Table 2.
The determinants of factors associated with under-five mortality in 2003, 2008, 2014 and 2003–2014 combined: modified Poisson with robust SE
| 2003 GDHS (Ref. period 1999 to 2003) | 2008 GDHS (Ref. period 2004–2008) | 2014 GDHS (Ref. period 2009–2014) | Overall GDHS (Ref. period 1999–2014) | |||||
| Poisson | Cox model | Poisson | Cox model | Poisson | Cox model | Poisson | Cox model | |
| aRR (95% CI) | aHR (95% CI) | aRR (95% CI) | aHR (95% CI) | aRR (95% CI) | aHR (95% CI) | aRR (95% CI) | aHR (95% CI) | |
| Age of household head | 1.0 (1.0 to 1.0)** | 1.0 (1.0 to 1.0)** | 1.0 (1.0 to 1.0) | 1.0 (1.0 to 1.0) | 1.0 (1.0 to 1.0) | 1.0 (1.0 to 1.0) | 1.0 (1.0 to 1.0)** | 1.0 (1.0 to 1.0)** |
| Sex of household head: Male | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| Female | 1.3 (0.9 to 1.8) | 1.2 (0.9 to 1.7) | 0.9 (0.6 to 1.4) | 0.9 (0.6 to 1.4) | 0.9 (0.6 to 1.3) | 0.9 (0.7 to 1.3) | 1.1 (0.9 to 1.4) | 1.1 (0.9 to 1.4) |
| Place: Urban | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| Rural | 1.3 (0.8 to 2.1) | 1.3 (0.8 to 2.1) | 1.3 (0.7 to 2.3) | 1.3 (0.8 to 2.3) | 1.1 (0.7 to 1.7) | 1.1 (0.7 to 1.6) | 1.2 (0.9 to 1.7) | 1.3 (0.9 to 1.7) |
| Region: Western | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| Central | 0.7 (0.4 to 1.3) | 0.8 (0.5 to 1.3) | 1.8 (0.8 to 4.2) | 1.6 (0.8 to 3.5) | 2.1 (1.0 to 4.3)* | 1.9 (1.0 to 3.8) | 1.3 (0.8 to 1.9) | 1.2 (0.8 to 1.8) |
| Greater Accra Central | 0.5 (0.2 to 1.2) | 0.6 (0.3 to 1.2) | 1.0 (0.4 to 2.7) | 1.0 (0.4 to 2.7) | 0.8 (0.3 to 2.0) | 0.8 (0.3 to 1.9) | 0.7 (0.4 to 1.2) | 0.7 (0.5 to 1.2) |
| Volta | 1.2 (0.7 to 2.0) | 1.2 (0.7 to 1.9) | 1.0 (0.4 to 2.7) | 0.9 (0.4 to 2.3) | 1.5 (0.7 to 3.3) | 1.5 (0.7 to 3.2) | 1.2 (0.8 to 1.9) | 1.2 (0.8 to 1.8) |
| Eastern | 0.6 (0.4 to 1.1) | 0.6 (0.4 to 1.0) | 1.5 (0.6 to 3.8) | 1.5 (0.6 to 3.4) | 1.9 (1 to 3.8) | 1.9 (1.0 to 3.6) | 1.1 (0.8 to 1.7) | 1.1 (0.8 to 1.6) |
| Ashanti | 0.9 (0.6 to 1.5) | 0.9 (0.6 to 1.4) | 1.6 (0.7 to 3.4) | 1.5 (0.7 to 3.2) | 2.6 (1.4 to 4.9)** | 2.5 (1.4 to 4.6)** | 1.4 (1.0 to 2.1) | 1.4 (1.0 to 2.0)* |
| Brong Ahafo | 0.9 (0.4 to 1.7) | 0.9 (0.5 to 1.6) | 1.3 (0.5 to 3.3) | 1.2 (0.5 to 3.2) | 1.3 (0.7 to 2.6) | 1.3 (0.7 to 2.4) | 1.1 (0.7 to 1.8) | 1.1 (0.8 to 1.6) |
| Northern | 0.9 (0.5 to 1.7) | 0.9 (0.5 to 1.6) | 3.1 (1.4 to 6.8)** | 2.8 (1.3 to 5.7)** | 1.9 (0.8 to 4.5) | 1.6 (0.7 to 3.7) | 1.7 (1.1 to 2.7)* | 1.6 (1.1 to 2.4)* |
| Upper East | 0.5 (0.2 to 1.1) | 0.5 (0.2 to 1.1) | 1.4 (0.5 to 4) | 1.3 (0.5 to 3.4) | 1 (0.4 to 2.7) | 0.9 (0.4 to 2.4) | 0.9 (0.5 to 1.5) | 0.8 (0.5 to 1.4) |
| Upper West | 1.2 (0.6 to 2.3) | 1.2 (0.7 to 2.0) | 5.8 (2.5 to 13.8)*** | 4.8 (2.2 to 10.5)*** | 1.9 (0.9 to 4.4) | 1.8 (0.8 to 3.9) | 2.3 (1.5 to 3.7)*** | 2.1 (1.4 to 2.2)*** |
