CHAPTER ONE INTRODUCTION TO THE STUDY   Background of the Study

The joy of every parent is to see their children grow healthy and live to continue their lineage. Sadly, some newborns do not live to celebrate their first birthday. Finding solutions to this problem has moved from the individual or household level through the national level to the global stage. The biggest source of resources of every nation is their human capital. This is replenished through procreation and nurturing the newborns to fill up the spaces left behind by the aged. The total number of newborns that do not live to celebrate their first anniversary per 1000 live births is termed as infant mortality rate (IMR). Infants are all newborns that are less than one year or 12 months old.

Infant mortality rates vary across regions, sub-regions and countries. This is because there are different factors that contribute to infant mortality at each level. Globally, neonatal deaths (as a result of intrapartum-related complications, preterm birth complications, congenital abnormalities, pneumonia, sepsis or meningitis and other neonatal disorders) contribute highest to under-five mortality in all the regions of the world (Liu et al., 2010). Apart from Africa that has malaria and diarrhea as the next highest cause of under-five deaths after other disorders, the Americas, Europe, and Western Pacific have injury as the next highest cause of under-five death after other disorders (Liu et al., 2010). However, Eastern Mediterranean and Southeast Asia have diarrhea as the next highest cause of under-five death after other disorders (Liu et al., 2010).

Globally, the infant mortality rate was evaluated to be 30.5 deaths per 1000 live births in 2016, which was a 47.1% reduction in the 1990 estimated rate of 64.8 deaths per 1000 live births (WHO,

2016a). Prior to the Sustainable Development Goal three, the Millennium Development Goal four intended at reducing under-five mortality rates by two-thirds between 1990 and 2015. Most of the countries across the globe adopted this goal; drafted and implemented policies and interventions that would help them meet this goal.

Among the regions of the world, the European region is the only one that came very close, with a reduction in their infant mortality rate from 24.9 deaths per 1000 births in 1990 to 8.7 deaths per 1000 births in 2015 (WHO, 2016a). As at 2016, the European region is the region with the lowest infant mortality rate, which stood at 8.3 deaths per 1000 live births. Africa among other regions of the world still had the utmost infant mortality rate of 52.3 deaths per 1000 live births (WHO, 2016a). Currently, sub-Saharan Africa’s rate of infant mortality is 56 death per 1000 live births (Population Reference Bureau, 2017). Infant mortality rate in sub-Saharan Africa is greater than that of Africa as a whole, simply because the countries in sub-Saharan Africa on the average have a higher infant mortality rate. Countries like Egypt, Tunisia, and Algeria in the northern part of Africa have much lower infant mortality rates of 16, 15 and 21, respectively (Population Reference Bureau, 2017). In addition, sub-Saharan Africa, has a high doctor to patient ratio, this makes it difficult for doctors to give their very best to a particular case. Also there is a vast socioeconomic disparity across place of residence (Gyimah, 2002). The health systems lack both the human resource and the necessary technology to save lives, especially, from preventable deaths.

There has been a stable reduction in the infant mortality rate of Ghana for some time now. Ghana’s infant mortality rates according to the 1998, 2003, 2008 and 2014 Ghana Demographic and Health Survey (GDHS) reports are 57, 64, 50 and 41 deaths per 1000 live births, respectively (GSS & Macro International, 1999; GSS GHS & ICF International, 2015; GSS GHS & ICF Macro, 2009; GSS NMIMR & ORC Macro, 2004). Over the years, successive governments have initiated and

implemented policies and interventions to take Ghana’s infant mortality rate to its current state. Some of these policies include “Ghana’s Under-five Child Health Strategies: 2007-2015”, “WHO Expanded Program on Immunization”, “Maternal and Child Health Strategies and Action Plans in Ghana”, “Integrated Management of Neonatal and Childhood illness Strategy”, “The National Health Insurance Scheme (Free Maternal Health Care)”, “the Community-based Health and Planning Service (CHPS) initiative”, just to mention few. The free maternal health care service was built into the National Health Insurance Scheme in 2008 to allow pregnant women access to antenatal care and also postnatal care after delivery (HERA-HPG, 2013). Most of these interventions have been targeted at rural areas in the country because that is where mortality has been highest and under-five mortality is currently highest. However, Ghana’s infant mortality is still high compared to the developed countries after several policies and interventions have been put in place. This current study seeks to examine factors associated with infant deaths in rural Ghana.

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