John K. Anarfi

Migration and AIDS.

This article presents the perspectives of UNAIDS and the International Organization for Migration (IOM) on migration and HIV/AIDS. It identifies research and action priorities and policy issues, and describes the current situation in major regions of the world. Migration is a process. Movement is enhanced by air transport, rising international trade, deregulation of trade practices, and opening of borders. Movements are restricted by laws and statutes. Denial to freely circulate and obtain asylum is associated with vulnerability to HIV infections. A UNAIDS policy paper in 1997 and IOM policy guidelines in 1988 affirm that refugees and asylum seekers should not be targeted for special measures due to HIV/AIDS. There is an urgent need to provide primary health services for migrants, voluntary counseling and testing, and more favorable conditions. Research is needed on the role of migration in the spread of HIV, the extent of migration, availability of health services, and options for HIV prevention. Research must be action-oriented and focused on vulnerability to HIV and risk taking behavior. There is substantial mobility in West and Central Africa, economic migration in South Africa, and nonvoluntary migration in Angola. Sex workers in southeast Asia contribute to the spread. The breakup of the USSR led to population shifts. Migrants in Central America and Mexico move north to the US where HIV prevalence is higher.

Health of urban Ghanaian women as identified by the Women’s Health Study of Accra

The purpose of the Womens Health Study of Accra was to provide an assessment of the prevalence of communicable and non‐communicable illnesses.

Prevalence, awareness, treatment and control of hypertension in urban poor communities in Accra, Ghana.

Background: Hypertension is a major public health problem in many sub-Saharan African countries including Ghana, but data on urban poor communities are limited. The aim of this study was therefore to assess the prevalence, awareness, management and control of hypertension among a young adult population in their reproductive ages living in urban poor communities in Accra. Methods: Cross-sectional, population-based survey of 714 young adults in their reproductive ages (women aged 15–49 years, men aged 15–59 years) living in three urban poor suburbs of Accra, Ghana. Results: The overall prevalence of hypertension in all three communities was 28.3% (women 25.6% and men 31.0%). Among respondents who had hypertension, 7.4% were aware of their condition; 4% were on antihypertensive medication while only 3.5% of hypertensive individuals had adequate blood pressure (BP) control (BP <140/90 mmHg). The level of awareness and treatment was lower in men than in women (3.1 and 1.3% for men and 11.9 and 6.5% for women, respectively). Among individuals with hypertension, the rate of control was higher among women than among men (5.0 and 2.1%, respectively). Conclusion: Although about a quarter of the young adult population in these low-income communities of Accra have hypertension, the levels of awareness, treatment and control are abysmally low. We recommend community-specific primary and secondary prevention interventions that draw on existing resources, specifically implementing cardiovascular disease (CVD) interventions in faith-based organizations and task-shifting CVD care through the national Community-based Health Planning and Services (CHPS) programme.

Secular trends in menarcheal age among Ghanaian women in Accra

Summary The Womens Health Study of Accra is a population-based cross-sectional survey that was conducted between March and September 2003 to assess the burden of disease in women in Accra. In addition to data relating to general health and living conditions, data on age at first menstruation was collected during the survey. A retrospective cohort analysis of the reported age at menarche was conducted using data from 2,644 women aged between 18 and 100 years. The median age of first menstruation of the entire cohort was 15.5 years and the median age of first menstruation among those aged <20 was 14.5 years. There was a statistically significant difference in median age at menstruation among the different age and socioeconomic groups. Multiple linear regression showed a significant decline of 0.2 years per decade in the mean age at menarche among Ghanaian women.

Education and Employment Outcomes in Ghana through the Lens of the Capability Approach

Existing literature on education and employment confirms that in Ghana educational qualification largely influences the type of work. Through the lens of the Capability Approach, which sees human development in terms of the expansion of freedoms and opportunities, this paper identifies, for a cross-section of Ghanaians, the array of employment opportunities between and within education endowments. “Between endowments” refers to differentials in opportunities for individuals with different levels of educational qualifications, while “within endowments” considers the differentials for individuals with the same level of education. The source of data is the 2005/06 Ghana Living Standard Survey (GLSS5). Results show that education is not enough to erase inequalities. Multinomial regression analysis demonstrates that functionings differ according to the individual’s context, household and personal conversion factors. This is explained by inequalities in the requirements for a particular job (between educational endowments) and by job accessibility due to personal characteristics (within educational endowments).

Social Support, Dysfunctional Coping, and Community Reintegration as Predictors of PTSD Among Human Trafficking Survivors

ABSTRACT Human trafficking exerts psychological effects on survivors that persist after intervention, and even after community reintegration. Effects include anxiety, depression, alienation, disorientation, aggression, suicidal ideation, attention deficit, and posttraumatic stress disorder (PTSD). Community supports and coping mechanisms may mitigate these effects. The report presented here is part of a long-term program of research to develop and test evidence-informed mental health and human capacity-building intervention programs for women and girls who are victims of trafficking. Structural equation modeling was used to assess a conditional process model (moderated mediation) of the effect of social support, coping, and community reintegration on PTSD among n = 144 girls and women. Participants received psychosocial intervention at a residential care facility for trafficking survivors. Results indicate model fit was excellent. Results indicate community reintegration indirectly influenced PTSD through its effect on perceived social support. Survivors who reported more difficulty reintegrating back into the community perceived less social support than those that reported easier community reintegration, and trafficking survivors who perceived less social support indicated more PTSD. Survivors with more PTSD symptoms tended to report using more dysfunctional coping mechanisms.

