannah and agricultural land expanded from 32.91% to 54.2% and 9.44% to 18.16% of the total area, respectively, at the expense of wooded savannah area (-32.9% of total area) between 1990 and 2019. Future predictions based on prevailing socio-economic development demonstrate that the observed trend would continue till the 2050 period. In the Bongo district, the settlement area will witness the highest proportion of net increase in total area (5.63 km2) at the expense of wooded savannah (-11.26 km2) between 2019 and 2050. Conversely, in the KNW district, the shrub and tree savannah area will experience the highest proportion of net gain in total area (156.02 km2) at the expense of wooded savannah area (-111.49 km2) between 2019 and 2050. This result is an indication that the synergy CA-MCM have effectively captured the spatiotemporal trend in LULCC in this study.

Resource-use Efficiency of Shea Nut Processing in Kassena-Nankana West District, Ghana: DEA Approach

The Shea tree, Vitellaria paradoxa, has been seen as a very important economic God-given tree with numerous benefits for a longtime. The Shea tree, though under threat due to deforestation, still remain abundant in several communities in Ghana. That notwithstanding, shea nut processors have not been able to fully optimize the gains from the Shea tree and thus, this research examines the Resource-use efficiency of Shea nut processing in the Kassena-Nankana West District of Ghana. Data Envelopment Analysis (DEA) was employed to determine the overall technical, pure technical and scale efficiency of the Shea nut processing while bivariate Tobit was used to identify the sources or determinants of both technical and pure technical efficiencies. A SWOT analysis was carried out to identify the potentials and challenges faced by the Shea processors. It was discovered that on the average, the processors operated 50% of their potential overall technical efficiency, 55% of their potential pure technical efficiency and 92% of their potential scale efficiency. Determinants of processors’ technical efficiency include age, household size, experience, access to credit and membership of processors’ group. The SWOT analysis revealed challenges including poor transportation and difficulty in accessing credit. The study, therefore, recommends that, easy access to financial facilities and sensitization on savings are ways to boost processors’ use of new, efficient technologies to help enhance their Resource-use efficiency. Improvement on the road network to enhance easy movement of goods and services is highly recommended.

Village savings and loans association participation and impact on off-farm income among rural women

PurposeThis paper aims to examine the factors that influence rural women’s participation in Village Savings and Loans Association (VSLA) and the savings contribution in the Kassena-Nankana West District of Ghana. The study also analysed the impact of VSLA participation on off-farm income and on poverty.Design/methodology/approachIn total, 120 rural women were selected for this study. The probit and heteroskedasticity linear regression models were used to examine the factors that influence VSLA participation and the savings made by members, respectively. The propensity score matching technique, coupled with Rosenbaum Sensitivity analysis, were used to analyse the impact of VSLA on off-farm income and poverty.FindingsDemographic and livelihood factors such as human, natural, financial, physical and social capitals have different influences on the participation and the savings contribution in the VSLA. Moreover, VSLA has a significant impact on off-farm income; however, it did not affect poverty.Originality/valueDespite the numerous studies on VSLA, there is little evidence of literature of its impact on off-farm income of rural women in West Africa, specifically, Ghana. Thus, this paper expands the frontiers of the existing literature on VSLA impact assessment and the factors that influence the savings made by women in the association.

The Risk Factors for Pulmonary Tuberculosis Incidence in Ghana: A Small Matched Case-control Study

Aims: Knowing the risk factors for tuberculosis (TB) opens up avenues for identifying target groups for intensified case finding. We aimed to identify the risk factors for pulmonary TB (PTB) incidence in a rural district in northern Ghana.
 Study Design: A matched case-control study.
 Place and Duration of Study: The Kassena Nankana West District of the Upper East Region of Ghana, between February 2019 and March 2019.
 Methodology: This study was conducted in 4 public health facilities. Cases were newly confirmed PTB patients aged 15 years or over, controls were age and sex matched outpatients. A pre-tested questionnaire collected information on a range of possible risk factors from participants. Conditional logistic regression identified independent risk factors for PTB incidence in a multivariable model at 95% confidence level.
 Results: The analysis included 174 cases and controls. Multivariable analysis showed that the risk of PTB was increased with low household monthly income (AOR=3.45; 95% CI: 1.08-10.97; P=.03), smoking (AOR=2.69; 95% CI: 1.13-6.43; P=.02) as well as household exposure to a known TB case (AOR=2.57; 95% CI: 1.08-6.10; P=.03).
 Conclusion: Low household monthly income, smoking, and household exposure to a known TB case were independent risk factors for PTB incidence. These factors can be used to actively screen for PTB in the population.

