Ghana Demographic And Health Survey Research Articles

Inequalities in the prevalence of full immunization coverage among one-year-olds in Ghana, 1993–2014

BackgroundWe examined the inequalities in the prevalence of full immunization coverage among one-year-olds in Ghana using nationally representative data from the 1993-2014 Ghana Demographic and Health Surveys (GDHSs). MethodsUsing the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the 1993–2014 GDHSs were analyzed. We disaggregated full immunization by five equity stratifiers: wealth quintile, education, sex, residence, and region. Second, we measured the inequality through summary measures, namely Difference, Population Attributable Risk, Ratio, and Population Attributable Fraction. Statistical significance was pegged at 95% Uncertainty Interval. ResultsFrom 1993 to 2014, full immunization was higher among children born to mothers of the richest wealth index compared with those born to mothers of the poorest wealth index. Children with highly educated mothers dominated in full immunization coverage from 1993 (86.67%; UI = 70.38, 94.68] to 2014 (79.90%; UI = 73.94, 84.78). Within the same period, children of women without education recorded the least prevalence. Full immunization coverage was high among urban children in 1993 (71.07%; UI = 63.20, 77.84) but favoured rural children in 2008 (80.09%; UI = 74.30, 84.84) and 2014 (79.50%; UI = 74.00, 84.09) compared to urban children. More females were fully immunized in 1993 (56.68%; UI = 50.32, 62.82). In 2003, 2008 and 2014, Volta region (82.29%; UI = 70.32, 90.11), Brong Ahafo (93.94%; UI = 82.00, 98.14) and Upper East (95.27%; UI = 87.35, 98.32) regions dominated in full immunization coverage respectively. ConclusionThe inequality estimates revealed significant socio-economic inequality in full immunization coverage between 1993 and 2014 in Ghana. Similarly, urban children and children of women with secondary or higher education were predominantly fully immunized. To accelerate full immunization, policy makers should consider these disparities in the implementation of policies on childhood immunization in Ghana.

Is Infant birth weight and mothers perceived birth size associated with the practice of exclusive breastfeeding in Ghana?

IntroductionDespite widespread advocacy for exclusive breastfeeding, and the associated benefits of exclusive breastfeeding for both infants and mothers, there is low prevalence in both developed and developing countries. Additionally, although several studies have been conducted on exclusive breastfeeding, very few of such studies have linked birth weight and birth size to exclusive breastfeeding. This study seeks to examine the influence of birth weight and birth size on exclusive breastfeeding.MethodologyThis study adopted a sequential explanatory mixed method approach using both quantitative and qualitative methods. The quantitative approach used cross-sectional data from the 2014 Ghana Demographic and Health Survey (GDHS) and the qualitative data from interviews with exclusive breastfeeding mothers from two health facilities in La Nkwantanang Municipal Assembly in Accra, Ghana. Logistic regression analysis was used to examine whether infants birth weight and mothers perceived birth size are associated with the practice of exclusive breastfeeding while the qualitative data provided further insights into the findings from the quantitative analysis.ResultsMajority (85%) of the infants in the study were of normal birth weight while 52% of the infants were perceived by their mothers to be of small birth size. The prevalence of exclusive breastfeeding was found to be 54.8%. The birth weight of infants and mothers’ perceived birth size were found to be significant predictors of exclusive breastfeeding. Infants of normal birth weight (OR = 7.532; 95% CI: 2.171–26.132) and high birth weight (OR = 6.654; 95% CI: 1.477–29.978) were more likely to be exclusively breastfed compared to low-birth-weight infants. Similarly, infants perceived to be of normal birth size were more likely (OR = 1.908; 95% CI: 1.058–3.441) to be exclusively breastfed compared to infants perceived to be of small birth size. The findings from the qualitative analysis show that birth weight rather than birth size influence mothers’ decision to practice exclusive breastfeeding.ConclusionThe findings of the study underscore the relevance of infant birth weight and perceived birth size in the practice of exclusive breastfeeding and highlights the need to incorporate both actual measurement of birth weight, and perception of infant’s birth size into policies targeted at exclusive breastfeeding. There is the need for deliberate targeted efforts at women who deliver infants of low birth weight and women who perceive their children to be of small birth size to practice exclusive breastfeeding.

