Akwasi Kumi-Kyereme

Influence of social connectedness, communication and monitoring on adolescent sexual activity in Ghana.

This paper examines connectedness to, communication with and monitoring of unmarried adolescents in Ghana by parents, other adults, friends and key social institutions and the roles these groups play with respect to adolescent sexual activity. The paper draws on 2004 nationally-representative survey data and qualitative evidence from focus group discussions and in-depth interviews with adolescents in 2003. Adolescents show high levels of connectedness to family, adults, friends, school and religious groups. High levels of adult monitoring are also observed, but communication with family about sex-related matters was not as high as with non-family members. The qualitative data highlight gender differences in communication. Multivariate analysis of survey data shows a strong negative relationship between parental monitoring and recent sexual activity for males and females, and limited effects of communication. Creating a supportive environment and showing interest in the welfare of adolescents appear to promote positive sexual and reproductive health outcomes.

DETERMINANTS OF EXCLUSIVE BREASTFEEDING AMONG MOTHERS IN GHANA: A CROSS-SECTIONAL STUDY

BackgroundMothers are encouraged to practice exclusive breastfeeding for the first six months of a child’s life. The general objective of the study was to assess the predictors of exclusive breastfeeding among mothers in Ghana.MethodsThis was a cross-sectional study using data from the 2008 Ghana Demographic and Health Survey (GDHS). The study sample (n = 316) was based on infants (0–5 months old) during the survey period; extracted from the individual (women) data set. Binary logistic regression was used to examine the association between selected independent variables.ResultsIn general, the rate of exclusive breastfeeding was 64 percent. Marital status, region and place of delivery were found to be associated with the practice of exclusive breastfeeding. The logistic regression model illustrated mothers from the Volta Region, those who delivered in a government health facility, and mothers who perceived their infants to be average in size were more likely to practice exclusive breastfeeding.ConclusionAppropriate health education programmes by the Ministry of Health targeting mothers who are less likely to practice exclusive breastfeeding are recommended.

Correlates of stunting among children in Ghana

BackgroundStunting, is a linear growth retardation, which results from inadequate intake of food over a long period of time that may be worsened by chronic illness. Over a long period of time, inadequate nutrition or its effects could result in stunting. This paper examines the correlates of stunting among children in Ghana using data from the 2008 Ghana Demographic and Health Survey (GDHS).MethodsThe paper uses data from the children recode file of the 2008 Demographic and Health Survey (DHS), a nationally representative cross sectional survey conducted in Ghana. A total of 2379 children under five years who had valid anthropometric data were used for the study. Data on the stunting of children were collected by measuring the height of all children under six years of age. A measuring board produced by Shorr Productions was used to obtain the height of the children. Children under 2xa0years of age were measured lying down on the board while those above 2xa0years were measured standing. In the DHS data, a z-score is given for the child’s height relative to the age. Both bi-variate and multi-variate statistics are used to examine the correlates of stunting.ResultsStunting was common among males than females. Age of child was a significant determinant of stunting with the highest odd of stunting been among children aged 36–47 months. Region was significantly related to stunting. Children from the Eastern Region were more likely to be stunted than children from the Western Region which is the reference group (ORu2009=u20091.7 at pu2009<u20090.05). Number of children in household was significantly related to stunting. Children in households with 5–8 children were 1.3 times more likely to be stunted compared to those with 1–4 children (pu2009<u2009.05). Mother’s age was a significant predictor of stunting with children whose mothers were aged 35–44 years being more likely to be stunted.ConclusionCulturally appropriate interventions and policies should be put in place to minimise the effects of the distal, proximal and intermediate factors on stunting among under 5 children in Ghana.

Effects of spatial location and household wealth on health insurance subscription among women in Ghana

BackgroundThis study compares ownership of health insurance among Ghanaian women with respect to wealth status and spatial location. We explore the overarching research question by employing geographic and proxy means targeting through interactive analysis of wealth status and spatial issues.MethodsThe paper draws on the 2008 Ghana Demographic and Health Survey. Bivariate descriptive analysis coupled with binary logistic regression estimation technique was used to analyse the data.ResultsBy wealth status, the likelihood of purchasing insurance was significantly higher among respondents from the middle, richer and richest households compared to the poorest (reference category) and these differences widened more profoundly in the Northern areas after interacting wealth with zone of residence. Among women at the bottom of household wealth (poorest and poorer), there were no statistically significant differences in insurance subscription in all the areas.ConclusionsThe results underscore the relevance of geographic and proxy means targeting in identifying populations who may be need of special interventions as part of the efforts to increase enrolment as well as means of social protection against the vulnerable.

