Determinants of under Five Mortality in Ghana; A Logistic Regression Analysis Using Evidence from the Demographic and Health Survey (1988-2014)

Gideon Kwarteng Acheampong^{1, 2,} and Yvette Eyram Avorgbedor²

¹Ghana Health Service, Disease Surveillance Department, PMB Ministries, Accra-Ghana

²Ensign College of Public Health, P.O. Box AK 136, Kpong, Eastern Region-Ghana

Cite this paper

Gideon Kwarteng Acheampong and Yvette Eyram Avorgbedor. Determinants of under Five Mortality in Ghana; A Logistic Regression Analysis Using Evidence from the Demographic and Health Survey (1988-2014). American Journal of Public Health Research. 2017; 5(3):70-78. doi: 10.12691/AJPHR-5-3-4

Abstract

A dramatic reduction in child mortality has been noted in Ghana in recent time and although the trend has been projected to continue to decline, studies have shown that the decline in under-five mortality has stalled and the effect more outstanding at different levels. Here we examine the issue of under five mortality using data from the demographic and health survey by examining the trends in under-five mortality between 1988-2014 and develop a predictive model to identify risk factors of under five mortality. Data from the Ghana Demographic and Health survey between 1988-2014 was used to conduct a retrospective analysis of recorded children data (0-5 years). A descriptive analysis of the explanatory and response variables was carried out followed by a subsequent trend analysis of under-five mortalities from 1988-2014. A logistic regression was used to predict the association between the explanatory variables and the dependent outcome variable. The study established that the decrease in under five mortality that Ghana witnessed from 1988-2014 was not significant and that more measures need to be put in place to reduce the phenomenon. Variables such as maternal age (R²=0.0646, p<0.05), duration of breastfeeding (R²=0.3300, p<0.05) and the type of assistance at delivery (R²=0.2898, p<0.05) were all strong predictors of under five mortality relative to other explanatory variables. The study identified that issues such as young maternal age, exclusive breast feeding beyond 6 months and unskilled or no assistance at birth were all contributors of under five mortality in Ghana and as such it is necessary for all these predictors to be addressed and factored during formulation and implementation of policies in an effort to curb under five mortality.

Keywords

under five mortality, Ghana demographic and health survey (GDHS), logistic regression, child survival, trend analysis

