Ghana Demographic And Health Survey Research Articles

Age at first sex and other determinants of multiple sexual partnerships among sexually active adolescent girls in Ghana: a regression analysis of the 2022 Ghana demographic and health survey

BackgroundEarly sexual debut is a widely recognized public health issue due to its influence on lifetime multiple sexual partners which can lead to complications such as teenage pregnancy, abortion, HIV/AIDS and other sexually transmitted infections. However, there is paucity of research evidence on sexual behaviour such as age at first sexual intercourse and the number of sexual partnerships among adolescent girls in Ghana. This study aims to examine the influence of age at first sexual intercourse and other determinants on multiple sexual partnerships among adolescent girls aged 15–19 years in Ghana.MethodsData for this study were obtained from the 2022 Ghana Demographic and Health Survey (GDHS) conducted between October 17, 2022 and January 14, 2023. A total weighted sample of 719 sexually active adolescent girls who reported having sexual partners was extracted from the women’s data file. Data were analyzed with SPSS version 27, employing multilevel logistics regression modelling. Statistical significance was set at p < 0.05.ResultsThe average age at sexual debut for adolescent girls aged 15–19 years in Ghana is 15.5 years. A little over half (51.6%) of adolescent girls reported having two or more lifetime sexual partners. Adolescent girls who initiated sex before reaching age 15 were more likely (aOR = 2.00; C.I 1.39–2.87) to have multiple partners compared to those who had their first sex before attaining age 20. After controlling for other factors, girls who had their sexual debut before age 15 had higher odds (aOR = 1.85; C.I:1.30–3.31) of engaging in multiple sexual partnerships. Girls living female headed households (aOR = 2.25; C.I:1.18–4.29] and consuming alcohol (aOR = 2.38; C.I 2.38–1.09–5.17) had higher odds of having multiple sexual partners.ConclusionThe study findings show that early sexual debut, living in female headed household, and consuming alcohol are strong predictors of multiple sexual partnerships among adolescent girls in Ghana. It suggests the need for policies promoting delayed sexual debut and empowering adolescents to make informed decisions to improve sexual health outcomes.

Factors associated with cervical cancer screening among women of reproductive age in Ghana

BackgroundCervical cancer remains a leading cause of cancer-related deaths among women in Ghana and other Sub-Sahara African (SSA) countries. Despite the importance of early diagnosis for timely treatment and death prevention, cervical cancer screening among women in developing countries remain very low. Nonetheless, there is a paucity of research examining the factors associated with screening uptake among women of reproductive age in Ghana. Thus, this study fills the scholarly void and contributes to the existing literature by examining the determinants of cervical cancer screening in Ghana.MethodsUtilizing data from the 2022 Ghana Demographic and Health Survey (GDHS) (N = 15,014 women), and by employing logistic regression models for a cross-sectional analysis, this study evaluated the factors associated with cervical cancer screening in Ghana.ResultsWomen with tertiary educational attainment (OR = 4.140; 95%CI: 2.960 5.789; p < 0.001), from the richer (OR = 1.968; p < 0.001) and richest households (OR = 2.492; p < 0.001), the married/living with partner (OR = 1.773; 95%CI:1.372 2.290; p < 0.001), the widowed/divorced/separated (OR = 1.888; 95%CI:1.320 2.701; p < 0.001), owners of valid health insurance card (OR = 1.356; 95%CI:1.086 1.693; p < 0.01), visitation to health facility in the past 12 months (OR = 1.312; 95%CI: 1.082 1.590; p < 0.001), those who watched television at least once in a week (OR = 1.395; 95%CI: 1.055 1.846; p < 0.001), as well as those who listened to radio at least once in a week (OR = 1.509; 95%CI: 1.228 1.853; p < 0.001), were all significantly more associated with cervical cancer screening in the study context. Also, ethnicity, religion, and the region of residence significantly predicted cervical cancer screening in the study context.ConclusionCervical cancer screening in Ghana can be improved by addressing socioeconomic and geographical disparities in the country’s healthcare system. To ensure early detection, timely treatment or care and prevention of cervical cancer-related deaths in the country, there must be coordinated efforts by the government of Ghana to improve healthcare access and surveillance systems for cervical cancer cases, particularly, in geographically disadvantage areas.

