Geospatial and Temporal Trends in Neonatal Mortality: Savannah Region, Ghana, 2020-2024

Geospatial and Temporal Trends in Neonatal Mortality: Savannah Region, Ghana, 2020-2024 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Geospatial and Temporal Trends in Neonatal Mortality: Savannah Region, Ghana, 2020-2024 Wadeyir Jonathan Abesig, Anthony Akuribire Ayambire, Julius Abesig This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7871868/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Introduction Despite progress in reducing child mortality globally, neonatal mortality remains a concern in Ghana, where preventable causes and regional disparities persist. Some regions experience rates twice as high as others, highlighting the need for targeted research and region-specific interventions. This study addresses the knowledge gap in the Savannah Region by examining 5-year geospatial and temporal trends in neonatal mortality (2020-2024), providing evidence to inform policy and programming. Methods This study used a retrospective, descriptive cross-sectional design, analysing 2020-2024 data on neonatal deaths in the Savannah Region from the DHIMS 2 database. Data was analysed using Microsoft Excel version 19, with results presented as frequencies, percentages, tables, graphs, and maps. Results The overall neonatal mortality rate was 3.5 per 1,000 live births (288/83,126), with a notable 35.7% increase from 2.8 per 1,000 live births in 2020 to 3.8 per 1,000 live births in 2024. Early neonatal deaths accounted for 94.0% of all neonatal deaths. The Central Gonja District had the highest proportion of neonatal deaths, contributing 22.6% (65/288) of the total. Conclusion The neonatal mortality rate in the Savannah Region increased from 2.8 to 3.8 per 1,000 live births, driven by early neonatal deaths. Targeted interventions in early neonatal care and improved antepartum, intrapartum, and postnatal care, along with equipped neonatal intensive care units in district hospitals, are crucial to reducing mortality rates. Figures Figure 1 Figure 2 Figure 3 Introduction Neonatal mortality remains a significant global health challenge, with 2.4 million newborn deaths occurring worldwide in 2019, accounting for almost half of all under-five deaths[1]. Despite progress in reducing child mortality rates globally, neonatal mortality remains[1-3]. The global neonatal mortality rate declined from 37 deaths per 1000 live births in 1990 to 17 deaths per 1000 live births in 2020[1]. However, Sub-Saharan Africa continues to bear a disproportionate burden, with 42% of global neonatal deaths[1, 4]. In Ghana, neonatal mortality rates range from 16 -29 per 1000 live births[4, 5], with preventable causes such as infections (31%), premature birth (29%), and complications during delivery (27%) being major contributors[4-7]. Regional disparities in neonatal mortality rates are evident in Ghana, with some regions experiencing rates twice as high as others[6, 8, 9]. These disparities highlight the need for targeted research and interventions to address the specific needs of different regions. The Savannah region, a deprived region in Ghana, is one such area that lacks research on neonatal health indicators, including mortality and morbidity. Given the region's unique characteristics and challenges, it is essential to generate evidence on neonatal health outcomes to inform policy and programming. This study aims to address this knowledge gap by determining the 5-year trend of neonatal mortality in the region. The findings will inform evidence-based strategies to enhance antenatal, intrapartum, and postnatal care, ultimately contributing to achieving Every Newborn Action Plan (ENAP) target of 12 or fewer neonatal deaths per 1000 live births by 2030. The study's findings will also have significant implications for policy and practice, highlighting areas that require improvement and investment. Methods Study Design This study employed a cross-sectional design, utilising secondary data analysis of neonatal mortality surveillance data from the Savannah Region, Ghana, spanning 2020 to 2024. The data were extracted from the District Health Information Management System 2 (DHIMS-2) database. Study Setting The study was conducted in the Savannah Region, one of Ghana's 16 administrative regions, located in the north-western part of the country. Established in 2019, the region spans 35,862 km², covering approximately 15% of Ghana's land area. It borders the Upper West, Bono, and Bono East Regions, as well as Côte d'Ivoire and Burkina Faso internationally. The region comprises seven Municipal/District Assemblies with an estimated population of 653,266[10]. The Savannah Region has a total of 205 healthcare facilities, including five District Hospitals, three Polyclinics, 26 Health Centres, 158 Community-based Health Planning and Services (CHPS) Compounds, and 13 clinics and maternity homes[11]. The region's vegetation is predominantly grassland with drought-resistant trees, and it experiences two main seasons: dry (December to April) and wet (July to November). The population primarily engages in farming, hunting, and gari processing, with some districts experiencing illegal small-scale mining activities. The region's unique characteristics, including the Mole National Park and rivers like the White and Black Volta, may impact healthcare delivery due to seasonal accessibility challenges[11]. Operational Definitions Neonatal death: Defined as deaths among live births during the first 28 completed days of life[12]. Early neonatal death: Deaths among live births between 0 and 7 completed days of birth (0 – 6 days)[12]. Late neonatal death: Deaths among live births after 7 days to 28 completed days of birth (7 – 27 days)[12]. Data Collection and Processing This study analysed secondary data to describe neonatal deaths in the Savannah Region of Ghana from 2020 to 2024. Data was abstracted from the District Health Information Management System-2 (DHIMS-2), a nationwide, internet-based electronic database that aggregates health facility-based data on health services provided in Ghana[13]. The abstracted variables included district, age, total neonatal deaths, and types of neonatal deaths. The data was extracted from DHIMS-2 into Microsoft Excel version 19, where it underwent thorough cleaning and quality checks for completeness and inconsistencies. Columns were inspected to ensure correct data formats, and data elements describing the same variable were rearranged for easy identification, verification, and aggregation. Due to the robust supervision of DHIMS-2 by its management team, the dataset was found to be comprehensive and accurate, with no instances of missing data or inconsistencies. Outcome Variable The outcome variable of interest in this study was the Neonatal Mortality Rate (NMR). NMR was measured as the number of neonatal deaths per 1000 live births, based on the 5 years preceding the surveys. The neonatal mortality rate is calculated by counting the number of deaths that occur within the first 28 days of life per 1000 live births in a given year or period. The DHIMS 2 provides the necessary information on dates of birth and age at death, enabling the calculation of NMR. Data Analysis Descriptive statistical analyses, including frequencies and percentages, were conducted to summarize key variables such as total neonatal deaths, deliveries, live births, and types of neonatal deaths. Geographic Information System (QGIS) software was used to create thematic maps illustrating trends and district-level proportions of neonatal deaths, utilizing shape files from DHIMS-2. Temporal patterns were examined through seasonal decomposition analysis. Results were presented in a