Joshua Amo-Adjei

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.

Household Nucleation, Dependency and Child Health Outcomes in Ghana

This study uses three key anthropometric measures of nutritional status among children (stunting, wasting and underweight) to explore the dual effects of household composition and dependency on nutritional outcomes of under-five children in Ghana. The objective is to examine changes in household living arrangements of under-five children to explore the interaction of dependency and nucleation on child health outcomes. The concept of nucleation refers to the changing structure and composition of household living arrangements, from highly extended with its associated socioeconomic system of production and reproduction, social behaviour and values, towards single-family households - especially the nuclear family, containing a husband and wife and their children alone. A negative relationship between levels of dependency, as measured by the number of children in the household, and child health outcomes is premised on the grounds that high dependency depletes resources, both tangible and intangible, to the disadvantage of young children. Data were drawn from the last four rounds of the Ghana Demographic and Health Surveys (GDHSs), from 1993 to 2008, for the first objective - to explore changes in household composition. For the second objective, the study used data from the 2008 GDHS. The results show that, over time, households in Ghana have been changing towards nucleation. The main finding is that in households with the same number of dependent children, in nucleated households children under age 5 have better health outcomes compared with children under age 5 in non-nucleated households. The results also indicate that the effect of dependency on child health outcomes is mediated by household nucleation and wealth status and that, as such, high levels of dependency do not necessarily translate into negative health outcomes for children under age 5, based on anthropometric measures.

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.

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...

Views of health service providers on obstacles to tuberculosis control in Ghana

BackgroundAlthough Ghana does not fall into the category of those countries which have a high burden of tuberculosis (TB), the disease does present considerable economic and health limitations to individuals infected with, and affected by, the disease, as well as to the health system in general. Despite this fact, insufficient studies have been done on the key barriers to controlling the disease. This paper presents results from an exploratory study on the constraints of controlling TB in Ghana based on the opinions of health service providers.MethodsIn-depth interviews were conducted with frontline health workers involved in TB control in the country. Participants were purposively selected from a pool of national and regional, and district and facility level coordinators of the National Tuberculosis Control Programme (NTP). One key informant was also selected from an international non-governmental organisation (NGO) involved in TB-related activities in Ghana. Observations were utilised to complement the study. Data were analysed inductively.ResultsRespondents identified the following as being constraints to TB control: clinical complication, bottlenecks in funding administration, quality of physical infrastructure, competition for attention and funding, unsatisfactory coordination between TB and HIV control programmes, a poor public-private partnership, and weak monitoring and evaluation of interventions.ConclusionsThis paper provides evidence of some key barriers to TB control. The barriers, as reported, were generally health system-based. Although this list of barriers is not exhaustive, it would be useful to take them into account when planning for TB control, thus adopting a more rounded approach to TB management in the country. As well as that, further studies should be done to explore patients’ views on health service-related barriers to TB control.

Reflections on tuberculosis diagnosis and treatment outcomes in Ghana

BackgroundAvailable evidence in Ghana shows the implementation of tuberculosis (TB) control activities efforts since the beginning of the 1900s. In spite of that, TB continues to be one of the common diseases in the country. In 1994, local and international policy windows opened for renewed strategies for the control of TB. This paper explores some of the approaches which have been in place since 1994 and their implications for treatment outcomes.MethodsThe study combines quantitative and qualitative data. The quantitative data consist of treatment outcome from 1997–2010 and the qualitative data are derived from in-depth interviews with some staff of the TB control programme. Poisson regression and inductive coding were applied to the quantitative and qualitative data respectively.ResultsReported cure rates increased from 43.6% to 87.7% between 1997 and 2010. The data from the in-depth interviews (IDIs) suggested that improvements in diagnosis, community TB care, stigma reduction among community and health workers towards TB patients, the public-private partnership, and the enablers’ package contributed to the improved better treatment outcomes, particularly from 2008.ConclusionsLessons learnt include the achievement of objectives with varying strategies and stakeholder interventions. Further studies would be needed to quantify the contributions of the various interventions to help determine those that are cost effective as well as efficient and effective for TB control.

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.

Myths and misconceptions about tuberculosis transmission in Ghana

BackgroundMyths and misconceptions about TB can serve as a barrier to efforts at reducing stigmatisation of people infected and affected by the disease. Understanding such drivers of myths and misconceptions is important for improving information, education and communication (IEC) efforts of national control and preventive interventions. This study therefore assesses the influence of interaction of spatial, socioeconomic and demographic characteristics on myths and misconceptions.MethodsData was drawn from male (N = 4,546) and female (N = 4,916) files of the 2008 Ghana Demographic and Health Survey. A myth and misconception variable was created from five-related constructs with internal consistency score of r = 0. 8802 for males (inter-item correlation: 0.5951) and for females, r = 0. 0.9312 (inter-item correlation: 0.7303). The Pearson Chi-square was used to test the bivariate relationship between the independent variables and the dependent variable. Logistic regression was subsequently used to explore the factors determining myths and misconceptions of TB transmission.ResultsMajority of Ghanaians (males: 66.75%; females: 66.13%) did not hold myths and misconceptions about TB transmission. Females resident in the Upper East (aOR = 0.31, CI = 0.17-0.55) and Upper West (aOR = 0.41, CI = 0.24-0.69) and males resident in the Northern (aOR = 0.23, CI = 0.13-0.39) and the Greater Accra (aOR = 0.25, CI = 0.16-0.39) regions were independently associated with no misconceptions about TB transmission. Significant differences were also found in education, ethnicity and age.ConclusionThat spatial and other socioeconomic difference exists in myths and misconceptions suggest the need for spatial, socioeconomic and demographic segmentations in IEC on TB. This holds potentials for reaching out to those who are in critical need of information and education on the transmission processes of TB.

Effects of planned, mistimed and unwanted pregnancies on the use of prenatal health services in sub-Saharan Africa: a multicountry analysis of Demographic and Health Survey data

We analysed the extent of planned, mistimed and unwanted pregnancies and how they predict optimal use of prenatal (timing and number of antenatal) care services in 30 African countries.

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.