Eugene Kofuor Maafo Darteh

Reproductive health decision making among Ghanaian women

IntroductionWomen’s reproductive health decision-making and choices, including engaging in sexual intercourse and condom use, are essential for good reproductive health. However, issues concerning sexual intercourse and condom use are shrouded in secrecy in many sub-Saharan African countries. This study investigates factors that affect decision making on engaging in sexual intercourse and use of condom among women aged 15–49.MethodA nationally representative sample (N = 3124) data collected in the 2008 Ghana Demographic and Health Survey was used. Multivariate logistic regression was used to study the association between women’s economic and socio-demographic characteristics and their decision making on engaging in sexual intercourse and use of condom.ResultsOne out of five women reported that they could not refuse their partners’ request for sexual intercourse while one out of four indicated that they could not demand the use of condoms by their partners. Women aged 35–49 were more likely to make decision on engaging in sexual intercourse (OR = 1.35) compared to those aged 15–24. Furthermore, the higher a woman’s education, the more likely that she would make decision regarding condom use. Also, if a woman had primary (OR = 1.37) or secondary (OR = 1.55) education, she is more likely to make decision regarding engaging in sexual intercourse compared to a woman who had no formal education. Compared to women in the Greater Accra region (the capital city region), women in the Western region (OR = 2.10), Central region (OR = 2.35), Brong Ahafo (OR = 1.70), Upper East (OR = 7.71) and Upper West (OR = 3.56) were more likely to make decision regarding the use of condom. Women who were in the richest, rich and middle wealth index categories were more likely to make decision regarding engaging in sexual intercourse as well as condom use compared to the poorest.ConclusionInterventions and policies geared at empowering women to take charge of their reproductive health should focus particularly on women from less wealthy backgrounds and those with low educational attainments.

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.

Correlates of HIV Testing Among Young People in Ghana

Knowledge of HIV status provides opportunities for patients to seek early treatment, facilitates referral for social support, counseling on contraceptive use and responsible sexual behavior. The authors identify factors that predispose young people (15 to 24 years) to seek HIV testing. Drawing on data from the 2008 Ghana Demographic and Health Survey, both bivariate and multivariate results are presented. Compared with females, males reported minimal levels of testing, although demand for testing was observed to be generally low among the respondents. For females, being married or cohabiting correlated with testing decisions, while age was the key determinant among males. High frequency of exposure to a radio was a common determinant between both sexes. Because testing will continue to be a major strategy for HIV prevention, it is imperative to make messages on testing attractive to increase uptake among young people who are at higher risk of infection.

DETERMINANTS OF UNPROTECTED CASUAL HETEROSEXUAL SEX IN GHANA

Casual heterosexual sex remains a significant contributor to HIV transmissions in Ghana. The study used data from the 2008 Ghana Demographic and Health Survey (GDHS) to assess the socio-demographic, economic and spatial factors influencing unprotected casual heterosexual sex among men and women. The results of the binary logistic regression models revealed that women aged 35-44 had significantly higher odds of engaging in unprotected casual heterosexual sex than those aged 15-24, unlike the men. There were significantly lower odds of unprotected casual heterosexual sex for women and men with exposure to print media compared with those without exposure. Compared with men residing in the Western Region, unprotected casual heterosexual sex was significantly less likely among those in the Upper East Region. There is the need for behavioural change campaigns in Ghana that take into consideration the multiplicity of factors that determine unprotected casual heterosexual sex.

Adolescents' exposure to mass media campaign messages on HIV/AIDS in Ghana

Using rich data collected from adolescents in Ghana by the Guttmacher Institute in collaboration with partners including the University of Cape Coast, this paper attempts to examine how exposure to specific messages designed for a media campaign dubbed “Stop AIDS-Love Life’ affected adolescents’ behaviour towards HIV/AIDS. Two logistic regression models are used to examine the effects of exposure to messages on HIV/AIDS on adolescents’ behavior towards HIV/AIDS. The study observed a direct and significant relationship between exposure to some of the messages and HIV/AIDS behavioural outcomes. It was established that adolescents who were exposed to the message titled “Think before you play” were about 1.3 times more likely to consider themselves at risk of HIV infection in both models. At p<.05, adolescents who reported exposure to HIV/AIDS messages “No means no - think” were more than 1.2 times more likely to express willingness to care for an HIV infected persons. The study highlights the need to put in place measures which will ensure that adolescents are reached with appropriate messages through mass media channels which are accessible to them. Efforts should be made to use mass media messages to reach adolescents on issues concerning HIV/AIDS stigma and discrimination. It is recommended that adolescents should be provided with supportive environments which will help them to sustain positive behaviour that they adopt in order to avoid a “slip” or “relapse”. Also, program designers and implementers should avoid the ‘once-size-all approach’ and consider the heterogeneity that exists among adolescents in the design of campaign messages.

Rape‐myth acceptance among students at the University of Cape Coast, Ghana

Sexual assault, including rape, is an egregious human rights violation that occurs around the world that has become increasingly prevalent on university campuses; by way of example, a large proportion of students in the USA will experience sexual assault during their university career [1]. In many settings, gender inequality is at the root of sexual assault and rape is justified by blaming victims for putting themselves in a vulnerable position. These “rape myths” affect what is considered rape, minimizing and rationalizing rape [2]. This article is protected by copyright. All rights reserved.

