Predictors of neonatal mortality in Ghana: evidence from 2017 Ghana Maternal Health Survey

Background: Neonatal mortality contributes about 45% of under-5 mortality globally; 35% in Sub-Saharan Africa; and over 50% of under-5 deaths in Ghana. Though there are existing studies on the determinants of neonatal mortality in Sub-Saharan Africa, limited population level analysis has been done in Ghana to understand the factors affecting neonatal mortality. Objectives The objective of the study was to examine the predictors of neonatal mortality in Ghana. Method Data from the 2017 Ghana Maternal Health Survey (GMHS) were analysed. The data used in the analysis included only responses from women who delivered live babies in the five years preceding the 2017 GMHS and the children lived for at least 28 days. A total of 10,624 respondents were included in the study after data cleaning. Descriptive statistical techniques (frequency and percentage distribution) were used to describe important background characteristics of the women included in the study. Pearson’s Chi-squares (χ 2 ) test was used to assess association between the outcome (neonatal death) and independent variables. Multivariate logistic regression analysis was done to estimate odds ratios and control for potential confounders. Confidence level was held at 95%, and a p< 0.05 was considered statistically significant. All the data analysis was done using STATA 15. Results The prevalence of neonatal mortality was 1.8% i.e. 18 per 1000 live births. Three factors predicted neonatal mortality: ANC attendance, sex of baby, and baby being put on mother’s chest immediately after birth. Women with at least one ANC visit were less likely to experience neonatal mortality as compared to women with no ANC visit prior to delivery (AOR=0.11; CI=0.02-0.56, p=0.01). Baby girls were less likely (COR=0.68; CI=0.48-0.20; p=0.03) to die during the neonatal period as compared to boys and this did not change when potential confounders were controlled for in a multiple logistic regression model (AOR=0.68, CI=0.47-0.98; p=0.04). The odds of a baby dying within the neonatal period when a baby was not put on the mother’s chest immediately after birth were 2.5 times higher than those who were put on their mother’s chest immediately after birth (COR=2.46; CI=1.66-3.65, p=0.00). Conclusion Community level and sociodemographic factors were not significant predictors of neonatal mortality in this study. Rather, neonatal, and maternal characteristics did. Education on the importance of timely and adequate antenatal care should be intensified. Also, targeted social and behaviour change communication emphasizing the importance of immediate skin-to-skin kangaroo mother care to prevent neonatal hypothermia and promote successful breastfeeding should intensified.