Child Mortality

24

Assessment of Data Quality in childhood mortality

In any survey, the quality of early childhood mortality estimates depends on sampling and non-sampling errors. For
MICS4, the sampling errors are dealt with in Appendix E. The non-sampling errors have to do with the completeness
of data on child mortality and the accuracy of the information provided by mother on the date of birth for all live
births, and date of death for deceased children. Typically, three types of non-sampling errors are known to affect
the childhood mortality estimates: omission of births and deaths, displacement of dates of births and deaths, and
misreporting of age at death.
Taking into consideration the different elements described above, some caution is necessary when interpreting the
childhood mortality trends suggested by MICS 2011.
Different Data Quality Tables presented in Appendix E were reviewed and below are our main observations:
Table DQ.2: The focus of this table is the completion rate by age-group. The results show that the completion rate
is very high: it goes from 96 percent to 98 percent for the 7 age-groups, with an overall rate of 97 percent for all
women aged 15-49 years. However, the ratios of age-groups 15-19 years to 10-14 years and 50-54 years to 45-49
years are 0.57 and 1.19 respectively. This means that some eligible women aged 15-49 years were left out of the
MICS4 womens sample.

Child Mortality

25

Levels and Trends of Early Childhood Mortality

The Ghana MICS4 was conducted from mid-September to mid-December 2011 and early childhood mortality rates
were estimated using the direct method. The reference point (mid-point interval) for the childhood mortality for the
most recent five year period is mid-March 2009.
Table CM.1 provides child mortality rates computed using the direct or birth history method of estimation. The
Ghana under-five mortality rate is estimated at 82 deaths per 1,000 live births for the most recent five-year period.
This means that one in every 12 children dies before reaching their fifth birthday. Child mortality rate (4q1) is
estimated at 31 deaths per 1,000 children aged 1 year, while Infant mortality rate is estimated at 53 deaths per
1,000 live births. Postneonatal and neonatal mortality rates are estimated at 21 and 32 deaths per 1000 live births,
respectively, for the same period.
Table CM.1 also reveals that the proportion of infant deaths occurring during the first month of life is above 60
percent for the three 5-year periods, and these results are more detailed in Table DQ.19, Appendix E. Furthermore,
this is consistent with other studies (MoH, 2007; USAID, 2002; DHS 2008, P.138), which indicate that in Ghana neonatal
deaths are an important component of infant mortality, representing an estimated 60 percent of all infant deaths.
Table CM.1: Early childhood mortality rates

Table DQ.3: This table shows the household population of children aged 0-7 years, children aged 0-4 years whose
mothers/caretakers were interviewed, and the percentage of under-5 children whose mothers/caretakers were
interviewed, by single ages. This table suggests that the ratio of the population aged 5 years to the population aged
4 yeas is 1.14. In other words, there is evidence of misreporting of age at birth for some children aged 4 years.
Table DQ.17: This table show the number of births, percentage with complete birth date, sex ratio at birth, and
calendar year ratio by year of birth, according to living, dead, and total children. The figures show some discrepancies
in the following areas:
Number of births: For 2011 and 2010, the number of births reported are lower compared to all previous years;
Percent of dead children with complete birth date: From 1992 to 2009, the percentage of dead children with
complete birth date is below 90%;
Sex ratio at birth: huge variations are noticed for the sex ratio at birth. For all births, for example, the sex ratio at
birth ranges from 89.5 in 1997 to 123.8 in 1993;
Calendar year ratio: major variations are also noted. These range from 23.5 in 1992 to 115.0 in 2004 for all births.
Table DQ.18: This table provides information on the distribution of reported deaths under one month of age by
age at death in days, and the percentage of neonatal deaths reported to have occurred at ages 0-6 days, by 5-year
periods preceding the survey. For the four five-periods considered, the figures show some heaping at ages zero, one,
three, seven, fourteen and 21 days.
Table DQ.19: The focus of this table is to examine the degree of heaping at ages one and 12 months as these are
the cut-off points for specific childhood mortality rates. Although there is evidence of some heaping in the overall
figures for the four five-year periods considered, the data do not suggest any heaping at these two cut-off points.
Although there is evidence of some typical data issues in different surveys (MICS and DHS) worldwide, there is no
apparent major concern regarding the overall data quality in Ghana MICS 2011, and especially for the most recent
period of 04 years preceding the survey.