Providers of antenatal care services in Ghana: evidence from Ghana demographic and health surveys 1988–2014

BackgroundAntenatal care is one of the three most essential care - antenatal, delivery and post-natal, given to women during pregnancy and has the potential to contribute towards the achievement of the Sustainable Development Goal (SDG) target 3.1- reducing the global maternal mortality ratio to less than 70 per 100,000 and target 3.8 – achieve universal health coverage. The main objective is to examine the contribution of the various providers of antenatal care services in Ghana from 1988 to 2014.MethodsThe study uses data from all the six rounds of the Ghana Demographic and Health Survey (GDHS). Binary logistic regression models were applied to examine the association between background characteristics of respondents and providers of antenatal care services.ResultsThe results show that majority of antenatal care services were provided by nurses over the period under review. The proportion of women who received antenatal care services from nurses improved over the period from 55% in 1988 to 89.5% in 2014. Moreover, there was a decline in antenatal care services provided by traditional birth attendants and women who did not receive antenatal care services from any service provider over the years under review. It was observed that women from rural areas were more likely to utilise antenatal care services provided by traditional birth attendants, whilst those from urban areas were more likely to utilise antenatal care from doctors and nurses.ConclusionTo further improve access to and utilisation of antenatal care services provided by nurses and doctors it is recommended that the Ghana Health Service and the Ministry of Health should put in place systems aimed at improving on the quality of care given such as regular training workshops for health personnel and assessment of patient’s satisfaction with services provided. Also, they should encourage women in rural areas especially those from the savannah zone to utilise antenatal care services from skilled providers through social and behaviour change communication campaigns.

Determinants of choice of skilled antenatal care service providers in Ghana: analysis of demographic and health survey

BackgroundThe International Safe Motherhood initiative provides a focus for programmes and research to improve maternal health in low – income countries. Antenatal care is one of the key pillars of the initiative. This study sought to examine the association between background characteristics and choice of skilled providers of antenatal care services in Ghana.MethodsThe study used data from the six rounds of the Ghana Demographic and Health Survey (GDHS). Binary logistic regression models were applied to analyse the data.ResultsResults show that the proportion of women who received antenatal care (ANC) services from skilled providers improved over the period. Also, women with secondary education (OR = 1.42, CI = 1.07–1.88), richest wealth status (OR = 5.10, CI = 2.28–11.85) were more likely to utilise antenatal care services from skilled providers. Whereas women from rural areas (OR = 0.55, CI = 0.41–0.74), with four births or more (OR = 0.55, CI = 0.36–0.85) and from the northern ethnic group were less likely to utilise antenatal care services from skilled providers.ConclusionChoice of skilled providers of antenatal care services were predicted by some predisposing factors including education, ethnicity, and ecological zone. Also enabling factors such as wealth status, residence and the need for care factor, parity predicted choice of skilled providers of antenatal care services. Women with secondary or higher education, those within richer and richest wealth status, those from forest zone are more likely to utilise the services of skilled providers during their antenatal care visits. Whereas women from rural areas, those with four births or more and those with the northern ethnic group were more likely to utilise ANC service from unskilled providers. The Ghana Health Service and Ministry of Health should encourage women in rural areas to utilise antenatal care services from skilled providers through social and behaviour change communication campaigns.

Attitudes toward abortion among students at the University of Cape Coast, Ghana

OBJECTIVES This study aimed to describe the attitudes toward abortion of Ghanaian University students and to determine factors which are associated with supporting a womans right to an abortion. METHODS This cross-sectional survey was administered to residential students at the University of Cape Coast. Participants were posed a series of 26 statements to determine to what extent they were supportive of abortion as a womans right. An exploratory factor analysis was used to create a scale with the pertinent factors that relate to abortion attitudes and a multivariable linear regression model explored the relationships among significant variables noted during exploratory factor analysis. RESULTS 1038 students completed the survey and these students had a generally negative view of abortion. Two factors emerged: (1) the Abortion as a Right scale consisted of five questions (α = .755) and (2) the Moral Objection to Abortion scale consisted of three questions (α = .740). In linear regression, being older (β = 1.9), sexually experienced (β = 1.2), having a boyfriend/girlfriend (β = 1.4), and knowing someone who has terminated a pregnancy (β = 1.1) were significantly associated with a more liberal view of a right to an abortion. DISCUSSION This work supports the idea that students who have personal exposure to an abortion experience hold more liberal views on abortion than those who have not had a similar exposure.

Why are our children wasting: Determinants of wasting among under 5s in Ghana

Background: Wasting is one of the indicators of malnutrition known to contribute to the deaths occurring from childhood malnutrition. It is the measure of body mass in relation to body length used to explain recent nutritional status. Aim: This paper examines the determinants of wasting among under 5s in Ghana. Method: Data were drawn from the 2014 Ghana Demographic and Health Survey children’s records file to examine the determinants of wasting among children. A total of 2720 children under 5 years with valid anthropometric data were used. Data on wasting were collected by measuring the weight and height of all children under 5 years of age. Bi-variate and multi-variate statistics are used to examine the determinants of wasting. Results: The bi-variate analysis showed significant differences (p < 0.001) in the prevalence of wasting among under 5s according to age of the child, region, and wealth status. On the other hand, the multi-variate analysis revealed that the odds of wasting were lower among children aged 24–35 months (Odds ratio (OR) = 0.37; p < 0.001), those from households of the middle wealth quintile (OR = 0.49, p < 0.05) and with health insurance (OR = 0.70; p < 0.10). Conclusions: Programmes and policies aimed at ensuring the survival of children during the first 24 months of life should be strengthened to reduce the risk of wasting among under 5s. Also, efforts should be made by the relevant government agencies and other stakeholders to strengthen the socio-economic status of mothers to enable them to provide adequate nutrition and improve access to health insurance for their children in order to reduce the incidence of wasting among these children.