Stigma-driven bypassing of ART services in Northern Ghana: a qualitative case study.

BackgroundGhana adopted the WHO-recommended Seasonal Malaria Chemoprevention (SMC) in 2016 following a pilot study as a vital strategy for malaria control. SMC is the intermittent administration of a preventive and curative dose of anti-malarial medicine (Sulfadoxine-Pyrimetamine + Amodiaquine) during four months of the malaria season. This study monitored the implementation of SMC to ensure the intervention is achieving its target.MethodsThis was a longitudinal study in four administrative districts of the Upper East Region of Ghana. Children aged between 3 and 59 months were sampled and followed up one week after each cycle of SMC dosing to complete a questionnaire. SMC status was determined through the caregiver’s report and child welfare cards, if available. Caregivers were asked if the participant had been treated for malaria since the last cycle. Simple and multiple logistic regressions were employed to determine associations between SMC adherence and the independent variables, with all results interpreted at a 95% confidence level (CI).ResultsThis study reported an average SMC coverage of 87% (CI: 86.7–89.5) per cycle with a 2% dropout after the first cycle. SMC adherence rate remained above 82% (CI: 1.4–2.5), with malaria incidence decreasing in those who received all four doses of SMC compared to partial recipients. Health system/programme (49%) and patient related factors (33%) were the main reasons reported for non-adherence. Significant predictors of adherence were household size (aOR = 1.04, 95% CI 1.01–1.08), sleeping under bed nets (aOR = 1.88, 95% CI 1.44–2.48), and indoor residual spraying (IRS) presence (aOR = 0.83, 95% CI 0.69–1.99).ConclusionDespite achieving an average coverage of 87% per cycle, it falls short of the national target of 90%. Notable reasons for drop-outs and non-adherence were, the caregiver being unavailable during the distribution, highlighting the need for diversified approaches in SMC campaigns to enhance coverage, and adherence, and maximize intervention benefits.

BackgroundMotivations for use of contraceptives vary across populations. While some women use contraceptives for birth spacing, others adopt contraception for stopping childbearing. As part of efforts to guide the policy framework to promote contraceptive utilization among women in Ghana, this paper examines the intentions for contraceptive use among reproductive-aged women in one of the most impoverished regions of Ghana.MethodsThis paper utilizes data collected in 2011 from seven districts in the Upper East Region of northern Ghana to examine whether women who reported the use of contraceptives did so for the purposes of stopping or spacing childbirth. A total of 5511 women were interviewed on various health and reproductive health related issues, including fertility and family planning behavior. Women were asked if they would like to have any more children (for those who already had children or those who were pregnant at the time of the survey).ResultsThe prevalence of contraceptive use was low at 13%, while unmet need is highly pervasive and demand for family planning is predominantly for spacing future childbearing rather than for the purpose of stopping. Overall, about 31.7%of women not using contraceptives reported a need for spacing while 17.6% expressed a need for limiting. Thus, the latent demand for family planning is dominated by preferences for space rather than limiting childbearing.ConclusionResults show that there is latent demand for family planning and therefore if family planning programs are appropriately implemented they can yield the desired impact.

