Dataset Information

Neonatal mortality in the central districts of Ghana: analysis of community and composition factors.

ABSTRACT:

Background

Communities and their composition have an impact on neonatal mortality. However, considering the smallest health administrative units as communities and investigating the impact of these communities and their composition on neonatal mortality in Ghana have not been studied. Therefore, this study aimed to investigate the effect of community-, household- and individual-level factors on the risk of neonatal mortality in two districts in Ghana.

Methods

This was a longitudinal study that used the Kintampo Health and Demographic Surveillance System as a platform to select 30,132 neonatal singletons with 634 deaths. Multilevel cox frailty model was used to examine the effect of community-, household- and individual-level factors on the risk of neonatal mortality.

Results

Regarding individual-level factors, neonates born to mothers with previous adverse pregnancy (aHR?=?1.38, 95% CI: 1.05-1.83), neonates whose mothers did not receive tetanus toxoid vaccine (aHR?=?1.32, 95% CI: 1.08-1.60) and neonates of mothers with Middle, Junior High School or Junior Secondary School education (aHR?=?1.30, 95% CI: 1.02-1.65) compared to mothers without formal education, had a higher risk of neonatal mortality. However, female neonates (aHR?=?0.61, 95% CI: 0.51-0.73) and neonates whose mother had secondary education or higher (aHR?=?0.37, 95% CI: 0.18-0.75) compared to those with no formal education had a lower risk of mortality. Neonates with longer gestation period (aHR?=?0.95, 95% CI: 0.94-0.97) and those who were delivered at home (aHR?=?0.56, 95% CI: 0.45-0.70), private maternity home (aHR?=?0.45, 95% CI: 0.30-0.68) or health centre/clinic (aHR?=?0.40, 95% CI: 0.26-0.60) compared to hospital delivery had lower risk of mortality. Regarding the household-level, neonates belonging to third quintile of the household wealth (aHR?=?0.70, 95% CI: 0.52-0.94) and neonates belonging to households with crowded sleeping rooms (aHR?=?0.91, 95% CI: 0.85-0.97) had lower risk of mortality.

Conclusion

The findings of the study suggest the risk of neonatal mortality at the individual- and household-levels in the Kintampo Districts. Interventions and strategies should be tailored towards the high-risk groups identified in the study.

SUBMITTER: Adjei G

PROVIDER: S-EPMC7819257 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Neonatal mortality in the central districts of Ghana: analysis of community and composition factors.

Adjei George G Darteh Eugene K M EKM Nettey Obed Ernest A OEA Doku David Teye DT

BMC public health 20210121 1

<h4>Background</h4>Communities and their composition have an impact on neonatal mortality. However, considering the smallest health administrative units as communities and investigating the impact of these communities and their composition on neonatal mortality in Ghana have not been studied. Therefore, this study aimed to investigate the effect of community-, household- and individual-level factors on the risk of neonatal mortality in two districts in Ghana.<h4>Methods</h4>This was a longitudin ...[more]

PMID: 33478435

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Project description:BackgroundGhana did not meet the Millennium Development Goal 4 of reducing child mortality by two-thirds and may not meet SDG (2030). There is a need to direct scarce resources to mitigate the impact of the most important risk factors influencing high neonatal deaths. This study applied both spatial and non-spatial regression models to explore the differential impact of environmental, maternal, and child associated risk factors on neonatal deaths in Ghana.MethodsThe study relied on data from the Ghana Demographic and Health Surveys (GDHS) and the Ghana Maternal Health Survey (GMHS) conducted between 1998 and 2017 among 49,908 women of reproductive age and 31,367 children under five (GDHS-1998 = 3298, GDHS-2003 = 3844, GDHS-2008 = 2992, GDHS-2014 = 5884, GMHS-2017 = 15,349). Spatial Autoregressive Models that account for spatial autocorrelation in the data at the cluster-level and non-spatial statistical models with appropriate sampling weight adjustment were used to study factors associated with neonatal deaths, and a p-value less than 0.05 was considered statistically significant.ResultsPopulation density, multiple births, smaller household sizes, high parity, and low birth weight significantly increased the risk of neonatal deaths over the years. Among mothers who had multiple births, the risk of having neonatal deaths was approximately four times as high as the risk of neonatal deaths among mothers who had only single birth [aRR = 3.42, 95% CI: 1.63-7.17, p < 0.05]. Neonates who were perceived by their mothers to be small were at a higher risk of neonatal death compared to very large neonates [aRR = 2.08, 95% CI: 1.19-3.63, p < 0.05]. A unit increase in the number of children born to a woman of reproductive age was associated with a 49% increased risk in neonatal deaths [aRR = 1.49, 95% CI: 1.30-1.69, p < 0.05].ConclusionNeonatal mortality in Ghana remains relatively high, and the factors that predisposed children to neonatal death were birth size that were perceived to be small, low birth weight, higher parity, and multiple births. Improving pregnant women's nutritional patterns and providing special support to women who have multiple deliveries will reduce neonatal mortality in Ghana.

