Geospatial disparities in infant mortality in Ghana: evidence from national data

Abstract

Background Infant mortality remains a major public health concern in Ghana, with progress occurring unevenly across population groups and locations. Understanding both the determinants and the spatial distribution of infant deaths is essential for designing targeted interventions and reducing persistent inequalities.Methods We analysed nationally representative data from multiple rounds of the Ghana Demographic and Health Surveys, comprising 19 558 infant survivors and 3464 infant deaths. Local Indicators of Spatial Association and kernel density estimation were applied to produce cluster and spatial risk maps, respectively. A shared frailty Cox proportional hazards model, accounting for unobserved heterogeneity at the regional level, was used to estimate adjusted HRs.Results Infant mortality exhibited significant spatial autocorrelation, while regional quantile maps revealed distinct yet overlapping geographic patterns for both neonatal and infant mortality. Infant mortality showed substantial clustering. Elevated risks were observed in Upper West, parts of Savannah and Ashanti, whereas lower risks were evident in Greater Accra, North East and Eastern regions. Factors associated with lower hazards included tertiary maternal education (adjusted HR (aHR)=0.66; 95% CI 0.48 to 0.89), health insurance coverage (aHR=0.86; 95% CI 0.80 to 0.94), early initiation of antenatal care (aHR=0.88; 95% CI 0.83 to 0.93) and completion of >= 4 antenatal visits (aHR=0.90; 95% CI 0.82 to 0.98). Socioeconomic gradients were apparent, with infants in relatively richer households experiencing lower mortality hazards. Infant-level characteristics strongly predicted survival, including normal birth weight (aHR=0.60; 95% CI 0.45 to 0.75), breastfeeding (aHR=0.39; 95% CI 0.31 to 0.47), longer birth intervals (aHR=0.63; 95% CI 0.57 to 0.70) and vaccination (aHR=0.42; 95% CI 0.32 to 0.53).Conclusions Infant mortality in Ghana displays marked spatial heterogeneity and regional-level effects. Strengthening maternal and newborn services in hot-spot regions, expanding early antenatal and postnatal care and targeting high-risk maternal profiles may accelerate progress toward equitable child survival.