Purpose Farmers all over the country have been exposed to various adaptation strategies to climate change. The adaptation options however focus too closely on technical skills and technologies and fail to address critical social factors such as culture, beliefs and values that influence the adoption and effective implementation of new adaptation technologies, skills and capacity. This paper aims to assess the socioeconomic factors influencing farmers’ specific adaptive strategies to climate change in Pwalugu and Balungu communities in the Talensi district of the Upper East Region of Ghana. This study used purposive sampling technique to select the study communities, whereas simple random sampling technique was used to select a total of 100 respondents from the selected communities. Questionnaires, key informant interviews and focus group discussions were used in collecting data from respondents. This study used detailed statistical test to analyze the data, and the results are presented in the form of figures and tables. This study highlights the legal and institutional context which must be adopted for effective response to climate change impacts in rural communities in Northern Ghana. It also recommends that government and relevant stakeholders should collaborate with financial institutions to ensure that funds are readily available to farmers to enable them to effectively adapt to climate change as well as provide training/workshop programs to farmers to enhance their capacity in planning and implementing effective strategies to climate change. Design/methodology/approach This study used the integrated methodological approach where quantitative methods were combined with appropriate qualitative methods. According to Sandelowski (2000), this method ensures reliability (the extents to which results are consistent over time) and validity (the means of which measurements are accurate) of the research. A combination of participatory methods, including key informant interviews, household questionnaire surveys and focus-group discussions were used, allowing local people the opportunity to participate by sharing their experiences and knowledge to outline possible solutions to the problem at hand. Multiple methods (Yeasmin and Rahman, 2012) are good at reducing the inadequacies of a single method. Cross-sectional study was used in designing the research. Variables were measured or determined at the same period in a given population. This method allowed the assessment of practices, attitudes, knowledge and beliefs of a population in relation to a particular event or phenomenon (Olsen and George, 2014). Findings The findings of this study revealed farming as the major occupation in the two communities with males being dominant. Diverse livelihood activities such as fishing, animal/poultry rearing, firewood/charcoal production, hunting and driving were other activities respondents engaged to earn a living. In terms of institutional arrangements, avoidance of bush burning and tree felling were the norms influencing decision-making in the two communities. Fear of being punished, animals feeding on some of the grasses, trees inducing rainfall as well as benefits respondents get from trees were the reasons these norms were adhered to in the study area. Access to land, gender dynamics and finance were identified as the socioeconomic factors in the study area. High demands by landowners, last minute change of mind by landowners, limited fertile lands, lack of money to acquire lands, behavior of tenants, number of acres required and lands far from water bodies were the challenges associated with acquiring land in the communities. Access to finance influenced respondents’ ability to acquire fertile lands, lands closer to water bodies and any number of acres of their choice. Gender however impeded women adaptation strategies to climate change. Women were not allowed to own land and other property in the form of animals simply because they are seen as migrants and they do not know the history of the land. Originality/value This is a master’s thesis project. This paper shows the socioeconomic factors, which are influencing farmers’ specific adaptation to climate change in the Talensi district of Ghana.

To assess whether supervision of primary health care workers improves their productivity in four districts of Northern Ghana. We conducted a time-use study during which the activities of health workers were repeatedly observed and classified. Classification included four categories: direct patient care; documentation and reporting; staff development and facility operations; and personal time. These data were supplemented by a survey of health workers during which patterns of supervision were assessed. We used logistic regression models with health facility fixed effects to test the hypothesis that supervision increases the amount of time spent providing direct patient care (productivity). We further investigated whether these effects depend on whether or not supervision is supportive. Direct patient care accounted for <25% of observations. In bivariate analyses, productivity was higher among midwives and in facilities with a high volume of care. Supervisory visits were frequent in those four districts, but only a minority of health workers felt supported by their supervisors. Having been supervised within the last month was associated with a significantly higher proportion of time spent on direct patient care (OR = 1.57). The effects of supervision on productivity further depended on whether the health workers felt supported by their supervisors. Supportive supervision was associated with increased productivity. Investments in supervision could help maximize the output of scarce human resources in primary health care facilities. Time-use studies represent an objective approach in monitoring the productivity of health workers and evaluating the impact of health-system interventions on human resources.

BackgroundComputerized decision-support systems (CDSS) and performance-based incentives (PBIs) have potential to contribute to client satisfaction with health services. However, rigorous evidence is lacking on the effectiveness of these strategies in lower-income countries such as Ghana. This study aimed to determine the effect of a combined CDSS-PBI intervention on client satisfaction with maternal health services in primary facilities in the Upper East Region of Ghana.MethodsWe employed a quasi-experimental controlled baseline and endline design to assess the effect of the combined interventions on client satisfaction with maternal health services, measured by quantitative pre/post-test client satisfaction survey. Our analysis used difference-in-difference logistic regression, controlling for potential covariates, to compare variables across intervention and comparison facilities at baseline and endline.ResultsThe combined CDSS-PBI intervention was associated with increased or unchanged client satisfaction with all maternal health services compared at endline. Antenatal client difference-in-difference of mean satisfaction scores were significant at endline for intervention (n = 378) and comparison (n = 362) healthcare facilities for overall satisfaction (DiD 0.058, p = 0.014), perception of providers’ technical performance (DiD = 0.142; p = 0.006), client-provider interaction (DiD = 0.152; p = 0.001), and provider availability (DiD = 0.173; p = 0.001). Delivery client difference-in-difference of satisfaction scores were significant at endline for intervention (n = 318) and comparison (n = 240) healthcare facilities for overall satisfaction with delivery services (DiD = 0.072; p = 0.02) and client-provider interaction (DiD = 0.146; p = 0.02). However, mean overall satisfaction actually reduced slightly in intervention facilities, while DiD for technical performance and provider availability were not significant.ConclusionThis combined CDSS-PBI intervention was associated with greater antenatal and delivery client satisfaction with some aspects of maternity services within two years of implementation. It could be expanded elsewhere if funds allow, though further research is still required to assess cost-effectiveness and long-term effects on client satisfaction and maternal health outcomes.