combination of tables, graphs, and maps to enhance visualization and interpretation of the data. Results Background Characteristics: Over the five-year study period, 288 neonatal deaths were recorded in the Savannah Region, with 94.4% (272/288) occurring in the early neonatal period (Table 1 ). The overall neonatal mortality rate was 3.5 per 1,000 live births (95% CI: [3.1, 3.9]). Notably, the rate increased from 2.8 per 1,000 live births (95% CI: [1.9, 3.6]) in 2020 to 3.8 per 1,000 live births (95% CI: [9.9, 4.7]) in 2024. Table 1 Deliveries, live births and neonatal mortality rate, Savannah Region, 2020–2024. Year Deliveries Live births END LND Total ND NMR ENMR LNMR 2020 14762 14536 38 2 40 2.8[1.9, 3.6] 2.6[1.8, 3.5] 0.1[0, 0.3] 2021 16313 16020 57 5 62 3.9[2.9, 4.8] 3.6[2.6, 4.5] 0.3[0, 0.6] 2022 17025 16652 39 0 39 2.3[1.6, 3.1] 2.3[1.6, 3.1] 0.0[0, 0.2] 2023 17925 17726 72 5 77 4.3[3.4, 5.3] 4.1[3.1, 5.0] 0.3[0, 0.5] 2024 18451 18192 66 4 70 3.8[2.9, 4.7] 3.6[2.8, 4.5] 0.2[0, 0.4] Total 84476 83126 272 16 288 3.5[3.1, 3.9] 3.3[2.9, 3.7] 0.2[0, 0.3] Trends in Neonatal Mortality Rates Over the five-year period, neonatal mortality rates exhibited an upward trend. The overall rate increased from 2.8 per 1,000 live births (95% CI: 1.9–3.6) in 2020 to 3.8 per 1,000 live births (95% CI: 2.9–4.7) in 2024 (Fig. 1 ). This rise was mirrored in both early and late neonatal mortality rates. Early neonatal mortality rose from 2.6 per 1,000 live births (95% CI: 1.8–3.5) in 2020 to 3.6 per 1,000 live births (95% CI: 2.8–4.5) in 2024, while late neonatal mortality increased from 0.1 per 1,000 live births (95% CI: 0-0.3) in 2020 to 0.2 per 1,000 live births (95% CI: 0-0.4) in 2024 (Fig. 1 ) Geospatial Distribution Neonatal deaths were recorded across all districts in the Savannah Region, with cumulative neonatal mortality rates ranging from 0.5 / 1000 LB to 6.4 1000 LB per 1,000 live births. The highest cumulative rate was recorded in West Gonja district, while the lowest rate was recorded in North Gonja district (Table 2 ) As shown in Fig. 3 , the Central Gonja District had the highest proportion of neonatal deaths at 22.6% (95% CI: 17.8–27.4), closely followed by West Gonja District at 22.2% (95% CI: 17.4–27.0) and Bole District at 20.5% (95% CI: 15.8–25.2), whereas the North Gonja and North East Gonja Districts recorded the lowest proportions at 1.0% (95% CI: 0-2.2) each. Temporal pattern Majority of neonatal deaths, 53.3% (95% CI [47.1, 59.6]) occurred during the dry season, Table 2 . Table 2 Neonatal Mortality Proportions by District and Season District Deliveries LiveBirth END LND ND NMR %[95% CI] Bole 20361 20108 57 2 59 2.9 20.5[15.8, 25.2] Central Gonja 17155 16822 59 6 65 3.9 22.6[17.8, 27.4] East Gonja 14037 13879 47 2 49 3.5 17[12.7,21.3] North Gonja 6657 6559 3 0 3 0.5 1.0[0, 2.2] North-East Gonja 3632 3614 3 0 3 0.8 1.0[0, 2.2] Sawla-Tuna-Kalba 12432 12112 43 2 45 3.7 15.6[11.4, 19.8] West Gonja 10202 10032 60 4 64 6.4 22.2[17.4, 27.0] Season Dry 33615 33067 121 9 130 3.9 53.3[47.1, 59.6] Rainy 35241 34719 111 3 114 3.3 46.7[40.5, 53.0] Total 68856 67786 232 12 244 3.6 100 Discussion This study examined geospatial and temporal trends in neonatal mortality in the Savannah Region, revealing an overall rate of 3.5 per 1,000 live births. Notably, this rate is lower than the national estimate of 16–29/1000[ 4 ] and meets the WHO target of under 12 per 1,000 live births[ 1 ]. However, given the increasing trend, health authorities should design targeted interventions to sustain these gains and further reduce neonatal mortality in the region. The neonatal mortality rate showed an upward trend over the study period, peaking at 4.3 per 1,000 live births in 2023. This finding aligns with another study that reported an increase in the neonatal mortality rate in the Savannah region from 2.3 per 1,000 live births in 2019 to 4.34 per 1,000 live births in 2023[ 9 ]. Notably, the rate observed in this study is significantly lower than national estimates, including 22.8 per 1,000 live births reported by UNICEF, 18 per 1,000 live births in 2023[ 5 ] and 1.2% in the 2022 Ghana demographic and health survey(GDHS)[ 14 ]. However, it's slightly lower than the projected rate of 5.13 per 1,000 live births in 2025 by Farhan et al[ 9 ] Our study found a higher incidence of early neonatal deaths compared to late neonatal deaths, consistent with findings from numerous studies in in Ghana and sub-Saharan Africa[ 7 – 9 , 15 , 16 ]. This trend is largely attributed to poor access to quality healthcare, skilled birth attendants, and neonatal care services in many parts of the region. For example, the Savannah region has a relatively low rate of skilled deliveries and low completion of continuum of maternal care (54.8%) as compared with 90.1% in the Upper West Region of Ghana[ 14 ]. Notably, two districts in the region lack district hospitals and neonatal intensive care units, exacerbating the challenge. Furthermore, health facilities across the region are often poorly equipped to manage critical conditions such as birth asphyxia and its complications, infections, prematurity, and congenital anomalies. Improving the quality of care during delivery and the immediate postpartum period would significantly impact early neonatal survival. Notably, the West Gonja District recorded the highest neonatal mortality rate of 6.4 per 1,000 live births. A possible explanation for this observation lies in the district's role as a referral hub, with Damongo serving as the regional capital and housing a hospital with a neonatal intensive care unit (NICU). The North Gonja District, which lacks a district hospital, refers cases to West Gonja, but challenges such as inadequate ambulance services and poor road conditions likely contribute to delayed and critical referrals. Interestingly, the North Gonja and North-East Gonja Districts, both without district hospitals, reported the lowest proportions of neonatal deaths (1% each), likely due to the practice of referring cases to districts with NICU-equipped hospitals, rather than an actual low incidence of mortality. Most neonatal deaths in the Savannah region occurred during the dry season, consistent with studies showing increased neonatal and child mortality during winter months[ 17 – 20 ]. The region's location in the Harmattan belt, marked by increased respiratory infections and cold weather, may contribute to this trend. Notably, neonatal mortality rates were not correspondingly high during the rainy season, despite challenges like difficulty accessing communities[ 21 ]. This might be attributed to the fact that only health facility-reported deaths are captured in DHIMS-2, potentially missing neonatal deaths in communities during the rainy season due to limited access to healthcare. Strengths and limitations This study's findings are based on actual data captured in DHIMS-2, eliminating potential recall bias by relying on retrospectively analysed data rather than perceptions or opinions. However, the study has several important limitations. Firstly, DHIMS-2 data lacked crucial information on neonatal deaths, such as gestational age, APGAR scores, maternal sociodemographic characteristics, and obstetric and medical factors, which are not routinely documented. This limited our ability to conduct a comprehensive analysis of neonatal mortality. Furthermore, relying on health facility-reported deaths may have underestimated the true neonatal mortality rate, potentially missing cases that occurred outside facilities. Conclusion This study examined geospatial and temporal trends in neonatal mortality in the Savannah Region (2020–2024), revealing an increasing trend in neonatal mortality rates from 2.8 to 3.8 per 1,000 live