Project description:BACKGROUND:An increasing demand for health care services and getting health care closer to doorsteps of communities has made health managers to use trained community-based health volunteers to support in providing health services to people in rural communities. Community volunteerism in Ghana has been identified as an effective strategy in the implementation of Primary Health Care activities since 1970s. However, little is known about the performance of these volunteers engaged in health interventions activities at the community level. This study assessed the level of performance and factors that affect the performance of health volunteers' activities in Northern Ghana. METHODS:This was a cross-sectional study using quantitative method of data collection. Two hundred structured interviews were conducted with health volunteers. Data collectors visited health volunteers at home and conducted the interviews after informed consent was obtained. STATA Version 11.2 was used to analyze the data. Descriptive statistics were used to assess the level of performance of the health volunteers. Multiple logistic regression models were then used to assess factors that influence the performance of health volunteers. RESULTS:About 45% of volunteers scored high on performance. In the multivariate analysis, educational status [OR = 4.64 95% CI (1.22-17.45)] and ethnicity [OR = 1.85 95% CI (1.00-3.41)] were the factors that influenced the performance of health volunteers. Other intermediary factors such as incentives and means of transport also affected the performance of health volunteers engaged in health intervention activities at the community level. CONCLUSION:The results suggest that higher educational status of health volunteers is more likely to increase their performance. In addition, providing non-monetary incentives and logistics such as bicycles, raincoats, torch lights and wellington boots will enhance the performance of health volunteers and also motivate them to continue to provide health services to their own people at the community level.

Project description:Malaria is a leading cause of morbidity and mortality among children in Ghana. As part of the effort to inform local and national decision-making in preparation for possible malaria vaccine introduction, this qualitative study explored community-level factors that could affect vaccine acceptance in Ghana and provides recommendations for a health communications strategy. The study was conducted in two purposively selected districts: the Ashanti and Upper East Regions. A total of 25 focus group discussions, 107 in-depth interviews, and 21 semi-structured observations at Child Welfare Clinics were conducted. Malaria was acknowledged to be one of the most common health problems among children. While mosquitoes were linked to the cause and bed nets were considered to be the main preventive method, participants acknowledged that no single measure prevented malaria. The communities highly valued vaccines and cited vaccination as the main motivation for taking children to Child Welfare Clinics. Nevertheless, knowledge of specific vaccines and what they do was limited. While communities accepted the idea of minor vaccine side effects, other side effects perceived to be more serious could deter families from taking children for vaccination, especially during vaccination campaigns. Attendance at Child Welfare Clinics after age nine months was limited. Observations at clinics revealed that while two different opportunities for counseling were offered, little attention was given to addressing mothers' specific concerns and to answering questions related to child immunization. Positive community attitudes toward vaccines and the understanding that malaria prevention requires a comprehensive approach would support the introduction of a malaria vaccine. These attitudes are bolstered by a well-established child welfare program and the availability in Ghana of active, flexible structures for conveying health information to communities. At the same time, it would be important to improve the quality of Child Welfare Clinic services, particularly in relation to communication around vaccination.

Project description:Ghana has been implementing Mass Drug Administration (MDA) since the year 2001, and Lymphatic Filariasis transmission has been interrupted in 76 out of the 98 targeted districts. The remaining districts have a microfilaria prevalence above the 1% threshold needed for the interruption of transmission. This study assesses the level of lymphatic filariasis MDA coverage and explored factors affecting the quality of implementation of the MDA in the Bole and Central Gonja Districts of Northern Ghana. A concurrent mixed methods study design approach was used to provide both a quantitative and qualitative insight. A descriptive analysis was carried out, and the results are presented in tables and charts. The transcripts of the qualitative interviews were imported into Nvivo and framework methods of analysis were used. The results were summarized based on the themes and buttressed with narratives with key quotes presented within the texts. The overall MDA coverage in Central Gonja is 89.3% while that of Bole district is 82.9%. Refusal to ingest the drug and adverse drug reactions were higher in Bole district than the Central Gonja District. The persistent transmission of lymphatic filariasis in Bole District was characterized by poor community mobilization and sensitization, nonadherence to the directly observed treatment strategy, refusal to ingest the drug due to the fear of adverse drug reactions, inadequate knowledge and misconceptions about the disease. Reported mass drug administration coverage will not necessarily result into interruption of transmission of the disease without strict compliance to the directly observed treatment strategy, strong stakeholder engagement coupled with evidence-based context-specific multi-channel community education strategies with key educational messages on the cause of the disease and adverse drug reactions. While the clock for the elimination of lymphatic filariasis by the year 2020 and meeting of the Sustainable Development Goal 3 target 3.3 by 2030 is ticking, there is an urgent need for a concerted effort to improve the fidelity of the ongoing lymphatic filariasis MDA campaigns in the Bole District of Northern Ghana.