Determinants of men’s perspectives on women contraceptive use in Ghana: an analysis of the 2022 Ghana demographic and health survey

BackgroundMale dominance in reproductive health decision-making, specifically regarding family planning and contraceptive use among women, has been argued to have a significant influence on Africa’s fertility transition. However, there is a paucity of research evidence on the extent to which men influence contraceptive adoption and the factors shaping their perspectives on contraceptive use among women in Ghana. This study aims to examine the factors influencing men’s perspectives on women’s contraceptive use in Ghana.MethodsData for this study was obtained from the 2022 Ghana Demographic and Health Survey (GDHS) conducted between October 17, 2022 and January 14, 2023. A total weighted sample of 7,044 men aged 15–59 was extracted from the men’s data file. Data was analyzed with SPSS version 27, employing both descriptive and binary logistics regression modeling. Statistical significance was set at p < 0.05.ResultsThe results indicate that 63% of men disagreed with the opinion that contraception is solely a woman’s concern, while 59% agreed with the view that contraceptive use encourages promiscuity among women. With factors that significantly influence men’s opinion on contraception being solely a woman’s concern, men with secondary (aOR = 0.69; C.I: 0.57–0.82) and higher education, residing in urban areas, belonging to other Christian faiths, Ga/Dangme, Ewe, and Mole-Dagbani men were less likely to agree with such opinions. Conversely, men dwelling in the Coastal zones were more likely to agree with that view. Men exposure to FP messages on radio and during community durbars had higher odds of agreeing with that opinion. Regarding the factors influencing men’s perspective on the perception that contraceptive use by women encourages promiscuity, men who are 20–24 (aOR = 1.51; C.I:1.12–2.03) and 35–39 years in Coastal and Middle Belt zones, cohabiting and formerly married men were more likely to agree with such opinions. Conversely, men with higher educational levels, in urban areas and unemployed had lower odds to agreeing with such perception.ConclusionsThe study underscores the importance of men’s socio-demographic characteristics and their exposure to FP messages in shaping their perspectives on women’s contraceptive use. Policy implications highlight the need to involve men in promoting safe sexual and reproductive health practices.

Spatial distribution and factors associated with high completed fertility among women aged 40–49 years in Ghana: evidence from the 2022 Ghana Demographic Health Survey

BackgroundHigh completed fertility among married and cohabiting women has profound consequences, including straining resources, increasing healthcare challenges, and contributing to educational and gender inequalities. This study examined the factors associated with high completed fertility among married and cohabiting women aged 40–49 years in Ghana.MethodsData for the study was sourced from the 2022 Ghana Demographic and Health Survey (GDHS). A spatial map was used to present the women's geographic variations in high completed fertility. A mixed-effect multilevel binary logistic regression analysis was performed to identify the factors associated with high completed fertility. The findings were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI).ResultsThe national proportion of high completed fertility among married and cohabiting women aged 40–49 years in Ghana was 52.0% [48.8, 55.2]. Women who were Ga/Dangme/Ewe by tribe [aOR = 2.32, 95% CI = 1.06, 5.08] had higher odds of high completed fertility than Akans. Women who indicated 6 + as their ideal number of children had a higher [aOR = 5.60, 95% CI = 2.90, 10.82] likelihood of high completed fertility compared to those whose ideal number of children was 0–3. Those who were using contraceptives at the time of the survey had a higher [aOR = 2.31, 95% CI = 1.17, 4.55] likelihood of high completed fertility compared to those who were not using contraceptives. Women with secondary/higher education [aOR = 0.32, 95% CI = 0.17, 0.58] had lower odds of high completed fertility than those without no formal education. Women with females as household heads [aOR = 0.56, 95% CI = 0.33, 0.95] had lower odds of high completed fertility than males. Women in Volta, Western North, Ahafo, and Bono regions had lower odds of high completed fertility compared to those living in the Northeast region, with the lowest odds among those living in the Volta region [aOR = 0.08, 95% CI = 0.02, 0.40].ConclusionHigh completed fertility is prevalent in Ghana, with more than half of married and cohabiting women having at least five or more children. The government and policymakers in Ghana should promote education for women, increase culturally sensitive family planning programs, increase access to family planning resources, address ideal family size preferences, and improve understanding of contraceptive use.