| Wealth: Poorest | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| Poorer | 1.2 (0.8 to 1.9) | 1.2 (0.8 to 1.8) | 0.7 (0.4 to 1.2) | 0.7 (0.4 to 1.1) | 0.8 (0.4 to 1.3) | 0.7 (0.5 to 1.2) | 1.0 (0.7 to 1.3) | 1.0 (0.7 to 1.2) |
| Middle | 1.4 (0.9 to 2.2) | 1.4 (0.9 to 2.1) | 0.9 (0.5 to 1.9) | 1.0 (0.5 to 1.8) | 0.6 (0.3 to 1.2) | 0.6 (0.3 to 1.2) | 1.1 (0.8 to 1.6) | 1.1 (0.8 to 1.5) |
| Richer | 1.1 (0.5 to 2.2) | 1.2 (0.6 to 2.2) | 1.0 (0.4 to 2.1) | 1.0 (0.5 to 2.0) | 0.6 (0.3 to 1.5) | 0.7 (0.3 to 1.5) | 1.1 (0.7 to 1.6) | 1.1 (0.7 to 1.6) |
| Richest | 1.1 (0.5 to 2.7) | 1.3 (0.6 to 2.7) | 0.9 (0.3 to 2.5) | 0.9 (0.4 to 2.4) | 0.6 (0.2 to 1.6) | 0.7 (0.3 to 1.6) | 1.1 (0.6 to 1.8) | 1.1 (0.7 to 1.8) |
| Household: <5 residents | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| 5–7 residents | 0.6 (0.4 to 1.0)* | 0.7 (0.5 to 1)* | 0.4 (0.3 to 0.7)** | 0.5 (0.3 to 0.7)** | 0.3 (0.2 to 0.5)*** | 0.4 (0.3 to 0.6)*** | 0.5 (0.4 to 0.6)*** | 0.5 (0.4 to 0.6)*** |
| 8+ residents | 0.5 (0.3 to 0.8)** | 0.5 (0.3 to 0.8)** | 0.5 (0.2 to 0.9)* | 0.5 (0.3 to 0.9)* | 0.4 (0.2 to 0.7)** | 0.4 (0.3 to 0.7)** | 0.5 (0.3 to 0.6)*** | 0.5 (0.3 to 0.6)*** |
| Household access to an improved water source: Improved | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| Not improved | 1.0 (0.7 to 1.4) | 1.1 (0.8 to 1.4) | 1.1 (0.7 to 1.9) | 1.1 (0.7 to 1.8) | 1.0 (0.6 to 1.6) | 1.0 (0.6 to 1.6) | 1.1 (0.9 to 1.4) | 1.1 (0.9 to 1.4) |
| Household access to an improved toilet: Improved not shared | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| Improved shared | 0.5 (0.3 to 0.9)* | 0.5 (0.3 to 0.9)* | 0.8 (0.4 to 1.6) | 0.8 (0.4 to 1.6) | 1.5 (0.7 to 3.0) | 1.4 (0.8 to 2.6) | 0.8 (0.6 to 1.2) | 0.8 (0.6 to 1.1) |
| Not improved | 0.7 (0.4 to 1.4) | 0.7 (0.4 to 1.3) | 0.6 (0.3 to 1.3) | 0.6 (0.3 to 1.2) | 1.4 (0.6 to 2.9) | 1.3 (0.7 to 2.5) | 0.8 (0.5 to 1.1) | 0.8 (0.5 to 1.1) |
| Mother’s age at child’s birth: <18 | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| 18–34 | 0.7 (0.5 to 1.0)* | 0.7 (0.5 to 0.9)* | 1.0 (0.6 to 1.6) | 1.0 (0.7 to 1.5) | 1.2 (0.8 to 1.6) | 1.1 (0.8 to 1.6) | 0.9 (0.7 to 1.1) | 0.9 (0.7 to 1.1) |
| 35+ | 0.4 (0.1 to 2.3) | 0.4 (0.1 to 1.9) | 3.7 (0.3 to 43.4) | 3 (0.3 to 31.3) | 3.2 (0.6 to 18.1) | 2.7 (0.6 to 12.4) | 1.4 (0.4 to 4.7) | 1.3 (0.4 to 4.0) |
| Marital status: Never married | ||||||||
| Currently married | 0.6 (0.3 to 1.3) | 0.7 (0.3 to 1.4) | 1.9 (0.6 to 6.5) | 2.3 (0.7 to 7.4) | 0.5 (0.3 to 0.8)** | 0.5 (0.3 to 0.9)* | 0.8 (0.5 to 1.2) | 0.9 (0.5 to 1.4) |
| Formerly married | 0.5 (0.2 to 1.2) | 0.6 (0.3 to 1.3) | 2.0 (0.5 to 8.0) | 2.6 (0.7 to 9.8) | 0.4 (0.2 to 0.7)** | 0.5 (0.2 to 1.0)* | 0.6 (0.4 to 1.1) | 0.8 (0.5 to 1.4) |
