Temporal trends in childhood mortality in Ghana: impacts and challenges of health policies and programs
Identifieur interne : 000134 ( Main/Exploration ); précédent : 000133; suivant : 000135Temporal trends in childhood mortality in Ghana: impacts and challenges of health policies and programs
Auteurs : Gbenga A. Kayode [Pays-Bas] ; Diederick E. Grobbee [Pays-Bas] ; Augustina Koduah [Ghana, Pays-Bas] ; Mary Amoakoh-Coleman [Pays-Bas, Ghana] ; Irene A. Agyepong [Ghana] ; Evelyn Ansah [Ghana] ; Han Van Dijk [Pays-Bas] ; Kerstin Klipstein-Grobusch [Pays-Bas, Afrique du Sud]Source :
- Global Health Action [ 1654-9716 ] ; 2016.
Abstract
Following the adoption of the Millennium Development Goal 4 (MDG 4) in Ghana to reduce under-five mortality by two-thirds between 1990 and 2015, efforts were made towards its attainment. However, impacts and challenges of implemented intervention programs have not been examined to inform implementation of Sustainable Development Goal 3.2 (SDG 3.2) that seeks to end preventable deaths of newborns and children aged under-five. Thus, this study aimed to compare trends in neonatal, infant, and under-five mortality over two decades and to highlight the impacts and challenges of health policies and intervention programs implemented.
Ghana Demographic and Health Survey data (1988–2008) were analyzed using trend analysis. Poisson regression analysis was applied to quantify the incidence rate ratio of the trends. Implemented health policies and intervention programs to reduce childhood mortality in Ghana were reviewed to identify their impact and challenges.
Since 1988, the annual average rate of decline in neonatal, infant, and under-five mortality in Ghana was 0.6, 1.0, and 1.2%, respectively. From 1988 to 1989, neonatal, infant, and under-five mortality declined from 48 to 33 per 1,000, 72 to 58 per 1,000, and 108 to 83 per 1,000, respectively, whereas from 1989 to 2008, neonatal mortality increased by 2 per 1,000 while infant and under-five mortality further declined by 6 per 1,000 and 17 per 1,000, respectively. However, the observed declines were not statistically significant except for under-five mortality; thus, the proportion of infant and under-five mortality attributed to neonatal death has increased. Most intervention programs implemented to address childhood mortality seem not to have been implemented comprehensively.
Progress towards attaining MDG 4 in Ghana was below the targeted rate, particularly for neonatal mortality as most health policies and programs targeted infant and under-five mortality. Implementing neonatal-specific interventions and improving existing programs will be essential to attain SDG 3.2 in Ghana and beyond.
Url:
DOI: 10.3402/gha.v9.31907
PubMed: 27558221
PubMed Central: 4996861
Affiliations:
- Afrique du Sud, Ghana, Pays-Bas
- Gauteng, Région du Grand Accra, Utrecht (province)
- Accra, Johannesbourg, Utrecht
- Université du Ghana, Université du Witwatersrand
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Le document en format XML
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Kayode</name><affiliation wicri:level="3"><nlm:aff id="AF0001">Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht</wicri:regionArea><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region></placeName></affiliation></author><author><name sortKey="Grobbee, Diederick E" sort="Grobbee, Diederick E" uniqKey="Grobbee D" first="Diederick E." last="Grobbee">Diederick E. Grobbee</name><affiliation wicri:level="3"><nlm:aff id="AF0001">Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht</wicri:regionArea><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region></placeName></affiliation></author><author><name sortKey="Koduah, Augustina" sort="Koduah, Augustina" uniqKey="Koduah A" first="Augustina" last="Koduah">Augustina Koduah</name><affiliation wicri:level="3"><nlm:aff id="AF0002">Ministry of Health, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Ministry of Health, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="AF0003">Social Science Group, Wageningen University and Research Center, Wageningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Social Science Group, Wageningen University and Research Center, Wageningen</wicri:regionArea><wicri:noRegion>Wageningen</wicri:noRegion></affiliation></author><author><name sortKey="Amoakoh Coleman, Mary" sort="Amoakoh Coleman, Mary" uniqKey="Amoakoh Coleman M" first="Mary" last="Amoakoh-Coleman">Mary Amoakoh-Coleman</name><affiliation wicri:level="3"><nlm:aff