Disturbing Infant Mortality (under-5) Cases in Ghana

Introduction

Maame Agyeiwaa Agyei

Losing a baby (infant mortality) is a devastating moment for every parent. Often, the circumstances surrounding such unfortunate events could be avoided if proper infrastructure were in place.

The United Nations International Children’s Emergency Fund (UNICEF) defines under-five mortality (infant mortality) as the possibility of a child dying between birth and age five per 1000 live births (UNICEF, 2012).

Infant mortality has been a major concern in Ghana for decades, and numerous campaigns to sensitise the general public have been carried out.

In 2019, the infant mortality rate in Ghana declined to 46.2 deaths per 1,000 live births from 202.3 deaths per 1,000 live births since 1970.

Although Ghana has seen progress in the survival rate in the past three decades, the decline rate is not impressive since the last two decades, as the rate was 79.3 per 1000 live births in 1990 to 35.7 per 1000 live births in 2017 (Dwomoh et al., 2019).

Ghana consist of 16 regions with a population of 30.8 million (GSS, 2020), so recording such a high rate of deaths among infants makes it disturbing, especially when the majority of infant deaths are recorded from rural Ghana.

In 2013 alone, approximately 44 % of all under-5 deaths occurred in the first month of life (Wardlaw et al, 2014).

Over the period 2009-2014, the neonatal mortality rate was also estimated to be 29 deaths per 1,000 live births (GSS, 2015). This means that Ghana is still lagging on Goal 3 target 2 of the Sustainable Development Goal (SDG), which aims to end preventable deaths of newborns and children under 5 years of age, reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births by 2030.

According to the United Nations (2019), Ghana’s yearly mortality rate is expected to begin rising in a few decades, whereas the child dependency rate has been declining since 1980 and is projected to continue falling until 2100. It is, therefore, imperative to put in place a pragmatic policy to curtail this imminent issue.

Nature and Magnitude of the Problem

Infant mortality can occur in both rich and poor families, irrespective of the geographical location, but the rate is higher in rural areas in Ghana.

Sarkodie (2021) corroborates that the urban child mortality rate is lower than the rural rate. It is therefore imperative to consider both urban and rural families when health interventions are being rolled out in the country.

According to statistics available, the leading causes of child mortality are neonatal, child pneumonia, malaria, diarrhea, HIV/AIDS, measles, and accidents (WHO, 2019; Wang et al., 2016).

Infant mortality continues to be a challenge, and Viguera Ester et al.’s (2011) study has revealed that the life expectancy of children born in Sub-Saharan Africa, including Ghana, is 51 years, and almost 10% of them die in the first year of life.

Fotso et al. (2007) argue that allocation of resources and policy should not relegate the urban poor and rural folks because the poorest families who cannot afford quality healthcare in society are usually the least likely to receive interventions.

Aheto (2019) suggests that the inequitable distribution of infrastructure and social amenities has contributed to the high infant mortality rate in Ghana, especially in rural areas.

The Ghana Demographic and Health Survey (GDHS, 2014) recorded that the under-five mortality rate in Ghana was 60 per 1000 live births, with significantly higher mortality in rural areas than urban areas (GSS, 2015).

These disparities in the under-five mortality rate between rural and urban Ghana are worrying since they dent the quest to achieve equity in improved health in the country (GSS, 2015).

Aheto (2019) asserts that many of the causes of infant mortality could have been prevented if the right policies were implemented and therefore calls for the need to identify drivers of infant mortality for appropriate intervention strategies to make Goal 3 Target 2 of the Sustainable Development Goals attainable.

Moreover, there are woefully inadequate health facilities in most rural areas in Ghana, and the few are under-resourced with a handful of personnel.

Emergencies are usually referred to district hospitals, which are mostly long-distance drives. Again, most access routes in the rural areas are unpaved, therefore making some parents resort to the use of traditional medicine when needed. For instance, an infant who has convulsion attacks is usually treated at home with concoctions, and some are even given marks on their faces because of the superstitious belief that they are attacked by evil spirits.

Affected Population

The population that is hugely affected by these disparities are the poor and marginalised, especially those living in rural areas.

There is a huge gap in terms of infrastructural distribution in Ghana. All the good roads, ultramodern hospitals, and specialists are located in the capital.

Although Ghana runs a decentralised system of governance, when it comes to infrastructural development, there is a vast gap between the rural and urban areas because of the centralised nature of the distribution.

This comparison between the rural and urban areas is very crucial because of the disparities in economic opportunities, social status, and infrastructure. The poor rural folks usually resort to their means in solving health challenges since they have been relegated.

Also, illiterate people are mostly affected by infant mortality because they cannot read and write.

When a woman has some level of formal education, her children have a better chance at surviving during the first 5 years (Babayara & Addo, 2018).

Babayara & Addo (2018) in this study revealed that infant mortality is highest among mothers with no formal education, and lower among literate mothers because they can make reasonable decisions.

Risk Factors

Babayara & Addo (2018), in their research, concluded that there is a correlation between infant mortality and the level of education of a mother.