Declining maize (Zea mays L.) yields caused by factors, such as inherently poor soils, continuous cropping of cereal after cereal, high cost and unavailability of chemical fertilizers, continuous crop-residue removal, and soil erosion and run-off, have all contributed to low soil fertility and reduced maize yields in northern Ghana. To address this negative trend, a three-year field trial was conducted at the Manga Agricultural Research Station in the Upper East Region of Ghana, which represents a Sudan Savannah agro-ecology. The treatments comprised 11 available sources of organic and inorganic fertilizers, which are soil fertility management practices used by peasant farmers. A randomized complete block design with four replications was used. The results revealed that the inorganic fertilizers with micro-nutrients, such as S, Zn, and Mg, (i.e., Actyva and 21:10:10:2 S) produced taller plants, caused earlier tasseling and silking, and produced higher grain yields on account of increased straw yields, plant height, stem girth, grain size, and harvest indices than organic fertilizers. Poultry manure and sheep manure were the best among the organic sources evaluated. Whereas most of the fertility management options accrued net benefits of more than $150.00, the goat droppings and town waste had low net benefits of $44.30 and $17.00, respectively, indicating low gains on investment and therefore, not profitable for field application.

Exposure to air pollution caused by cooking with solid fuels is estimated to cause 4 million excess deaths per year (Global Burden of Disease Study 2010) and in many regions, personal exposures to cookstove pollution and clean cookstove adoption is still poorly understood. REACCTING (Research of Emissions, Air Quality, Climate, and Cooking Technologies In Northern Ghana) is a multi-year project studying the emissions, exposure, and atmospheric implications of cooking behaviors in Northern Ghana. The project includes a cookstove intervention amongst a rural population in Sub-Saharan African in the Upper East Region of Ghana. Two hundred randomly selected households with at least one woman aged 25-60 years and one child aged 0-5 years were chosen for participation. The study includes four groups: 50 households were given two Philips High Efficiency Cookstoves (www.ace.co.ls), 50 households were given two wood burning stoves produced in Accra, Ghana (Gyapa), 50 households were given one Philips and one Gyapa stove, and 50 households were selected as a control group. At a subset of households from each study group, personal and micro-environmental real-time carbon monoxide (CO) and integrated particulate matter with diameters less than 2.5 microns (PM2.5) are being measured. Stove usage is also monitored at these households, using temperature data loggers, to assess stove adoption and identify relationships between personal exposure and cooking behavior in each study arm. We present results for the first six months of personal CO and PM2.5 (EC/OC) exposure measurements, as well as modeling results relating the personal and micro-environmental measurements.

Folate is a vitamin B-related substance needed by expectant mothers during the period right before and after conception (peri-conceptional period) to help protect foetuses against neural tube defects (NTDs). Despite efforts to promote the peri-conceptional uptake of folic acid (FA), adherence remains low. The aim of this study was to assess the prevalence and determinants of peri-conceptional FA uptake among childbearing women in northern Ghana. In a cross-sectional study, data from 303 women accessing antenatal care services in the Upper East Region of Ghana between February and July 2017 were collected and analysed in Stata (Version 12.1). Chi-square and logistic regression analysis were used to identify the independent determinants of peri-conceptional uptake of FA. The mean age of the study population was 27.4 (±5.73) years. The prevalence of uptake of peri-conceptional FA was 28.7% (95% confidence interval: 26.7%-34.2%); 66% of the women were aware of FA and 52% had acceptable knowledge about FA. Initiating ANC after 3months of pregnancy was associated with 91% less chance of peri-conceptional FA use [adjusted odds ratio (AOR) 0.09; 95% confidence interval (CI) 0.04-0.22; P<.001]. Not knowing the frequency of dosing of FA was associated with a 58% less likelihood of uptake of peri-conceptional FA (AOR 0.42; 95% CI 0.23-0.76; P=.004). There is low uptake of peri-conceptional FA among women of childbearing age accessing antenatal services in Northern Ghana, and this uptake is determined by the time of initiation of ANC visit and knowledge of dosage regimen of FA.

