Geographical Inequalities and Social and Environmental Risk Factors for Under-Five Mortality in Ghana in 2000 and 2010: Bayesian Spatial Analysis of Census Data.
Under-five mortality is declining in Ghana and many other countries. Very few studies have measured under-five mortality-and its social and environmental risk factors-at fine spatial resolutions, which is relevant for policy purposes. Our aim was to estimate under-five mortality and its social and environmental risk factors at the district level in Ghana.



We used 10% random samples of Ghana's 2000 and 2010 National Population and Housing Censuses. We applied indirect demographic methods and a Bayesian spatial model to the information on total number of children ever born and children surviving to estimate under-five mortality (probability of dying by 5 y of age, 5q0) for each of Ghana's 110 districts. We also used the census data to estimate the distributions of households or persons in each district in terms of fuel used for cooking, sanitation facility, drinking water source, and parental education. Median district 5q0 declined from 99 deaths per 1,000 live births in 2000 to 70 in 2010. The decline ranged from <5% in some northern districts, where 5q0 had been higher in 2000, to >40% in southern districts, where it had been lower in 2000, exacerbating existing inequalities. Primary education increased in men and women, and more households had access to improved water and sanitation and cleaner cooking fuels. Higher use of liquefied petroleum gas for cooking was associated with lower 5q0 in multivariate analysis.



Under-five mortality has declined in all of Ghana's districts, but the cross-district inequality in mortality has increased. There is a need for additional data, including on healthcare, and additional environmental and socioeconomic measurements, to understand the reasons for the variations in mortality levels and trends.
Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America.
Raphael E
RE
Arku
MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom.|Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
James E
JE
Bennett
Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America.
Marcia C
0000-0003-4606-2795
MC
Castro
Ghana Statistical Service, Accra, Ghana.
Kofi
K
Agyeman-Duah
Ghana Statistical Service, Accra, Ghana.
Samilia E
SE
Mintah
Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America.
James H
JH
Ware
Ghana Statistical Service, Accra, Ghana.
Philomena
0000-0002-0765-9807
P
Nyarko
Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America.
John D
JD
Spengler
Department of Geography and Resource Development, University of Ghana, Legon, Ghana.
Samuel
S
Agyei-Mensah
MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom.|Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.|Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom.
Majid
0000-0002-2109-8081
M
Ezzati
D001499:Bayes Theorem; D019352:Censuses; D046688:Child Mortality; D002675:Child, Preschool; D005260:Female; D005843:Geography; D005869:Ghana; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D012959:Socioeconomic Factors