Project description:BackgroundCause-specific mortality data are required to set interventions to reduce neonatal mortality. However, in many developing countries, these data are either lacking or of low quality. We assessed the completeness and accuracy of cause of death (COD) data for neonates in Ghana to assess their usability for monitoring the effectiveness of health system interventions aimed at improving neonatal survival.MethodsA lot quality assurance sampling survey was conducted in 20 hospitals in the public sector across four regions of Ghana. Institutional neonatal deaths (IND) occurring from 2014 through 2017 were divided into lots, defined as neonatal deaths occurring in a selected facility in a calendar year. A total of 52 eligible lots were selected: 10 from Ashanti region, and 14 each from Brong Ahafo, Eastern and Volta region. Nine lots were from 2014, 11 from 2015 and 16 each were from 2016 and 2017. The cause of death (COD) of 20 IND per lot were abstracted from admission and discharge (A&D) registers and validated against the COD recorded in death certificates, clinician's notes or neonatal death audit reports for consistency. With the error threshold set at 5%, ≥ 17 correctly matched diagnoses in a sample of 20 deaths would make the lot accurate for COD diagnosis. Completeness of COD data was measured by calculating the proportion of IND that had death certificates completed.ResultsNineteen out of 52 eligible (36.5%) lots had accurate COD diagnoses recorded in their A&D registers. The regional distribution of lots with accurate COD data is as follows: Ashanti (4, 21.2%), Brong Ahafo (7, 36.8%), Eastern (4, 21.1%) and Volta (4, 21.1%). Majority (9, 47.4%) of lots with accurate data were from 2016, followed by 2015 and 2017 with four (21.1%) lots. Two (10.5%) lots had accurate COD data in 2014. Only 22% (239/1040) of sampled IND had completed death certificates.ConclusionDeath certificates were not reliably completed for IND in a sample of health facilities in Ghana from 2014 through 2017. The accuracy of cause-specific mortality data recorded in A&D registers was also below the desired target. Thus, recorded IND data in public sector health facilities in Ghana are not valid enough for decision-making or planning. Periodic data quality assessments can determine the magnitude of the data quality concerns and guide site-specific improvements in mortality data management.

Project description:BACKGROUND:Yaws is a chronic relapsing disease caused by Treponema pallidum subspecies pertunue, which can result in severe disability and deformities. Children below the age of 15?years in resource-poor communities are the most affected. Several non-specific factors facilitate the continuous transmission and resurgence of the disease. Endemic communities in rural Ghana continue to report cases despite the roll out of several intervention strategies in the past years. The objective of this study was to determine the factors associated with cutaneous ulcers among children in two yaws-endemic districts in Ghana. METHODS:A community-based unmatched 1:2 case-control study was conducted among children between 1 and 15?years. Data on socio-demographic, environmental and behavioral factors were collected using a structured questionnaire. Active case search and confirmation was done using the Dual Path Platform (DPP) Syphilis Screen and Confirm test kit. Data were analyzed using STATA 15. Logistic regression was done to determine the exposures that were associated with yaws infection at 0.05 significant level. RESULTS:Sixty-two cases and 124 controls were recruited for the study. The adjusted multivariable logistic regression model showed that yaws infection was more likely among individuals who reside in overcrowded compound houses (aOR =?25.42, 95% CI: 6.15-105.09) and with poor handwashing habits (aOR?=?6.46, 95% CI: 1.89-22.04). Male (aOR =?4.15, 95% CI: 1.29-13.36) and increasing age (aOR =?5.90, 95% CI: 1.97-17.67) were also associated with yaws infection. CONCLUSIONS:Poor personal hygiene, overcrowding and lack of access to improved sanitary facilities are the factors that facilitate the transmission of yaws in the Awutu Senya West and Upper West Akyem districts. Yaws was also more common among males and school-aged children. Improving living conditions, access to good sanitary facilities and encouraging good personal hygiene practices should be core features of eradication programs in endemic communities.