births, primarily driven by early neonatal deaths. To address this, targeted interventions are recommended, including improved early neonatal care, enhanced antepartum, intrapartum, and postnatal care, and the establishment of equipped neonatal intensive care units in district hospitals. Additionally, continuous professional development for midwives and community health nurses in identifying and managing high-risk pregnancies, as well as timely referrals, is crucial. Training neonatal nurses in basic and advanced life support for neonates across the region is also essential. These findings inform further research and interventions to reduce early neonatal mortality in the Savannah Region Abbreviations APGAR: Appearance, Pulse, Grimace, Activity, and Respiration DHIMS: District Health Information Management System ENAP: Every Newborn Action Plan END: Early Neonatal Death ENMR: Early Neonatal Mortality Rate GDHS: Ghana Demographic and Health Survey GHS: Ghana Health Service GSS: Ghana Statistical Service NICU: Neonatal Intensive Care Unit LND: Late Neonatal Death LNMR: Late Neonatal Mortality Rate NMR: Neonatal Mortality Rate QGIS: Quantum Geographic Information System SRHD: Savannah Regional Health Directorate UNICEF: United Nations Children’s Fund WHO: World Health Organisation Declarations Availability of Data and Materials The data for this study are available in the DHIMS-2 database, a secure system managed by the Ghana Health Service (GHS) and the Government of Ghana. The data can be accessed upon request through the Director-General of the Ghana Health Service via (https://dhims.chimgh.org). Access requires a username and password authorised by the GHS. Acknowledgment We gratefully acknowledge the Savannah Regional Health Directorate for granting us administrative permission to abstract data from the District Health Information Management System (DHIMS-2). Funding No funding was received for this study. Author information Authors and Affiliations Ghana Health Service (GHS), Bole District Hospital, Bole, Savannah Region, Ghana Wadeyir Jonathan Abesig Ghana Health Service (GHS), Central Gonja District Hospital, Buipe, Savannah Region, Ghana Anthony A. Ayambire Christian Health Association of Ghana (CHAG), St. Theresa Hospital, Nandom, Upper West Region, Ghana Julius Abesig Contribution WJA conceptualised the study, did the data abstraction and analysis. WJA and JA drafted the manuscript. JA, and AAA reviewed the manuscript. All authors read and approved the final version of the manuscript. Correspondence Wadeyir jonathan Abesig Email: [email protected] Ethical clearance Ethics approval and consent to participate This study utilised de-identified, aggregated neonatal mortality data from the District Health Information Management System 2 (DHIMS-2), which is mandated by the Ghana Health Service under the Public Health Act (Act 851), 2012, for disease surveillance and response. Given the use of aggregated, de-identified data, formal ethical clearance and informed consent were not required. Permission for data extraction and use was obtained from the Savannah Regional Health Directorate. Data were stored securely on a password-protected computer, accessible only to authorised personnel. The study adhered to the principles outlined in the World Medical Association Declaration of Helsinki and relevant data protection regulations, ensuring confidentiality and ethical conduct throughout Clinical trial number: Not applicable. Consent for Publication Not applicable. Competing Interests The authors declare no conflict of interest. References UN IGME: Levels & Trends in Child Mortality: Report 2020, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation’, United Nations Children’s Fund, New York. 2020. In.; 2020. Blencowe H, Cousens S. Addressing the challenge of neonatal mortality. Trop Med Int Health. 2013;18(3):303–12. Jena BH, Jaldo MM, Demesa YY, Kebede BA, Melaku LM. Magnitude of neonatal mortality and its association with maternal and child health care in sub-Saharan africa: a systematic review and meta-analysis. Arch Public Health. 2025;83(1):219. Poulin D, Nimo G, Royal D, Joseph PV, Nimo T, Nimo T, Sarkodee K, Attipoe-Dorcoo S. Infant mortality in Ghana: investing in health care infrastructure and systems. Health Affairs Scholar 2024, 2(2). Adongo EA, Ganle JK. Predictors of neonatal mortality in Ghana: evidence from 2017 Ghana maternal health survey. BMC Pregnancy Childbirth. 2023;23(1):556. Tette EMA, Nartey ET, Nuertey BD, Azusong EA, Akaateba D, Yirifere J, Alandu A, Seneadza NAH, Gandau NB, Renner LA. The pattern of neonatal admissions and mortality at a regional and district hospital in the Upper West Region of Ghana; a cross sectional study. PLoS ONE. 2020;15(5):e0232406. Abdul-Mumin A, Cotache-Condor C, Owusu SA, Mahama H, Smith ER. Timing and causes of neonatal mortality in Tamale Teaching Hospital, Ghana: A retrospective study. PLoS ONE. 2021;16(1):e0245065. Dare S, Oduro AR, Owusu-Agyei S, Mackay DF, Gruer L, Manyeh AK, Nettey E, Phillips JF, Asante KP, Welaga P, et al. Neonatal mortality rates, characteristics, and risk factors for neonatal deaths in Ghana: analyses of data from two health and demographic surveillance systems. Glob Health Action. 2021;14(1):1938871. Abubakr AF, Kubio C. Unveiling neonatal mortality inequities in Ghana: A geospatial and temporal analysis of regional disparities, healthcare accessibility, and institutional gaps to drive targeted interventions. Pediatr Neonatol 2025. GSS. Ghana 2021 population and housing census: general report. In.; 2021. SRHD. 2022 Annual Report, Savannah Regional Health Directorate (SRHD). In.; 2022. Pathirana J, Munoz FM, Abbing-Karahagopian V, Bhat N, Harris T, Kapoor A, Keene DL, Mangili A, Padula MA, Pande SL, et al. Neonatal death: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine. 2016;34(49):6027–37. Agongo EE, Agana-Nsiire P, Enyimayew NK, Adibo MK, Mensah EN. Primary health care systems (PRIMASYS): case study from Ghana, abridged version. Geneva: World Health Organization; 2017. Fofie CO. CONTINUUM OF MATERNAL CARE IN GHANA: EVIDENCE FROM THE 2022 DHS. Mangu CD, Rumisha SF, Lyimo EP, Mremi IR, Massawe IS, Bwana VM, Chiduo MG, Mboera LEG. Trends, patterns and cause-specific neonatal mortality in Tanzania: a hospital-based retrospective survey. Int Health. 2021;13(4):334–43. Alebel A, Wagnew F, Petrucka P, Tesema C, Moges NA, Ketema DB, Yismaw L, Melkamu MW, Hibstie YT, Temesgen B, et al. Neonatal mortality in the neonatal intensive care unit of Debre Markos referral hospital, Northwest Ethiopia: a prospective cohort study. BMC Pediatr. 2020;20(1):72. Dalili H, Shariat M, Sahebi L. Time series analysis for forecasting neonatal intensive care unit census and neonatal mortality. BMC Pediatr. 2025;25(1):339. Dalla-Zuanna G, Rosina A. An Analysis of Extremely High Nineteenth-Century Winter Neonatal Mortality in a Local Context of Northeastern Italy. Eur J Popul / Revue européenne de Démographie. 2010;27(1):33–55. Doyle MA. Seasonal patterns in newborns' health: Quantifying the roles of climate, communicable disease, economic and social factors. Econ Hum Biol. 2023;51:101287. Strand LB, Barnett AG, Tong S. The influence of season and ambient temperature on birth outcomes: a review of the epidemiological literature. Environ Res. 2011;111(3):451–62. Eriksson L, Nga NT, Hoa DTP, Duc DM, Bergstrom A, Wallin L, Malqvist M, Ewald U, Huy TQ, Thuy NT, et al. Secular trend, seasonality and effects of a community-based intervention on neonatal mortality: follow-up of a cluster-randomised trial in Quang Ninh province, Vietnam. J Epidemiol Community Health. 2018;72(9):776–82. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 14 Nov, 2025 Editor invited by journal 24 Oct, 2025 Editor assigned by journal 21 Oct, 2025 Submission checks completed at journal 21 Oct, 2025 First submitted to journal 15 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7871868","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":550104799,"identity":"0873864a-9edb-4f50-8f9e-92dd2567064b","order_by":0,"name":"Wadeyir Jonathan Abesig","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYHACAxCSA7EOPCBFizFYSwLxWhgYEhtAJFFaDI4f3viYp+Be+vywww+BttjJ6TYQ0nImrdiYx6A4d+PtNAOglmRjswMEtJgdyDGT5jFIyN04OwGk5UDiNoJazr8x/w3Ukm44O/0DkVpu5JgxA7UkyEvnEGmL/Y1nxZJzDBIMN0jnFBxIMCDCL5L9yRs/vPmTIC8/O33zhw8VdnIEtYAAEw+QMACrNCBCOQgw/gAS8g1Eqh4Fo2AUjIKRBwCbvUZR9x2ERQAAAABJRU5ErkJggg==","orcid":"","institution":"Ghana Health Service, Bole Municipal Hospital","correspondingAuthor":true,"prefix":"","firstName":"Wadeyir","middleName":"Jonathan","lastName":"Abesig","suffix":""},{"id":550104800,"identity":"a18467ea-1258-49aa-b9ea-0e1666fee1ae","order_by":1,"name":"Anthony Akuribire Ayambire","email":"","orcid":"","institution":"Ghana Health Service, Central Gonja District Hospital","correspondingAuthor":false,"prefix":"","firstName":"Anthony","middleName":"Akuribire","lastName":"Ayambire","suffix":""},{"id":550104801,"identity":"31ad1673-5257-42f5-ba01-5d90bf598d8a","order_by":2,"name":"Julius Abesig","email":"","orcid":"","institution":"Christian Health Association of Ghana, St. Theresa Hospital","correspondingAuthor":false,"prefix":"","firstName":"Julius","middleName":"","lastName":"Abesig","suffix":""}],"badges":[],"createdAt":"2025-10-15 22:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7871868/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7871868/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96845452,"identity":"1f678719-9adb-4a7c-870d-10d18c76bc1d","added_by":"auto","created_at":"2025-11-26 16:33:22","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1740562,"visible":true,"origin":"","legend":"","description":"","filename":"NeonatalMortalityResearch.docx","url":"https://assets-eu.researchsquare.com/files/rs-7871868/v1/17b5176ae5008168386f5fac.docx"},{"id":96918056,"identity":"b4ed3e72-6387-4cb2-8108-325be1b0e5e9","added_by":"auto","created_at":"2025-11-27 14:11:05","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5174,"visible":true,"origin":"","legend":"","description":"","filename":"26c2bba337f94fde8d854e2ed62a72d1.json","url":"https://assets-eu.researchsquare.com/files/rs-7871868/v1/b5114c07067914df27adeae8.json"},{"id":96845443,"identity":"da6138a7-0f34-4171-a1e0-18d488df7279","added_by":"auto","created_at":"2025-11-26 16:33:22","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":72230,"visible":true,"origin":"","legend":"","description":"","filename":"26c2bba337f94fde8d854e2ed62a72d11enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7871868/v1/1ba9db342c5e13597d9e2416.xml"},{"id":96845453,"identity":"b3f5da71-07e5-4a97-8e5a-b2d3323f5014","added_by":"auto","created_at":"2025-11-26 16:33:22","extension":"jpeg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":831760,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7871868/v1/aff4b9be302c855cb4b343bc.jpeg"},{"id":96845454,"identity":"49f16c08-58e6-453a-8f73-835b85978a3c","added_by":"auto","created_at":"2025-11-26 16:33:22","extension":"jpeg","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":829864,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7871868/v1/bb5c766ba1ef86f083c3ba7f.jpeg"},{"id":96917957,"identity":"335f1c27-5454-4482-82a6-47af7bfacf9e","added_by":"auto","created_at":"2025-11-27 14:10:52","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":111993,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7871868/v1/ffba14a023a1abdd41410dea.png"},{"id":96918472,"identity":"6377f3de-2d93-4ea3-8a40-666ba57b0bc8","added_by":"auto","created_at":"2025-11-27 14:11:58","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":111802,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7871868/v1/ab4492cf2521a1cce7189f48.png"},{"id":96918426,"identity":"eb54e2eb-cb57-4d87-8232-9f517d327e28","added_by":"auto","created_at":"2025-11-27 14:11:55","extension":"xml","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":71399,"visible":true,"origin":"","legend":"","description":"","filename":"26c2bba337f94fde8d854e2ed62a72d11structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7871868/v1/5e10e2625688a82f471641c4.xml"},{"id":96845451,"identity":"a382e12c-22e5-40f0-b78d-bff32f88d387","added_by":"auto","created_at":"2025-11-26 16:33:22","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":77511,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7871868/v1/8d07dedcfb0f4b3e0f3896d2.html"},{"id":96918490,"identity":"c345017e-963e-448f-b376-f4d270202d64","added_by":"auto","created_at":"2025-11-27 14:12:01","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":115209,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTrends in Neonatal Mortality Rate (NMR) per 1000 Live Births in Savannah Region (2020-2024)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7871868/v1/bc7c04e6581fc961a6753303.jpg"},{"id":96919045,"identity":"ca833a28-db0b-4f6a-95eb-507325cbdb66","added_by":"auto","created_at":"2025-11-27 14:13:03","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":197288,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of neonatal mortality rate by Districts in Savannah Region, 2020 – 2024\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7871868/v1/a4c3c5f76aba386dea177bea.jpg"},{"id":96845448,"identity":"fc8cbab2-1f9c-4bda-b50a-b98ffd449147","added_by":"auto","created_at":"2025-11-26 16:33:22","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":200335,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eProportion of Neonatal Deaths by District in Savannah Region (2020 - 2024)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7871868/v1/364bc91804b679c85ad702cc.jpg"},{"id":96922962,"identity":"725a9646-eaa9-4519-adac-dbbe5b241826","added_by":"auto","created_at":"2025-11-27 14:20:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1254165,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7871868/v1/0bceb57e-14fd-401f-b0b0-86c14e923448.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e Geospatial and Temporal Trends in Neonatal Mortality: Savannah Region, Ghana, 2020-2024\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNeonatal mortality remains a significant global health challenge, with 2.4 million newborn deaths occurring worldwide in 2019, accounting for almost half of all under-five deaths[1]. Despite progress in reducing child mortality rates globally, neonatal mortality remains[1-3]. The global neonatal mortality rate declined from 37 deaths per 1000 live births in 1990 to 17 deaths per 1000 live births in 2020[1]. However, Sub-Saharan Africa continues to bear a disproportionate burden, with 42% of global neonatal deaths[1, 4].\u003c/p\u003e\n\u003cp\u003eIn Ghana, neonatal mortality rates range from 16 -29 per 1000 live births[4, 5], with preventable causes such as infections (31%), premature birth (29%), and complications during delivery (27%) being major contributors[4-7]. Regional disparities in neonatal mortality rates are evident in Ghana, with some regions experiencing rates twice as high as others[6, 8, 9]. These disparities highlight the need for targeted research and interventions to address the specific needs of different regions.\u003c/p\u003e\n\u003cp\u003eThe Savannah region, a deprived region in Ghana, is one such area that lacks research on neonatal health indicators, including mortality and morbidity. Given the region's unique characteristics and challenges, it is essential to generate evidence on neonatal health outcomes to inform policy and programming. This study aims to address this knowledge gap by determining the 5-year trend of neonatal mortality in the region.