Impact of Socioeconomic Factors and Health Insurance Coverage on Out-of-Pocket Health Expenditure among Ghanaian Women: Implications for Health Financing Policy

Background. The cost of health financing is an age-long social challenge in resource-constrained settings. Out-of-pocket (OOP) health spending adversely affects maternal healthcare provisions and use, making health insurance one of the most effective social interventions. Objective. The purpose of this research was to study the effect of OOP health expenditure on socioeconomic factors and health insurance coverage among Ghanaian women. Materials and Methods. Secondary statistical data pulled out from Ghana Demographic and Health Survey (GDHS)—2014 was investigated. A sample of 9,396 women whose ages ranged from 15 to 49 years was studied. We used marginal predictive model to examine the interaction effect between socioeconomic factors and health insurance coverage on OOP health expenditure. The significance level was determined at 5%. Results. Overall, about 41.9% (95% CI: 39.4%−44.4%) of Ghanaian women reported OOP health expenditure for drugs and services. Amongst those covered by health insurance, this was 37.9% (95% CI: 35.3%−44.4%). The marginal interaction effects of OOP health expenditure were higher for women in the lowest neighborhood socioeconomic disadvantage group (42.6%) than those in the highest neighborhood socioeconomic disadvantage group (26.0%) who were covered by health insurance. In addition, the marginal interaction effects of OOP health expenditure were found to be greater among women who had higher education (43.8%) compared with those who had no formal education (34.0%) who were covered by health insurance. Furthermore, the marginal interaction effects of OOP health expenditure were higher for rural (39.0%), than their urban counterpart (36.6.0%) who were under the covering of health insurance. Conclusion. There is a gap in health insurance coverage, which leads to increased OOP health expenditure. The OOP health expenditure effect was more concentrated among high socioeconomic women with health insurance. The healthcare system’s stakeholders should implement policies aimed at eliminating OOP health expenditure for maternal health services.

Unveiling Shadows: Investigating women's experience of intimate partner violence in Ghana through the lens of the 2022 Demographic and Health Survey.

Intimate partner violence (IPV) is a significant public health issue, predominantly among women in sub-Saharan Africa, including Ghana. Existing evidence indicates high rates of IPV perpetration and its associated adverse health outcomes. Despite previous studies, reliance on old data underscores the need for current, nationally representative data to inform policy-making and interventions. Therefore, this study utilizes the 2022 Ghana Demographic and Health Survey (GDHS) to examine IPV experiences and associated factors, aiming to provide updated insights for effective IPV mitigation strategies in Ghana. This is a cross-sectional study of a weighted sample of 3,741 women between the ages of 15-49 years old from the 2022 GDHS. Binary logistic regression analysis was used in predicting the outcome. The study found that 36.4 percent of women in Ghana had experienced some form of IPV, primarily emotional violence (31.5%), physical violence (17.3%), and sexual violence (7.6%). Women with higher levels of education had a significantly reduced risk of 60% of experiencing some form of IPV than those with no formal education. Partner domineering behaviours, such as women whose partners often get jealous for seeing them talk with other men [adjusted OR:1.76, 95%CI:1.25,2.48], accusing them of unfaithfulness [adjusted OR:2.59, 95%CI:1.03,2.46], not permitting them to meet female friends [adjusted OR:1.1.59, 95%CI:1.03,2.46], and limiting their contact with family [adjusted OR:5.75, 95%CI:2.27,13.42], were more likely to experience at least one form of IPV. Similarly, women who justified or endorsed wife beating had a higher likelihood [aOR = 1.57, 95%CI = 1.22,2.02] of experiencing at least one form of IPV than those who did not endorse such behaviour. Identifying educational attainment, partner dominance, and violence endorsement as IPV predictors underscore targeted interventions. Promoting women's education bolsters empowerment and IPV prevention. Addressing dominance through education, counselling, and legal frameworks is crucial for fostering safer relationships and challenging violence normalization.

Examining the relationships between contraception and fertility rate in Ghana: Evidence from the 1988 to 2014 Ghana Demographic and Health Surveys

Background: There have been some discrepancies between Contraceptive Prevalence Rate (CPR) and Total Fertility Rate (TFR) in Ghana over the years which we examined in this study. Methods: We adopted a repeated cross-sectional study design to examine the relationship between Ghana's CPR and TFR using data from 1988 to 2014 Ghana Demographic and Health Surveys (GDHS). Results: Our findings show that TFR declined from 6.4 to 4.2 births per woman between 1988 and 2014. Bivariate models fitted revealed that between 1988 and 2014, women using contraceptives had higher prospects of bearing more children than women not using contraceptives. This manifested in 1988 (IRR=1.16, 95% CI=1.11, 1.22) and 2014 (IRR=1.20, 95% CI=1.12, 1.29). The multivariable Poisson regression models also showed the same patterns in all the surveys including the 1988 GDHS (IRR=1.12, 95% CI=1.09,1.19) and 2014 (1RR=1.13,95% CI=1.09,1.17). Contrary to earlier studies reports, and common perceptions held by stakeholders in family planning that there is an inverse relationship between CPR and TFR in Ghana, we did not find any such inverse relationship between CPR and TFR in Ghana during the period under review. Conclusions: Based on our findings we believe, contraception alone does not guarantee low fertility in Ghana, hence we recommend a qualitative study to further investigate the plausible factors behind our results/observations from this current study to inform policy and program decisions.

