Trends, sex and socioeconomic inequalities, and future projections of under-five mortality in Ghana from 1992 to 2035.

Authors

Dennis Bardoe, Joana Apenkwa, Ernest Osei, Daniel Hayford, Adnan Bardoe Mohammed, Robert Bagngmen Bio, Mohammed Zakaria

Published in

Scientific reports. Jun 23, 2026. Epub Jun 23, 2026.

Abstract

Under-five mortality (U5M) remains a key indicator of child health outcomes and health system performance. In Ghana, while national trends in U5M are well documented, limited evidence exists on how socioeconomic and sex-disaggregated inequalities have evolved and how future trajectories may unfold. This study, therefore, assessed three-decade trends, identified inequalities in U5M, and projected future patterns in Ghana. A descriptive analytical design was employed using the WHO Health Equity Assessment Toolkit. Absolute and relative measures of inequality, including Difference (D), Ratio (R), Population Attributable Risk (PAR), and Population Attributable Fraction (PAF), were computed using the WHO HEAT online built-in software. Moreover, temporal trends were examined using the Joinpoint Regression programme to estimate the Annual Percentage Change (APC) and Average Annual Percentage Change (AAPC) at p < 0.05. In addition, time-series forecasting was conducted using an Auto-Regressive Integrated Moving Average (ARIMA) model to project U5M trends in Ghana from 2023 to 2035. Between 1992 and 2022, Ghana's U5M declined substantially from 120.20 to 42.34 deaths per 1,000 live births. Six distinct periods of statistically significant decline were identified, with the steepest annual decrease occurring between 2008 and 2016 (APC = -4.50%, 95% CI: -4.60, -4.04). The overall AAPC was - 3.42% (95% CI: -3.44, -3.40). U5M remained consistently higher among males than females, although the absolute difference narrowed from - 16.15 deaths per 1,000 in 1992 to -8.90 in 2022. Socioeconomic inequalities also persisted, with children from the poorest quintile consistently experiencing higher mortality than those from the richest, despite reductions in both absolute (D: 62.36 to 20.81 deaths per 1,000) and relative (R: 1.73 to 1.65) measures. Forecasts from 2023 to 2035 indicate a continued decline in U5M, although the rate of reduction is projected to be gradual. U5M, along with persistent sex and socioeconomic inequalities, has declined over the past 3 decades. The rate of U5M is also projected to decline further from 2023 to 2035. This echoes the need to expand access to quality maternal care, improve nutrition, and address social determinants of health. These interventions are essential for accelerating progress and ensuring equitable survival outcomes.

PMID:
42336990
Bibliographic data and abstract were imported from PubMed on 24 Jun 2026.

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