Association between mass media exposure and endorsement of HIV-infected female teachers' teaching: insight from 2014 Ghana Demographic and Health Survey

IntroductionGhana recorded 19,931 new annual HIV infections in 2018 translating to 14,181 AIDS-related deaths. Mass media is capable of ensuring the sustainability of initiatives aimed at curbing HIV/AIDS epidemic by reducing HIV/AIDS stigma and discrimination. The study aimed at exploring if mass media plays a role in whether HIV-infected female teachers should be allowed to teach in Ghana.Materials and methodsThe study used women’s file of the 2014 Ghana Demographic and Health Survey (GDHS). The current study was restricted to 6025 women who had complete information on the variables analysed. Binary Logistic regression was conducted between mass media and the dependent variable whilst controlling for the effect of the significant covariates. The results were presented in odds ratio (OR) and adjusted odds ratio (AOR) at 95% confidence interval (CI). All analyses were carried out using STATA version 14.0.ResultsGenerally, 51% of the women mentioned that HIV-infected female teachers should be allowed to teach in Ghana. Women who accessed mass media had higher odds of endorsing that HIV-infected female teachersshould be allowed to teach compared to those without access to mass media [AOR = 1.37, CI 1.200–1.555], just as among those with secondary or higher education compared to those with no formal education [AOR = 1.30, CI 1.102–1.529]. Rural inhabitants had decreased odds of proclaiming that HIV-infected female teachers should be allowed to continue teaching compared with urban residents [AOR = 0.83, CI 0.717–0.957].ConclusionsEndorsement of HIV-positive female teachers’ continued teaching was associated with access to mass media. This is suggestive that various mass media platforms could help to reach the public with HIV/AIDS-related information, particularly those that touch on stigma and discrimination, which will potentially increase women’s knowledge and shape their perceptions about persons living with HIV.

Fertility among women in Ghana: Do child mortality and education matter?

BackgroundChild mortality and fertility are crucial in determining the growth of a country's population and have implications for public health and family planning interventions. An understanding of the effect of child mortality and education on fertility would be relevant to direct policies towards fertility reduction in Ghana. ObjectiveThe study examined the effect of child mortality and education on fertility in Ghana. MethodThe study used data from the 2014 Ghana Demographic and Health Survey (GDHS), using a sample of 4938 women who have ever given birth to at least one or more children. An instrumental variable Poisson generalized method of moments estimator was used in estimating the model. This helped in dealing with the eminent endogeneity among our key variables of interest. ResultsThe results show that the experience of child mortality contributes to the high fertility rate in Ghana, while education leads to a reduction in fertility. The results suggest that women who have experienced the death of a child or live in a cluster with high mortality ratio tend to have higher fertility in line with the replacement effect, whereas women facing a high risk of child mortality are inclined to high fertility through the hoarding effect. The results further show that women with higher average years of education have a lower fertility rate. Additionally, the negative interactive terms suggest that the effect of child mortality on fertility depends on the woman's education. Women with a higher level of education, have lower fertility even in an environment marked with high child mortality. ConclusionThe results affirm that a high rate of child mortality increases fertility in Ghana through both the replacement and hoarding effects. Besides, the education of the woman leads to fertility reduction. Our findings imply that while efforts are made to reduce fertility in Ghana, policy should emphasize public education on the adverse consequences of higher fertility while prioritizing measures aimed at reducing child mortality or the risk of child mortality in Ghana. Besides, increasing access to education for women will also contribute to the reduction in fertility in Ghana. The focus of such education should complement and consolidate already existing efforts that aim to reduce child mortality such as the Sustainable Development Goals.

