Geostatistical analysis and mapping: Social and environmental determinants of under-five child mortality, evidence from the 2014 Ghana Demographic and Health Survey.

Abstract Background Under-five mortality (U5M) rates are among the health indicators of utmost importance globally. It is the goal 3 target 2.1 of the Sustainable Development Goals that is expected to be reduced to at least 25 per 1000 livebirths by 2030. Despite a considerable reduction in U5M was observed globally, several countries especially those in sub-Saharan Africa (SSA) like Ghana are struggling to meet this target. Evidence-based targeting and utilization of the available limited public health resources are critical for effective design of intervention strategies that will enhance under-five child survival. We aimed to estimate and map U5M risk, with the ultimate goal of identifying communities at high risk where interventions can be targeted.Methods The 2014 Ghana Demographic and Health Survey data was used in this study. Geostatistical analyses were conducted on 5,801 children residing in 423 geographical clusters. The outcome variable is child survival status (alive or dead). We employed a geostatistical generalised linear mixed model to investigate both measured and unmeasured child specific and spatial risk factors for child survival. We then visualise child mortality by mapping the predictive probability of survival.Results Of the total sampled under 5 children, 280 (4.83%) experienced the outcome of interest. Children born as multiple births were at increased risk of mortality with AOR (9.28, 95% CI: 6.35 – 13.58) compared to singletons. Maternal education AOR (0.80, 95% CI: 0.68 – 0.93) and number of children under 5 within each household AOR (0.34, 95% CI: 0.28 – 0.41) were shown to have a protective effect. The predicted U5M risk in 2014 was at 8.3%. High altitude areas were highly associated with high U5M.Conclusion The analysis found that multiple births and high elevation are highly associated with U5M in Ghana. The high-resolution maps show areas and communities where interventions for U5M can be prioritised to have health impact.