Predictors of Not Exclusively Breastfeeding Among Ghanaian Women: A CrossSectional Study

Background: Exclusive breastfeeding (EBF) is a practice highly recommended by WHO and UNICEF for all infants to be given solely breastmilk in the first six months. This practice is advised because breastmilk is the gold standard of infant feeding as it is untainted and comprises all of the essential nutrients for the first few months of a child’s life. The objective of this study is to focus on the factors that prevent mothers from not exclusively breastfeeding among Ghanaian women residents in rural and urban geographic locations. Methods: Data was acquired from the 2014 Ghana Demographic and Health Survey (GDHS) for this analysis. A total of 557 mothers who had infants in the last 2 years between the ages of 0 – 5 months were extracted from the individual child (KR) dataset. A Logistic regression model was utilized to ascertain the predictors of not exclusively breastfeeding among Ghanaian women. Results: Overall, mothers engaged in exclusive breastfeeding was 52%. Ethnicity, infant size, region, marital status, mother’s age, and husband’s occupation have a significant association with breastfeeding status [Table 1]. The binary logistic regression revealed that timing of first antennal visits, maternal education, region, ethnicity, and husband’s occupation were significantly associated with predictors of EBF. Mothers without formal education and mothers whose husbands/partners' occupation was skilled manual labor were more likely to not breastfeed exclusively. Mothers residing in the northern part of Ghana, mothers of a minority ethnic group, and the timing of first antennal visits had lower odds of not exclusively breastfeeding. Conclusion: The findings suggest that breastfeeding in Ghana is a universal practice since more than 98% of infants were birthed in the last 2 years before at some point. Despite the existence of breastfeeding campaigns and the high awareness created, EBF rates continue to decline in the nation. It is, therefore, crucial to develop and implement EBF intervention programs that aim at eliminating misconceptions and misinformation about the practice with more emphasis on the health and economic benefits of EBF.

Evidences of Widespread Hunger in Gbeo Community, North East Region, Ghana; the Determinants of Malnutrition and Susceptibility to Extreme Hunger

Background: The global community aspires towards zero hunger and minimized prevalence of various metrics of malnutrition by 2030 and beyond. Despite mainstream routine nutrition/food surveillance interventions carried out by provincial, national and civil society bodies, the markers of global hunger are rife. This study sought to investigate with the aid of household food insecurity experience scale (HFIES) and nutrition indices, the evidence of hunger, child malnutrition and other forms of extreme household deprivation in Gbeo; a rural hard-to-reach community in the Mamprugu East Municipality, North East Region. Methods: This study was a case analysis of Gbeo community using cross-sectional modalities. Mother – child dyads from 235 systematically selected households were recruited for one-on-one interviews including anthropometric/dietary assessments. Data were obtained on household hunger (using HFIES as proxy), child (6 – 59 months) malnutrition and their potential predictors (SE characteristics, IYCF, WASH, etc.). Child anthropometric growth indices were computed in accordance with WHO (2017) revised standard protocols. Findings: Out of 235 children 34.4% were stunted, 18.8% underweight and 37.9% wasted; these are elevated above Ghana Demographic and Health Survey (GDHS) data for Northern Region, Ghana as a whole and WHO/UNICEF/World Bank (2021) latest global estimates. Four (1.8%) children had all growth failure and in 5.6% of cases, underweight co-occur with stunting and wasting. The proportion of HHs in the 3rd tertile [T3], 2nd tertile [T2] and 1st tertile [T1] of food insecurity were 33%, 29% and 38% respectively. Multiple logistic regression models showed that mean HFIES scores were higher among households that; has a female food-based decision maker [t (degrees of freedom=1, n=235) = 1.93, significance level p =.000], have not received any form of remittances within the past 12 months [t (1, 235) = 2.65, p = .016], source their food stuffs from predominantly purchasing [t (1, 235) = 2.65, p = .009] and has a caregiver or household head that is an alcoholic [t (1, 235) = 4.01, p = .000]. Conclusion: Food insecurity predicts acute child malnutrition. Social protection and economic empowerment interventions should be integrated with nutrition-based initiatives for holistic household improvement.

