Spatio-temporal variations in neonatal mortality rates in Ghana: An application of hierarchical Bayesian methods

Ghana might not meet the SDGs target 3.2 of reducing neonatal mortality to 12 deaths per 1000 live births by 2030. Identifying core determinants of neonatal deaths provide policy guidelines and a framework aimed at mitigating the effect of neonatal deaths. Most studies have identified household and individual-level factors that contribute to neonatal mortality. However, there are relatively few studies that have rigorously assessed geospatial covariates and spatiotemporal variations of neonatal deaths in Ghana. This study focuses on modeling and mapping of spatiotemporal variations in the risk of neonatal mortality in Ghana using Bayesian Hierarchical Spatiotemporal models. This study used data from the Ghana Demographic and Health Surveys (GDHS) conducted in 1993, 1998, 2003, 2008, and 2014. We employed Bayesian Hierarchical Spatiotemporal regression models to identify geospatial correlates and spatiotemporal variations in the risk of neonatal mortality. The estimated weighted crude neonatal mortality rate for the period under consideration was 33.2 neonatal deaths per 1000 live births. The results obtained from Moran's I statistics and CAR model showed the existence of spatial clustering of neonatal mortality. The map of smooth relative risk identified Ashanti region as the most consistent hot-spot region for the entire period under consideration. Small body size babies contributed significantly to an increased risk of neonatal mortality at the regional level [Posterior Mean: 0.003 (95% CrI: 0.00,0.01)]. Hot spot GDHS clusters exhibiting high risk of neonatal mortality were identified by LISA cluster map. Rural residents, small body size babies, parity, and aridity contributed significantly to a higher risk of neonatal mortality at the GDHS cluster level. The findings provide actionable and insightful information to prioritize and distribute the scarce health resources equitably to tackle the menace of neonatal mortality. The regions and GDHS clusters with excess risk of neonatal mortality should receive optimum attention and interventions to reduce the neonatal mortality rate.