Multiple births, smaller households cause high child mortality in Ghana – Study

A research study conducted by the Department of Biostatistics at the University of Ghana, School of Public Health, has found out that factors such as multiple births, smaller household sizes, high parity, and low birth weight account for high child mortality in the country.

However, “environmental factors such as rainfall, temperature, enhanced vegetation index, proximity to a protected area, population density, length of the growing season and livestock density” did not account for child mortality in Ghana.

The research study, which made use of complex health survey data from the Ghana Demographic and Health Surveys and the Ghana Maternal Health survey collected between 1998 and 2017, captured Ghana’s inability to achieve the Millennium Development Goal 4 of reducing under-five mortality rate by two-thirds before 2015.

According to the research study funded by the Ghana Scholarship Secretariat, the country may not meet the target for the Sustainable Development Goal (SDG) 3, which states that “by 2030, neonatal mortality should be reduced to at least as low as 12 deaths per 1,000 live births and under-5 mortality to, at least, as low as 25 deaths per 1,000 live births.”

This, the research study explained, will require the need to “direct scarce resources to mitigate the impact of the most important risk factors contributing to preventable child deaths.”

The study was supervised by a lecturer at the Department of Biostatistics at the University of Ghana, School of Public Health, Mr Dwomoh Duah.

The study also made some recommendations:

1. The Government and Non-Governmental Organisations should focus more on policies that reduce poverty among women. The priority area of the policy should aim at increasing the percentage of female labour force participation. There should be a more flexible labour market arrangements (maternity leave, and child support), improved maternal health, paternal involvement in childbearing, removing the cultural and religious barrier especially traditional views on gender roles and job-related discrimination by gender, increasing access to women education, lower fertility rate through the use of contraceptive, and increased female entrepreneurship can increase female labour force participation.

2. The Government of Ghana, through the Ministry of Health and the Ghana Health Service, should organise routine practical simulation training for obstetricians, general medical practitioners, nurses, and midwives on how to handle complications associated with multiple births. There should be a clearly defined direct policy on multiple births that incorporates routine training of health professionals.

3. Multiple-births has a long term impact on the child beyond the neonatal period. There should be a policy for all health facilities to design a database that captures all multiple births which occurred in the health facility or the community, including multiple births that originate from in vitro fertilisation (IVF) intervention. This could facilitate the process of tracking these births during antenatal, delivery, postnatal through to age 5. This activity could be spearheaded by the community health nurses and monitored by specialist obstetricians.

4. Efforts should be made to monitor both twins, triplet etc., during labour.

5. There should be early pregnancy ultrasound scans and monochorionic twins should be referred for specialist obstetrician care.

6. Except for a few private health facilities, most pregnancies including multiple births, are generally handled by midwives at the health facility but we recommend, in addition to the midwives, there should be specialist obstetrician care for all multiple births during antenatal, delivery and postnatal care.

7. The Ministry of Health (MOH), Ghana Health Service (GHS), Ghana Medical Association (GMA) and all fertility centers across the country may consider a policy of elective single embryo transfer (eSET) to reduce the chances of a woman having multiple births and to reduce to the barest minimum the complications associated with multiple births among women and their respective children who are delivered via Assisted Reproductive Technology (ART). To encourage eSET, blastocyst culture, preimplantation genetic screening, and time lapse imaging could help identify the embryo with the greatest implantation potential.

8. The MOH and the GHS should use the pregnancy school and the media (radio, television, and social media), together with community health nurses, and other healthcare professionals to provide intensive education about the risk of multiple births, high parity, birth spacing, antenatal care attendance, facility delivery, postnatal care, immunisation, vitamin A supplement for the child six months after delivery, tetanus injection, contraceptive use by mothers, efficient ways to improve the weight of the unborn baby and nutritional requirements during pregnancy.

9. The Government should increase healthcare expenditure by investing more in health infrastructure, modern medical equipment to ensure safe delivery, human resources, procurement of essential medicines required during pregnancy, antenatal, and postnatal care.

10. There should be a complete death audit for all stillbirths, neonatal, infant, child, and under-five mortalities in Ghana. There should be a monthly review of all completed reports by experts to identify causes and to prevent future occurrences.

11. There should be a conscious effort to reduce the rate of cesarean section among mothers who are at low risk of birth complications.

12. We can’t reduce child mortality rates in Ghana if experience obstetricians, gynecologists, and midwives are not willing to work in rural communities. The government and other interested parties should endeavor to solve the challenges preventing qualified medical personnel from accepting postings to rural communities.

These experts should understand that the government cannot address all their challenges within their preferred time-frame but the spirit of patriotism should drive their zeal to work in highly deprived communities.

The children need all the attention and support to live a fulfilling life.