Individual and community determinants of neonatal mortality in Ghana: a multilevel analysis

BMC Pregnancy and Childbirth

Kerstin Klipstein-Grobusch²  Diederick E Grobbee¹  Mary Amoakoh-Coleman³  Irene Akua Agyepong⁴  Evelyn Ansah³  Gbenga A Kayode¹ 

[1] Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, Utrecht, GA 3508, The Netherlands;School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;Ghana Health Service, Greater Accra Region, Accra, Ghana;Ghana School of Public Health, University of Ghana, Legon, Accra, Ghana

关键词: Ghana;    Multilevel analysis;    Community factors;    Individual factors;    Neonatal mortality;   

Others  :  1127342
DOI  :  10.1186/1471-2393-14-165

 received in 2013-06-06, accepted in 2014-04-24,  发布年份 2014

【 摘 要 】

Background

Neonatal mortality is a global challenge; identification of individual and community determinants associated with it are important for targeted interventions. However in most low and middle income countries (LMICs) including Ghana this problem has not been adequately investigated as the impact of contextual factors remains undetermined despite their significant influence on under-five mortality and morbidity.

Methods

Based on a modified conceptual framework for child survival, hierarchical modelling was deployed to examine about 6,900 women, aged 15 – 49 years (level 1), nested within 412 communities (level 2) in Ghana by analysing combined data of the 2003 and 2008 Ghana Demographic and Health Survey. The aim was to identify individual (maternal, paternal, neonatal, antenatal, delivery and postnatal) and community (socioeconomic disadvantage communities) determinants associated with neonatal mortality.

Results

The results showed both individual and community characteristics to be associated with neonatal mortality. Infants of multiple-gestation [OR 5.30; P-value < 0.001; 95% CI 2.81 – 10.00], neonates with inadequate birth spacing [OR 3.47; P-value < 0.01; 95% CI 1.60 – 7.57] and low birth weight [OR 2.01; P-value < 0.01; 95% CI 1.23 – 3.30] had a lower chance of surviving the neonatal period. Similarly, infants of grand multiparous mothers [OR 2.59; P-value < 0.05; 95% CI 1.03 – 6.49] and non-breastfed infants [OR 142.31; P-value < 0.001; 95% CI 80.19 – 252.54] were more likely to die during neonatal life, whereas adequate utilization of antenatal, delivery and postnatal health services [OR 0.25; P-value < 0.001; 95% CI 0.13 – 0.46] reduced the likelihood of neonatal mortality. Dwelling in a neighbourhood with high socioeconomic deprivation was associated with increased neonatal mortality [OR 3.38; P-value < 0.01; 95% CI 1.42 – 8.04].

Conclusion

Both individual and community characteristics show a marked impact on neonatal survival. Implementation of community-based interventions addressing basic education, poverty alleviation, women empowerment and infrastructural development and an increased focus on the continuum-of-care approach in healthcare service will improve neonatal survival.

【 授权许可】

   
2014 Kayode et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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