Financial Management Practices and Growth of Small and Medium-Scale Enterprises: The case of Kassena-Nankana West District

The promotion of financial management practices and growth of Small and Medium-scale Enterprises (SMEs) can contribute significantly towards the sustained elevation of a nation for a better or more humane life. SMEs play a crucial role in addressing the impediments of poverty, inequality and job creation. Yet, many SMEs face numerous challenges ranging from the lack of capital, poor management skills and the application of best financial management practices.This paper explores SMEs’ financial management skills and practices in relation to their growth. The study used questionnaire to collect data from managers or owners of SMEs. Descriptive statistics was used to present the results of the data. Not only that but also, a multiple regression model was also used to test the correlation between financial management practices of SMEs and business growth. The results indicates a moderate correlation between the financial management practices of the SMEs and the growth of the enterprises. Based on the findings, it is recommended for targeted financial education programmes to help managers and owners of SMEs develop and adopt best financial management practices.

Groundwater fluoride contamination and probabilistic health risk assessment in fluoride endemic areas of the Upper East Region, Ghana

Groundwater fluoride contamination has long been recognized as a water-related health issue in some parts of Ghana. However, the extent of fluoride contamination and the related human health risk to the communities in the fluoride endemic areas are not adequately studied. In this paper, fluoride concentrations in existing and newly drilled wells were assessed. Probabilistic non carcinogenic human health risk assessment, uncertainty and sensitivity analysis for three age groups (Group A: 0–10 years; Group B: 11–20 years; Group C: 21–72 years) was also carried out using Monte Carlo simulation technique. The results showed that, 27.27% and 15.38% of the existing wells in the Bongo and Kassena Nankana West districts have fluoride values above the guideline value 1.5 mg L−1 respectively. The non-carcinogenic risk of fluoride associated with oral ingestion recorded a mean Hazard Quotient (HQ) > 1 for younger age group (0–10 years) in all the study areas signifying potential health risk to this age group. Additionally, when the upper 95th percentile is used for the HQ, the oral ingestion for all the age categories recorded an HQ > 1. Sensitivity analyses indicated that fluoride concentration in the drinking water and ingestion rate were the most relevant variables in the model to reduce the potential health effect. The study established the basis for a strong advocacy and public awareness on the effect of water quality on human health and proposed some management strategies to guide future groundwater resources management to reduce the potential health risk to the population.

Understanding the gap in emergency obstetric and neonatal care in Ghana through the PREventing Maternal And Neonatal Deaths (PREMAND) study.

To explore basic and comprehensive emergency obstetric service provision across four districts in rural northern Ghana, and whether women were more likely to deliver at facilities with more skilled care. Field workers geo-coded all health facilities in East Mamprusi, Sissala East, Kassena Nankana Municipal, and Kassena Nankana West districts, and administered surveys to assess providers and emergency obstetric care available. Data were also prospectively collected on delivery locations of women and neonates who died, or nearly died (near misses), between September 1, 2015 and April 30, 2017. There were 14 physicians for a population of nearly 360000 women. Six (6%) facilities could provide basic emergency care, and 3 (3%) could provide comprehensive care. Services were distributed unequally, with 6 (67%) of the emergency facilities located in the least populated district. Among the sample of women and neonates who died or nearly died, 175 (39%) delivered at locations unable to provide basic emergency services. Access to emergency obstetric and neonatal care was distributed inequitably across these districts, suggesting the need to revisit geographic placement of facilities relative to population. The study also raised the question of how to ensure facilities are equipped to respond to emergencies.

Potential factors influencing lymphatic filariasis transmission in \u201chotspot\u201d and \u201ccontrol\u201d areas in Ghana: the importance of vectors

BackgroundMass drug administration (MDA) programmes for the control of lymphatic filariasis in Ghana, have been ongoing in some endemic districts for 16 years. The current study aimed to assess factors that govern the success of MDA programmes for breaking transmission of lymphatic filariasis in Ghana.MethodsThe study was undertaken in two “hotspot” districts (Ahanta West and Kassena Nankana West) and two control districts (Mpohor and Bongo) in Ghana. Mosquitoes were collected and identified using morphological and molecular tools. A proportion of the cibarial armatures of each species was examined. Dissections were performed on Anopheles gambiae for filarial worm detection. A questionnaire was administered to obtain information on MDA compliance and vector control activities. Data were compared between districts to determine factors that might explain persistent transmission of lymphatic filariasis.ResultsHigh numbers of mosquitoes were sampled in Ahanta West district compared to Mpohor district (F = 16.09, P = 0.002). There was no significant difference between the numbers of mosquitoes collected in Kassena Nankana West and Bongo districts (F = 2.16, P = 0.185). Mansonia species were predominant in Ahanta West district. An. coluzzii mosquitoes were prevalent in all districts. An. melas with infected and infective filarial worms was found only in Ahanta West district. No differences were found in cibarial teeth numbers and shape for mosquito species in the surveyed districts. Reported MDA coverage was high in all districts. The average use of bednet and indoor residual spraying was 82.4 and 66.2%, respectively. There was high compliance in the five preceding MDA rounds in Ahanta West and Kassena Nankana West districts, both considered hotspots of lymphatic filariasis transmission.ConclusionsThe study on persistent transmission of lymphatic filariasis in the two areas in Ghana present information that shows the importance of local understanding of factors affecting control and elimination of lymphatic filariasis. Unlike Kassena Nankana West district where transmission dynamics could be explained by initial infection prevalence and low vector densities, ongoing lymphatic filariasis transmission in Ahanta West district might be explained by high biting rates of An. gambiae and initial infection prevalence, coupled with high densities of An. melas and Mansonia vector species that have low or no teeth and exhibiting limitation.