\u003c/p\u003e\n\u003cp\u003eThe findings will inform evidence-based strategies to enhance antenatal, intrapartum, and postnatal care, ultimately contributing to achieving Every Newborn Action Plan (ENAP) target of 12 or fewer neonatal deaths per 1000 live births by 2030. The study's findings will also have significant implications for policy and practice, highlighting areas that require improvement and investment.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a cross-sectional design, utilising secondary data analysis of neonatal mortality surveillance data from the Savannah Region, Ghana, spanning 2020 to 2024. The data were extracted from the District Health Information Management System 2 (DHIMS-2) database.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in the Savannah Region, one of Ghana\u0026apos;s 16 administrative regions, located in the north-western part of the country. Established in 2019, the region spans 35,862 km\u0026sup2;, covering approximately 15% of Ghana\u0026apos;s land area. It borders the Upper West, Bono, and Bono East Regions, as well as C\u0026ocirc;te d\u0026apos;Ivoire and Burkina Faso internationally. The region comprises seven Municipal/District Assemblies with an estimated population of 653,266[10].\u003c/p\u003e\n\u003cp\u003eThe Savannah Region has a total of 205 healthcare facilities, including five District Hospitals, three Polyclinics, 26 Health Centres, 158 Community-based Health Planning and Services (CHPS) Compounds, and 13 clinics and maternity homes[11]. The region\u0026apos;s vegetation is predominantly grassland with drought-resistant trees, and it experiences two main seasons: dry (December to April) and wet (July to November).\u003c/p\u003e\n\u003cp\u003eThe population primarily engages in farming, hunting, and gari processing, with some districts experiencing illegal small-scale mining activities. The region\u0026apos;s unique characteristics, including the Mole National Park and rivers like the White and Black Volta, may impact healthcare delivery due to seasonal accessibility challenges[11].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational Definitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNeonatal death:\u003c/strong\u003e Defined as deaths among live births during the first 28 completed days of life[12].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEarly neonatal death:\u003c/strong\u003e Deaths among live births between 0 and 7 completed days of birth (0 \u0026ndash; 6 days)[12].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLate neonatal death:\u003c/strong\u003e Deaths among live births after 7 days to 28 completed days of birth (7 \u0026ndash; 27 days)[12].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection and Processing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study analysed secondary data to describe neonatal deaths in the Savannah Region of Ghana from 2020 to 2024. Data was abstracted from the District Health Information Management System-2 (DHIMS-2), a nationwide, internet-based electronic database that aggregates health facility-based data on health services provided in Ghana[13]. The abstracted variables included district, age, total neonatal deaths, and types of neonatal deaths. The data was extracted from DHIMS-2 into Microsoft Excel version 19, where it underwent thorough cleaning and quality checks for completeness and inconsistencies. Columns were inspected to ensure correct data formats, and data elements describing the same variable were rearranged for easy identification, verification, and aggregation. Due to the robust supervision of DHIMS-2 by its management team, the dataset was found to be comprehensive and accurate, with no instances of missing data or inconsistencies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome Variable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe outcome variable of interest in this study was the Neonatal Mortality Rate (NMR). NMR was measured as the number of neonatal deaths per 1000 live births, based on the 5 years preceding the surveys. The neonatal mortality rate is calculated by counting the number of deaths that occur within the first 28 days of life per 1000 live births in a given year or period. The DHIMS 2 provides the necessary information on dates of birth and age at death, enabling the calculation of NMR.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistical analyses, including frequencies and percentages, were conducted to summarize key variables such as total neonatal deaths, deliveries, live births, and types of neonatal deaths. Geographic Information System (QGIS) software was used to create thematic maps illustrating trends and district-level proportions of neonatal deaths, utilizing shape files from DHIMS-2. Temporal patterns were examined through seasonal decomposition analysis. Results were presented in a combination of tables, graphs, and maps to enhance visualization and interpretation of the data.\u003c/p\u003e"},{"header":"Results","content":"\n\u003ch3\u003eBackground Characteristics:\u003c/h3\u003e\n\u003cp\u003eOver the five-year study period, 288 neonatal deaths were recorded in the Savannah Region, with 94.4% (272/288) occurring in the early neonatal period (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The overall neonatal mortality rate was 3.5 per 1,000 live births (95% CI: [3.1, 3.9]). Notably, the rate increased from 2.8 per 1,000 live births (95% CI: [1.9, 3.6]) in 2020 to 3.8 per 1,000 live births (95% CI: [9.9, 4.7]) in 2024.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDeliveries, live births and neonatal mortality rate, Savannah Region, 2020\u0026ndash;2024.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDeliveries\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLive births\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEND\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLND\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal ND\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNMR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eENMR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eLNMR\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14762\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14536\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e2.8[1.9, 3.6]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e2.6[1.8, 3.5]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.1[0, 0.3]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16313\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3.9[2.9, 4.8]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e3.6[2.6, 4.5]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.3[0, 0.6]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16652\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e2.3[1.6, 3.1]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e2.3[1.6, 3.1]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.0[0, 0.2]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17925\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17726\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e4.3[3.4, 5.3]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e4.1[3.1, 5.0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.3[0, 0.5]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18451\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3.8[2.9, 4.7]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e3.6[2.8, 4.5]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.2[0, 