Project description:ObjectiveEvidence is limited on whether Integrated Community Case Management (iCCM) improves treatment coverage of the top causes of childhood mortality (acute respiratory illnesses (ARI), diarrhoea and malaria). The coverage impact of iCCM in Central Uganda was evaluated.MethodsBetween July 2010 and December 2012 a pre-post quasi-experimental study in eight districts with iCCM was conducted; 3 districts without iCCM served as controls. A two-stage household cluster survey at baseline (n = 1036 and 1042) and end line (n = 3890 and 3844) was done in the intervention and comparison groups respectively. Changes in treatment coverage and timeliness were assessed using difference in differences analysis (DID). Mortality impact was modelled using the Lives Saved Tool.Findings5,586 Village Health Team members delivered 1,907,746 treatments to children under age five. Use of oral rehydration solution (ORS) and zinc treatment of diarrhoea increased in the intervention area, while there was a decrease in the comparison area (DID = 22.9, p = 0.001). Due to national stock-outs of amoxicillin, there was a decrease in antibiotic treatment for ARI in both areas; however, the decrease was significantly greater in the comparison area (DID = 5.18; p<0.001). There was a greater increase in Artemisinin Combination Therapy treatment for fever in the intervention areas than in the comparison area but this was not significant (DID = 1.57, p = 0.105). In the intervention area, timeliness of treatments for fever and ARI increased significantly higher in the intervention area than in the comparison area (DID = 2.12, p = 0.029 and 7.95, p<0.001, respectively). An estimated 106 lives were saved in the intervention area while 611 lives were lost in the comparison area.ConclusioniCCM significantly increased treatment coverage for diarrhoea and fever, mitigated the effect of national stock outs of amoxicillin on ARI treatment, improved timeliness of treatments for fever and ARI and saved lives.

Project description:Meningitis, a disease of the Central Nervous System is described as inflammation of the covering of the brain and spinal cord (meninges). It is characterised by fever, severe headache, nausea, vomiting, stiff neck, photophobia, altered consciousness, convulsion/seizures and coma. In December, 2015, twelve suspected cases of meningitis were reported in Tain district in Brong Ahafo region (BAR). Subsequently, dozens of suspected cases were hospitalized in five district hospitals in BAR. We investigated to determine the magnitude, causative agent and risk factors for the disease transmission.A community-based 1:2 case-control study (with 126 individuals) was conducted form 10/12/15 to 26/4/16 in 27 districts of Brong-Ahafo Region, Ghana. We defined suspected meningitis cases as people presenting with sudden headache and fevers (Temp>?38.0 °C) in combination with one of the following signs: neck stiffness, altered consciousness, convulsions, bulging fontanelle (infants) and other meningeal signs. Controls were selected from the same neighbourhood and defined as individuals with no overt meningitis signs/symptoms. We collected CSF samples and performed serological testing using Pastorex-Meningitis-Kit and culture for bacterial isolation. Moreover, structured questionnaires were used to collect data on socio-demographics, living conditions, health status and other risk factors. We conducted univariate data analysis and logistic regressions to study disease-exposure associations using Stata 15.A total of 969 suspected cases with 85 deaths (CFR?=?9.0%) were recorded between December, 2015 and March, 2016. Majority, 55.9% (542/969) were females aged between 10 months-74 years (median 20 years, IQR; 14-34). Of the 969 cases, 141 were confirmed by Laboratory test with Streptococcus pneumoniae identified as the causative agent. Cases were reported in 20 districts but 6 of these districts reported cases above threshold levels. The outbreak peaked in week 6 with 178 cases. Overall attack rate (AR) was 235.0/100,000 population. District specific ARs were; Tain; 143.6/100,000, Wenchi; 110.0/100,000, Techiman; 46.6/100,000, Jaman North; 382.3/100,000 and Nkoranza South; 86.4/100,000. Female and male specific ARs were 251.3/100,000 and 214.5/100,000 respectively. Age group 10-19 years were most affected 33.8% (317/940). We identified sore throat [aOR?=?5.2, 95% (CI 1.1-26.1)] and alcohol use [aOR?=?9.1, 95%(CI 1.4-55.7)] as factors associated with the disease transmission.Meningitis outbreak due to Streptococcus pneumoniae was established in BAR. Upper respiratory tract infection and alcohol use were associated with the outbreak. Mass campaigns on healthy living habits, signs and symptoms of meningitis as well as the need for early reporting were some of the control measures instituted. Moreover, we recommend Pneumococcal vaccination in BAR to prevent future outbreaks.

Dataset Information

Neonatal mortality in the central districts of Ghana: analysis of community and composition factors.

Background

Methods

Results

Conclusion

Publications

Neonatal mortality in the central districts of Ghana: analysis of community and composition factors.

Similar Datasets

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