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Understanding the determinants of infant and under-five mortality rates: a multivariate decomposition analysis of Demographic and Health Surveys in Ghana, 2003, 2008 and 2014
  1. Duah Dwomoh1,
  2. Susan Amuasi2,
  3. Kofi Agyabeng3,
  4. Gabriel Incoom4,
  5. Yakubu Alhassan3,
  6. Alfred Edwin Yawson5
  1. 1 Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
  2. 2 Department of Physician Assistantship, School of Medicine and Health Sciences, Central University College, Accra, Ghana
  3. 3 Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
  4. 4 Department of Management Science, School of Business, Ghana Institute of Management and Public Administration, Accra, Ghana
  5. 5 Department of Community Health, School of Public, College of Health Sciences, University of Ghana, Accra, Ghana
  1. Correspondence to Dr Duah Dwomoh; duahdwomoh{at}


Introduction Despite the decline in infant and under-five mortality rates since the last decade, Ghana did not meet the millennium development goal (MDG) 4 target. To implement effective interventions that could fast-track progress towards achieving the sustainable development goal 3 in 2030, factors contributing to the decline in child mortality throughout the MDG period and which factor(s) has/have been consistent in affecting child survival in the last decade need to be understood.

Methods This study used Demographic and Health Surveys (DHS) from 2003, 2008 and 2014 and data from World Bank Development Indicators (2000–2018). We employed modified Poisson with robust SE and multivariate decomposition approach to assess risk factors of child mortality using DHS data from 2003, 2008 and 2014. Penalised regression was used assess the effect of 25 country-level contextual factors on child survival.

Results The risk of infant mortality is approximately five times higher among mothers who had multiple births compared with mothers who had single birth over the last decade (adjusted relative risk 4.6, 95% CI 3.2 to 6.6, p<0.001). An increase in the annual percentage of female labour force participation (FLFP) is associated with the reduction of approximately 10 and 18 infant and under-five annual deaths per 1000 live births, respectively.

Conclusions This study found that multiple births and shorter birth spacing are associated with increased risk of infant and under-five deaths over the last decade. Increased in FLFP, and the proportion of children sleeping under bed-net are associated with reduced risk of both infants and under-five deaths.

  • infant mortality
  • under-five mortality
  • multivariate decomposition
  • modified Poisson
  • least absolute shrinkage and selection operator

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  • Handling editor Sanni Yaya

  • Contributors All authors contributed significantly to this manuscript and met the authorship criteria set out for the BMJ Global Health.

  • Competing interests No, there are no competing interests for any author.

  • Ethics approval This study involves the analysis of anonymous publicly available secondary data and therefore no ethical approval was required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.

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