Neonatal, Postneonatal, Infant, child and under-five mortality rates by 5 year periods, Ghana, 2011
Years
preceding the
survey

Neonatal
mortality rate
(NM R)
[1]

Post neonatal
mortality rate
(PNMR)
[2]

Infant
mortality
rate (1q0)
[3]

Child
mortality rate
(4q1)
[4]

Under five
mortality rate
(5q0)
[5]

0-4

32

21

53

31

82

5-9

32

19

50

39

87

10-14

36

22

58

47

102

As shown in Figure CM.1, under-five mortality rate declined from 102 deaths per 1,000 live births for the period
10-14 years before the survey to 87 deaths per 1,000 live births during the 5-9 years before the survey, and to 82
deaths per 1,000 live births for the 5-year period prior to the survey. For the 10-14 years before the survey, the infant
mortality rate declined from 58 deaths per 1,000 live births to 50 deaths per 1,000 live births for the 5-9 years before
the survey. The data further show that for the 0-4 years prior to the survey, the infant mortality rate was estimated
at 53 deaths per 1,000 live births. For these 2 five-year periods prior to the survey, neonatal mortality rate remained
stable at 32 deaths per 1,000 live births.

Child Mortality

26

Child Mortality

Figure CM. 1 Trends in Childhood Mortality Rates for MICS4, Ghana, 2011

Figure CM. 2 Trends in Under-five mortality rates in Ghana, various data sources
160

120

DHS 1998 - U5MR

82

53 50

39

36

MICS 2006 - U5MR

80
60

47

DHS 2008 - U5MR

40

31

20

21 19 22

DHS 2011 - U5MR

National
mortality rate

Post neonatal
mortality rate

0-4 years before the survey

Infant
mortality rate

Child
mortality rate

Under five
mortality rate

5-9 years before the survey

10-14 years before the survey

The trend in childhood mortality rates over time can also be assessed by comparing the MICS 2011 data, together
with the data from three previous DHS (1998, 2003 and 2008) and the MICS 2006. Figure CM.2 shows childhood
mortality trends for the past 30 years using data from the five surveys.
Overall, Figure CM.2 reveals that in the past 30 years, under-five mortality rate has declined in Ghana, from 145
deaths per 1,000 live births in DHS 1998 to 82 deaths per 1,000 live births in MICS 2011.
The data from DHS 1998, DHS 2008 and MICS 2011 are in line with this trend of under-five mortality rate decline
over the last 3 decades. However, those from DHS 2003 and MICS 2006 show stagnation of under-five mortality rate
above 100 deaths per 1,000 live births during the period of 18 years (1988 to 2006).
The most recent under-five mortality rate estimated from MICS 2011 (82 deaths per 1,000 live births) is about 2
percent higher than the estimate from the Ghana Demographic and Health Survey (DHS 2008). This minor difference
is likely to be as a result of sampling errors.

2011

2009

2007

2005

2003

2001

1999

1997

1995

1993

1991

0
1985

20

100

1989

32 32

58

DHS 2003 - U5MR

1987

60

120

87
Percent

80
Percent

140

102

100

40

27

Early childhood mortality rates by region, residence and socio-economic characteristics

Table CM.2 provides estimates of childhood mortality by region, residence and other socio-economic characteristics.
To minimize sampling errors associated with mortality estimates and to ensure a sufficient number of cases for
statistical reliability, the mortality rates shown in Table CM.2 are calculated for a ten-year period (2001-2011)
preceding the survey. Note that the longer reference period allows the inclusion of more cases in the calculation
and makes it possible to obtain more precise estimates.
The data presented in Table CM.2 and Figure CM.3 reveal that under-5 mortality rate is lowest in the Greater Accra
region (56 deaths per 1,000 live births), followed by Eastern region (61 deaths per 1,000 live births). Under-5 mortality
rate is highest in the Northern region (124 deaths per 1,000 live births). Other regions with Under-5 mortality rate
of over 100 deaths per 1,000 live births include Brong Ahafo (104 deaths per 1,000 live births), and Upper West (108
deaths per 1,000 live births). Also, Greater Accra (37 deaths per 1,000 live births) and Eastern region (38 deaths per
1,000 live births) have the lowest infant mortality rates. Regions with the highest infant mortality rates are Volta (68
deaths per1000 live births), Upper West (67 deaths per 1000 live births), Northern and Brong Ahafo (both with 66
deaths per 1000 live births). The data also reveal that Volta (47 deaths per 1,000 live births), Brong Ahafo (44 deaths
per 1000 live births) and Upper West (41 deaths per 1000 live births) have the highest neonatal mortality rates in
Ghana, while Greater Accra (20 deaths per 1,000 live births) has the lowest.