Impact of Child Health Interventions on Under-Five Mortality in Ghana, Evidence from 2008 and 2014 Ghana Demographic and Health Surveys
Date
2019-07
Authors
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Journal ISSN
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Publisher
University Of Ghana
Abstract
Background: Although under-five mortality (U5M) decreased worldwide and in
Ghana in the era of the Millennium Development Goals (MDGs), the decline in Ghana
has not been parallel with the level of interventions in maternal and child health.
Between 1990 and 2015, there was a 53% decline in mortality among children underfive
years globally. Ghana achieved a 50% decline in mortality (119/1,000 live births
to 60/1,000 live births) between 1993 and 2014. However, about 6 million under-five
deaths were recorded globally in 2015. Under-five mortality decline in Ghana has been
considered slow compared to countries at the global level even though there has been
an increase in coverage of some of the 26 listed interventions advocated for improving
child survival in Ghana. What was not known was the contribution of these
interventions to mortality reduction which this study sought to determine.
Objective: The objective of the study was to assess the impact of child health
interventions on under-five mortality in Ghana.
Methods: Secondary data of the 2008 and 2014 Ghana Demographic and Health
Surveys (GDHS) were analysed for this study. The main data sets comprised 2,992 and
5,884 observations of children under-five years from the 2008 and 2014 data sets
respectively. Coarsened Exact matching (CEM) with logistic and Poisson regressions
and Lives Saved Tool (LiST) were used for the impact assessment, while logistic and
Poisson regressions were fitted to assess the association between these interventions
and under-five mortality. The 2008 and 2014 data sets were pooled for the logistic
regression and CEM analysis.
Results: There were 6,098 children under-five years and 93 (1.5%) died. Among the
children who died, 47 (47.0%) were less than one month old. Fifty-six (56),
representing 65.7% of children who died were born to mothers below 35 years. Among the interventions, antenatal care visits coverage level was the highest (84.0%), while
water connection in the home had the lowest coverage level (8.1%). About 58 (1.4%)
of all children received all eight (8) interventions evaluated at the individual level, and
none of those who received all the eight interventions died. Early initiation of
breastfeeding reduced odds of death by 58% (aOR = 0.42, 95% CI: 0.2 - 0.8), while
clean postnatal care caused a 59% reduction in the odds of death (aOR = 0.41, 95%CI:
0.2-0.9). Interventions that saved the most lives among children under-five years at the
population level were malaria control interventions including insecticide treated net and
or indoor residual spraying (ITN/IRS) (8,524 lives saved, 16% mortality rate reduction)
and artemisinin-based combination therapy (ACTs) (5,702 lives saved, 10% mortality
rate reduction), labour and delivery management (skilled delivery) (4,726 lives saved,
8% mortality rate reduction) and pneumococcal vaccine (2,406 lives saved, 8%
mortality rate reduction). Reduction in the prevalence of wasting saved 11,918 lives
and contributed to a 19% reduction of mortality rate while, reduction in the prevalence
of stunting also saved 5,761 lives and contributed to an 11% reduction in under-five
mortality rate. However, complementary feeding targeted at reducing mortality via
reduction in stunting (-457 lives saved, -1% mortality rate reduction) and wasting (-62
lives saved, 0% mortality rate reduction) resulted in negative lives saved (excess
deaths/additional deaths) between 2008 and 2014.
Conclusion: Only two (2), interventions caused mortality reduction at the individual
level. A further decline in under-five mortality in Ghana will require increase in the
coverage levels of the few high impact interventions, especially those with low
coverage levels. Neonatal level interventions should be prioritized, since neonatal
mortality decline is slow and the proportion of neonatal deaths is on the increase in
Ghana as at the global level. Additionally, attention should be paid to other children at higher risk of dying including multiple births and children from polygamous homes.
Strategies to reduce the prevalence of stunting and wasting would also be beneficial.
Description
PhD. Public Health
Keywords
Under-Five Mortality (U5M), Child Health, Ghana Demographic and Health Surveys (GDHS)