Maternal health care policy intervention and its impact on perinatal mortality outcomes in Ghana: evidence from a quasi-experimental design

ObjectiveThis study aimed to evaluate the impact of Ghana's free maternal health care policy on stillbirth and perinatal death since its implementation a decade ago. Study designThe study used the propensity score matching method, a quasi-experimental design technique and secondary data to construct two groups of mothers with a history of perinatal deaths who subscribed to the ‘free’ maternal health care policy versus mothers who did not. MethodThe study merged two rounds of repeated cross-sectional data sets obtained from the Ghana Demographic and Health Survey (GDHS), 2008 and 2014, and generated exposure variables; pregnant women policy holding status and outcome variables; stillbirth and perinatal death by constructing binary outcomes from the under-five mortality variables of the DHS data sets. Fetal and early neonatal deaths within the data set were categorized into two groups: those exposed to the free maternal health care policy and those who did not. The propensity scores of the two groups were then generated and analyzed after checking for bias and common support. The analysis applied sample weighting to account for clustering and stratification due to the complex design of the DHS. All analyses were done with STATA 15 and adjusted for confounding using independent covariates. ResultsStillbirth (43.3%) and perinatal death (60.2%) were high in the intervention group compared to the comparison group, and the differences were statistically significant (stillbirth, 0.0156, and perinatal death, 0.0012). Stillbirth and perinatal deaths were 12 and 13 percentage points higher in the intervention group, and these were statistically significant: adj. coef. = 0.12; 95% CI: [0.03–0.19]; P = 0.005 and adj. coef. = 0.13; 95% CI: [0.03–0.22]; P = 0.005. ConclusionThe results show that stillbirth and perinatal death were high in the maternal health care policy group, poorly reflecting as outcomes. However, the percentage point difference between stillbirth and perinatal death suggests a decline in early neonatal mortality and a positive impact of the ‘free’ maternal health care policy on perinatal death over stillbirth.

Examining the risk factors for overweight and obesity among women in Ghana: A multilevel perspective

Overweight/obesity prevalence is on the increase in epidemic proportions across Low- and Middle-Income countries (LMICs). The public health burden associated with obesity/overweight cannot be underestimated due to its association with chronic health outcomes. This study investigated the individual- and community level risk factors for obesity/overweight among reproductive women. The data used consist of 4393 reproductive women and form part of the 2014 Ghana Demographic and Health Survey (GDHS). Information on these women are clustered within 427 communities. A 2-tier random intercept multilevel logistic model was used to assess the effect of individual- and community level factors on the likelihood of a woman to be obese/overweight. The obesity/overweight prevalence among reproductive women was estimated to be 35.5% (95% CI: 34.04, 36.90%), which significantly differed across clusters. Most at risk were women from middle-income households (aOR = 2.85; 95% CI: 2.28, 3.56), upper-income households (aOR = 5.019, 95% CI: 3.85, 6.55), attaining secondary education (aOR = 1.74; 95% CI: 1.41, 2.16), and higher (aOR = 1.63; 95% CI: 1.14, 2.33), old age (20–29 years (aOR = 4.26; 95% CI: 3.142,5.78); 30–39 years (aOR = 8.59; 95% CI: 6.15, 12.00); 40–49 years (aOR = 12.81; 95% CI: 9.10, 18.16)). Significant differences in the probability of being overweight/obese between different communities were observed (MOR = 1.39). The high prevalence of overweight/obesity requires urgent public health interventions to prevent future public health crises. Efforts to strengthen the healthcare system, encourage lifestyle modification, and public health education are needed to solidify the gains of ensuring a healthy population by 2030 (SDG 3).

Socio-demographic correlates and trends in the timing of the onset of parenthood among women of reproductive age in Ghana: evidence from three waves of the demographic and health surveys.

Childbearing is one of the central events in a woman's life and the age at which this event occurs has important health, socioeconomic and fertility implications for her. Methods: We used three waves of the Ghana Demographic and Health Surveys (GDHS) from the individual files of married women aged 15 to 49 years old to explore the trends in the timing of the onset of parenthood among women in Ghana. The Cox proportional hazard model was used to assess the effect of socio-demographic factors on the birth experience of women. Results: Results showed the median age of the women increases from 17 years in 1998 to 19 years in 2014. Further, results showed that women with secondary education had 0.67, 0.89- and 0.77-times lower hazard risk of early birth than women without any formal education in 1988, 1998, and 2014 respectively. The hazard risk of early childbirth consistently decreased as age increased in all the years of surveys except in the case of the age group 40-44 in 1988, 1998 and 2014. Conclusions: This study showed that the timing of first childbirth is changing in the direction of a late childbirth regime in Ghana and could facilitate improvement on individual health, job stability and higher level of education. Efforts should be channeled to sensitizing women on the importance of delaying childbearing.

