Leveraging lessons from practice and research to guide actions toward achieving Sustainable Development Goal for Neonatal Mortality
Founder: Global Affairs Canada
PI: Dr. Amos Laar, University of Ghana
Co-PI: Dr. Kwame Sakyi , Dr. Mufaro Kanyangarara (Johns Hopkins Bloomberg School of Public Health)
Significant progress has been made to reduce child mortality globally, but neonatal mortality has declined at a slower pace. The 1993 and 2014 Demographic and Health Surveys reported under-five mortality rates of 119 and 60 deaths per 1000 live births, respectively, for the five-year period preceding each survey. This reduction contrasts with a rather stable neonatal mortality rate estimated at 30 and 29 deaths per 1,000 for the same time period. In order to meet the Sustainable Development Goal to reduce neonatal mortality to under 12 deaths per 1,000 live births, intensified and sustained efforts are imperative. However, there is limited evidence on what priority interventions at the sub-national level will put Ghana on the trajectory to attain this goal by 2030. This project will focus on ascertaining the historical change in neonatal interventions and associated impacts in the context of policies, program strategies, and community actions. More specifically, the project aims to evaluate the historical impact of different neonatal interventions on neonatal mortality in the Northern, Volta and Upper West Regions by conducting a situational analysis. Cognizant of the role of contextual factors in facilitating or hindering progress, the project also seeks to elucidate the role of contextual factors and provide lessons learned for the improvement of the content, quality and implementation of priority interventions, maximizing the impact on neonatal mortality. The current project will provide a basis for strategic program planning by the Ghana Health Services, Savanna Signatures, and other organizations to save the most newborn lives.
We are proposing to conduct a historical and forecast analysis to identify interventions that contribute the most in reducing neonatal mortality and delineate the policy and community context that facilitates their impact.
The specific objectives are to:
1. Assess how epidemiologic status and coverage of proven newborn interventions have contributed to the patterns of decline in neonatal mortality in the Northern, Volta, and Upper West Regions of Ghana.
Hypothesis: Coverage levels of neonatal survival interventions will explain the variability in neonatal mortality across the Northern, Upper West and Volta Regions
2. Delineate policies, program strategies, and community actions that led to the 67% decline in neonatal mortality rate in the Northern Region of Ghana, from 1993 to 2014.
Hypothesis: Changes in contextual factors account for gains in neonatal mortality in the Northern region.
3. Identify what evidenced-based newborn interventions need to be prioritized for the Northern, Volta, and Upper West Regions of Ghana to each reach the SDG target of at most least 12 deaths per 1000 live births.
Priority Interventions to Reach the UN Sustainable Development Goal for Neonatal Mortality in Ghana: Evidence from a Mixed-Methods Study
Prince Owusu, MPhil, Catherine Ohrt, Lydia Ademuwagun, Kristin Watkoske, Bsc., Blessed Sheriff, Leonie Akofio-Sowah, Msc., Mufaro Kanyangarara, PhD, Amos Laar, PhD, MPH, MA, and Kwame Sakyi, PhD, MSPH, (1) Center for Learning and Childhood Development-Ghana, Accra, MI, Ghana, (2) Brown University, Providence, RI, (3) Oakland University, Rochester, MI, (4) Center for Learning and Childhood Development-Ghana, Accra, Ghana, (5) Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (6) University of Ghana, Accra, Ghana
Purpose: There is limited evidence on what priority interventions at the sub-national level will put countries in sub-Saharan Africa, like Ghana, on a trajectory to reach the UN Sustainable Development Goal (SDG) for neonatal mortality. This study’s aim was to identify evidenced-based newborn interventions that need to be implemented for the Northern, Volta, and Upper West Regions of Ghana to each reach the SDG target of 12 deaths per 1,000 live births by 2030.
Information and Methods: This mixed-methods study had two parts. The rst part was a statistical model based on the Lives Saved Tool. The data was from the nationally representative Ghana Demographic and Health Survey (1993-2014). The second part included 38 in-depth qualitative interviews with health workers and of cials, local leaders, non-pro t leaders, and traditional birth attendants. Interviews were collected in June, 2018.
Results: Across regions, prioritizing labor and delivery management, and clean postnatal practices can reduce neonatal mortality by 42%-60%. In the Volta Region, syphilis detection and treatment, and age appropriate breastfeeding are additionally needed. All these interventions, the qualitative results demonstrate, need to be coupled with efforts to i) reduce transportation barriers to skilled attendants at birth, ii) improve capacity development of front-line workers on neonatal health, and iii) address harmful postnatal practices at both community and health facility levels.
Conclusion: In Ghana, meeting the SDG target for neonatal mortality at the sub-national level will require concurrent investments in facility-based interventions, capacity development, and health education.