| Educational attainment: None | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| Primary | 1.0 (0.7 to 1.6) | 1.0 (0.7 to 1.5) | 1.6 (0.9 to 2.7) | 1.5 (0.9 to 2.5) | 0.9 (0.6 to 1.6) | 0.9 (0.5 to 1.5) | 1.1 (0.8 to 1.5) | 1.1 (0.8 to 1.4) |
| Secondary | 0.7 (0.5 to 1.2) | 0.7 (0.5 to 1.1) | 1.2 (0.6 to 2.2) | 1.1 (0.6 to 2.1) | 0.7 (0.5 to 1.1) | 0.7 (0.5 to 1.1) | 0.8 (0.6 to 1.0) | 0.8 (0.6 to 1.0) |
| Tertiary | 0.7 (0.1 to 3.3) | 0.6 (0.1 to 2.8) | 0.2 (0.0 to 1.6) | 0.2 (0.0 to 1.6) | 1.2 (0.5 to 3.1) | 1.0 (0.4 to 2.4) | 0.7 (0.3 to 1.4) | 0.6 (0.3 to 1.2) |
| Sex of child: Male | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| Female | 0.9 (0.7 to 1.2) | 0.9 (0.7 to 1.2) | 1.0 (0.7 to 1.5) | 1.0 (0.7 to 1.4) | 0.8 (0.6 to 1.2) | 0.8 (0.6 to 1.1) | 0.9 (0.8 to 1.1) | 0.9 (0.8 to 1.1) |
| Birth type: Single birth | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| Multiple birth | 5.2 (3.2 to 8.6)*** | 4.2 (2.8 to 6.2)*** | 3.4 (1.6 to 7.1)** | 3.0 (1.7 to 5.3)*** | 4.7 (2.6 to 8.5)*** | 4.2 (2.6 to 6.8)*** | 4.3 (3.1 to 6.1)*** | 3.8 (2.9 to 5.0)*** |
| Birth order: First | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| Second | 0.8 (0.5 to 1.4) | 0.8 (0.5 to 1.2) | 0.7 (0.4 to 1.2) | 0.7 (0.4 to 1.1) | 1.4 (0.9 to 2.4) | 1.3 (0.8 to 2.2) | 0.9 (0.7 to 1.2) | 0.8 (0.6 to 1.1) |
| Third | 1.0 (0.6 to 1.6) | 1.0 (0.6 to 1.5) | 1.1 (0.6 to 2.0) | 1.0 (0.6 to 1.8) | 1.7 (0.9 to 3.2) | 1.5 (0.8 to 3.0) | 1.2 (0.8 to 1.6) | 1.1 (0.8 to 1.5) |
| Fourth or higher | 1.1 (0.7 to 1.7) | 1.1 (0.7 to 1.6) | 1.3 (0.7 to 2.3) | 1.2 (0.7 to 2.0) | 2 (1.2 to 3.2)** | 1.8 (1.1 to 2.9)* | 1.3 (1.0 to 1.8)* | 1.3 (1.0 to 1.6) |
| Delivered in a health facility: No | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| Yes | 1.1 (0.8 to 1.6) | 1.1 (0.8 to 1.6) | 1.0 (0.6 to 1.6) | 1.0 (0.7 to 1.6) | 1.2 (0.8 to 1.6) | 1.0 (0.8 to 1.4) | 1.0 (0.8 to 1.2) | 1.0 (0.8 to 1.2) |
| Number of children slept under mosquito net previous net: None | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| One or more | 0.6 (0.4 to 0.9)* | 0.5 (0.3 to 0.8)** | 0.4 (0.3 to 0.6)*** | 0.4 (0.3 to 0.6)*** | 0.6 (0.4 to 0.8)** | 0.6 (0.4 to 0.8)*** | 0.5 (0.4 to 0.6)*** | 0.5 (0.4 to 0.6)*** |
| Effect of selected indicators excluded from the multivariable analysis due to the fact that the variable was not measured at all in a particular survey year or was only available for the most recent birth | ||||||||
| BMI: Underweight | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| Normal | 1.0 (0.6 to 1.7) | 1.1 (0.7 to 1.7) | 0.6 (0.3 to 1.2) | 0.6 (0.3 to 1.1) | 0.7 (0.3 to 1.7) | 0.8 (0.4 to 1.8) | 0.8 (0.5 to 1.1) | 0.8 (0.6 to 1.1) |
