Examining the Influence of Antenatal Care Visits and Skilled Delivery on Neonatal Deaths in Ghana
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Many Sub-Saharan African countries may not achieve the Millennium Development goal of reducing child mortality by 2015 partly due to the stalled reduction in neonatal deaths, which constitute about 60 % of infant deaths. Although many studies have emphasized the importance of accessible maternal healthcare as a means of reducing maternal and child mortality, very few of these studies have explored the affordability and accessibility concerns of maternal healthcare on neonatal mortality.
This study bridges this research gap as it aims to investigate whether the number of antenatal visits and skilled delivery are associated with the risk of neonatal deaths in Ghana.
Using individual level data of women in their reproductive years from the 2008 Demographic and Health Survey, the study employs an instrumental variable strategy to deal with the potential endogeneity of antenatal care visits.
Estimates from the instrumental variable estimation show that antenatal care visits reduce the risk of neonatal death by about 2 %, while older women have an approximately 0.2 % higher risk of losing their neonates than do younger women.
Findings suggest that women who attend antenatal visits have a significantly lower probability of losing their babies in the first month of life. Further, results show that women’s age significantly affects the risk of losing their babies in the neonatal stage. However, the study finds no significant effect of skilled delivery and education on neonatal mortality.
KeywordsNeonatal Mortality Neonatal Death Birth Interval National Health Insurance Scheme Wealth Quintile
Conflict of interest
The authors declare they have no conflicting interests.
Monica P. Lambon-Quayefio (MLQ) conceived of the study. Both MLQ and Nkechi S. Owoo (NSO) undertook the analysis; a greater portion of the analysis was undertaken by MLQ. MLQ did the write-up of the analysis. Both MLQ and NSO read and approved the final manuscript. MLQ is the guarantor for the overall content of this manuscript.
There was no funding for this study.
- 3.United Nations Inter-Agency Group for Child Mortality Estimates (UN-IGME). Levels and trends in child mortality. Report; 2011.Google Scholar
- 7.United Nations Inter-Agency Group for Child Mortality Estimates (UN-IGME). Levels and trends in child mortality. Report; 2012.Google Scholar
- 14.Villar JH, Ba’aqeel G, Piaggio P, Lumbiganon JM, Belizán U, Farnot Y, Al-Mazrou G, Carrolli A, Pinol A, Donner A, Langer G, Nigenda M, Mugford J, Fax-Rushby G, Hutton P, Bergsjo L, Berendes Bakketeig H. WHO antenatal care randomized trial for the evaluation of a new model of routine antenatal care. Lancet. 2001;357:1551–64.PubMedCrossRefGoogle Scholar
- 15.Magadi MA, Madise NJ, Rodrigues RN. Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities. J Soc Sci. 2000;51:551–61.Google Scholar
- 19.Mensah J, Oppong J, Bobi-Barimah K, Frempong G, Sabi W. An evaluation of the Ghana National Health Insurance Scheme in the Context of the Health MDGs. Working Paper No. 40, Global Development Network 1999–2009, Working Paper Series; 2010.Google Scholar
- 20.World Bank Indicators Report; 2012.Google Scholar
- 21.Edmond KM, Quigley MA, Zandoh C, Danso S, Hurt C, Agyei SO, Kirkwood BR. Aetiology of stillbirths and neonatal deaths in rural Ghana: implications for health programming in developing countries. Paediatr Perinatal Epidemiol. 2008;22:430–7. doi: 10.1111/j.1365-3016.2008.00961.x.CrossRefGoogle Scholar
- 24.World Health Organization, Perinatal and Neonatal Mortality. Country, regional and global estimates. Geneva: WHO; 2004.Google Scholar
- 28.Rooney C. Antenatal care and maternal health: how effective is it? A review of the Evidence Maternal Health and Safe Motherhood Programme Division of Family Health. Geneva: WHO; 1992 [WHO/MSM/92.4].Google Scholar
- 29.Starrs A. The safe motherhood action agenda: priorities for the next decade. New York: Inter-Agency Group for Safe Motherhood and Family Care International; 1997.Google Scholar
- 33.Campbell OMR, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006. doi: 10.1016/S0140-6736(06)69381-1.
- 34.Raatikainen K, Heiskanen N, Heinonen S. Under-attending free antenatal care is associated with adverse pregnancy outcomes. BMC Public Health. 2007;14:268. doi: 10.1186/1471-2458-7-268.
- 36.Lincetto O, et al. Antenatal care, in the partnership for maternal, newborn and child health opportunities for Africa’s newborns; 2006.Google Scholar
- 37.Ghana Demographic and Health Survey Report; 2008. http://www.measuredhs.com/publications/publication-FR221-DHS-Final-Reports.cfm.
- 38.Moran Allisyn C. et al. “Birth-Preparedness for Maternal Health: Findings from Koupéla District, Burkina Faso”, 24 J. HEALTH POP. NUTR. 489 (2006).Google Scholar
- 44.Adjiwanou V, Le Grand T. Does antenatal care matter in the use of skilled birth attendance in rural Africa: a multi-country analysis. Soc Sci Med. 2013.Google Scholar
- 45.Saving Newborn Lives. The state of the world’s newborns: a report from saving newborn lives. Washington, D.C.: Save the Children; 2001.Google Scholar
- 51.Singh K, Brodish P, Suchindran CA (2007) Multilevel regional analysis: can skilled birth attendants uniformly decrease neonatal mortality? Maternal Child Health J. doi: 10.1007/s10995-013-1260-7.
- 55.Rannohan A, Iqbal K, Awofeso N. Reducing neonatal mortality in India: critical role of access to emergency obstetric care. PLoS ONE. 2013;8(3).Google Scholar
- 56.Blanchet NJ, Fink G, Osei-Akoto I. The effect of Ghana’s National Health Insurance on health care utilisation. Ghana Med J. 2012;46(2).Google Scholar
- 57.Mensah J, Oppong J, Bobi-Barimah K, Frempong G, Sabi W. An evaluation of the Ghana National Health Insurance Scheme in the Context of the Health MDGs. GDN Working Paper Series; 2010.Google Scholar
- 58.Owoo NS, Lambon-Quayefio MP. National health insurance, social influence and antenatal care use in Ghana. Health Econ Rev. 2013;3(19).Google Scholar
- 60.Brugiavini A, Pace N. Extending health insurance: effects of the National Health Insurance Scheme in Ghana. EUI Working Papers, European Report on Development, RSCAS; 2011.Google Scholar
- 61.Pediatric Research Report; 2013.Google Scholar
- 62.Bashir Amal O, Ghada HI, Igbal AB, Ishag A. Neonatal mortality in Sudan: analysis of the Sudan household survey. BMC Public Health. 2013;13:287. doi: 10.1186/1471-2458-13-27.
- 63.Bhalota S, Van Soest A. Birth spacing, fertility and neonatal mortality in India: dynamics, frailty and fecundity (no. 2163). IZA Discussion Papers; 2006.Google Scholar
- 66.Nasreen H-E, Bhuiya A, Ahmed SM, Chowdhury M. Woman focused development intervention reduces neonatal mortality in rural Bangladesh: a study of pathways of influence. J Neonatol. 2006;20(4):304–15.Google Scholar