Determinants of Neonatal Mortality, Brong Ahafo Region, Ghana

ABSTRACT

Background: Worldwide an estimated four million babies die in the first 4 weeks of life (the neonatal period), however almost all of these deaths (99%) occur in low- and middle-income countries, and about half of the deaths occur at home(Lawn, Osrin, Adler, & Cousens, 2008). Neonatal mortality contributes to 60% of the under-five mortality in Brong Ahafo. It is among the regions in Ghana with the highest under-five mortality rate. According to the demographic and health survey report ( DHS) 2014, the under-five mortality was reduced from 111 per 1000 live births in 2003 to 60 per 1000 live birth in 2014, However, despite the numerous interventions in the region such as “Kangaroo mother care”, “helping babies breathe” integrated management of child and neonatal illnesses and postnatal care, neonatal mortality still continue to be high in the region (Profile, 2012). Objective: This study aimed to determine the causes and factors associated with neonatal mortality in Brong Ahafo Region. Method: An unmatched case control study was conducted in which a total of 226 neonatal deaths of singleton live born babies from June to December 2015 was recorded from 13 hospitals with neonatal units in the region. The variables extracted were the cause of death, the birth weight, address of the mother or caregiver including any land mark, telephone number of mother, father or landlord. Out of 226, a total of 80 cases were selected based on availability of specific cause of death of the case and reliable contact of the mother or caregiver (reliable address or land mark and telephone number of parent or landlord). A total of 80 mothers with neonatal deaths (cases) were followed in their homes and from where 160 controls (post neonatal) were also selected and their mothers interviewed using the same structured questionnaire as the mothers of the cases. Univariate analysis was done to determine the frequencies, bivariate to determine the variables that were associated with neonatal mortality and multivariate logistic regression was done to find determinants of neonatal mortality in the region. Results: The main causes of neonatal mortality in the region were birth asphyxia (32.5%), neonatal sepsis (23.75%), prematurity (18.75%) and neonatal jaundice (6.25%). Multivariate analysis indicated that determinants of neonatal mortality in the region were birth weight, postnatal care and household size were statistically significant to neonatal mortality in the region. The following were found to be associated with neonatal mortality. Birth weight (aOR 18.4, 95% CI 5.03-64.62); postnatal care (aOR 0.01, 95% CI 0.00- 0.001) and Household size (aOR 0.06, 95% CI 0.01-0.064) Conclusion: The main causes of neonatal mortality in the region were birth asphyxia, neonatal sepsis, prematurity, and neonatal jaundice and the determinants of neonatal mortality were birth weight, postnatal care and household size. Birth asphyxia, neonatal sepsis and prematurity are keys to the substantial reduction of neonatal mortality in Brong Ahafo region.