Cause specific under-five mortality rates and associated risk factors among children in northern Ghana between 2007 and 2012 using survival analysis techniques

This study assessed the causes of under-five (U5) deaths and examined the associated risk factors in northern Ghana. The study analyzed prospectively collected longitudinal data of children born between 1st January 2007 and 31st December 2012 and resident in the Navrongo Health and Demographic Surveillance System (NHDSS) area in northern Ghana. Data from 20,651 children were analyzed with 1,056 under-five deaths and 51,783 person-years of observation. The overall mortality rate was 19.5 per 1000 person-years of observation. The main cause of under-five deaths was malaria (19.5%). Being male (Hazards ratio [95% CI]; 1.20 [1.06-1.36]; p=0.004), children born to single mothers (1.3 [1.18-1.59]; p<0.001) and home deliveries (1.29 [1.12-1.48]; p<0.001) were associated with increased risk of mortality. Children born to women aged 20-34 years (0.81 [0.67 – 0.98]; p=0.0.25) were associated with relatively lower risk of death compared to those born to women aged 19 years and below. Children from high socioeconomic households had relatively lower risk of death even though not statistically significant (0.87 [0.74-1.03]; p=0.056). Malaria remains the leading cause of under-five deaths in the study area. Adherence to prevailing malaria prevention measures including use of insecticide treated bed-nets, seasonal chemo-prophylaxis, indoor-residual spraying and adequate access to healthcare will greatly improve child survival.