FRUIT AND VEGETABLE CONSUMPTION BY ECOLOGICAL ZONE AND SOCIOECONOMIC STATUS IN GHANA.

The disease burden in both developed and developing countries is moving towards higher proportions of chronic diseases, and diseases such as cancers are now considered to be of public health concern. In sub-Saharan Africa, healthy behaviours such as fruit and vegetable consumption are recommended to reduce the chances of onset of chronic diseases. This paper examines the determinants of fruit and vegetable consumption in Ghana with particular emphasis on consumption by ecological zone. Data were from the 2008 Ghana Demographic and Health Survey (n=4916 females; n=4568 males). Univariate and multivariate analyses were performed using basic descriptive and Poisson regression. The main independent variable was ecological zone and the dependent variables were levels of fruit and vegetable consumption. The mean number of fruits and vegetables consumed in a week was higher among females (fruits: 7.5, 95% CI=7.3-7.7; vegetables: 8.1, 95% CI=7.8-8.3) than males (fruits: 6.2, 95% CI=6.0-6.4; vegetables: 7.9, 95% CI=7.7-8.2). There were significant differences in consumption by ecological zone. Respondents in the Savannah zone consumed less fruit than those in the Coastal and Forest zones, but the differences in fruit and vegetable consumption between the Coastal and Savannah zones were not consistent, especially for vegetable consumption. The findings suggest that one of the key interventions to improve fruit and vegetable consumption could lie in improving distribution systems since their consumption is significantly higher in the Forest zone, where the production of fruit and vegetables is more developed than in the Savannah and Coastal zones. The findings relating to household wealth challenge conventional knowledge on fruit and vegetable consumption, and rather argue for equal consideration of spatial differences in critical health outcomes.

Socioeconomic inequalities in cigarette smoking among men: evidence from the 2003 and 2008 Ghana demographic and health surveys

BackgroundTobacco use is a public health burden in both developed and developing countries. However, there is still a dearth of nationally representative studies from Sub-Saharan Africa to inform interventions in the region. Socioeconomic trends and disparities in cigarette smoking were explored among Ghanaian men.MethodA nationally representative sample of Ghanaian men 15–59xa0years was surveyed in the 2003 (Nu2009=u20095015) and 2008 (Nu2009=u20094568) Ghana Demographic and Health Surveys (Nu2009=u20099583). Logistic regression analyses were conducted to investigate cigarette smoking by socioeconomic status (SES) and the changes over the two study periods. The results are presented as adjusted odds ratios (AOR) at 95% confidence intervals (CI)ResultsThe prevalence decreased by 1.7% from 9% (95% CI 0.09–0.11) in 2003 to 7.3% (95% CI 0.07–0.09) in 2008. The prevalence of cigarette smoking was higher in the older age groups (25–34xa0year-olds and 35–59xa0year-olds) compared to 15–24xa0year-olds. Education (AORu2009=u20092.2, 95% CI 1.4–3.4; no education vs higher education) and occupation (AORu2009=u20094.2, 95% CI 2.3–7.6; not working vs managerial position) and being in labour force (AORu2009=u20092.6, 95% CI 1.7–4.0) were related to cigarette smoking. Furthermore, religion, wealth (AORu2009=u20093.1 95% CI 2.1–4.5; poorest compared to richest) and rural residence (AORu2009=u20091.8, 95% CI 1.5–2.1) were associated with cigarette smoking. Over the period, cigarette smoking seems to have decreased among Ghanaian male at the population level but not among all groups by age, education, wealth and place of residence.ConclusionCigarette smoking interventions should be structured to reduce the menace among men. Such interventions must also particularly target lower socioeconomic groups in order to avert an increase in the inequalities in the behaviour and prervent a consequent increase in the socioeconomic gradient in tobacco-related diseases and deaths.

