Newborn Mortality Rates In Ghana And The United States Today

n Analysis of Newborn Mortality Rates in Ghana and the United States Today

Introduction

It is frequently been suggested that the infant mortality rate (IMR) is a reliable indicator of a country's civilization and focus on the welfare of its citizens (Berger 2001). Although global infant mortality rates has shown steady improvement over the past century, many developing countries continue to experience inordinately high rates compared to the world levels; surprisingly, though, even the United States which claims to have one of the best healthcare systems in the world continues to experience relatively high infant mortality rates, higher even than many developing nations (Berger 2001). This paper will provide an overview of the problem, followed by an examination of the infant mortality rates in the Republic of Ghana and the United States. A summary of the research will be provided in the conclusion.

Review and Analysis

Background and Overview. Infant mortality reflects the well-being of entire populations, whether nations or subgroups, a fact that makes it a fundamental area of mortality study (Zopf 1992). According to Berger (2001), infant mortality has been subdivided into three major categories to clarify understanding of risk factors. Infant mortality encompasses two subgroups: neonatal (birth to 27 days) and postneonatal (28 days to 364 days). Child mortality applies to one-to-18 years olds. For the purposes of this investigation, the IMR will employ the definition provided by the CIA World Factbook, defined as infant deaths within the first year of life. This IMR therefore provides the number of deaths of infants under one year old in a given year per 1,000 live births in the same year.

Worldwide, rates of infant mortality have shown significant decreases since the early 1900s; for example, In 1915 the rate of infant death was 100 infants per 1,000 live births, declining to 7.2 per 1,000 live births by 1997. This has translated into an overall decline of almost 90 percent (Berger 2001). The majority of this decline in the IMR has been attributed to improvements related to urban living (for example, sanitation, pasteurization, improved water and sewage, reduced fertility rates, and improved economic and educational levels), followed by improved technological and public health strategies (Berger 2001). Infant mortality rates have declined sharply in most developing countries in the past several decades, just as they did earlier in the developed countries. The reductions in the IMR also resulted from improvements in the prevention and treatment of diarrhea, which is a major killer of infants in poor socioeconomic conditions (Zopf 1992).

Infant Mortality in Ghana. While Ghana is relatively small in area and population, the nation is one of the leading countries of Africa, due in part because of its considerable natural wealth, and because it was the first black African country south of the Sahara to achieve independence from colonial rule and to embark on its own extensive educational and industrialization programs. Ghana became independent on March 6, 1957, and is comprised of the former British colony of the Gold Coast and that part of Togoland which was formerly a UN Trust Territory under British administration (Fage 2004). The current infant mortality rates for Ghana are provided in Table 1 below (2003 estimates):

Table 1. Infant Mortality Rates: Ghana.

Total: 53.02 deaths/1,000 live births

Female: 49.98 deaths/1,000 live births (2003 est.)

Male: 55.97 deaths/1,000 live births

[Source: CIA World Factbook, Ghana.]

Some of the major health problems facing Ghana today are communicable diseases, poor sanitation, and poor nutrition. Studies conducted in Ghana by the World Health Organization (WHO) have shown that the mortality rate in infants younger than 6 months of age who contract yellow fever is higher than 70%, and that young children are disproportionately infected in unimmunized populations during yellow fever outbreaks (Osei-Kwasi, Dunyo & Koram 2001). While much has been learned about the management of malnourish children in the past, WHO reports that Ghanaian pediatric staff frequently ignore established WHO guidelines, resulting in inordinately high mortality rates for infants during their first year.

According to a study conducted by Deen, Funk, and Guevara (2003), at one Ghanaian hospital, resource constraints and bed space limitations meant that severely malnourished children were admitted only if they had another severe illness such as a malignancy or disseminated tuberculosis. "At another hospital, nutritionists had administered special formulae not optimal for severely malnourished children for over 20 years, and they were not open to change" (Deen et al. 2003:237). At the same hospital, a recently implemented cost-recovery scheme resulted in a decrease in the number of admissions and days of hospitalization. In addition, at many Ghanaian hospitals, the infants' families had to pay for food and medicines during hospitalization, and there are unnecessarily restrictive visitation policies in place that adversely affect newborn infant development, particularly among the malnourished, that also contributed to the high incidences of infant mortality in Ghana.

The primary focus of Ghanaian government health policy to date has been on improved public health, and since independence many improvements have been made in nutrition and in maternal and child care services. Consequently, the infant mortality rate has shown a steady decline, especially in urban areas, as a result of improved healthcare facilities and dietary habits; while the infant mortality rate in Ghana is among the lowest in western Africa, it remains high by world standards (Fage 2004).

Despite the improvements and initiatives to date, much remains to be done, particularly in the rural districts in Ghana, where there are wide disparities in the availability healthcare services and childbearing practices. For instance, according to Smith, Fortney and Wong et al. (2001), the Brong-Ahafo region of central Ghana is poor and mainly rural. Even though the health services in this region are more extensive than in regions in northern Ghana, two districts out of 13 within the region do not have a hospital, and the main hospital is in the regional capital of Sunyani and is not a teaching hospital (Smith et al. 2001). The Kassena-Nankana district is in the Sahelian area in the north east of Ghana, whereas the Brong-Ahafo region is located in the forested central area. Generally speaking,