Determinants of under-five mortality in the Builsa District Upper East Region, Ghana
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Date
2005-11-07
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Abstract
Under-five mortality rate (U5MR) is an important indicator of the social development of a country. Worldwide more than 10 million children die before their fifth birthday with the bulk of such deaths occurring in developing countries (and with Sub-Saharan Africa alone accounting for 50% of them). The gravity of the problem of under-five mortality is evident in its inclusion as one of the Millennium Development Goals.
The U5MR of Ghana increased slightly from 100/1000 in 2002 to 111/1000 in 2003. The Upper East, one of the worst poverty stricken regions of the country has however recorded a decline in its U5MR since 1993 (from 180/1000 in 1993 to 79/1000 in 2003). The aim of the study was to identify the determinants of under-five mortality in one of the districts of the region, the Builsa district and also to determine the factors which may have led to the decrease in the U5MR of the region. The study was a case control study with cases being children under five who had died in the district between January 2003- June 2005 and controls were children matched for age, sex and place of residence and who were alive at the time of the study. Mothers of 59 cases and 118 controls were interviewed on various child survival issues.
More than 65% of mothers in both study groups were illiterate. However the educational level of a mother did not have any influence on her child’s risk of death. Over 90% of mothers had an ITN and more than 50% of them breastfed their children for up to 6 months. Protective risk factors identified in the study were exclusive breastfeeding (OR 0.72, 95% CI [0.56-0.92], p0.008), use of an ITN (OR 0.12, 95% CI [0.04- 0.34], p0.000), the number of live children a mother had (OR 0.54, 95% CI [0.40-0.73] p=0.000) and immunization (OR
0.53, 95% CI [0.43-0.77], p=0.000). Children of mothers who had had previous child deaths were 7 times at risk of death (OR 7.45, 95% CI [3.63-15.46], p=0.000).Those who had not had vitamin A supplementation were about 10 times more likely to die (OR 9.57, 95% [2.10- 43.70], p=0.006). The distance to the nearest health facility also appeared to be statistically significant (OR 0.72, 95% [0.52-1.00], p=0.049).
It is recommended that the district assembly put in place programmes to improve the socioeconomic status of women and also improve the road network in the district to improve access to health facilities. The district health authority should support the work of the community based agents (CBAs) under the C-IMCI concept and also review existing child survival initiatives in the district with relevant stakeholders to improve upon them.
Description
A Dissertation submitted to the School of Graduate Studies in
partial fulfilment of the requirements for the award of
Master of Public Health Degree
(Population and Reproductive Health), 2005