A Multilevel and Survival Analysis of the Ecological Factors Associated with Under-five Mortality in Ghana

Abstract

Under-five mortality continues to be a major public health challenge in many sub-Saharan African countries. To assist Ghana in achieving the Sustainable Development Goal three target two of eliminating preventable infant and under-five mortality, a thorough understanding of the risk factors for death in children under five is critical for guiding targeted interventions. This study examines the ecological factors (environmental and social) associated with under-five mortality in Ghana. The study adopted the positivist research philosophy using quantitative methods to model data from four rounds of Ghana Demographic and Health Survey, Demographic and Health Survey Geospatial Covariates and Land Cover Climate Change Initiative datasets. Cox proportional hazard and multilevel logistic regression techniques were used to quantify the associations between the ecological factors and under-five mortality in Ghana, accounting for important confounders. The analysis covered 12460 (1998 GDHS= 3298 2003 GDHS = 3611, 2008 GDHS = 2742, and 2014 GDHS = 2809) children aged 0 to 59 months for whom information on survival status and complete data on other selected variables were available. The results show that the probability of dying was significantly lower for children sampled from 1998, 2003, and 2008 GDHS when compared to those surveyed in the 2014 GDHS. The results suggested that temperature, annual rainfall, and malaria incidence were significantly associated with under-five mortality regarding the ecological factors.