Determinants of Child Under-Five Mortality in Ghana: Analysis of the 2022 DHS Survey

Background Globally, under-five child mortality is still a significant public health concern that disproportionately affects low- and middle-income nations. Significant sociodemographic and geographical discrepancies still exist in Ghana despite significant advances. Effective policy interventions require an understanding of the factors that contribute to death in children under five. Methods 39,305 women between the ages of 15 and 49 who gave birth within the five years before to the survey were included in a secondary analysis of the 2022 Ghana Demographic and Health Survey. To evaluate the relationships between under-five mortality and maternal age, education, marital status, household wealth, region, antenatal care, immunisation, postnatal care, and exclusive breastfeeding, descriptive statistics were conducted first, and then bivariate and multivariate logistic regression analyses were conducted. The threshold for statistical significance was fixed at p < 0.05. Results The percentage of mothers who reported child deaths under five was about 25.2%. In comparison to adolescents aged 15–19 years (p < 0.001), older maternal age was significantly linked to higher odds of under-five mortality, especially among women aged 25–29 years (AOR = 2.50), 30–34 years (AOR = 4.57), and 35–49 years (AOR = 8.44). All categories of marital status showed higher odds relative to women never in union. Protective factors included secondary (AOR = 0.55) and higher education (AOR = 0.25), richest household wealth (AOR = 0.42), exclusive breastfeeding (AOR = 0.85), and immunisation uptake, with children having 2–3 immunisation entries showing a 77% reduction in mortality risk (AOR = 0.23) ( p  < 0.001). Conclusion Maternal health service use and sociodemographic disparities are the main causes of under-five mortality in Ghana. Strengthening maternal education, reducing socioeconomic disparities, and expanding immunisation and breastfeeding support are essential for achieving Sustainable Development Goal 3.2. Trial registration Not applicable.