Inequalities in prevalence of birth by caesarean section in Ghana from 1998-2014

BackgroundCaesarean section (CS) is an intervention to reduce maternal and perinatal mortality, for complicated pregnancy and labour. We analysed trends in the prevalence of birth by CS in Ghana from 1998 to 2014.MethodsUsing the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the 1998-2014 Ghana Demographic and Health Surveys (GDHS) were analysed with respect of inequality in birth by CS. First, we disaggregated birth by CS by four equity stratifiers: wealth index, education, residence, and region. Second, we measured inequality through simple unweighted measures (Difference (D) and Ratio (R)) and complex weighted measures (Population Attributable Risk (PAR) and Population Attributable Fraction (PAF)). A 95% confidence interval was constructed for point estimates to measure statistical significance.ResultsThe proportion of women who underwent CS increased significantly between 1998 (4.0%) and 2014 (12.8%). Throughout the 16-year period, the proportion of women who gave birth by CS was positively skewed towards women in the highest wealth quintile (i.e poorest vs richest: 1.5% vs 13.0% in 1998 and 4.0% vs 27.9% in 2014), those with secondary education (no education vs secondary education: 1.8% vs 6.5% in 1998 and 5.7% vs 17.2% in 2014) and women in urban areas (rural vs urban 2.5% vs 8.5% in 1998 and 7.9% vs 18.8% in 2014). These disparities were evident in both complex weighted measures of inequality (PAF, PAR) and simple unweighted measures (D and R), although some uneven trends were observed. There were also regional disparities in birth by CS to the advantage of women in the Greater Accra Region over the years (PAR 7.72; 95% CI 5.86 to 9.58 in 1998 and PAR 10.07; 95% CI 8.87 to 11.27 in 2014).ConclusionGhana experienced disparities in the prevalence of births by CS, which increased over time between 1998 and 2014. Our findings indicate that more work needs to be done to ensure that all subpopulations that need medically necessary CS are given access to maternity care to reduce maternal and perinatal deaths. Nevertheless, given the potential complications with CS, we advocate that the intervention is only undertaken when medically indicated.

Distribution of wealth quintiles and risk factors of non-communicable diseases in Ghana: evidence from the Ghana demographic and health survey 2014 using concentration curves model.

Introductionin recent times, the assertion of non-communicable diseases afflicting the rich has been demystified but cuts across the rich and the poor. Individuals in all categories of wealth quintiles are affected by the risk factors of non-communicable diseases such as alcohol consumption, tobacco use, unhealthy dietary practices and physical inactivity. However, information on the distribution of these risk factors across different socio-economic status is scanty. This study assessed the distribution of wealth quintiles and the risk factors of non-communicable diseases, using the concentration curve model.Methodsit was a quantitative study with analytical design using the Ghana Demographic and Health Survey (GDHS), 2014 data. The variables of interest were income status of respondents and risk factors of non-communicable diseases. In the analysis, income levels were categorized into wealth quintiles with assigned percentages (25%, 50%, 75% and 100%) denoting poor, rich, richer and richest respectively. The risk factors of non-communicable diseases were also categorized and assigned percentages (relatively exposed 25%, exposed 50%, more exposed 75% and most exposed 100%). A concentration table was employed to assess the risk factors of non-communicable diseases labelled X-axis and wealth quintiles labelled Y-axis. The cumulative percentage of the wealth quintiles (Y-axis) were plotted against the cumulative percentage of the risk factors of non-communicable diseases on the X-axis.Resultsthe study found moderate concentration of alcohol consumption among the middle to upper wealth quintiles (richest). Again, the study revealed that, wealth quintiles are practically indifferent to tobacco use and that both the rich and poor equally and minimally use tobacco as the concentration curve is very close to the perfect line of equality (45°). This study found near equal distribution of unhealthy dietary practices among the rich and poor in Ghana. It was found that, 40% - 80% of rich people were physically inactive with the application of a physical activity level of 100%. It was noticed that, 40% of the rich people only performed 20% of physical activities.Conclusionthe study concludes that; wealth quintiles have implications for the risk factors of non-communicable diseases.