Community characteristics and the risk of non-communicable diseases in Ghana.

Non-communicable Diseases (NCDs) are rising quickly in low- and middle- income countries. In Ghana, chronic diseases are major causes of morbidity and mortality, yet data and the evidence- base for awareness, detection, and management of NCDs are lacking. Using data from the 2014 Ghana Demographic and Health Survey (GDHS), the first national study with information on hypertension and other risk factors, we examine the correlates and community characteristics associated with the risk of hypertension, obesity, and anemia among women. We find that hypertension prevalence in Ghana was 16 percent and 17 percent were overweight/obese, while 41 percent had anemia of any form. On community characteristics, the level of poverty in a community was significantly associated with lower risks of all three NCDs, while the aggregate level of employment had higher risks. On individual characteristics, the wealth of a household, women's educational level and urban residence were significant predictors of NCDs. We interpret the findings within the literature on neighborhood characteristics, the social gradient of health and in the context of speeding up the attainment of the Sustainable Development Goals (SGDS) to reduce premature deaths by one-third by 2030.

Multiple sexual partnership among adolescent boys and young men in Ghana: analysis of the 2003–2014 Ghana Demographic and Health Survey

BackgroundMultiple sexual partnership (MSP) is a major cause of HIV/AIDS epidemic and unplanned pregnancies in sub-Saharan Africa. We investigate how individual, household, interpersonal, community and structural factors correlate with multiple sexual partnership of adolescent boys and young men in Ghana.MethodsWe pooled secondary data from the 2003, 2008 and 2014 Ghana Demographic and Health Surveys (GDHS). Analytic sample of 1422 males aged 15–24 years who are sexually active and never married were used for the study. The outcome variable for the study was two or more sexual partners in the last 12 months preceding the survey. Five models were fitted using multilevel mixed effects logistic regression to identify predictors of multiple sexual partners. Results were presented using adjusted odds ratios (ORadj) with its corresponding 95% confidence interval.ResultsThe pooled data prevalence of multiple sexual partnership was 28.1%, with 18.7%, 30.0% and 33.3% of adolescent boys and young men involved in multiple sexual partnerships in 2003, 2008 and 2014, respectively. Results of the study showed that young men aged 20–24 years [ORadj = 1.39, 95% CI = 1.01–1.91], being from household with richest wealth index [ORadj = 1.76, 95% CI = 1.01–3.06] and those with secondary/higher education [ORadj = 2.94, 95% CI = 1.44–6.06] were more likely to have multiple sexual partners. On the other hand, those who delayed their first sex [ORadj = 0.45, 95% CI = 0.29–0.70] and those currently using modern contraceptive methods [ORadj = 0.37, 95% CI = 0.28–0.50] were less likely to have multiple sexual partners.ConclusionThe findings provide support for the social ecological argument that sexual health behaviours are influenced by individual, interpersonal, community and contextual characteristics. Future policies and interventions seeking to address the increasing prevalence of multiple sexual partnerships among adolescent boys and young men should take into consideration family planning programmes and sexual education in affluent communities, secondary and higher institutions.

Inequalities in the prevalence of skilled birth attendance in Ghana between 1993 and 2014.

Globally, maternal and neonatal health remains a public health priority, particularly for resource-constrained regions like sub-Saharan Africa (SSA). Skilled birth attendance (SBA) is essential in promoting maternal and neonatal health. This study investigated the inequalities in the prevalence of SBA in Ghana using data from the Ghana Demographic and Health Survey (GDHS) between 1993 and 2014. Data were analysed using the World Health Organization's Health Equity Assessment Toolkit software. In analysing the data, we first disaggregated SBA by four inequality stratifiers: wealth index, education, residence, and region. Second, we measured the inequality through summary measures, namely difference, population attributable risk, ratio, and population attributable fraction. A 95% confidence interval was constructed for point estimates to measure statistical significance. Throughout the period, SBA was highest among women in the highest wealth quintile and those with a secondary or higher level of education. The analysis also indicated that SBA was highly concentrated among urban residents in 1993 (80.78 [95% uncertainty interval {UI} 76.20-84.66]) and persisted to 2014 (91.55 [95% UI 88.80-93.68]). In 1993, Northern region recorded the lowest prevalence of SBA in Ghana (15.69 [95% UI 11.20-21.54]) and the region consistently recorded the lowest SBA prevalence even into 2014 (38.21 [95% UI 27.44-50.27]). There are significant inequalities in SBA across education, wealth, residence, and region in Ghana. To enhance SBA, there is the need for policymakers and interventionists to design and develop targeted policies and programs that are tailored to the needs of the subpopulations at risk of low SBA: women with no formal education, those within the poorest wealth quintile, rural-dwelling women and women in the Northern region. This will facilitate the uptake of SBA and ultimately translate into the realization of Sustainable Development Goals 3.1 and 3.2.

