Mortality Trends in Ghana

Mortality Levels

Life expectancy at birth is a measure of mortality concerned with how long an average person is expected to live. It is calculated by determining the “average number of years of life expected by a hypothetical cohort of individuals who would be subject during all their lives to the mortality rates of a given period” (United Nations, 2019). It is expressed in units of years.

In 2015-2020, the life expectancy in more developed regions was 79.24 years while in less developed regions it was 70.70 years. Ghana had a life expectancy of 63.65 years which is below the average life expectancy in both more developed and less developed regions. However, Ghana had a higher life expectancy during this period than the average of all nations in Western Africa which was 57.32 years. This shows that while Ghanaians had a lower life expectancy than the average less developed nation, the nation fares better in this measure of mortality compared to other nations in its geographical region. Crude death rate is a measure of mortality that is a representation of the number of deaths overall in a population over a given time period. It is defined as “the number of deaths over a given period divided by the person-years lived by the population over that period” and it is measured as average annual deaths per 1,000 people in a population (United Nations, 2019). The crude death rate in more developed countries in the 2015-2020 period was 10.2 while the crude death rate in less developed regions was 7. Ghana had a crude death rate of 7.3, close to that of the average of less developed nations. However, the crude death rate in Ghana was much lower than the average crude death rate in West African countries which was 10.3. Infant mortality rate is defined as “the probability of dying between birth and age 1” and is measured as the average annual deaths per 1,000 births (United Nations, 2019). This measure provides information about a small portion of the population but is important in assessing the health of a nation. In the 2015-2020 period, the infant mortality rate was 4 deaths/1,000 in more developed regions whereas it was 32/1,000 in less developed regions. Ghana had an infant mortality rate of 36 deaths/1,000 during this period, which is similar to the average of less developed regions. Ghana fared better in terms of infant mortality than the average West African country, as the infant mortality rate in this region was 57 deaths/1,000. All in all, Ghana generally had higher mortality than developed countries, similar mortality to less developed countries, and better mortality than the average West African nation.

Mortality Trends:

During this time interval, the onset of mortality decline for these regions was between 1950-1955 because at this point both the crude death rate and the infant mortality rate decreased, and the life expectancy increased from this point forward. The decline may have started at this time, or it could have begun at an earlier time not revealed by this data. Life expectancy increased in all the selected regions. However, less developed regions including Ghana had a larger increase in life expectancy from the beginning to the end of the time period compared to more developed regions. The crude death rate stayed relatively constant in the more developed regions while it declined significantly in less developed regions, Western African, and Ghana. The infant mortality rate declined in all regions, but the decline was more significant in the less developed regions including Ghana. In terms of the amount of decline in mortality measures, Ghana behaved more like the average less developed nation because it experienced a greater decline in infant mortality and crude death rate, while there were great increases in life expectancy.

Life expectancy at birth in Ghana increased by an average of 1.55 years in every 5-year interval from 1950-2020. This was similar to the average of other countries in Western Africa (1.7 years). Ghana’s life expectancy increased faster than it did in more developed regions (.96 years). However, the rate of Ghana’s rise in life expectancy was lower than the average of less developed nations (2.2 years). Over time, Ghana’s rate of increase in life expectancy was relatively constant, despite a short period of decline then stagnation from 1990-1995 to 2000-2005. The crude death rate in Ghana decreased by an average of 1.03/1,000 in every 5-year interval from 1950-2020. This was a slower rate of decline than in the average of less developed regions (1.19/1,000) and the average of countries in Western Africa (1.44/1,000). However, it is important to note that Ghana started out with a lower crude death rate than the average of less developed regions and the average of countries in Western Africa. Significantly, Ghana’s rate of decline in crude death rate was significantly higher than in the average of more developed regions where the death rate was relatively stagnant but showed a small increase (.0314/1,000). The rate of decrease in crude death rate in Ghana was relatively constant over this time interval, except for a brief plateau from 1990-1995 to 1995-2000. The rate of decline in infant mortality in Ghana was an average of 8.07 deaths/1,000 in every 5-year internal from 1950-2020. This was a slower rate of decline than the average of less developed regions (9.74 deaths/1,000) and the average of countries in Africa (9.93 deaths/1,000). Ghana had a faster rate of decline in infant mortality compared to the average of more developed regions (3.5 deaths/1,000). The rate of decline in infant mortality in Ghana was relatively constant over the selected interval, except for a brief decrease in rate of decline from 1990-1995 to 1995-2000.

Overall, Ghana had similar decreases in mortality compared to its neighboring countries and the average of less developed countries. The rate of increase in life expectancy at birth and rates of decline in crude death rate were all slightly lower in Ghana than in its counterparts. However, Ghana’s mortality rates changed at a more favorable rate than in more developed countries. The brief period of stagnation and decline in mortality rate decrease that occurred in Ghana from 1990-1995 to 1995-2000 across all 3 measures was also seen in the average West African country but was not evident in the averages from both more and less developed nations. All in all, infant mortality rate, crude death rate, and life expectancy at birth provide a similar picture of mortality changes in Ghana over this time period.

COVID-19 Mortality:

Excess mortality data due to COVID-19 are not available for Ghana, however there are estimates. A central estimate projected that there were fewer deaths in Ghana due to COVID-19 until September 12, 2021. From this point, it was projected that there was an excess in deaths due to COVID-19 that reached a high of 25.02 additional deaths/100,000 people on the last day of data collection (February 6th, 2022). However, upper estimates project that for almost the full duration of the pandemic Ghana has had a high number of additional deaths/100,000 people with an estimate of 235 additional deaths/100,000 on February 6th, 2020. This demonstrates that there is great variability in the estimates so a conclusion about the excess mortality due to COVID-19 in Ghana cannot be determined.

