Department of Community Medicine, University of Cape Coast, Cape Coast, Ghana.
Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
BMC Public Health. 2021 Jan 21;21(1):173. doi: 10.1186/s12889-021-10156-6.
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.
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.
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.
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.
社区及其构成对新生儿死亡率有影响。然而，将最小的卫生行政单位视为社区，并研究这些社区及其构成对加纳新生儿死亡率的影响尚未得到研究。因此，本研究旨在调查社区、家庭和个人层面的因素对加纳两个地区新生儿死亡风险的影响。
这是一项纵向研究，使用金塔蓬健康和人口监测系统作为平台，选择了 30132 名新生儿单胎，其中有 634 例死亡。多水平 cox 脆弱性模型用于检验社区、家庭和个人层面因素对新生儿死亡风险的影响。
就个人层面因素而言，与没有正规教育的母亲相比，母亲有过不良妊娠史（aHR=1.38，95%CI：1.05-1.83）、母亲未接种破伤风类毒素疫苗（aHR=1.32，95%CI：1.08-1.60）和母亲具有中等、初中或初中教育程度（aHR=1.30，95%CI：1.02-1.65）的新生儿，其死亡风险更高。然而，与没有正规教育的母亲相比，女性新生儿（aHR=0.61，95%CI：0.51-0.73）和母亲接受过中等教育或更高教育程度（aHR=0.37，95%CI：0.18-0.75）的新生儿，其死亡风险较低。胎龄较长的新生儿（aHR=0.95，95%CI：0.94-0.97）和在家分娩（aHR=0.56，95%CI：0.45-0.70）、私人妇产医院（aHR=0.45，95%CI：0.30-0.68）或卫生中心/诊所（aHR=0.40，95%CI：0.26-0.60）分娩的新生儿，其死亡风险较低。就家庭层面而言，属于家庭财富第三五分位数的新生儿（aHR=0.70，95%CI：0.52-0.94）和居住在拥挤卧室的新生儿（aHR=0.91，95%CI：0.85-0.97），其死亡风险较低。
本研究结果表明，金塔蓬地区的新生儿在个人和家庭层面存在死亡风险。干预和策略应针对研究中确定的高危群体进行定制。