Does NHIS Enrollment Increase Maternal Healthcare Utilization? Evidence from the Ghana Demographic and Health Survey (GDHS)

Purpose: This research aims to examine the effects of Ghana’s National Health Insurance Scheme (NHIS) on maternal healthcare utilization.&#x0D; Originality: The most of the previous studies examined the association between health insurance enrollment and the use of maternal healthcare service. However, our paper investigated the causal relationship of the NHIS enrollment and maternal healthcare utilization based on the latest available dataset of 2014 Ghana Demographic and Health Survey (GDHS), using the Propensity Score Matching (PSM). Another difference between our analysis and previous papers is that control variables were selected from a theory-based framework.&#x0D; Methodology: To address selection bias and move towards more causal estimates, PSM was conducted for analysis.&#x0D; Result: The NHIS increased 9.5% points of access to at least four antenatal care visits. It also led to the positive effects on facility-based delivery after at least four antenatal care visits, which increased by 11% points. Lastly, women enrolled in the NHIS were significantly 13.4% points more likely to have the first prenatal check in a trimester.&#x0D; Conclusions and Implication: Our results imply that broadening access to the NHIS offering coverage of maternal healthcare is needed to encourage women to use maternal healthcare, at the level of minimum recommended standards. On the other hand, since the endogeneity problem is still an issue despite using PSM, the overestimation of the results in our study needs to be considered.

Health Insurance Coverage, Socioeconomic Status of Women, and Antenatal Care Utilization in Ghana

Promoting antenatal care (ANC) utilization is one of the key drivers of the Safe Motherhood Initiative aimed at improving maternal health in low-income countries. The study sought to examine the effects of health insurance coverage and socioeconomic status of women on antenatal care utilization in Ghana. The study used cross-sectional data from the 2014 Ghana Demographic and Health Survey (GDHS). Negative binomial and binary logistic regression models were applied. The results showed that women covered with national health insurance were more likely to have more antenatal care visits and adequate and timely antenatal care. The results showed that having an advanced age, attaining secondary or higher-level education, being employed, being in the richest wealth quintile, and having an active national health insurance subscription during pregnancy significantly predicted ANC utilization. The study suggests that if interventions aimed at reducing the burden of prenatal care are not implemented, coupled with women’s economic empowerment to cater to the cost of prenatal care, the benefits of the ANC associated with early and adequate ANC services may not optimally be achieved. That aside, ANC services in Ghana are technically ‘free’ through the user-fee exemption policy under the NHIS. However, socioeconomic factors still largely determine women’s decisions to utilize maternal health services.

Spatio-temporal variations in neonatal mortality rates in Ghana: An application of hierarchical Bayesian methods.

Ghana might not meet the SDGs target 3.2 of reducing neonatal mortality to 12 deaths per 1000 live births by 2030. Identifying core determinants of neonatal deaths provide policy guidelines and a framework aimed at mitigating the effect of neonatal deaths. Most studies have identified household and individual-level factors that contribute to neonatal mortality. However, there are relatively few studies that have rigorously assessed geospatial covariates and spatiotemporal variations of neonatal deaths in Ghana. This study focuses on modeling and mapping of spatiotemporal variations in the risk of neonatal mortality in Ghana using Bayesian Hierarchical Spatiotemporal models. This study used data from the Ghana Demographic and Health Surveys (GDHS) conducted in 1993, 1998, 2003, 2008, and 2014. We employed Bayesian Hierarchical Spatiotemporal regression models to identify geospatial correlates and spatiotemporal variations in the risk of neonatal mortality. The estimated weighted crude neonatal mortality rate for the period under consideration was 33.2 neonatal deaths per 1000 live births. The results obtained from Moran's I statistics and CAR model showed the existence of spatial clustering of neonatal mortality. The map of smooth relative risk identified Ashanti region as the most consistent hot-spot region for the entire period under consideration. Small body size babies contributed significantly to an increased risk of neonatal mortality at the regional level [Posterior Mean: 0.003 (95% CrI: 0.00,0.01)]. Hot spot GDHS clusters exhibiting high risk of neonatal mortality were identified by LISA cluster map. Rural residents, small body size babies, parity, and aridity contributed significantly to a higher risk of neonatal mortality at the GDHS cluster level. The findings provide actionable and insightful information to prioritize and distribute the scarce health resources equitably to tackle the menace of neonatal mortality. The regions and GDHS clusters with excess risk of neonatal mortality should receive optimum attention and interventions to reduce the neonatal mortality rate.

