Part Two: Socio-cultural context of infant / child morbidity and mortality in Kasena-Nankana district (part two)

Infant and child mortality rates in Northern Ghana are among the highest in Africa, but the reasons remain uncertain. A population based case-control study was carried out to look at potential risk factors for mortality. Cases and controls were matched for age, sex and locality from the demographic database for the district. Mothers or guardians of each case and matched control were interviewed to obtain information on social, economic, demographic, environmental and other possible risk factors. Matched analyses were performed using discordant pairs and conditional logistic regression. The mortality rate of children aged 6 months to 4 years was estimated as 23.9/1000. An increased risk of death was observed when a child was not fed colostrum after birth (OR=l.8 95% CI 1.2-2.6), had a history of measles (OR= 2.4, 95% CI 1.0-5.8), the preceeding birth interval was less than 24 months, if the father beat the child's mother (OR=2.9, 95% CI 1.2-6.8), the compound was poor measured by the absence of corrugated zinc roof(OR=1.7, 955 CI, 1.2-2.6) or ifthe water source was poor (OR=l.4, 95% CI 1.0-1. 9). No association was found between perinatal factors, other feeding practices, parental education or any of the other socio-economic or compound sanitation variables considered. Malaria, Acute Gastroenteritis and acute respiratory infection accounted for 60% of deaths with agreed cause of death determined by verbal autopsy. Relatively few risk factors were identified and none which were very strong determinants of child death. This may have been because of the relative homogeneity of the study population. While child mortality rates may be reduced by targeted intervention such as improved and well managed primary health care delivery system, vitamin A supplementation, insecticide impregnated bednets, more general improvements in the socio-economic status in the region are essential