Contribution of Nontimber Forest Products to Rural Household Income in the Kassena-Nankana West District of Ghana

Abstract The contribution of income from nontimber forest products (NTFPs) to rural livelihoods and household income has received global recognition. However, there are growing concerns of overexploitation of NTFPs driven by poverty and policy neglect that threaten the sustainability of the NTFP resource base in Kassena-Nankana West District (KNWD) of Ghana. The study investigated the contribution of income from NTFPs to household income and socioeconomic factors that influence the collection and marketing of NTFPs in KNWD. Using a multistage sampling technique, quantitative data were collected from 375 households through structured survey questionnaires. Qualitative data were gathered through focus group discussions, key informant interviews, and field observations. Results showed that income from NTFPs forms a significant part of household income with a contribution of 32.69 percent to household income. Regression analysis revealed sex of respondent (P = 0.057), household size (P = 0.046), agricultural land size (P = 0.000), NTFP retailers (P = 0.000), NTFP wholesalers (P = 0.000), and value-added NTFPs (P = 0.000) as significantly and positively correlated with income from NTFPs. Results further indicated that poor households depend primarily on NTFPs in order to achieve their subsistence and income needs compared to high-income households. This research recommends that stakeholders and policymakers consider the needs of forest-dependent communities in policy analysis on NTFP conservation measures. Also, the role of households, especially the low income (poor), in the management of forest resources should be spelled out since they depend primarily on NTFPs to meet their subsistence and income needs.

Climate change adaptation through agroforestry: The case of Kassena Nankana West District, Ghana

The paper aims at assessing agroforestry as an adaptation strategy to a changing local climate. Agroforestry is necessitated by the need to improve tree population along the Sisili River and other areas in the Kassena Nankana West District. Primary data were generated through survey methods in which questionnaires were administered to 75 agroforestry farmers. It was triangulated with eight focus group discussions and five key informant interviews. Additionally, secondary data on rainfall and temperature (1984–2015) were analysed. The study revealed that farmers have noticed changes in the local climate as declining rainfall and increasing sunshine associated with rising temperature. Secondly, agroforestry was found to be useful in reducing water and wind erosion of soil, it improves soil nutrients, moisture retention and household food availability. Agroforestry is challenged with water shortages, unsupervised livestock grazing and bushfires. The study concludes that agroforestry is a dynamic agricultural adaptation option to a changing local climate. Therefore, the Ministry of Food and Agriculture and NGOs should support farmers with dams and fencing materials and encourage more farmers to adopt agroforestry.

Change and Continuity in Kassena Men's Perceptions of Family Planning in Northern Ghana

Studies suggest that men's perceptions of family planning in sub-Saharan Africa would be improved if they were included more extensively in family planning programs. However, few studies capture how men's views change over time and what processes are responsible for these shifts. Examining the processes that underpin men's shifting family formation strategies is essential in order to understand the impact of family planning programs. This research, framed by a political economy of fertility approach that draws on life history data, highlights intergenerational change and continuity in men's perceptions of family planning in Kassena-Nankana West District of the Upper East Region of Ghana, where a family planning program involving men was implemented in the 1990s. Eight months of ethnographic fieldwork was conducted in rural village and clinic settings in 2013 and 2014. We find that men's sense of responsibility for the cost of schooling, against a changing economic backdrop, as well as shifts toward “companionate marriage” are among the most salient factors contributing to their growing approval of family planning. This study highlights the importance of paying attention to changes in the larger socioeconomic context that encourage men's acceptance of family planning. We argue that programs incorporating men should move beyond health education to consider broader social and economic drivers of attitudinal change.