0.4]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e84476\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83126\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e272\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3.5[3.1, 3.9]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e3.3[2.9, 3.7]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.2[0, 0.3]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eTrends in Neonatal Mortality Rates\u003c/h3\u003e\n\u003cp\u003eOver the five-year period, neonatal mortality rates exhibited an upward trend. The overall rate increased from 2.8 per 1,000 live births (95% CI: 1.9\u0026ndash;3.6) in 2020 to 3.8 per 1,000 live births (95% CI: 2.9\u0026ndash;4.7) in 2024 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This rise was mirrored in both early and late neonatal mortality rates. Early neonatal mortality rose from 2.6 per 1,000 live births (95% CI: 1.8\u0026ndash;3.5) in 2020 to 3.6 per 1,000 live births (95% CI: 2.8\u0026ndash;4.5) in 2024, while late neonatal mortality increased from 0.1 per 1,000 live births (95% CI: 0-0.3) in 2020 to 0.2 per 1,000 live births (95% CI: 0-0.4) in 2024 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eGeospatial Distribution\u003c/h2\u003e\u003cp\u003eNeonatal deaths were recorded across all districts in the Savannah Region, with cumulative neonatal mortality rates ranging from 0.5 / 1000 LB to 6.4 1000 LB per 1,000 live births. The highest cumulative rate was recorded in West Gonja district, while the lowest rate was recorded in North Gonja district (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the Central Gonja District had the highest proportion of neonatal deaths at 22.6% (95% CI: 17.8\u0026ndash;27.4), closely followed by West Gonja District at 22.2% (95% CI: 17.4\u0026ndash;27.0) and Bole District at 20.5% (95% CI: 15.8\u0026ndash;25.2), whereas the North Gonja and North East Gonja Districts recorded the lowest proportions at 1.0% (95% CI: 0-2.2) each.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eTemporal pattern\u003c/h3\u003e\n\u003cp\u003eMajority of neonatal deaths, 53.3% (95% CI [47.1, 59.6]) occurred during the dry season, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNeonatal Mortality Proportions by District and Season\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistrict\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDeliveries\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLiveBirth\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEND\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLND\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eND\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNMR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e%[95% CI]\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBole\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20361\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e2.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20.5[15.8, 25.2]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCentral Gonja\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16822\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e22.6[17.8, 27.4]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEast Gonja\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13879\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e17[12.7,21.3]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNorth Gonja\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6657\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6559\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.0[0, 2.2]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNorth-East Gonja\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3632\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3614\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.0[0, 2.2]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSawla-Tuna-Kalba\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15.6[11.4, 19.8]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWest Gonja\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10202\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e6.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e22.2[17.4, 27.0]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSeason\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33615\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e53.3[47.1, 59.6]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRainy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35241\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34719\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e46.7[40.5, 53.0]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e68856\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e67786\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined geospatial and temporal trends in neonatal mortality in the Savannah Region, revealing an overall rate of 3.5 per 1,000 live births. Notably, this rate is lower than the national estimate of 16\u0026ndash;29/1000[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and meets the WHO target of under 12 per 1,000 live births[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, given the increasing trend, health authorities should design targeted interventions to sustain these gains and further reduce neonatal mortality in the region.\u003c/p\u003e\u003cp\u003eThe neonatal mortality rate showed an upward trend over the study period, peaking at 4.3 per 1,000 live births in 2023. This finding aligns with another study that reported an increase in the neonatal mortality rate in the Savannah region from 2.3 per 1,000 live births in 2019 to 4.34 per 1,000 live births in 2023[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Notably, the rate observed in this study is significantly lower than national estimates, including 22.8 per 1,000 live births reported by UNICEF, 18 per 1,000 live births in 2023[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and 1.2% in the 2022 Ghana demographic and health survey(GDHS)[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, it's slightly lower than the projected rate of 5.13 per 1,000 live births in 2025 by Farhan et al[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eOur study found a higher incidence of early neonatal deaths compared to late neonatal deaths, consistent with findings from numerous studies in in Ghana and sub-Saharan Africa[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This trend is largely attributed to poor access to quality healthcare, skilled birth attendants, and neonatal care services in many parts of the region. For example, the Savannah region has a relatively low rate of skilled deliveries and low completion of continuum of maternal care (54.8%) as compared with 90.1% in the Upper West Region of Ghana[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Notably, two districts in the region lack district hospitals and neonatal intensive care units, exacerbating the challenge. Furthermore, health facilities across the region are often poorly equipped to manage critical conditions such as birth asphyxia and its complications, infections, prematurity, and congenital anomalies. Improving the quality of care during delivery and the immediate postpartum period would significantly impact early neonatal survival.\u003c/p\u003e\u003cp\u003eNotably, the West Gonja District recorded the highest neonatal mortality rate of 6.4 per 1,000 live births. A possible explanation for this observation lies in the district's role as a referral hub, with Damongo serving as the regional capital and housing a hospital with a neonatal intensive care unit (NICU). The North Gonja District, which lacks a district hospital, refers cases to West Gonja, but challenges such as inadequate ambulance services and poor road conditions likely contribute to delayed and critical referrals.