Subnational variations in electricity access and infant mortality: Evidence from Ghana

ObjectivesThe study investigated the relationship between electricity access and infant mortality at the subnational level in Ghana, controlling for correlates such as birth interval, children living with both parents, women’s education, and income distribution. MethodsThe study employed a pooled cross-section regression approach using data from the Ghana Demographic and Health Survey (GDHS) for 10 administrative regions from 1993 to 2014. The GDHS is a detailed data set that provides comprehensive information on households and their socio-economic and demographic characteristics in Ghana. ResultsThe results show that in regions with low incidence of infant mortality, a 10% improvement in electricity access reduces infant death by 11.8 per 1,000 live births, whereas in high mortality regions, improvement in electricity access has no impact on infant death. Birth interval reduces the risk of infant death in low mortality regions but not in high mortality regions. Children living with both parents have a high probability of survivorship in high mortality regions. Women’s median years of education lowers the likelihood of infant death in high mortality regions but increases the likelihood in low mortality regions. Wealth distribution is inconsequential for infant death in low mortality regions, but in high mortality regions, both the wealthiest and the poorest experienced significant decline in infant death. ConclusionsThe findings underscore the fruitfulness of investigating the effects of electricity access and other correlates on infant mortality at the subnational level. The study recommends that the provision of reliable access to electricity is needed to improve infant mortality rates. However, policies that seek to improve access to reliable electricity should be implemented together with health infrastructure development policies, especially in the regions with high infant mortality rates, for electricity access to have the desired effect.

Socioeconomic inequalities in access and use of skilled birth attendants during childbirth in Ghana: a decomposition analysis

BackgroundEquitable access to skilled birth attendance during delivery is vital for reducing global maternal deaths to 70 deaths per 100, 000 to achieve the Sustainable Development Goals (SDGs) by 2030. Although several initiatives have been implemented to reduce maternal mortality in Ghana, inequalities in access to skilled birth attendance during delivery still exist among women of different socioeconomic groups. This study assesses the socioeconomic inequalities in access and use of skilled birth attendants during delivery in Ghana.MethodsResearch was conducted through literature reviews and document reviews, and a secondary data analysis of the 2014 Ghana Demographic and Health Survey (GDHS), a nationally representative survey. A total of 1305 women aged 15–49 years, who had a live birth the year before to the survey in the presence of a skilled birth attendant were analysed using concentration indices and curves. The indices were further decomposed to identify the major socioeconomic factors contributing most to the inequalities.ResultsThe results found that access to skilled birth attendants was more among women from rich households showing a pro-rich utilization. The decomposition analysis revealed that household wealth index, educational level of both mother and husband/partner, area of residence and mother’s health insurance coverage were the major contributing factors to socioeconomic inequalities in accessing skilled birth attendants during child delivery among Ghanaian women.ConclusionThis study confirms that a mother’s socioeconomic status is vital to reducing maternal deaths. Therefore, it is worthy to focus attention on policy interventions to reduce the observed inequalities as revealed in the study.

Determinants of the type of health care sought for symptoms of Acute respiratory infection in children: analysis of Ghana demographic and health surveys

BackgroundGlobally, acute respiratory infection (ARI) is a leading cause of infant and childhood morbidity and mortality. Currently, it is estimated that 50 million cases of childhood ARI are untreated. In this study, we identified determinants of the type of treatment sought for symptoms of childhood acute respiratory infection (ARI), including non-treatment, amongst a nationally representative sample of children under five years in Ghana.MethodsIn total, 1 544 children were studied by a secondary analysis of pooled survey data from the 1993, 1998, 2003, 2008, and 2014 Ghana Demographic and Health Surveys (GDHS). Cross-tabulations, chi-square, multinomial logistic regression, and Bayesian hierarchical spatial logistic regression analyses were used to identify relationships between the type of treatment sought and maternal socio-economic and household characteristics.ResultsSeeking medical care was significantly associated with child age (RRR= 1.928, 95 % CI 1.276 – 2.915), maternal employment status (RRR = 1.815, 95 % CI 1.202 – 2.740), maternal health insurance status, (RRR = 2.618, 95 % CI 1.801 – 3.989), children belonging to middle (RRR = 2.186, 95 % CI 1.473 – 3.243), richer (RRR = 1.908, 95 % CI 1.145 – 3.180) and richest households (RRR = 2.456, 95 % CI 1.363 – 4.424) and the 1998 survey period (RRR = 0.426, 95 % CI 0.240 – 7.58). Seeking self-care or visiting a traditional healer was significantly associated with maternal educational status (RRR = 0.000, 95 % CI 0.000 – 0.000), and the 1998 (RRR= 0.330, 95 % CI 0.142 – 0.765), 2003 (RRR= 0.195, 95 % CI 0.071 – 0.535), 2008 (RRR= 0.216, 95 % CI 0.068 – 0.685) and 2014 (RRR= 0.230, 95 % CI 0.081 – 0.657) GDHS periods. The probability that the odds ratio of using medical care exceeded 1 was higher for mothers/caregivers in the Western, Ashanti, Upper West, and Volta regions.ConclusionsGovernment policies that are aimed at encouraging medical care-seeking for children with ARI may yield positive results by focusing on improving maternal incomes, maternal NHIS enrolment, and maternal household characteristics. Improving maternal education could be a positive step towards addressing challenges with self-care or traditional healing amongst children with ARI.