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	G. A. Kayode, V. T. Adekanmbi, and O. A. Uthman, “Risk factors and a predictive model for under-five mortality in Nigeria: evidence from Nigeria demographic and health survey.,” BMC Pregnancy Childbirth, vol. 12, no. 1, p. 10, 2012.
[2]	D. Sahu, S. Nair, L. Singh, B. K. Gulati, and A. Pandey, “Levels, trends & predictors of infant & child mortality among Scheduled Tribes in rural India.,” The Indian journal of medical research, vol. 141, no. 5. pp. 709-19, 2015.
[3]	Jamal Uddin, “Predictors of Infant Mortality in a Developing Country,” Asian J. Epidemiol., vol. 3, no. 2, pp. 1-16, 2008.
[4]	UNDP, “Sustainable Development Goals,” 2015.
[5]	M. Saaka and M. Iddrisu, “Patterns and Determinants of Essential Newborn Care Practices in Rural Areas of Northern Ghana,” vol. 2014, 2014.
[6]	M. Vaahtera, T. Kulmala, M. Ndekha, a M. Koivisto, T. Cullinan, M. L. Salin, and P. Ashorn, “Antenatal and perinatal predictors of infant mortality in rural Malawi.,” Arch. Dis. Child. Fetal Neonatal Ed., vol. 82, no. 3, pp. F200-F204, 2000.
[7]	C. Papageorgiou, “Education Inequality among Women and Infant Mortality: A cross-country empirical investigation ∗,” 2008.
[8]	K. Rosicova, A. Madarasova Geckova, J. P. Van Dijk, J. Kollarova, M. Rosic, and J. W. Groothoff, “Regional socioeconomic indicators and ethnicity as predictors of regional infant mortality rate in Slovakia,” Int. J. Public Health, vol. 56, no. 5, pp. 523-531, 2011.
[9]	P. N. Cohen, “Maternal age and infant mortality for White, Black, and Mexican mothers in the United States,” Sociol. Sci., vol. 2, no. 2013, pp. 32-38, 2016.
[10]	D. Buor, Accessibility and utilisation of health services in Ghana. 2004.
[11]	E. Frankenberg, “The effects of access to health care on infant mortality in Indonesia,” Heal. Transit. Rev., vol. 5, no. 2, pp. 143-163, 1995.
[12]	C. Ronsmans, “Birth Spacing and Child Survival in Rural Senegal,” vol. 25, no. 5, 1996.
[13]	Augusta Hanu Okantey, “LOGISTIC REGRESSION ANALYSIS OF DETERMINANTS OF NEONATAL MORTALITY IN GHANA,” 2008.
[14]	Ghana Statistical Service, “Ghana Multiple Indicator Cluster Survey with an Enhanced Malaria Module and Biomarker,” Ghana Stat. Serv., 2011.
[15]	Unicef, World Health Organization, and The World Bank, “UNICEF-WHO- World Bank. Joint Child Malnutrition Estimates: Levels & trends in child malnutrition,” Africa (Lond)., p. 35, 2012.
[16]	World Health Organization, “Trends in Maternal Mortality:1990 to 2010, in: WHO, UNICEF, UNFPA and The World BankEstimatesNo Title,” 2012.
[17]	UNICEF, “Newborn Mortality,” pp. 0-2, 2015.
[18]	Population and Housing Census, “2010 Population and housing census: Final results,” Ghana Stat. Serv. Final results, p. 11, 2012.
[19]	GDHS, “Ghana Demographic Health Survey,” Ghana Stat. Serv., p. 530, 2014.
[20]	UNICEF, “Map of Ghana,” no. 4186, p. 4186, 2005.
[21]	R.. Bello and A.. Joseph, “Determinants of Child Mortality in Oyo State, Nigeria,” An Int. Multidiscip. Journal, Ethiop., vol. 8, no. 32, pp. 252-272, 2014.
[22]	H. E. Mustafa, “Socioeconomic determinants of infant mortality in Kenya,” Humanit. Soc. Sci., vol. 2, no. 2, pp. 1-16, 2008.
[23]	O. K. Ezeh, K. E. Agho, M. J. Dibley, J. J. Hall, and A. N. Page, “Risk factors for postneonatal, infant, child and under-5 mortality in Nigeria: a pooled cross-sectional analysis.,” BMJ Open, vol. 5, no. 3, p. e006779, 2015.
[24]	J. E. Finlay, E. Ozaltin, and D. Canning, “The association of maternal age with infant mortality, child anthropometric failure, diarrhoea and anaemia for first births: evidence from 55 low- and middle-income countries,” BMJ Open, vol. 1, no. 2, pp. e000226-e000226, 2011.
[25]	J. Balayla, “Maternal Marital Status and the Risk of Stillbirth and Infant Death: A Population- Based Cohort Study on 40 Million Births in the United States,” no. September 2016, 2011.
