Impact of Maternal and Child Health Interventions On Under-Five Mortality in Ghana: A Quasi-Experimental Study Design With Coarsened Exact Matching

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Abstract Background Despite a 53% decline in under-five mortality (U5M) worldwide during the period of the Millennium Development Goals (MDGs), U5M remains a challenge. Under-five mortality decline in Ghana is slow and not parallel with the level of coverage of child health interventions. This study sought to assess the effectiveness of these interventions on U5M in Ghana. Methods A quasi-experimental study was conducted using secondary data of the 2008 and 2014 Ghana Demographic and Health Surveys. Coarsened Exact Matching and logistic regression were done. Results There were 6,098 children under-five years old and 93 (1.46%) died. Among the children who died, 47 (47%) were less than one month old. Coverage of antenatal care visits was the highest coverage level with 5,045 (84.0%) while water connection in the home was the lowest coverage level of 469 (8.1%). Less than 1.5% (58) of children received all eight (8) interventions and none of those who received all the eight interventions died. After controlling for potential confounders, clean postnatal care for babies within 2 days after delivery caused a 64% reduction in the average odds of death (aOR=0.36, 95%CI:0.15, 0.90) while early initiation of breastfeeding caused a 61% reduction in the average odds of death (aOR=0.39, 95% CI: 0.22-0.71). In the midst of the various interventions, some socio-demographic factors placed children at higher odds of death. Children with less than two years preceding birth interval, being a neonate, multiple birth, or from a polygamous home put children at a higher odds of under-five mortality.Conclusion Two out of eight interventions caused reduction in the average odds of death. A further decline in under-five mortality in Ghana will require increase in the coverage levels of these two high impact interventions. Additionally, attention should be paid to children at higher risk of dying including neonates, multiple births, children from polygamous homes and those with preceding birth interval less than two years.

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