Neonatal mortality in the Kintampo North and South Districts: analysis of community, composition and spatial factors

Abstract

Communities and their composition (individuals and households) coupled with spatial factors have impact on neonatal mortality. However, considering the smallest health administrative units as communities (sub-districts) and investigating the impact of these communities, their composition and spatial factors on neonatal mortality in Ghana has not been considered. Therefore, the aim of this study was to investigate the effect of communities, households, individuals and spatial factors on the risk of neonatal mortality in the Kintampo Districts of Ghana. Multilevel cox frailty model and Kulldorf methods were used to analyse longitudinal data (January 2005-December 2014) involving 30,132 neonatal singletons with 634 deaths. The study found that, the highest risk of neonatal mortality within the Kintampo Districts occurred in the first three days of life. In addition, risk of neonatal mortality was found to be higher in the early neonatal period (1-8 days) than in the late neonatal period (9-28 days). With regards to individual level factors, neonates whose mothers had previous adverse pregnancy had a higher risk of mortality compared to neonates whose mothers did not experience any previous adverse pregnancy. Also, neonates whose mothers did not receive tetanus toxoid injection during pregnancy had a higher risk of mortality compared to those whose mothers received tetanus toxoid injection. However, neonates whose mothers had secondary education or higher had a lower risk of mortality compared to those whose mothers had no formal education. Also, the neonates belonging to the third quintile households had a lower risk of mortality compared to neonates from poorest households. There was a significant clustering of deaths attributable to asphyxia and prematurity. The findings of the study suggest risk of neonatal deaths at the individual and household levels and also cause-specific neonatal mortality clustering in some parts of the Kintampo Districts. More women in the Kintampo Districts should be encouraged to attend antenatal clinics and visit health facilities for early postnatal care.