ABSTRACTSoybean is becoming an important cash crop in northern Ghana. Yet the yields are low due to use of low yielding varieties and limited use of inputs. Greenhouse and field experiments were carried out to evaluate the effects of two phosphorus (P) sources and Rhizobium inoculation on growth, nodulation, P uptake, and yield of three soybean genotypes on Ferric Lixisols of the Guinea savanna zone of Ghana. The P sources were triple superphosphate (TSP) and Morocco phosphate rock (MPR), while the genotypes were TGx 1448-2E, TGx 1904-6F, and TGx 1955-4F. The greenhouse experiment was conducted at the University of Ghana, Legon in a completely randomized design. The field experiment which was carried out in the Upper East region of Ghana was laid out in a split-split plot design with four replicates. In both the greenhouse and field experiments, application of TSP at 30 kg P ha−1 resulted in significantly higher growth and P uptake in shoot compared with MPR and control. Soybean genotypes showed significant differences in growth, nutrient uptake, and grain yield in both the greenhouse and the field experiments. Rhizobium inoculation increased nodule number and dry weight but did not increase grain yield. The genotype TGx 1955-4F appears to show greater potential for increasing productivity of soybean in low P soils in northern Ghana.

A four-year field trial was conducted at Bonia in the Upper East Region of Ghana to evaluate soybean-maize rotation amendment systems. The treatments included soybean without amendment, inoculated soybean, inoculated soybean with fertisol, inoculated soybean with phosphorus and potassium (P, K), inoculated soybean with P, K and fertisol, inoculated soybean with nitrogen, phosphorus, and potassium (N, P, K), and continuous maize. Treatments were arranged in a randomized complete block design with four replications. Inoculation negatively affected yields by 2% and 14% in 2013 and 2015, respectively. Soil amendments with P, K or N, P, K increased yields within 45–51%, fertisol increased by 95%, and integration of P, K and fertisol recorded 76% increment of inoculated soybean. Yields of maize increased by 1%, 20%, 25%, 43%, 44%, and 46% under inoculated soybean, inoculated soybean with N, P, K, inoculated soybean with P, K, inoculated soybean with fertisol, soybean without amendment, and inoculated soybean with P, K and fertisol, respectively. Maize after inoculated soybean with fertisol and maize after inoculated soybean with P, K and fertisol consistently scored higher benefit-cost ratio across the two years of experimentation. Thus, the two systems are conceivable for recommendation to the farmers in northern Ghana.

This paper examines the linkages between institutions, assets and the existing gender differentials in levels of production and poverty in peasant economies in Northern Ghana from an institutional economics perspective. Quantitative and qualitative empirical data were collected from eight study communities in four major ethnic groups in the Upper East Region of Ghana. The results from the analysis show that the institutionalization age old norms regarding the ownership, access and control of assets have affected the degree to which men and women in traditional societies actually own and control critical productive assets like land, cattle, irrigation water and even their own labour. Women were found to have minimal control over these assets, since the accepted norm is that the male head of household has ultimate control over these assets. The direct consequences of these institutionalized ownership and control norms are the low levels of production of women and the relative poverty of women in the region. An outstanding merit of the study is the unraveling of the complex relationships between institutional set-ups, assets, production and poverty. These complexities points to the fact the issue of poverty in Northern Ghana and how it can be addressed is a complex subject and one will need to appreciate the institutional context. The findings also provide useful information to both policy makers and practitioner on how to address the complex issue related to gender and development. Ghana Journal of Development Studies Vol.1(1) 2004: 25-48

BackgroundLack of an adequate and well-performing health workforce has emerged as the biggest barrier to scaling up health services provision in sub-Saharan Africa. As the global community commits to the Sustainable Development Goals and universal health coverage, health workforce challenges are critical. In northern Ghana, performance-based incentives (PBIs) were introduced to improve health worker motivation and service quality.ObjectiveThe goal of this study was to determine the impact of PBIs on maternal health worker motivation in two districts in northern Ghana.DesignA quasi-experimental study design with pre- and post-intervention measurement was used. PBIs were implemented for 2 years in six health facilities in Kassena-Nankana District with six health facilities in Builsa District serving as comparison sites. Fifty pre- and post-intervention structured interviews and 66 post-intervention in-depth interviews were conducted with health workers. Motivation was assessed using constructs for job satisfaction, pride, intrinsic motivation, timelines/attendance, and organisational commitment. Quantitative data were analysed to determine changes in motivation between intervention and comparison facilities pre- and post-intervention using STATA™ version 13. Qualitative data were analysed thematically using NVivo 10 to explore possible reasons for quantitative findings.ResultsPBIs were associated with slightly improved maternal health worker motivation. Mean values for overall motivation between intervention and comparison health workers were 0.6 versus 0.7 at baseline and 0.8 versus 0.7 at end line, respectively. Differences at baseline and end line were 0.1 (p=0.40 and p=0.50 respectively), with an overall 0.01 difference in difference (p=0.90). Qualitative interviews indicated that PBIs encouraged health workers to work harder and be more punctual, increasing reported pride and job satisfaction.ConclusionsThe results contribute evidence on the effects of PBIs on motivational constructs among maternal health workers in primary care facilities in northern Ghana. PBIs appeared to improve motivation, but not dramatically, and the long-term and unintended effects of their introduction require additional study.