Transactional sex among female university students in Ghana: Implications for HIV education

Purpose – Older males having sex with younger females is known to increase unsafe sex practices, exacerbated by power and economic imbalances between partners. The purpose of this paper is to examine transactional sexual relationships (i.e. long-term relationships constructed as “girlfriends not ‘prostitutes’” based on the exchange of gifts and other obligations) among female students of University of Cape Coast, Ghana. It particularly explores the implications for HIV education in institutions of higher learning. HIV/AIDS has been labelled as a disease of the poor and the uneducated, and it might be expected university students would engage in safer sexual practices: if they do not it highlights the problem around gender and economic imbalances and their repercussions even more clearly. Design/methodology/approach – Using snowballing, 40 university-educated female students engaged in transactional sex were interviewed using unstructured interview. The data were analysed thematically. Findings – These you...

Barriers and motivations for health insurance subscription in Cape Coast, Ghana: a qualitative study

BackgroundOne of the main objectives of the Ghana National Health Insurance Scheme, at its establishment in 2003, was to ease financial burden of the full cost recovery policy, particularly on the poor. However, currently, majority of the scheme’s subscribers are individuals in the upper wealth quintile, as the poor in society rather have not subscribed. We explored the motivational factors as well as the barriers to health insurance subscription in the Cape Coast Metropolis of Ghana.MethodsThis study collected qualitative data from 30 purposively selected subscribers and non-subscribers to the National Health Insurance Scheme using an in-depth interview guide.ResultsMajor motivational factors identified were; affordable health insurance premium, access to free drugs, and social security against unforeseen health challenges. Encouragement by friends, family members, and colleagues, was also found to motivate subscription to the health insurance. The major barriers to health insurance subscription included; long queues and waiting time, perceived poor quality of drugs, and negative attitude of service providers both at the healthcare facilities and the health insurance office. The study underscores the need for the National Health Insurance Authority to conduct intensive education to change the negative perception people have regarding the quality of health insurance drugs. Efforts should also be made to reduce the waiting time in accessing healthcare with the National Health Insurance Scheme card. This would motivate more people to subscribe or renew their membership.ConclusionsThe implication of barriers found is that people may not subscribe to the scheme in subsequent years. This would, therefore, consequently defeat the objective of achieving universal healthcare coverage with the scheme.

Leisure motivation of people with physical and visual disabilities in Ghana

Abstract Leisure motivation is central to the provision of leisure services especially to marginalised groups such as disabled people who may have different interests from non-disabled people. Using cross-sectional data from 536 people with physical and visual disabilities, this study assessed the leisure motivations of disabled people in Ghana. The findings suggest that the motivations of people with visual and physical disabilities were fourfold, namely competence mastery, social, intellectual, and stimulus avoidance. The influence of social motivation varied across marital status and household size, while stimulus avoidance varied by type of disability, sex, and employment status. Competence mastery and intellectual motivation varied across sex and income levels. It was concluded that the leisure motivations of disabled people in this study are based on their personal circumstances; they are heterogeneous. The study recommends that research on leisure motivation should be conducted with reference to specific context and interpreted in relation to the individual’s circumstances.

Household wealth, residential status and the incidence of diarrhoea among children under-five years in Ghana

This study examines the impact that the joint effect of household wealth quintile and urban–rural residence has on the incidence of diarrhoea among Ghanaian children. Data for this paper were drawn from the Ghana Multiple Indicator Cluster Survey (MICS) of 2006. Descriptive and logistic regression was applied to analyse data on 3466 children. Rural residents are less likely, albeit insignificant, to report diarrhoea compared with those in urban areas. Significant wealth gradients are manifested in childhood experiences of diarrhoea. However, an interaction of wealth with residence does not show significant disparities. Controlling for other important covariates of childhood, the odds of diarrhoea incidence were significantly higher among: the rural poorer (OR = 4.869; 95% CI = 0.792, 29.94), the rural middle (OR = 7.477; 95% CI = 1.300, 42.99), the rural richer (OR = 6.162; 95% CI = 0.932, 40.74) and the rural richest (OR = 6.152; 95% CI = 0.458, 82.54). Apart from residential status and wealth quintile, female children (OR = 0.441; 95% CI = 0.304, 0.640), older children (OR = 0.968; 95% CI = 0.943, 0.993), having a mother with secondary and higher education (OR = 0.313; 95% CI) had lesser odds of experiencing diarrhoea. The findings show that there is a need to apportion interventions intended to improve child health outcomes even beyond residential status and household wealth position.