| Overweight | 0.8 (0.5 to 1.5) | 0.9 (0.5 to 1.6) | 0.6 (0.3 to 1.1) | 0.6 (0.3 to 1.1) | 1.3 (0.5 to 3.0) | 1.3 (0.6 to 3.1) | 0.7 (0.5 to 1.1) | 0.8 (0.5 to 1.1) |
| Obese | 0.9 (0.5 to 1.8) | 0.9 (0.5 to 1.8) | 0.9 (0.4 to 2.0) | 0.9 (0.4 to 1.9) | 0.9 (0.3 to 2.2) | 1.0 (0.4 to 2.6) | 0.8 (0.5 to 1.2) | 0.8 (0.5 to 1.3) |
| Birth interval: <2 years | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| 24–35 months | 0.6 (0.4 to 0.8)** | 0.5 (0.4 to 0.8)** | 0.6 (0.3 to 1.1) | 0.6 (0.3 to 1.0)* | 0.8 (0.4 to 1.5) | 0.8 (0.4 to 1.5) | 0.6 (0.5 to 0.9)** | 0.6 (0.5 to 0.8)** |
| 36+ | 0.5 (0.4 to 0.8)** | 0.5 (0.4 to 0.7)*** | 0.6 (0.4 to 1.1) | 0.6 (0.4 to 1.0)* | 0.5 (0.3 to 0.9)* | 0.5 (0.3 to 1.0)* | 0.5 (0.4 to 0.7)*** | 0.5 (0.4 to 0.7)*** |
| Number of ANC: None | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| 1–3 times | 0.8 (0.4 to 1.8) | 0.8 (0.4 to 1.7) | 1.1 (0.3 to 3.8) | 1.0 (0.3 to 3.4) | 0.3 (0.1 to 0.8)* | 0.3 (0.1 to 0.9)* | 0.8 (0.4 to 1.3) | 0.8 (0.4 to 1.3) |
| 4+ times | 0.9 (0.5 to 1.8) | 1.0 (0.5 to 1.9) | 0.6 (0.2 to 2.1) | 0.7 (0.2 to 2.1) | 0.4 (0.2 to 1.0)* | 0.5 (0.2 to 1.1) | 0.6 (0.4 to 1) | 0.7 (0.4 to 1.1) |
| Tetanus injection: None | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| One | 1.2 (0.7 to 2.2) | 1.3 (0.7 to 2.2) | 1 (0.4 to 2.3) | 1.0 (0.4 to 2.4) | 0.8 (0.4 to 1.6) | 0.9 (0.5 to 1.7) | 1 (0.7 to 1.5) | 1.1 (0.7 to 1.5) |
| Two or more | 1.3 (0.8 to 2.2) | 1.4 (0.8 to 2.3) | 1 (0.4 to 2.5) | 1.1 (0.5 to 2.6) | 0.7 (0.4 to 1.3) | 0.8 (0.5 to 1.4) | 1 (0.7 to 1.4) | 1.1 (0.7 to 1.5) |
| Household owns a mosquito net: No | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| Yes | 0.9 (0.6 to 1.2) | 0.9 (0.6 to 1.2) | 0.7 (0.5 to 1.0)* | 0.6 (0.5 to 0.9)** | 0.9 (0.6 to 1.4) | 0.9 (0.7 to 1.4) | 0.7 (0.6 to 0.8)*** | 0.7 (0.6 to 0.8)*** |
| Mother slept under a bednet the previous night : No | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| Yes | 0.9 (0.6 to 1.2) | 0.8 (0.6 to 1.2) | 0.6 (0.4 to 0.8)** | 0.5 (0.4 to 0.7)*** | 1.1 (0.8 to 1.5) | 1.1 (0.8 to 1.4) | 0.7 (0.6 to 0.8)*** | 0.7 (0.6 to 0.8)*** |
| Valid national health insurance card: No | n/a | n/a | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
| Yes, card seen | n/a | n/a | 0.3 (0.2 to 0.7)** | 0.4 (0.2 to 0.8)** | 1.0 (0.6 to 1.9) | 1 (0.5 to 1.7) | 0.7 (0.5 to 1.1) | 0.7 (0.5 to 1.1) |
| Yes, card not seen | n/a | n/a | 0.4 (0.2 to 0.8)* | 0.4 (0.2 to 0.9)* | 1.3 (0.7 to 2.5) | 1.2 (0.7 to 2.3) | 0.9 (0.5 to 1.5) | 0.9 (0.5 to 1.4) |
P value notation: ***p<0.001, **p<0.01, *p<0.05.
ANC, antenatal care; BMI, body mass index; GDHS, Ghana Demographic and Health Surveys; aHR, adjusted hazard ratio; aRR, adjusted relative risk; n/a, not applicable since variable was not measured.