ArticleBMJ open2026
Trend and pattern of antenatal care utilisation and neonatal mortality in Ghana: analyses 2003-2022 demographic and health survey.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNeonatal mortality remains a significant public health issue in most of the developing countries including Ghana. This study examines the trends and patterns of antenatal care (ANC) utilisation and neonatal mortality in Ghana using the Ghana Demographic and Health Survey (GDHS) from 2003 to 2022. It also appraises the association between ANC visits and neonatal mortality while acknowledging key elements impelling the mortality rates over time
designThe Demographic and Health Survey (DHS) employed a cross-sectional study using nationally representative survey data.
participantsWomen in Ghana aged 15-49 years who had a live birth within 5 years preceding the 2003, 2008, 2014 and 2022 GDHS. The pooled weighted sample included 14 436 most recent live births. MEASURE OF RESPONSE VARIABLE: Neonatal mortality, defined as death within the first 28 days of life. The primary exposure was ANC utilisation, measured by the number of visits and the timing of the first visit. Survey-weighted logistic regression and Joinpoint regression were used to assess trends and associations.
resultsNeonatal mortality declined significantly over the study period. Compared with 2003, the odds of neonatal death were significantly lower in 2014 (OR 0.59; 95% CI 0.43 to 0.81) and 2022 (OR 0.49; 95% CI 0.35 to 0.67). Joinpoint regression showed a significant average annual percentage decline of 3.7% (p<0.05). ANC utilisation improved substantially, with the proportion of women attending eight or more visits increasing from 22.8% in 2003 to 38.8% in 2022, and first-trimester initiation rising from 46.3% to 63.7% over the same period. Neonatal mortality was generally lower among women with higher numbers of ANC visits, although patterns were not strictly linear across all survey years.
conclusionNeonatal mortality in Ghana declined significantly between 2003 and 2022, coinciding with improvements in ANC utilisation. However, fluctuations in mortality across ANC categories suggest that increased coverage alone may not be sufficient; quality and timeliness of care remain critical. Strengthening comprehensive ANC services and ensuring equitable access may further accelerate progress towards Sustainable Development Goal target 3.2.
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