[26]	H. Lee, D. Van Do, S. Choi, O. Thi, H. Trinh, and K. G. To, “Trends and determinants of infant and under-five childhood mortality in Vietnam, 1986 2011,” vol. 1, pp. 1-10, 2016.
[27]	P. T. Amankwaa-Adansi, A., Bavon, A. I. and Nkansah, “Rural Urban Migration and its Effects on Infant and Child mortality in Ghana,” African Popul. Stud., vol. 18, pp. 1-26, 2003.
[28]	O. Gruebner, S. Lautenbach, M. M. H. Khan, and S. Kipruto, “Place of Residence Moderates the Risk of Infant Death in Kenya: Evidence from the Most Recent Census 2009,” pp. 1-17, 2015.
[29]	J. R. Weeks, A. G. Hill, A. Getis, and D. Stow, “Ethnic residential patterns as predictors of intra-urban child mortality in Accra, Ghana,” Urban Geogr., vol. 3638, no. May 2013, pp. 37-41, 2006.
[30]	D. G. Wiehl, “The Correction of Infant Mortality Rates for Residence,” no. 2, pp. 495-510.
[31]	P. K. Mwaniki, E. W. Kabiru, and G. G. Mbugua, “Utilisation of antenatal and maternity services by mothers seeking child welfare services in Mbeere District, Eastern Province, Kenya.,” East Afr. Med. J., vol. 79, no. 4, pp. 184-187, Apr. 2002.
[32]	D. Buor, “Mothers’ education and childhood mortality in Ghana,” Health Policy (New. York)., vol. 64, no. 3, pp. 297-309, 2003.
[33]	R. N. O. Aryeetey and Y. E. Goh, “Duration of Exclusive Breastfeeding and Subsequent Child Feeding Adequacy,” Ghana Med. J., vol. 47, no. 1, pp. 24-29, 2013.
[34]	B. G. B. Y. W. A. G. YK, “Exclusive breast feeding is the strongest predictor of infant survival in Northwest Ethiopia: a longitudinal study. TT -,” J. Heal. Popul. Nutr., vol. 34, no. 9, p. [6] p, 2015.
[35]	S. Arifeen, B. Re, G. Antelman, A. Baqui, L. Caulfield, and B. S. Exclusive, “Effect of Breastfeeding on Diarrheal Mortality,” pp. 52-71, 2001.
[36]	L. A. Brakohiapa, A. Bille, E. Quansah, K. Kishi, J. Yartey, E. Harrison, M. A. Armar, and S. Yamamoto, “DOES PROLONGED BREASTFEEDING ADVERSELY AFFECT A CHILD’S NUTRITIONAL STATUS?,” Lancet, vol. 332, no. 8608, pp. 416-418, Sep. 2016.
[37]	M. S. Kramer, L. Matush, I. Vanilovich, R. W. Platt, N. Bogdanovich, Z. Sevkovskaya, I. Dzikovich, G. Shishko, J. Collet, R. M. Martin, G. D. Smith, and M. W. Gillman, “Effects of prolonged and exclusive breastfeeding on child height , weight , adiposity , and blood pressure at age 6 . 5 y: evidence from a,” pp. 1717-1721, 2007.
[38]	W. A. Stanley, L. R. B. Huber, S. B. Laditka, E. F. Racine, and W. A. Stanley, “Association of type of birth attendant and place of delivery on infant mortality in sub-Saharan Africa .,” vol. 16, no. 1, pp. 1-9, 2016.
[39]	S. J. Atunah-Jay, S. Pettingell, S. A. Ohene, J. Michael Oakes, and I. W. Borowsky, “The relationship between antenatal provider type and maternal care in rural Ghana: A cross-sectional study,” Trop. Med. Int. Heal., vol. 18, no. 6, pp. 678-686, 2013.
[40]	F. Tessema, “Under five mortality and its predictors in Gilgel Gibe Health and Demographic Surveillance System Site , South West Ethiopia Fasil Tessema Gilgel Gibe Field Research Center Institute of Health Sciences Research Jimma University,” pp. 1-17, 2013.
[41]	E. W. Kimani-Murage, J. C. Fotso, T. Egondi, B. Abuya, P. Elungata, A. K. Ziraba, C. W. Kabiru, and N. Madise, “Trends in childhood mortality in Kenya: The urban advantage has seemingly been wiped out,” Heal. Place, vol. 29, pp. 95-103, 2014.
[42]	C. Mutunga, “Environmental determinants of child mortality in urban Kenya,” Discussed an informal Work. held Abdus …, no. April 2004, pp. 1-13, 2004.
[43]	J. Davanzo, A. Razzaque, M. Rahman, L. Hale, W. K. Ahmed, M. A. L. I. Khan, G. Mustafa, and K. Gausia, “The Effects of Birth Spacing on Infant and Child Mortality , Pregnancy Outcomes , and Maternal Morbidity and Mortality in Matlab , Bangladesh,” no. October, 2004.
[44]	R. Afeworki, J. Smits, J. Tolboom, and A. Van Der Ven, “Positive Effect of Large Birth Intervals on Early Childhood Hemoglobin Levels in Africa Is Limited to Girls: Cross-Sectional DHS Study,” pp. 1-14, 2015.