Factors associated with comorbidity of diarrhoea and acute respiratory infections among children under five years in Ghana.

IntroductionGlobally, childhood mortality is an important public health concern. In Ghana, both diarrhoea and acute respiratory infections (ARIs) are among the top five causes of morbidity and mortality among children under five years old (CU5). Yet, there is a paucity of studies on the comorbidity of diarrhoea and ARIs in CU5 in Ghana.AimThis study sought to examine factors associated with comorbidity of diarrhoea and ARIs among CU5 in Ghana.MethodsThe Ghana Demographic and Health Survey (GDHS) 2014 was used for this study. A total of 932 CU5 who had at least one morbidity were included in the study. Binary logistic regression was used to predict the factors associated with comorbidity among CU5.ResultsThe prevalence of comorbidity of diarrhoea and ARI among CU5 was 11%. Factors including unimproved source of water, unimproved main floor material, age of child, and initiation of breastmilk were significantly associated with comorbidity of diarrhea and ARI. Improved source of water (AOR = 0.42; 95% CI = 0.22–0.78; p = 0.01) reduces the likelihood of having comorbidity than unimproved source of water. Children aged 36–47 months were less likely (AOR = 0.36; 95% CI = 0.14–0.93; p = 0.04) to have comorbidity than those aged 48–59 months. Also, improved floor materials (AOR = 0.45; 95% CI = 0.22–0.95; p = 0.03) reduces the likelihood of having comorbidity than unimproved floor materials. Children breastfed within the first day of birth were more likely (AOR = 1.66; 95% CI = 1.01–0.2.72; p = 0.04) to have comorbidity than those breastfed immediately after birth.ConclusionPolicymakers and health practitioners should consider risk factors such as age of child, initiation of breastfeeding, unimproved floor material, and unimproved water supply in the design of interventions to reduce morbidity and mortality associated with comorbidity of diarrhoea and ARI among CU5.

Prevalence and Associated Factors of Hypertension among Women in Southern Ghana: Evidence from 2014 GDHS.

Background Hypertension, coupled with prehypertension and other hazards such as high blood pressure, is responsible for 8·5 million deaths from stroke, ischaemic heart disease, other vascular diseases, and renal disease worldwide. Hypertension is the fifth commonest cause of outpatient morbidity in Ghana. Some evidence have illustrated geographical variation in hypertension and it seems to have a heavy toll on women in southern Ghana compared to the north. This study seeks to determine the prevalence and associatedfactors of hypertension among women in southern Ghana using the most recent demographic and health survey (DHS) data set. Materials and Methods This study used data of 5,662 women from the current DHS data from Ghana that was conducted in 2014. Data were extracted from the women's file of the 2014 Ghana DHS. The outcome variable of this current study was hypertension and it was measured by blood pressure, according to guidelines of the Joint National Committee Seven (JNC7). Multivariable binary logistic regression analyses were performed to establish the factors associated with hypertension at the individual and community levels. Results Prevalence of hypertension among women in southern Ghana was 16%. Women aged 40–44 years (aOR = 8.04, CI = 4.88–13.25) and 45–49 years (aOR = 13.20, CI = 7.96–21.89] had the highest odds of hypertension relative to women aged 15–19 years. Women with two births (aOR = 1.45, CI = 1.01–2.07) and those with three births (aOR = 1.47, CI = 1.01–2.15) had a higher likelihood of being hypertensive. Greater Accra women had higher odds (aOR = 1.35, CI = 1.02–1.79) of being hypertensive relative to the reference category, women from the Western region. Women of Guan ethnicity had a lesser likelihood (aOR = 0.54, CI = 0.29–0.98) of being hypertensive. Women who engaged in agriculture had the least likelihood (aOR = 0.72, CI = 0.52–0.99) of being classified hypertensive compared to unemployed women. Conclusion This study has revealed the prevalence of hypertension among women in southern Ghana. The associated factors include age, parity, region, and occupation. As a result, existing interventions need to be appraised in the light of these factors. Of essence is the need for Ghana Health Service to implement wide-embracing health promotion initiatives that accommodate the nutritional, exercise, and lifestyle needs of women in southern Ghana. Having more children is associated with higher propensity of hypertension and consequently, women need to limit childbearing to reduce their chances of being hypertensive. It will also be advisable for women in the Greater Accra region to have frequent hypertension screening, as women in the region exhibited higher hypertension prospects.