Maternal Migration and Under-Five Mortality in The Kassena-Nankana Municipality and Kassenanankana West District Of Northern Ghana

Abstract

The levels of under-five mortality are disproportionately high in the developing world compared with those in the developed world. Several factors are responsible for this, and even though efforts have been made to address the problem, these needless deaths still occur. Sadly, children under age five tend to bear the brunt of these high death rates. This study seeks to examine the effect of maternal migration on under-five mortality in the Kassena-Nankana Municipality and Kassena-Nankana West District of northern Ghana. The study area is predominantly rural and agriculture is the mainstay of the people. Poverty is pervasive due to the generally low agricultural outputs and limited economic opportunities. As a result, seasonal migration has been one of the main livelihood strategies, where the people move to other places in the country in search of jobs. The study thus seeks to compare under-five mortality levels between children of migrant mothers and non-migrant mothers in the study area. Data from the Navrongo Health and Demographic Surveillance System (HDSS) in northern Ghana were used for the study. The HDSS has been operating since 1993 and uses fieldworkers who visit households periodically to collect health and demographic data. Specific data that are collected include pregnancies, births, deaths, in- and out migrations, household characteristics and assets, educational status of all individuals age six years and over, marital status and vaccination status of all children who are at most 3 years. The outcome (dependent) variable in the analysis was the survival status of the children (dead or alive). The main independent variable for the study was migration status of the mother, which was categorised into two main groups of migrants (return migrants) and non-migrants. The return migrants were further categorised into three groups according to their duration of stay before returning to place of origin (study area). Other independent variables were age of mother at time of birth of child, educational status of the mother, household socioeconomic status, birth order of children, place of delivery of children, number of children born from a single pregnancy (multiple or single birth) and presence or absence of grandmother in the household. In all, 20,990 children who were born between 2000 and 2014 were used for the analysis. Out of this number, 1,854 (8.8%) died before attaining age five years. Proportional Hazard Model, with a Weibull distribution, was used to examine the effect of the independent variables on the survival outcomes of the children. The results showed decline in neonatal, infant and under-five mortality in the study area over the years. However, neonatal mortality increased between 2013 and 2014, while infant mortality also increased marginally within the same period. The results also revealed that households of female return migrants (irrespective of duration) have a higher socioeconomic status than households of non-migrant mothers. With regards to the association between maternal migration and under-five mortality, the results showed that children of women who have ever migrated and returned have a better survival chance than children of non-migrant mothers. In terms of migration duration before return, survival benefits was highest for children whose mothers had been away for one year and more. Other factors that were found to impact on under-five mortality in the study area include maternal education, maternal age at birth of child, place of delivery of child, birth order of child, number of birth from one pregnancy and the presence of grandmother.

The study concludes with some recommendations aimed to improve child health and survival, as well as the general well-being of the people. Specifically, it recommended that so long as migration continues to play a part of the livelihood strategy of rural people, due to the unending challenges in these areas, policies should be put in place to improve migrants’ wellbeing at place of destination to enable them improve themselves and their origin households while at the same time contribute to the growth of the economy in the destination areas and the country at large. It also recommended that the health system should be strengthened to reverse the increases in neonatal and infant mortality recorded in recent times in the study area.