The study mainly analyzes some protracted conflicts in Africa, particularly in Northern Ghana in Bawku in the Upper East Region of Ghana. The theoretical perspective was on protracted social conflict theory with insights from Edward Azar and its implications or ramifications on the internal and external relations of countries. The method used was largely a descriptive survey design, with the main instrument of data collection being a questionnaire, which was administered in the Bawku area in June 2023. A simple random sampling technique was used to select the respondents. The sample size was 399, and the data was analyzed with basic statistics and presented in tables and charts. The study found that the Bawku conflict significantly affected or impacted both the people's access to healthcare facilities (56.3%) and their access to healthcare service utilization (51.2%). Also, the study found that the most detrimental effects of the conflict were in terms of death (78.7%), injuries (74.5%), and obstructions to people's daily activities or operations (66%). In terms of the most effective or most common conflict resolution mechanisms that have been used in the conflict, they include the use of police and the military, followed by traditional councils and houses of chiefs. The study recommends that there must be concerted efforts by the central government and all stakeholders to address the conflict and find a long-lasting solution to the ethnic conflicts that have engulfed the Bawku traditional area. Also, political parties should limit their interference (meddling or snooping) and allow the traditional leaders in the Upper East Region, together with the National House of Chiefs’ free hand, to mediate and resolve the protracted Bawku conflict in Ghana.

BackgroundMaternal mortality remains a major challenge to health systems in low and middle-incoming countries. Some pregnant women develop potentially life-threatening complications during childbirth. Therefore, home delivery is a precursor for maternal mortality. In this study, we aimed at not only estimating the percentage of deliveries occurring at home and examining the factors associated with home delivery, but we also explored the reasons for home delivery among women in rural Ghana.MethodsThe study was conducted among mothers with delivery experience in selected communities in the Builsa South district located in the Upper East Region of Ghana. Both quantitative and qualitative data were collected using semi-structured questionnaires and Focus Group Discussion (FGD) guide respectively. A total of 456 mothers participated in this study. Regression models were used in the quantitative analysis whereas a thematic analysis approach was used to analyze the qualitative data.ResultsOf the 423 mothers in the quantitative research, 38.1% (95% CI: 33.5–42.8) delivered their index child at home. In adjusted analysis, women who were not exposed to information (AOR = 13.64, p<0.001) and women with 2 (AOR = 4.64, p = 0.014), 3 (AOR = 4.96, p = 0.025) or at least 4 living children (AOR = 9.59, p = 0.001) had higher odds of delivering at home. From the qualitative analysis, the poor attitude of nurses (midwives), lack of, and cost of transportation, cost of delivery kits, and traditional beliefs and practices were cited as reasons for home delivery.ConclusionDespite the government’s efforts to provide free maternal care services to women in Ghana, a significant proportion of rural women still deliver at home due to other ‘hidden costs’. Addressing poor staff attitude, transportation challenges, and negative traditional beliefs and practices through awareness creation may contribute to improving health facility delivery by rural pregnant women in Ghana.

Groundnut (Arachis hypogaea), an ancient oilseed crop is cultivated worldwide for its beneficial uses. It is one of the main cultivated crops in Northern Ghana. Pod borers (Elasmolomus sordidus) are the major biotic setbacks of groundnut production in the Upper East Region of Ghana, where it infests almost every farm in the region especially Tedema in the Builsa North District. The research hence assess the effects of the pod borer on the groundnut, and find measures to control it. There was a high positive correlation between days of exposer of the groundnut to Elasmolomus sordidus, and weight loss of the groundnut kernel with above 80% correlation coefficient and p < 0.05 for all analysis. The % pod infestation and weight loss ranged from 11.80% to 26.04% and 9.01% to 22.17%, respectively. The abundance of Elasmolomus sordidus on the field increase with time. The weight loss of groundnut kernel caused by Elamolomus sordidus also increases with time of exposer of the groundnut to Elasmolomus sordidus. Farm sanitation and immediate harvesting of the groundnut after the uprooting of the groundnut are control measures identified to offset the pod borer infestation. Platostoma africanum was also identified to repel Elasmolomus sordidus when placed within the groundnuts as it reduces the infestation of Elasmolomus sordidus on the groundnut. Further research strategies are recommended for the effect of pests on the oil content and germination properties of the groundnut.