Women empowerment and minimum daily meal frequency among infants and young children in Ghana: analysis of Ghana demographic and health survey

BackgroundThe nutritional quality of food has an important impact on the health and well-being of families, especially children whose bodies need to grow, develop and reach their full physical and mental potential. Traditionally, women in Ghana provide care and nourishment for their children and families if they have the means to do so or if they are financially, legally and socially empowered. Women’s empowerment is not only important for women’s human rights, but also improves nutrition and health outcomes of both mothers and their children. Women’s empowerment is concerned with increasing ability to make strategic life choices in situations where the ability was hitherto denied. This study sought to investigate the association between women’s empowerment and minimum daily meal frequency (minimum number of meals to be consumed in a day) in Ghana.MethodsThe study used data from the 2014 Ghana Demographic and Health Survey (GDHS). A sample of 1640 mother-child dyad was used. Mothers ages ranged from 15 to 49 while children’s ages ranged from 6 to 23 months. Univariate and multiple linear regression techniques were applied to identify women empowerment (economic, socio-familial and legal) and sociodemographic factors associated with minimum daily meal frequency scores. Data was analyzed by the STATA statistical package software version 13.0. Statistical significance level was set at P < 0.10.ResultsData from decisions on large household purchases (β = 0.351, p < 0.01) family visits (β = 0.743, p < 0.01), home ownership (β = − 0.245, p < 0.10), age of child (β = 1.387, p < 0.01), mother’s educational attainment (β = 0.496, p < 0.10) and place of residence (β = − 0.298, p < 0.10) showed significant positive association with minimum daily meal frequency in Ghana.ConclusionMinimum daily meal frequency was largely influenced by economic and socio-familial factors that contribute to empowerment of women. as decisions on large household purchases and family visits showed significant positive association with minimum daily meal frequency. Interventional programs should target households and mothers with lower socio-demographic characteristics such as lower educational levels and low economic status to improve minimal daily meal frequency in their children thereby ensuring better child health and well-being.

Trends and factors associated with the nutritional status of adolescent girls in Ghana: a secondary analysis of the 2003-2014 Ghana demographic and health survey (GDHS) data.

We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana. Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition. Countrywide, covering rural and urban areas in Ghana. Non-pregnant adolescent girls aged 15-19 years. Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted. The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls.

Factors influencing under-five mortality in rural- urban Ghana: An applied survival analysis

ObjectivesThis paper uses a survival analysis technique to examine socio-economic and demographic factors that influence under-five mortality for rural and urban Ghana. MethodThe paper employs the Breslow Method for Ties for survival probability and uses data for the 2014 Ghana Demographic and Health Survey (GDHS). Data on some 5884 children was also generated through the interview of 4086 women aged 15–49. They indicated the birth histories of the children under five years. ResultsThe study finds the most significant socio-economic determinants of a child survival in Ghana to be maternal age, mother's education, household wealth index quintile, place of delivery and birth order. The influence of these determinants on child survival differ from urban to rural. ConclusionThe survival probabilities of these explanatory variables are different in the rural area from the urban area. Therefore, it is imperative to scale up efforts in the rural area to ensure children live up to age five.