Educational status and beliefs regarding non-communicable diseases among children in Ghana

BackgroundIncreasing prevalence of non-communicable diseases (NCDs) has been observed in Ghana as in other developing countries. Past research focused on NCDs among adults. Recent researches, however, provide evidence on NCDs among children in many countries, including Ghana. Beliefs about the cause of NCDs among children may be determined by the socioeconomic status of parents and care givers. This paper examines the relationship between educational status of parents and/or care givers of children with NCDs on admission and their beliefs regarding NCDs among children.MethodsA total of 225 parents and/or care givers of children with NCDS hospitalized in seven hospitals in three regions (Greater Accra, Ashanti and Volta) were selected for the study. Statistical techniques, including the chi-square and multinomial logistic regression, were used for the data analysis.ResultsEducational status is a predictor of care giver’s belief about whether enemies can cause NCDs among children or not. This is the only belief with which all the educational categories have significant relationship. Also, post-secondary/polytechnic (p-value =0.029) and university (p-value = 0.009) levels of education are both predictors of care givers being undecided about the belief that NCDs among children can be caused by enemies, when background characteristics are controlled for. Significant relationship is found between only some educational categories regarding the other types of beliefs and NCDs among children. For example, those with Middle/Juniour Secondary School (JSS)/Juniour High School (JHS) education are significantly undecided about the belief that the sin of parents can cause NCDs among children.ConclusionsEducation is more of a predictor of the belief that enemies can cause NCDs among children than the other types of beliefs. Some categories of ethnicity, residential status and age have significant relationship with the beliefs when background characteristics of the parents and/or care givers were controlled for.

Non-communicable diseases among children in Ghana: health and social concerns of parent/caregivers.

BACKGROUND Globally, there is a progressive rise in the burden of non-communicable diseases (NCDs). This paper examined the health and social concerns of parents/caregivers on in-patient care for children with NCDs in Ghana. METHODS This was a cross-sectional study in three large health facilities in Ghana (the largest in the South, the largest in the North and the largest in the Eastern part of Ghana. Data was collected with a structured questionnaire among 225 caregivers (≥18 years) of 149 children with NCDs in health facilities in the three regions. Data was analyzed with simple descriptive statistics. RESULTS Most caregivers 169(75.0%) were women, relatively young (median age 35years), mostly married and resided in urban areas. Sickle cell disease was the commonest NCD among the children. All 169(75.0%) caregivers believed children suffer NCDs because of sins of parents/ancestors, 29(12.9%) believed herbalists/spiritualists have insights into treating NCDs and 73(32.6%) have previously used herbs/traditional medicine for childs illness. NCD in children was a burden and caused financial difficulties for families. Most caregivers (>96.0%) indicated NCDs in children should be included in national health insurance benefits package and a comprehensive national NCD policy is needed. CONCLUSION Absence of national NCD policy for children is a major challenge. The burden of care rests mainly on the parents/caregivers. A national strategic intervention on the importance of awareness generation on the causes, risk factors, prevention and treatment of NCDs for families and communities is essential. Government support through national health and social policy initiatives are essential.

“Shaping the Family”: Individual’s capabilities to exercise reproductive rights seen through a qualitative survey

We analyze here the outcome of focus group discussions and individual interviews conducted in Mali and Ghana. The aim is to identify collective images about family norms and emergence of alternative values, and to examine people’s degree of ambivalence towards norms and their ability to conceive and realize their own family plans. Discourses show that family life plans should not be seen as pre-established. Ability to shape the family appears conjectural both as regards current resources and the position in the family trajectory. In both countries, two types of resources play a key role: schooling and influence/support from the family and network. Results highlight that the least individual freedom is to be found at the start of family life and in gender power relationships; some freedom appears in the timing of fertility; while more room for individual agency characterizes youth and individuals with more personal resources and supportive surroundings.

W428 “PEOPLE REALLY WORRY ABOUT UNWANTED PREGNANCY”: WOMEN'S DESIRED FAMILY SIZE AND ATTITUDES TOWARDS ABORTION IN ACCRA, GHANA

W428 “PEOPLE REALLY WORRY ABOUT UNWANTED PREGNANCY”: WOMEN’S DESIRED FAMILY SIZE AND ATTITUDES TOWARDS ABORTION IN ACCRA, GHANA N. Lince, K. Blanchard, R. Adanu, J. Anarfi, A. Hill. Ibis Reproductive Health, Johannesburg, South Africa; Population Family and Reproductive Health Department, School of Public Health, University of Ghana, Accra, Ghana; Regional Institute for Population Studies, University of Ghana, Accra, Ghana; Ibis Reproductive Health, Cambridge, MA, United States; Harvard Center for Population & Development Studies, Cambridge, MA, United States; School of Social Sciences, University of Southampton, Southampton, United Kingdom