They assert that mothers who are educated can make well-informed decisions concerning their children, hence reducing the risk of death.

Most people in rural Ghana cannot read or write, which makes it difficult for them to comprehend instructions from health personnel.

Again, most of these women in rural areas do not know the essence of postnatal and neonatal education that sensitises them about their newborns.

Quansah et al. (2016) posit that the level of education of a mother has a great influence on the survival of her child since most decisions are made by them.

The study added that the association of maternal education and child mortality is not unique to Ghana alone.

According to Oyefara (2012), some of the risk factors for infant and child mortality include the age of the mother at the time of childbirth, family size, birth interval, access to healthcare, and aspects that come along with prenatal and postnatal such as the degree of complications.

In Ghana, some of the prevalent risk factors include diarrheal diseases and infections, malnutrition, which is predominant in rural communities.

Babayara & Addo (2018) uncovered that women within the age group of 20–29 (5.9%) years and those between 30 and 39 (5.7%) years recorded fewer infant mortality.

Additionally, Binka et al. (1995) observed that there is a risk of death where delivery is not performed by health personnel.

Although the study seems old, the context is relevant because most villages and hamlets in Ghana do not have health facilities and older women deliver babies, putting both the baby and the mother at risk.

Impact on the Economy

Every country’s development depends on the strength of its teeming youth as human capital for its growth, thus the shortage of youth retards its progress.

Infant mortality has a grave impact on the economy, country, and humanity at large. Once newborns are dying, it will affect population growth and the shortage of human resources.

A population with high unhealthy infants and mortality eventually dampens economic progress, decreases workforce and productivity, under-utilises resources, both natural and man-made, and increases government expenditure medical-care care (World Development Report, 1993).

Raivio (1990) corroborates that, when infant mortality surges, fertility reduction follows; in other words, the number of people who can give birth in the future decreases with the net effect of lower growth of population.

According to Skolnik (2019), many poor families, knowing the high probability that their newborns will die, tend to have high fertility, have more children to compensate for these deaths.

Proposed Solutions

Infant mortality has a negative repercussion on a country in the long run, hence the need for pragmatic measures to reduce it to the barest minimum.

To decrease the infant mortality rate in Ghana, it is crucial to invest in the healthcare sector. Infrastructure should be prioritised, including well-equipped hospitals, clinics, health personnel, accessible roads, and investments in education and sensitisation.

Education will not mainly focus on mothers or women in general, but also on capacity building for health workers.

An all-inclusive training program shall be rolled out for all relevant healthcare providers to equip them to work efficiently.

The goal is to ensure that all stakeholders, as well as the general public, are well informed about how to control under-5 mortality.

Research has revealed that most causes of infant mortality are preventable; there is a need to invest in the health sector to curb all other diseases that can put pregnant women and unborn babies at risk Aheto, 2019).

As part of investing in the health sector, more community health nurses should be engaged, dispatched to every part of the country, especially villages, to embark on effective public health education, sensitisation, and behavioural change of the general public, which I believe would yield positive results.

Finally, an effective health insurance scheme, equal and equitable access to healthcare in Ghana can curb the infant mortality rate in Ghana.

Even if there are available health facilities, but not affordable, low-income earners would not be able to access adequate health care.

It is therefore imperative to make access to healthcare affordable for people of all social classes within society, since healthcare is considered a basic human right.

Classism exists in every society, this includes extremely poor people, low-income earners, middle-income earners, this means that to cut down the financial burden on the government, subsidies, monetary contribution, incentives, and free health insurance coverage would focus on the extremely lacking people such as poor pregnant women, lactating mothers, and all under-5 mothers in rural areas will be incorporated under this policy.

Therefore, integration of cash transfers such as the PROGRESA model will be adopted (Levine, 2007) for mothers to buy what they need.

Since it is going to be a long-term project, Public-Private Partnerships (PPP) will also help to cut down the financial burden on the government.

This PPP will include private insurance schemes, pharmaceutical companies, private health facility owners, and any other corporate bodies that would be interested in the health sector.

More potential investors will be invited to bring competition to break the monopoly on the market, to make products cheaper.

Also, encourage all stakeholders in the industry, including pharmaceutical companies, private health facility owners, and private insurance companies, to understand and structure policies to support the goal.

By doing so, there would be access to affordable drugs under this policy. The first tranche of support should be for US$50 million to embark on this project.

Since it is the first phase and tranche of funds, US$35 million will be invested in infrastructure, and the remaining US$15 million will be spent on other components. Also, private partners will bring funding.

I believe that successive policies that had higher budgets were not successful mainly because they did not incorporate PPP and involve mothers themselves. This policy uses a participatory, bottom-up approach, and I am optimistic it will be successful.

By Maame Agyeiwaa Agyei (Maame), BA, MA

She is a Doctoral Student at, University of Memphis, USA. Maame is also an Instructor and CWC Consultant.

 

 

 

 

 

 

 

 

 

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