id="AF0001">Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht</wicri:regionArea><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region></placeName></affiliation><affiliation wicri:level="4"><nlm:aff id="AF0004">School of Public Health, University of Ghana, Legon, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>School of Public Health, University of Ghana, Legon, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></affiliation></author><author><name sortKey="Agyepong, Irene A" sort="Agyepong, Irene A" uniqKey="Agyepong I" first="Irene A." last="Agyepong">Irene A. Agyepong</name><affiliation wicri:level="4"><nlm:aff id="AF0004">School of Public Health, University of Ghana, Legon, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>School of Public Health, University of Ghana, Legon, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></affiliation><affiliation wicri:level="3"><nlm:aff id="AF0005">Ghana Health Service, Greater Accra Region, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Ghana Health Service, Greater Accra Region, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Ansah, Evelyn" sort="Ansah, Evelyn" uniqKey="Ansah E" first="Evelyn" last="Ansah">Evelyn Ansah</name><affiliation wicri:level="3"><nlm:aff id="AF0005">Ghana Health Service, Greater Accra Region, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Ghana Health Service, Greater Accra Region, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Van Dijk, Han" sort="Van Dijk, Han" uniqKey="Van Dijk H" first="Han" last="Van Dijk">Han Van Dijk</name><affiliation wicri:level="1"><nlm:aff id="AF0003">Social Science Group, Wageningen University and Research Center, Wageningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Social Science Group, Wageningen University and Research Center, Wageningen</wicri:regionArea><wicri:noRegion>Wageningen</wicri:noRegion></affiliation></author><author><name sortKey="Klipstein Grobusch, Kerstin" sort="Klipstein Grobusch, Kerstin" uniqKey="Klipstein Grobusch K" first="Kerstin" last="Klipstein-Grobusch">Kerstin Klipstein-Grobusch</name><affiliation wicri:level="3"><nlm:aff id="AF0001">Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht</wicri:regionArea><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region></placeName></affiliation><affiliation wicri:level="4"><nlm:aff id="AF0006">Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg</wicri:regionArea><orgName type="university">Université du Witwatersrand</orgName><placeName><settlement type="city">Johannesbourg</settlement><region type="region" nuts="2">Gauteng</region></placeName></affiliation></author></analytic><series><title level="j">Global Health Action</title><idno type="ISSN">1654-9716</idno><idno type="eISSN">1654-9880</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background</title><p>Following the adoption of the Millennium Development Goal 4 (MDG 4) in Ghana to reduce under-five mortality by two-thirds between 1990 and 2015, efforts were made towards its attainment. However, impacts and challenges of implemented intervention programs have not been examined to inform implementation of Sustainable Development Goal 3.2 (SDG 3.2) that seeks to end preventable deaths of newborns and children aged under-five. Thus, this study aimed to compare trends in neonatal, infant, and under-five mortality over two decades and to highlight the impacts and challenges of health policies and intervention programs implemented.</p></sec><sec id="st2"><title>Design</title><p>Ghana Demographic and Health Survey data (1988–2008) were analyzed using trend analysis. Poisson regression analysis was applied to quantify the incidence rate ratio of the trends. Implemented health policies and intervention programs to reduce childhood mortality in Ghana were reviewed to identify their impact and challenges.</p></sec><sec id="st3"><title>Results</title><p>Since 1988, the annual average rate of decline in neonatal, infant, and under-five mortality in Ghana was 0.6, 1.0, and 1.2%, respectively. From 1988 to 1989, neonatal, infant, and under-five mortality declined from 48 to 33 per 1,000, 72 to 58 per 1,000, and 108 to 83 per 1,000, respectively, whereas from 1989 to 2008, neonatal mortality increased by 2 per 1,000 while infant and under-five mortality further declined by 6 per 1,000 and 17 per 1,000, respectively. However, the observed declines were not statistically significant except for under-five mortality; thus, the proportion of infant and under-five mortality attributed to neonatal death has increased. Most intervention programs implemented to address childhood mortality seem not to have been implemented comprehensively.