\u003c/p\u003e\u003cp\u003eInterestingly, the North Gonja and North-East Gonja Districts, both without district hospitals, reported the lowest proportions of neonatal deaths (1% each), likely due to the practice of referring cases to districts with NICU-equipped hospitals, rather than an actual low incidence of mortality.\u003c/p\u003e\u003cp\u003eMost neonatal deaths in the Savannah region occurred during the dry season, consistent with studies showing increased neonatal and child mortality during winter months[\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The region's location in the Harmattan belt, marked by increased respiratory infections and cold weather, may contribute to this trend. Notably, neonatal mortality rates were not correspondingly high during the rainy season, despite challenges like difficulty accessing communities[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This might be attributed to the fact that only health facility-reported deaths are captured in DHIMS-2, potentially missing neonatal deaths in communities during the rainy season due to limited access to healthcare.\u003c/p\u003e\n\u003ch3\u003eStrengths and limitations\u003c/h3\u003e\n\u003cp\u003eThis study's findings are based on actual data captured in DHIMS-2, eliminating potential recall bias by relying on retrospectively analysed data rather than perceptions or opinions. However, the study has several important limitations. Firstly, DHIMS-2 data lacked crucial information on neonatal deaths, such as gestational age, APGAR scores, maternal sociodemographic characteristics, and obstetric and medical factors, which are not routinely documented. This limited our ability to conduct a comprehensive analysis of neonatal mortality. Furthermore, relying on health facility-reported deaths may have underestimated the true neonatal mortality rate, potentially missing cases that occurred outside facilities.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study examined geospatial and temporal trends in neonatal mortality in the Savannah Region (2020\u0026ndash;2024), revealing an increasing trend in neonatal mortality rates from 2.8 to 3.8 per 1,000 live births, primarily driven by early neonatal deaths. To address this, targeted interventions are recommended, including improved early neonatal care, enhanced antepartum, intrapartum, and postnatal care, and the establishment of equipped neonatal intensive care units in district hospitals. Additionally, continuous professional development for midwives and community health nurses in identifying and managing high-risk pregnancies, as well as timely referrals, is crucial. Training neonatal nurses in basic and advanced life support for neonates across the region is also essential. These findings inform further research and interventions to reduce early neonatal mortality in the Savannah Region\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eAPGAR:\u003c/strong\u003e Appearance, Pulse, Grimace, Activity, and Respiration\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDHIMS:\u0026nbsp;\u003c/strong\u003eDistrict Health Information Management System\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eENAP:\u0026nbsp;\u003c/strong\u003eEvery Newborn Action Plan\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEND:\u0026nbsp;\u003c/strong\u003eEarly Neonatal Death\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eENMR:\u0026nbsp;\u003c/strong\u003eEarly Neonatal Mortality Rate\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGDHS:\u0026nbsp;\u003c/strong\u003eGhana Demographic and Health Survey\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGHS:\u0026nbsp;\u003c/strong\u003eGhana Health Service\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGSS:\u0026nbsp;\u003c/strong\u003eGhana Statistical Service\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNICU:\u0026nbsp;\u003c/strong\u003eNeonatal Intensive Care Unit\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLND:\u0026nbsp;\u003c/strong\u003eLate Neonatal Death\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLNMR:\u0026nbsp;\u003c/strong\u003eLate Neonatal Mortality Rate\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNMR:\u0026nbsp;\u003c/strong\u003eNeonatal Mortality Rate\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQGIS:\u0026nbsp;\u003c/strong\u003eQuantum Geographic Information System\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSRHD:\u0026nbsp;\u003c/strong\u003eSavannah Regional Health Directorate\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUNICEF:\u003c/strong\u003e United Nations Children’s Fund\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHO:\u0026nbsp;\u003c/strong\u003eWorld Health Organisation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data for this study are available in the DHIMS-2 database, a secure system managed by the Ghana Health Service (GHS) and the Government of Ghana. The data can be accessed upon request through the Director-General of the Ghana Health Service via (https://dhims.chimgh.org). Access requires a username and password authorised by the GHS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe gratefully acknowledge the Savannah Regional Health Directorate for granting us administrative permission to abstract data from the District Health Information Management System (DHIMS-2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors and Affiliations\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eGhana Health Service (GHS), Bole District Hospital, Bole, Savannah Region, Ghana\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eWadeyir Jonathan Abesig\u003c/p\u003e\n\u003col start=\"2\" type=\"1\"\u003e\n \u003cli\u003eGhana Health Service (GHS), Central Gonja District Hospital, Buipe, Savannah Region, Ghana\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eAnthony A. Ayambire\u003c/p\u003e\n\u003col start=\"3\" type=\"1\"\u003e\n \u003cli\u003eChristian Health Association of Ghana (CHAG), St. Theresa Hospital, Nandom, Upper West Region, Ghana\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eJulius Abesig\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWJA conceptualised the study, did the data abstraction and analysis. WJA and JA drafted the manuscript. JA, and AAA reviewed the manuscript. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrespondence\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWadeyir jonathan Abesig\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical clearance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study utilised de-identified, aggregated neonatal mortality data from the District Health Information Management System 2 (DHIMS-2), which is mandated by the Ghana Health Service under the Public Health Act (Act 851), 2012, for disease surveillance and response. Given the use of aggregated, de-identified data, formal ethical clearance and informed consent were not required. Permission for data extraction and use was obtained from the Savannah Regional Health Directorate. Data were stored securely on a password-protected computer, accessible only to authorised personnel. The study adhered to the principles outlined in the World Medical Association Declaration of Helsinki and relevant data protection regulations, ensuring confidentiality and ethical conduct throughout\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUN IGME: Levels \u0026amp; Trends in Child Mortality: Report 2020, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation\u0026rsquo;, United Nations Children\u0026rsquo;s Fund, New York. 2020. In.; 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBlencowe H, Cousens S. Addressing the challenge of neonatal mortality. Trop Med Int Health. 