{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:47:28Z","timestamp":1787896048998,"version":"build-2784847793"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T00:00:00Z","timestamp":1624579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Identifying high risk geographical clusters for neonatal mortality is important for guiding policy and targeted interventions. However, limited studies have been conducted in Ghana to identify such clusters.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>This study aimed to identify high-risk clusters for all-cause and cause-specific neonatal mortality in the Kintampo Districts.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>Secondary data, comprising of 30,132 singleton neonates between January 2005 and December 2014, from the Kintampo Health and Demographic Surveillance System (KHDSS) database were used. Verbal autopsies were used to determine probable causes of neonatal deaths. Purely spatial analysis was ran to scan for high-risk clusters using Poisson and Bernoulli models for all-cause and cause-specific neonatal mortality in the Kintampo Districts respectively with village as the unit of analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>The study revealed significantly high risk of village-clusters for neonatal deaths due to asphyxia (RR = 1.98, p = 0.012) and prematurity (RR = 5.47, p = 0.025) in the southern part of Kintampo Districts. Clusters (emerging clusters) which have the potential to be significant in future, for all-cause neonatal mortality was also identified in the south-western part of the Kintampo Districts.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Study findings showed cause-specific neonatal mortality clustering in the southern part of the Kintampo Districts. Emerging cluster was also identified for all-cause neonatal mortality. More attention is needed on prematurity and asphyxia in the identified cause-specific neonatal mortality clusters. The emerging cluster for all-cause neonatal mortality also needs more attention to forestall any formation of significant mortality cluster in the future. Further research is also required to understand the high concentration of prematurity and asphyxiated deaths in the identified clusters.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0253573","type":"journal-article","created":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T17:31:54Z","timestamp":1624642314000},"page":"e0253573","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Neonatal mortality clustering in the central districts of Ghana"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7977-7071","authenticated-orcid":true,"given":"George","family":"Adjei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene K. 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UN IGME Rep. 2019;52."},{"issue":"6","key":"pone.0253573.ref002","doi-asserted-by":"crossref","first-page":"e710","DOI":"10.1016\/S2214-109X(19)30163-9","article-title":"National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis","volume":"7","author":"L Hug","year":"2019","journal-title":"Lancet Glob Heal"},{"key":"pone.0253573.ref003","first-page":"1","author":"Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation","year":"2018","journal-title":"United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), \u2018Levels & Trends in Child Mortality: Report 2018"},{"key":"pone.0253573.ref004","unstructured":"WHO Fact Sheet. Report 2016. Available from http:\/\/www.who.int\/mediacentre\/factsheets\/fs178\/en\/"},{"key":"pone.0253573.ref005","unstructured":"WHO. Newborns: reducing mortality [Internet]. World Health Organization. 2018. p. 2017\u201320. Available from: http:\/\/www.who.int\/news-room\/fact-sheets\/detail\/newborns-reducing-mortality"},{"key":"pone.0253573.ref006","unstructured":"Ghana Statistical Service, Ghana Health Service & ICF International. Ghana Demographic and Health Survey 2014. Rockville, Maryland, USA: GSS, GHS, and ICF International."},{"issue":"1","key":"pone.0253573.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2393-14-165","article-title":"Individual and community determinants of neonatal mortality in Ghana: A multilevel analysis","volume":"14","author":"GA Kayode","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"issue":"9462","key":"pone.0253573.ref008","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/S0140-6736(05)71048-5","article-title":"4 Million neonatal deaths: When? Where? Why?","volume":"365","author":"JE Lawn","year":"2005","journal-title":"Lancet"},{"issue":"9832","key":"pone.0253573.ref009","doi-asserted-by":"crossref","first-page":"2151","DOI":"10.1016\/S0140-6736(12)60560-1","article-title":"Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends since 2000","volume":"379","author":"L Liu","year":"2012","journal-title":"Lancet"},{"issue":"1","key":"pone.0253573.ref010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2458-13-483","article-title":"Neonatal mortality in Ethiopia: Trends and determinants.","volume":"13","author":"Y Mekonnen","year":"2013","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0253573.ref011","first-page":"77","article-title":"Biodemographic and health seeking behaviour factors influencing neonatal and postneonatal mortality in Bangladesh: evidence from DHS data","volume":"6","author":"M Rahman","year":"2009","journal-title":"East Afr J Public Health"},{"issue":"September","key":"pone.0253573.ref012","first-page":"80","article-title":"Health Surveys in Sub-Saharan Africa","author":"AG Boco","year":"2010","journal-title":"Africa (Lond)"},{"issue":"2","key":"pone.0253573.ref013","doi-asserted-by":"crossref","first-page":"211","DOI":"10.2307\/2061873","article-title":"Community characteristics, individual and household attributes, and child survival in Brazil","volume":"33","author":"N Sastry","year":"1996","journal-title":". Demography"},{"issue":"1","key":"pone.0253573.ref014","doi-asserted-by":"crossref","first-page":"5225","DOI":"10.3402\/gha.v3i0.5225","article-title":"Space and time clustering of mortality in rural South Africa (Agincourt HDSS), 1992\u20132007","volume":"3","author":"B Sartorius","year":"2010","journal-title":"Glob Health Action"},{"issue":"1","key":"pone.0253573.ref015","doi-asserted-by":"crossref","first-page":"5233","DOI":"10.3402\/gha.v3i0.5233","article-title":"Clustering