Trends in under-five mortality rate disaggregated across five inequality dimensions in Ghana between 1993 and 2014.

Abstract Objectives Globally, there has been a considerable decline in under-five mortality in the past years. However, it remains a critical issue among low- and middle-income countries, especially in sub-Saharan Africa. In Ghana, under-five mortality is a critical public health issue that requires national interventions. In the present study, we examined the trends of under-five mortality in Ghana from 1993 to 2014. Methods Using the World Health Organization's Health Equity Assessment Toolkit, we analyzed data from the 1993–2014 Ghana Demographic and Health surveys. We disaggregated the under-five mortality rate by five equity stratifiers: wealth index, education, sex, place, and region of residence. We measured the inequality through summary measures, namely difference, population attributable risk, ratio and population attributable fraction. Results In 1993, under-five mortality among children in poor households (172.90, uncertainty intervals [UIs = 153.21–194.53]) was more than twice the proportion of children from the richest households who died before their 5th birthday (74.96; UI = 60.31–92.81) and this trend continued until 2008. However, in 2014, the poorest had the lowest rate (30.91, UI = 78.70–104.80). Children of women with no formal education consistently recorded the highest burden of under-five mortality. Although in 2014 the gap appeared to have narrowed, children of mothers with no formal education record the highest under-five mortality rate (91.61; UI = 79.73–105.07) compared with those with secondary or higher education (54.34; UI = 46.24–63.77). Under-five mortality was higher among rural residents throughout the years. Men repeatedly had the greatest share of under-five mortality with the highest prevalence occurring in 1993 (137.52; UI = 123.51–152.85) and the lowest occurring in 2014 (77.40; UI = 69.15–86.54). The Northern region consistently accounted for the greatest proportion of under-five mortality. Conclusion Ghana has experienced a decline in under-five mortality from 1993 to 2014. Context-specific appropriate interventions are necessary for various disadvantaged sub-populations with risks of health disparities.