Multilevel analysis of risk factors associated with severe underweight among children under 5 years: evidence from the 2014 Ghana Demographic and Health Survey

Background: Undernutrition among children &lt;5yr. is a global public health problem, especially in developing countries like Ghana. Undernutrition increases the risk of child morbidity and mortality. There is paucity of data on household-level effects on severe underweight and associated factors. Objective: The study investigated the risk factors associated with severe underweight among children &lt; 5yr.in Ghana and examined unobserved differences across households based on the 2014 Ghana Demographic and Health surveys (GDHS) data. Methods: Data from a population-based cross-sectional study was obtained from the 2014 Ghana Demographic and Health Survey. Data on 2720 children nested within 1972 households was extracted for analysis. Our regression analysis used data on 2716 children with complete data on the outcome and risk factors. Children with weight-for-age Z-score below -3 standard deviations were classified as severely underweight based on the 2006 WHO child growth standards. We applied random intercept multilevel logistic regression to examine whether severe underweight status in children differ across households while simultaneously identifying potential risk factors. Results: A total of 2720 children had valid weight-for-age z-score and 53 (1.95%) of them were identified as severely underweight. In the univariate model, child level variables such as multiple birth [odds ratio (OR), 4.03;95%confidence interval (CI): 1.85-8.76]and child born average (OR, 2.17;95%CI: 1.09-4.32) or small (OR, 4.08; 95%CI: 2.01-8.28) in size at birth are associated with increased odds of severe underweight. Maternal/household level variables such as increase in number of children below 5 yr. (OR, 1.61; 95%CI: 1.28-2.04), poorest households (OR, 4.85; 95%CI: 1.14-20.59) and increase in number of births in last 5 yr. (OR, 1.80, 95%CI: 1.24-2.60) were associated with increased odds of severe underweight. Increase in maternal years of education (OR, 0.89; 95%CI: 0.83-0.95) was associated with reduced odds of severe underweight. In the multilevel logistic model, only type of birth (OR, 1.61;95%CI: 1.28-2.04), size of child (average: OR, 2.12;95%CI: 1.04-4.33; small: OR, 3.87;95%CI: 1.80-8.33) at birth, and maternal education (OR, 0.92;95%CI: 0.84-1.00) were independently associated with severe underweight. There were no significant residual household-level variations in severe underweight status. Conclusion: Our findings suggest that improving maternal education, socioeconomic conditions of families, and family planning are critical in addressing severe underweight

Factors influencing early postnatal care utilisation among women: Evidence from the 2014 Ghana Demographic and Health Survey.

IntroductionEarly postnatal care (EPNC) utilisation is crucial for averting maternal deaths as recommended by the World Health Organisation. About 30% of women do not obtain EPNC in Ghana and no national level study have investigated the determinants of EPNC. Therefore, this study aimed at assessing factors associated with EPNC uptake among women aged 15–49 in Ghana.Materials and methodsThe study utilised data from the women’s file of the 2014 Ghana Demographic and Health Survey (GDHS) and sampled 1,678 women aged 15–49 who had complete data on EPNC. Descriptive computation of EPNC was done. Since EPNC (which is the main outcome variable for the study) was dichotomous, the binary logistic regression was used to determine factors influencing utilisation of EPNC at 95% two-tailed confidence interval. The results were presented as adjusted odds ratio (AOR). Stata version 14.0 was used for all the analyses.ResultsDescriptively, the results indicated that 31% of women aged 15–49 sought EPNC. At the inferential level, women aged 40–44 were more likely to seek EPNC compared to those aged 15–19 [AOR = 3.66, CI = 1.25–10.67]. Islam women had higher odds of EPNC as compared with Christians [AOR = 1.70, CI = 1.23–2.35]. Comparatively, women of Mande ethnic group had higher propensity to seek EPNC than the Akan [AOR = 3.22, CI = 1.20–8.69]. Residents of the Greater Accra region were over 11 times probable to utilise EPNC compared with the residents of Western region.ConclusionThe key determinants of EPNC were age, religion, ethnicity, marital status and region. Therefore, the Health Promotion and Education Unit and Reproductive and Child Health Department of the Ghana Health Service need to scale up EPNC sensitisation programmes and should target women aged 15–19, Christians and other category of women with less likelihood of EPNC in order to offset the disparities.

