Takramah Wisdom Kwami, Aheto Justice Moses K
Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana.
Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.
Heliyon. 2023 Aug 6;9(8):e18961. doi: 10.1016/j.heliyon.2023.e18961. eCollection 2023 Aug.
Neonatal mortality accounts for an increasing share of under-five deaths, and they are declining at a slower rate than postnatal deaths. Apparently, neonatal mortality is increasingly becoming a major public health problem in Ghana and the world over. The current study sought to analyze neonatal mortality as a function of predictor variables and to estimate and understand unobserved household and community-level residual effects on neonatal mortality to provide data driven evidence to shape informed policies and interventions aimed at reducing the neonatal mortality burden.
The current study extracted three-level complex data on 5884 children born in the five years preceding the 2014 Ghana Demographic and Health Survey. A two-level and three-level multilevel logistic models were applied to estimate unobserved household and community-level variations in neonatal mortality in the presence of set of predictor variables. Sampling weights were incorporated in both the descriptive and inferential analysis since the data used emanated from a complex survey. Model fit statistics such as AIC scores for a weighted two-level and three-level random intercept logistic models were compared. The model with the lowest AIC score was considered the most preferred model.
The household-level random intercept model suggested that the odds of neonatal mortality was higher among multiple births [OR = 3.15 (95% CI: 1.17, 8.50)], babies born to mothers who received prenatal care from non-skilled worker [OR = 5.88 (95% CI: 2.90, 11.91)], babies delivered through caesarian section [OR = 2.47 (95% CI: 1.06, 5.79)], a household with 1-4 members [OR = 10.23 (95% CI: 4.17, 25.50)], a short preceding birth interval (<24 months) [OR = 3.05 (95% CI: 1.18, 7.88)], and preceding birth interval between 24 and 47 months [OR = 2.88 (95% CI: 1.41, 5.91)]. Substantial unobserved household-level residual variations in neonatal mortality were observed.
The findings of the current study provide an actionable information to be used by government and other stakeholders in the health sector to renew commitment to reduce neonatal mortality to an acceptable level. There is the need to intensify maternal health education by health providers to encourage pregnant women to visit antenatal clinics at least four times so they could benefit substantially from ANC services.
新生儿死亡率在五岁以下儿童死亡中所占比例日益增加，且其下降速度比出生后死亡的下降速度更慢。显然，新生儿死亡率在加纳乃至全世界正日益成为一个重大的公共卫生问题。本研究旨在分析新生儿死亡率与预测变量之间的函数关系，并估计和了解家庭及社区层面未观察到的对新生儿死亡率的残余影响，以提供数据驱动的证据，为制定旨在减轻新生儿死亡负担的明智政策和干预措施提供依据。
本研究提取了2014年加纳人口与健康调查前五年出生的5884名儿童的三级复杂数据。应用二级和三级多水平逻辑模型，在存在一组预测变量的情况下，估计家庭和社区层面未观察到的新生儿死亡率差异。由于所使用的数据来自复杂调查，在描述性分析和推断性分析中均纳入了抽样权重。比较了加权二级和三级随机截距逻辑模型的AIC得分等模型拟合统计量。AIC得分最低的模型被认为是最优选的模型。
家庭层面的随机截距模型表明，多胞胎新生儿死亡的几率更高[比值比（OR）=3.15（95%置信区间：1.17，8.50）]，母亲接受非技术工人产前护理的婴儿[OR=5.88（95%置信区间：2.90，11.91）]，剖宫产分娩的婴儿[OR=2.47（95%置信区间：1.06，5.79）]，家庭成员为1至4人的家庭[OR=10.23（95%置信区间：4.17，25.50）]，前次生育间隔短（<24个月）[OR=3.05（95%置信区间：1.18，7.88）]，以及前次生育间隔在24至47个月之间[OR=2.88（95%置信区间：1.41，5.91）]。观察到家庭层面新生儿死亡率存在大量未观察到的残余差异。
本研究结果为政府和卫生部门的其他利益相关者提供了可采取行动的信息，以重新致力于将新生儿死亡率降低到可接受的水平。卫生服务提供者有必要加强孕产妇健康教育，鼓励孕妇至少四次前往产前诊所就诊，以便她们能从产前护理服务中大幅受益。