2013;18(3):303\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJena BH, Jaldo MM, Demesa YY, Kebede BA, Melaku LM. Magnitude of neonatal mortality and its association with maternal and child health care in sub-Saharan africa: a systematic review and meta-analysis. Arch Public Health. 2025;83(1):219.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePoulin D, Nimo G, Royal D, Joseph PV, Nimo T, Nimo T, Sarkodee K, Attipoe-Dorcoo S. Infant mortality in Ghana: investing in health care infrastructure and systems. \u003cem\u003eHealth Affairs Scholar\u003c/em\u003e 2024, 2(2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdongo EA, Ganle JK. Predictors of neonatal mortality in Ghana: evidence from 2017 Ghana maternal health survey. BMC Pregnancy Childbirth. 2023;23(1):556.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTette EMA, Nartey ET, Nuertey BD, Azusong EA, Akaateba D, Yirifere J, Alandu A, Seneadza NAH, Gandau NB, Renner LA. The pattern of neonatal admissions and mortality at a regional and district hospital in the Upper West Region of Ghana; a cross sectional study. PLoS ONE. 2020;15(5):e0232406.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdul-Mumin A, Cotache-Condor C, Owusu SA, Mahama H, Smith ER. Timing and causes of neonatal mortality in Tamale Teaching Hospital, Ghana: A retrospective study. PLoS ONE. 2021;16(1):e0245065.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDare S, Oduro AR, Owusu-Agyei S, Mackay DF, Gruer L, Manyeh AK, Nettey E, Phillips JF, Asante KP, Welaga P, et al. Neonatal mortality rates, characteristics, and risk factors for neonatal deaths in Ghana: analyses of data from two health and demographic surveillance systems. Glob Health Action. 2021;14(1):1938871.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbubakr AF, Kubio C. Unveiling neonatal mortality inequities in Ghana: A geospatial and temporal analysis of regional disparities, healthcare accessibility, and institutional gaps to drive targeted interventions. Pediatr Neonatol 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGSS. Ghana 2021 population and housing census: general report. In.; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSRHD. 2022 Annual Report, Savannah Regional Health Directorate (SRHD). In.; 2022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePathirana J, Munoz FM, Abbing-Karahagopian V, Bhat N, Harris T, Kapoor A, Keene DL, Mangili A, Padula MA, Pande SL, et al. Neonatal death: Case definition \u0026amp; guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine. 2016;34(49):6027\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAgongo EE, Agana-Nsiire P, Enyimayew NK, Adibo MK, Mensah EN. Primary health care systems (PRIMASYS): case study from Ghana, abridged version. Geneva: World Health Organization; 2017.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFofie CO. CONTINUUM OF MATERNAL CARE IN GHANA: EVIDENCE FROM THE 2022 DHS.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMangu CD, Rumisha SF, Lyimo EP, Mremi IR, Massawe IS, Bwana VM, Chiduo MG, Mboera LEG. Trends, patterns and cause-specific neonatal mortality in Tanzania: a hospital-based retrospective survey. Int Health. 2021;13(4):334\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlebel A, Wagnew F, Petrucka P, Tesema C, Moges NA, Ketema DB, Yismaw L, Melkamu MW, Hibstie YT, Temesgen B, et al. Neonatal mortality in the neonatal intensive care unit of Debre Markos referral hospital, Northwest Ethiopia: a prospective cohort study. BMC Pediatr. 2020;20(1):72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDalili H, Shariat M, Sahebi L. Time series analysis for forecasting neonatal intensive care unit census and neonatal mortality. BMC Pediatr. 2025;25(1):339.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDalla-Zuanna G, Rosina A. An Analysis of Extremely High Nineteenth-Century Winter Neonatal Mortality in a Local Context of Northeastern Italy. Eur J Popul / Revue europ\u0026eacute;enne de D\u0026eacute;mographie. 2010;27(1):33\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDoyle MA. Seasonal patterns in newborns' health: Quantifying the roles of climate, communicable disease, economic and social factors. Econ Hum Biol. 2023;51:101287.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStrand LB, Barnett AG, Tong S. The influence of season and ambient temperature on birth outcomes: a review of the epidemiological literature. Environ Res. 2011;111(3):451\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEriksson L, Nga NT, Hoa DTP, Duc DM, Bergstrom A, Wallin L, Malqvist M, Ewald U, Huy TQ, Thuy NT, et al. Secular trend, seasonality and effects of a community-based intervention on neonatal mortality: follow-up of a cluster-randomised trial in Quang Ninh province, Vietnam. J Epidemiol Community Health. 2018;72(9):776\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7871868/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7871868/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite progress in reducing child mortality globally, neonatal mortality remains a concern in Ghana, where preventable causes and regional disparities persist. Some regions experience rates twice as high as others, highlighting the need for targeted research and region-specific interventions. This study addresses the knowledge gap in the Savannah Region by examining 5-year geospatial and temporal trends in neonatal mortality (2020-2024), providing evidence to inform policy and programming.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study used a retrospective, descriptive cross-sectional design, analysing 2020-2024 data on neonatal deaths in the Savannah Region from the DHIMS 2 database. Data was analysed using Microsoft Excel version 19, with results presented as frequencies, percentages, tables, graphs, and maps.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall neonatal mortality rate was 3.5 per 1,000 live births (288/83,126), with a notable 35.7% increase from 2.8 per 1,000 live births in 2020 to 3.8 per 1,000 live births in 2024. Early neonatal deaths accounted for 94.0% of all neonatal deaths. The Central Gonja District had the highest proportion of neonatal deaths, contributing 22.6% (65/288) of the total. \u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe neonatal mortality rate in the Savannah Region increased from 2.8 to 3.8 per 1,000 live births, driven by early neonatal deaths. Targeted interventions in early neonatal care and improved antepartum, intrapartum, and postnatal care, along with equipped neonatal intensive care units in district hospitals, are crucial to reducing mortality rates.\u003c/p\u003e","manuscriptTitle":"Geospatial and Temporal Trends in Neonatal Mortality: Savannah Region, Ghana, 2020-2024","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-26 16:33:17","doi":"10.21203/rs.3.rs-7871868/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-11-14T17:20:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-24T17:01:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-21T07:58:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-21T07:57:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-10-15T22:28:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2bfb3f95-6913-484c-b31d-8101919296ef","owner":[],"postedDate":"November 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-26T16:33:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-26 16:33:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7871868","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7871868","identity":"rs-7871868","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}