Assessing the Impact of In-service Training Programmes on Basic School Teachers of China in the Kassena Nankana West District of Ghana

Assessing the Impact of In-service Training Programmes on Basic School Teachers of China in the Kassena Nankana West District of Ghana Dr. Anthony Kudjo Donkor, Ronald Diwora Banki Abstract Teachers, like any other professional staff need continuous professional development programmes to get abreast with the changing needs of the profession. This can be achieved through in-service education and training (INSET). It is obvious that lack of access to in-service training cripples the development of the staff as well as the academic performance of students. The issue at stake was that in-service training programmes were not adequately organized on regular basis for teachers of Chiana in the Kassena Nankana West District (KNWD). The research study employed a descriptive approach design. In all fifty-one (51) teachers from schools in the school district and four education officers of the Ghana education Service and the Ministry of Education took part in the study. Research instruments include questionnaires, interviews and training documents or records were used to obtain data for the study. Frequencies and percentage distribution tables were used in analyzing the data from the questionnaires while the interviews were also transcribed to obtain themes. The study revealed that teachers were not naïve to INSETs as well as their relevance. The teachers in Chiana admitted that when they attend INSETs, knowledge and skills were acquired for professional development and competency. Based on the findings of the study it was recommended that regular INSETs should be organized for teachers in order to update their knowledge and skills for efficient delivery on their jobs. This study will be beneficial to teachers, students and policy makers in education. Full Text: PDF DOI: 10.15640/jehd.v6n4a8

Data Reliability: Comparison between Census and Health and Demographic Surveillance System (HDSS) Outputs for Kassena-Nankana East and West Districts, Ghana

Considering the importance of reliable and accurate demographic data for development planning and the errors often associated with census data in Africa, this paper examines the level of consistency of reporting between the 2010 Ghana Population Census and the Health and Demographic Surveillance System (HDSS) for Kasena-Nankana East Municipal and Kassena-Nankana West district in the Republic of Ghana. We apply data evaluation techniques to assess data quality and adopt Test of Proportions to examine differences between the two data systems. The results show some level of consistency between the Census and HDSS data relative to age-sex distribution, crude death rate and mortality pattern. However, the HDSS data suggest relatively better reporting than the Census. We conclude that the large differences observed in some indicators need to be interrogated further to identify their sources so as to allow for improvement in quality of subsequent waves of data collection.

Mapping vulnerability to multiple hazards in the savannah Ecosystem in Ghana

The interior savannah ecosystem in Ghana is subjected to a number of hazards, including droughts, windstorms, high temperatures and heavy rainfall. The frequency and intensity of these hazards are projected to increase during the twenty-first century as a result of climate variability and change. Vulnerabilities to these hazards vary, both spatially and temporally, due to differences in susceptibilities and adaptive capacities. Many mapping exercises in Ghana have considered the impacts of single hazards on single sectors, particularly agriculture. But the hazards often occur concurrently or alternately and have varying degrees of impacts on different sectors. The impacts also interact. These interactions make mapping of the vulnerabilities of multiple sectors to multiple hazards imperative. This paper presents an analysis of the spatial dimension of vulnerabilities by mapping vulnerability of sectors that support livelihood activities at a single point in time, using the Upper East Region of Ghana as a case study. Data collected to develop the maps were largely quantitative and from secondary sources. Other data drew on fieldwork undertaken in the region from July to September 2013. Quantitative values were assigned to qualitative categorical data as the mapping process is necessarily quantitative. Data were divided into susceptibility and adaptive capacity indicators and mapped in ArcGIS 10.2 using weighted linear sum aggregation. Agriculture was found to be the most vulnerable sector in all districts of the Upper East Region and experienced the greatest shocks from all hazards. Although all districts were vulnerable, the Talensi, Nabdam, Garu-Temapane and Kassena-Nankana West Districts were most vulnerable. Findings highlight the need for more targeted interventions to build adaptive capacity in light of the spatial distributions of vulnerabilities to hazards across sectors.

Clustering of under-five mortality in the Navrongo HDSS in the Kassena-Nankana District of northern Ghana

Background: Under-five mortality is a major public health problem and one of the health indicators of health care in sub-Saharan Africa. In order to address inefficient health systems, there is a need to identify the spatial distribution of under-five mortality, especially areas of high mortality clustering. This study aimed to explore spatial and temporal clustering in under-five mortality in the Kassena-Nankana11In 2008, the Kassena-Nankana District was split into two districts: Kassena-Nankana West District and Kassena-Nankana East District. District of the Upper East region.Methods: We used data from the Navrongo Health and Demographic Surveillance System in the Kassena- Nankana District of northern Ghana, which had an average population of 140,000 of which about 18,400 were under five years of age. We analysed under-five mortality in 49 villages during the period 1997–2006. We calculated total under-five mortality rates and investigated their geographical distributions. A spatial scan statistic was used to test for clustering of the mortality in both space and time.Results: Under-five mortality has been declining during the period. However, the data show a persistently higher than average clustering of mortality over the period among villages mainly in the north-eastern parts of the district.Conclusion: There is a higher than average under-five mortality clustering in the villages in the north-east of the district and this may suggest a relatively poor health care system despite the many health interventions that took place over time in the district, including the Community Health and Family Planning Project, whose impact may not have been felt in these parts of the district between 1995 and 2004.