Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Greater Accra, Ghana.
BMC Public Health. 2021 Mar 12;21(1):492. doi: 10.1186/s12889-021-10473-w.
Ghana 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.
The 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.
Population 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].
Neonatal 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.
加纳未能实现将儿童死亡率降低三分之二的千年发展目标 4，可能也无法实现可持续发展目标（2030 年）。有必要将稀缺资源用于减轻对新生儿死亡影响最大的重要风险因素。本研究应用空间和非空间回归模型来探讨环境、产妇和儿童相关风险因素对加纳新生儿死亡的差异影响。
该研究依赖于 1998 年至 2017 年期间进行的加纳人口与健康调查（GDHS）和加纳产妇健康调查（GMHS）中的数据，调查对象为 49908 名育龄妇女和 31367 名五岁以下儿童（GDHS-1998=3298，GDHS-2003=3844，GDHS-2008=2992，GDHS-2014=5884，GMHS-2017=15349）。使用考虑到数据在群集级别上的空间自相关的空间自回归模型和具有适当抽样权重调整的非空间统计模型来研究与新生儿死亡相关的因素，p 值小于 0.05 被认为具有统计学意义。
多年来，人口密度、多胎、较小的家庭规模、高胎次和低出生体重显著增加了新生儿死亡的风险。与仅生育单胎的母亲相比，多胎生育的母亲的新生儿死亡风险大约高四倍[aRR=3.42，95%CI：1.63-7.17，p<0.05]。与非常大的新生儿相比，母亲认为较小的新生儿死亡风险更高[aRR=2.08，95%CI：1.19-3.63，p<0.05]。生育年龄妇女所生的孩子数量每增加一个单位，新生儿死亡的风险就会增加 49%[aRR=1.49，95%CI：1.30-1.69，p<0.05]。
加纳的新生儿死亡率仍然相对较高，导致儿童发生新生儿死亡的因素是出生时被认为体型较小、低出生体重、高胎次和多胎。改善孕妇的营养模式并为多胎分娩的妇女提供特别支持，将降低加纳的新生儿死亡率。