of under-five mortality in the Navrongo HDSS in the Kassena-Nankana District of northern Ghana","volume":"3","author":"M Adjuik","year":"2010","journal-title":"Glob Health Action"},{"issue":"1","key":"pone.0253573.ref016","doi-asserted-by":"crossref","first-page":"5258","DOI":"10.3402\/gha.v3i0.5258","article-title":"Clustering of childhood mortality in the Kintampo Health and Demographic Surveillance System in Ghana","volume":"3","author":"OEA Nettey","year":"2010","journal-title":". Glob Health Action"},{"issue":"1","key":"pone.0253573.ref017","first-page":"1","article-title":"Spatial variation and hot-spots of district level diarrhea incidences in Ghana: 2010\u20132014.","volume":"17","author":"FB Osei","year":"2017","journal-title":"BMC Public Health"},{"key":"pone.0253573.ref018","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3402\/gha.v5i0.19033","article-title":"Demographic patterns and trends in Central Ghana: baseline indicators from the Kintampo Health and Demographic Surveillance System","volume":"5","author":"S Owusu-Agyei","year":"2012","journal-title":"Glob Health Action"},{"key":"pone.0253573.ref019","unstructured":"Kintampo Health and Demographic Surveillance System_Data, 2014."},{"issue":"1","key":"pone.0253573.ref020","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-015-1572-1","article-title":"Predictors of abortions in Rural Ghana: A cross-sectional study","volume":"15","author":"G Adjei","year":"2015","journal-title":"BMC Public Health"},{"issue":"5","key":"pone.0253573.ref021","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/j.1365-3016.2008.00962.x","article-title":"Diagnostic accuracy of verbal autopsies in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana.","volume":"22","author":"KM Edmond","year":"2008","journal-title":"Paediatr Perinat Epidemiol"},{"issue":"3","key":"pone.0253573.ref022","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0058924","article-title":"Why Are Babies Dying in the First Month after Birth? A 7-Year Study of Neonatal Mortality in Northern Ghana","volume":"8","author":"P Welaga","year":"2013","journal-title":"PLoS One"},{"issue":"5","key":"pone.0253573.ref023","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1111\/j.1365-3016.2008.00961.x","article-title":"Aetiology of stillbirths and neonatal deaths in rural Ghana: Implications for health programming in developing countries","volume":"22","author":"KM Edmond","year":"2008","journal-title":"Paediatr Perinat Epidemiol"},{"key":"pone.0253573.ref024","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/1471-2393-12-42","article-title":"Impact on postpartum hemorrhage of prophylactic administration of oxytocin 10 IU via UnijectTM by peripheral health care providers at home births: design of a community-based cluster-randomized trial.","volume":"12","author":"CK Stantoni","year":"2012","journal-title":"BMC Pregnancy and Childbirth"},{"issue":"1","key":"pone.0253573.ref025","first-page":"1","article-title":"Determinants of neonatal mortality in rural India, 2007\u20132008","volume":"2013","author":"A Singh","year":"2013","journal-title":"PeerJ."},{"key":"pone.0253573.ref026","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S0168-8510(02)00178-1","article-title":"Mother\u2019s education and child mortality in Ghana","volume":"64","author":"D Buor","year":"2003","journal-title":". Health Policy"},{"issue":"2","key":"pone.0253573.ref027","first-page":"177","article-title":"Child mortality in India: the community-level effect of education. Population Studies","volume":"52","author":"O. Kravdal","year":"2004","journal-title":"A Journal of Demography"},{"key":"pone.0253573.ref028","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/srep30291","article-title":"The influence of distance and quality of care on place of delivery in rural Ghana","volume":"6","author":"RC Nesbitt","year":"2016","journal-title":"Scientific Reports"},{"key":"pone.0253573.ref029","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1186\/s12889-019-7547-x","article-title":"Determinants of trends in neonatal, postneonatal, infant, child and under-five mortalities in Tanzania from 2004 to 2016","volume":"19","author":"FA Ogbo","year":"2019","journal-title":"BMC Public Health."},{"issue":"5","key":"pone.0253573.ref030","doi-asserted-by":"crossref","first-page":"e97253","DOI":"10.1371\/journal.pone.0097253","article-title":"Inadequate knowledge of neonatal danger signs among recently delivered women in southwestern rural Uganda: a community survey.","volume":"9","author":"J Sandberg","year":"2014","journal-title":"PLoS One"},{"issue":"Sup 1","key":"pone.0253573.ref031","first-page":"1","article-title":"Born Too Soon: The Global Epidemiology of 15 million preterm births","volume":"10","author":"H Blencowe","journal-title":"Reproductive Health"},{"issue":"1","key":"pone.0253573.ref032","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4172\/2167-0897.1000246","article-title":"Sub-Saharan African Neonates\u2013Ghosts to statistics","volume":"6","author":"BM Afolabi","year":"2017","journal-title":"J Neonatal Biol"},{"key":"pone.0253573.ref033","first-page":"1","volume-title":"SaTScan User Guide V94","author":"M Kulldorff","year":"2015"},{"issue":"1","key":"pone.0253573.ref034","doi-asserted-by":"crossref","first-page":"92","DOI":"10.4269\/ajtmh.2003.69.92","article-title":"Evaluating the completeness of demographic surveillance of children less than five years old in western Kenya: a capture-recapture approach","volume":"69","author":"TP Eisele","year":"2003","journal-title":"Am J Trop Med Hyg"},{"issue":"3","key":"pone.0253573.ref035","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1093\/ije\/30.3.485","article-title":"Clustering of childhood mortality in rural Burkina Faso","volume":"30","author":"OA Sankoh","year":"2001","journal-title":"Int J Epidemiol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0253573","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T17:32:45Z","timestamp":1624642365000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0253573"}},"subtitle":[],"editor":[{"given":"Kazumichi","family":"Fujioka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,6,25]]},"references-count":35,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0253573","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,25]]}}}