The current total case count for COVID-19 in Ghana is 158,000 cases and 1,419 deaths. However, due to limited testing and other challenges in attributing death to COVID, these case and death counts are likely largely underestimated. Based on confirmed cases, the peak of COVID cases in Ghana occurred during February 2022 with more than 40 cases/1 million people. However, the highest death rate occurred in February 2021 with more than .3 deaths/1 million people. The number of deaths Ghana attributed to COVID has been lowest in the 2022 peak compared to all other peaks in cases and deaths.

Interpretation:

Ghana’s declining mortality trends can be explained by historical occurrences and various public health interventions that have been implemented since the nation’s independence. Ghana declared independence from Britain in 1957 and a republic was established (United Nations Development Program). There was a period of instability and corruption, but in 1992, the country established a democracy. Ghana’s declining mortality can be attributed to its effective government and improving economy. In fact, “Ghana is often seen as a model for political and economic reform in Africa” (United Nations Development Program). This may also explain why Ghana has had a more rapid decline in morality compared to other West African countries. Ghana has been one of the fastest growing economies in Africa, and as a result, there has been a significant reduction in poverty (United Nations Development Program). This economic development is a significant contributor in reducing the nation’s mortality because increased national wealth correlates with less starvation and greater access to health resources.

There are a significant number of public health interventions implemented in Ghana that have contributed to the decrease in mortality seen over the past 70 years. Many interventions have targeted infant and child health, as infant mortality was high in Ghana in the 1950s. Two intervention programs are the Ghana Child Health Policy and the Child Health Strategy. These programs are focused on improving access and the quality of healthcare in Ghana (Adua et al., 2017). Additionally, UNICEF has provided public health support in Ghana (UNICEF). These programs target a variety of sectors including health and nutrition, water and sanitation, hygiene, education, and child protection. Several child health interventions include vaccination, vitamin supplementation, drinking water services, insecticide mosquito nets, diarrhea treatment, and acute respiratory infection treatment (UNICEF). Other interventions target expectant mothers and have dramatically decreased infant and maternal mortality. For instance, there has been an expansion in pre and postnatal care as well as the training of more birth attendants (UNICEF). The AIDS epidemic has also been a target of mortality reducing interventions in Ghana. The brief period in the 1990s in which the declines in mortality in Ghana briefly stalled can be explained by a high incidence of HIV infections during this time period. The subsequent expansion of HIV testing and access to antiretroviral therapy have contributed to the morality decline in Ghana after this period (UNICEF). All of these interventions have contributed to the dramatic declines in mortality in Ghana since the 1950s. In fact, recent data on the Universal Health Coverage index, which is a measure of a country's effectiveness in providing essential health services, shows that Ghana continues to improve its score on this index by 1.8% each year (Ritchie et a., 2020).

It is important to note that mortality in Ghana still has significantly higher mortality compared to the more developed regions of the world. Though public health interventions have helped millions of people, there are many Ghanaians who still live in poverty without access to clean water, adequate nutrition, and medical care. Additionally, malaria is still a major concern as it is the leading cause of morbidity in Ghana.

COVID-19 Response:

The COVID-19 response in Ghana has had some success in containing the virus and lessening its impact on the country. The laboratory system for COVID testing has been rapidly expanded from 2 to 16 labs across the country (World Bank Group, 2021). Additionally, a contact tracing system trained over 1,300 personnel in just the first few months of the project (World Bank Group, 2021). The health system has made accommodations for the treatment of COVID infected individuals in Ghana. 21 treatment centers and 129 ICU beds in at least 10 of the nation’s 16 regions (World Bank Group, 2021). The government also created an official website for COVID-19 information shortly after the first cases were detected in Ghana, and this has been an important route for communication of information about COVID. Compared to its neighbors, Ghana has done very well in implementing public health measures to stop the spread of COVID. These interventions have maintained a case fatality rate of .75% which is low compared to even more developed regions (World Bank Group, 2021). However, it is important to keep in mind that there are lower rates of testing in Ghana compared to other countries, which may lead to the underreporting of cases.

References

Adua, E., Frimpong, K., Li, X., & Wang, W. (2017, August 18). Emerging issues in public health: A perspective on Ghana's healthcare expenditure, policies and outcomes. The EPMA journal. Retrieved February 12, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607056/#CR22

Ritchie, H., Mathieu, E., Rodés-Guirao, L., Appel, C., Giattino, C., Ortiz-Ospina, E., Hasell, J., Macdonald, B., Beltekian, D., & Roser, M. (2020, March 5). Coronavirus pandemic (COVID-19). Our World in Data. Retrieved February 12, 2022, from https://ourworldindata.org/coronavirus

UNICEF. (n.d.). What we do. UNICEF Ghana. Retrieved February 12, 2022, from https://www.unicef.org/ghana/what-we-do

United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019, Online Edition. Rev. 1.

United Nations Development Program. (n.d.). About Ghana. UNDP in Ghana. Retrieved February 12, 2022, from https://www.gh.undp.org/content/ghana/en/home/countryinfo.html#:~:text=Ghana%20was%20the%20first%20place,power%2C%20in%20this%20instance%20Britain.

World Bank Group. (2021, March 19). Saving lives and protecting people in Ghana and boosting the COVID-19 response. World Bank. Retrieved February 12, 2022, from https://www.worldbank.org/en/results/2021/03/17/saving-lives-and-protecting-people-in-ghana-and-boosting-the-covid-19-response

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