</p></sec><sec id="st4"><title>Conclusion</title><p>Progress towards attaining MDG 4 in Ghana was below the targeted rate, particularly for neonatal mortality as most health policies and programs targeted infant and under-five mortality. Implementing neonatal-specific interventions and improving existing programs will be essential to attain SDG 3.2 in Ghana and beyond.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Darmstadt, Gl" uniqKey="Darmstadt G">GL Darmstadt</name></author><author><name sortKey="Bhutta, Za" uniqKey="Bhutta Z">ZA Bhutta</name></author><author><name sortKey="Cousens, S" uniqKey="Cousens S">S Cousens</name></author><author><name sortKey="Adam, T" uniqKey="Adam T">T Adam</name></author><author><name sortKey="Walker, N" uniqKey="Walker N">N Walker</name></author><author><name sortKey="De, Bernis L" uniqKey="De B">Bernis L de</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Knippenberg, R" uniqKey="Knippenberg R">R Knippenberg</name></author><author><name sortKey="Lawn, Je" uniqKey="Lawn J">JE Lawn</name></author><author><name sortKey="Darmstadt, Gl" uniqKey="Darmstadt G">GL 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Osafo</name></author><author><name sortKey="Sodzi Tettey, S" uniqKey="Sodzi Tettey S">S Sodzi-Tettey</name></author><author><name sortKey="Boadu, Ro" uniqKey="Boadu R">RO Boadu</name></author><author><name sortKey="Atinbire, S" uniqKey="Atinbire S">S Atinbire</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Singh, K" uniqKey="Singh K">K Singh</name></author><author><name sortKey="Speizer, I" uniqKey="Speizer I">I Speizer</name></author><author><name sortKey="Handa, S" uniqKey="Handa S">S Handa</name></author><author><name sortKey="Boadu, Ro" uniqKey="Boadu R">RO Boadu</name></author><author><name sortKey="Atinbire, S" uniqKey="Atinbire S">S Atinbire</name></author><author><name sortKey="Barker, Pm" uniqKey="Barker P">PM Barker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mangiaterra, V" uniqKey="Mangiaterra V">V Mangiaterra</name></author><author><name sortKey="Mattero, M" uniqKey="Mattero M">M Mattero</name></author><author><name sortKey="Dunkelberg, E" uniqKey="Dunkelberg E">E Dunkelberg</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Afrique du Sud</li><li>Ghana</li><li>Pays-Bas</li></country><region><li>Gauteng</li><li>Région du Grand Accra</li><li>Utrecht (province)</li></region><settlement><li>Accra</li><li>Johannesbourg</li><li>Utrecht</li></settlement><orgName><li>Université du Ghana</li><li>Université du Witwatersrand</li></orgName></list><tree><country name="Pays-Bas"><region name="Utrecht (province)"><name sortKey="Kayode, Gbenga A" sort="Kayode, Gbenga A" uniqKey="Kayode G" first="Gbenga A." last="Kayode">Gbenga A. Kayode</name></region><name sortKey="Amoakoh Coleman, Mary" sort="Amoakoh Coleman, Mary" uniqKey="Amoakoh Coleman M" first="Mary" last="Amoakoh-Coleman">Mary Amoakoh-Coleman</name><name sortKey="Grobbee, Diederick E" sort="Grobbee, Diederick E" uniqKey="Grobbee D" first="Diederick E." last="Grobbee">Diederick E. Grobbee</name><name sortKey="Klipstein Grobusch, Kerstin" sort="Klipstein Grobusch, Kerstin" uniqKey="Klipstein Grobusch K" first="Kerstin" last="Klipstein-Grobusch">Kerstin Klipstein-Grobusch</name><name sortKey="Koduah, Augustina" sort="Koduah, Augustina" uniqKey="Koduah A" first="Augustina" last="Koduah">Augustina Koduah</name><name sortKey="Van Dijk, Han" sort="Van Dijk, Han" uniqKey="Van Dijk H" first="Han" last="Van Dijk">Han Van Dijk</name></country><country name="Ghana"><region name="Région du Grand Accra"><name sortKey="Koduah, Augustina" sort="Koduah, Augustina" uniqKey="Koduah A" first="Augustina" last="Koduah">Augustina Koduah</name></region><name sortKey="Agyepong, Irene A" sort="Agyepong, Irene A" uniqKey="Agyepong I" first="Irene A." last="Agyepong">Irene A. Agyepong</name><name sortKey="Agyepong, Irene A" sort="Agyepong, Irene A" uniqKey="Agyepong I" first="Irene A." last="Agyepong">Irene A. Agyepong</name><name sortKey="Amoakoh Coleman, Mary" sort="Amoakoh Coleman, Mary" uniqKey="Amoakoh Coleman M" first="Mary" last="Amoakoh-Coleman">Mary Amoakoh-Coleman</name><name sortKey="Ansah, Evelyn" sort="Ansah, Evelyn" uniqKey="Ansah E" first="Evelyn" last="Ansah">Evelyn Ansah</name></country><country name="Afrique du Sud"><region name="Gauteng"><name sortKey="Klipstein Grobusch, Kerstin" sort="Klipstein Grobusch, Kerstin" uniqKey="Klipstein Grobusch K" first="Kerstin" last="Klipstein-Grobusch">Kerstin Klipstein-Grobusch</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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