Geospatial analysis of determinants of neonatal mortality in Ghana

BackgroundGhana did not meet the Millennium Development Goal 4 of reducing child mortality by two-thirds and may not meet SDG (2030). There is a need to direct scarce resources to mitigate the impact of the most important risk factors influencing high neonatal deaths. This study applied both spatial and non-spatial regression models to explore the differential impact of environmental, maternal, and child associated risk factors on neonatal deaths in Ghana.MethodsThe study relied on data from the Ghana Demographic and Health Surveys (GDHS) and the Ghana Maternal Health Survey (GMHS) conducted between 1998 and 2017 among 49,908 women of reproductive age and 31,367 children under five (GDHS-1998 = 3298, GDHS-2003 = 3844, GDHS-2008 = 2992, GDHS-2014 = 5884, GMHS-2017 = 15,349). Spatial Autoregressive Models that account for spatial autocorrelation in the data at the cluster-level and non-spatial statistical models with appropriate sampling weight adjustment were used to study factors associated with neonatal deaths, and a p-value less than 0.05 was considered statistically significant.ResultsPopulation density, multiple births, smaller household sizes, high parity, and low birth weight significantly increased the risk of neonatal deaths over the years. Among mothers who had multiple births, the risk of having neonatal deaths was approximately four times as high as the risk of neonatal deaths among mothers who had only single birth [aRR = 3.42, 95% CI: 1.63–7.17, p < 0.05]. Neonates who were perceived by their mothers to be small were at a higher risk of neonatal death compared to very large neonates [aRR = 2.08, 95% CI: 1.19–3.63, p < 0.05]. A unit increase in the number of children born to a woman of reproductive age was associated with a 49% increased risk in neonatal deaths [aRR = 1.49, 95% CI: 1.30–1.69, p < 0.05].ConclusionNeonatal mortality in Ghana remains relatively high, and the factors that predisposed children to neonatal death were birth size that were perceived to be small, low birth weight, higher parity, and multiple births. Improving pregnant women’s nutritional patterns and providing special support to women who have multiple deliveries will reduce neonatal mortality in Ghana.

Inequalities in out-of-pocket health expenditure among women of reproductive age: after-effects of national health insurance scheme initiation in Ghana

BackgroundImprovement in maternal healthcare is a public health priority. Unfortunately, in spite of the efforts made over time regarding universal coverage, there remain issues with accessibility and use of healthcare services up to now. In this study, we examined inequalities in out-of-pocket health expenditure among women of reproductive age in Ghana. We analyzed secondary data collected in Ghana Demographic and Health Survey (GDHS) - 2014. A total of 9,002 women of reproductive age were included in this study. Lorenz curves and the concentration index were used to examine neighborhood socioeconomic disadvantage inequalities in out-of-pocket expenditure for maternal healthcare utilizationResultsAbout two thirds (66.0%) of women of reproductive age in Ghana were covered by health insurance. In sum, women of high neighborhood socioeconomic disadvantage status had the least out-of-pocket expenditure for total healthcare utilization, laboratory investigations, antenatal care visits, post-natal care visits, care for new born for up to 3 months, and other healthcare services. The converse was however true for family planning service utilization. Using Concentration Index, we quantified the degree of neighborhood socioeconomic disadvantage inequalities in healthcare service utilizations.ConclusionThis study showed a gap in health insurance coverage among women of reproductive age. There were also inequalities in out-of-pocket expenditure for healthcare services utilization. It is expedient for stakeholders in the healthcare system to make policies targeted at bridging the neighborhood socioeconomic differences in maternal healthcare use and develop programs to improve women’s financial protection. Moreover, enlightenment on health insurance availability and coverage should focus on women at risk of out-of-pocket expenditure.

Predictive model and determinants of odds of neonates dying within 28 days of life in Ghana.

BackgroundOne of the priorities and important current problem in public health research globally is modeling of neonatal mortality and its risk factors in using the appropriate statistical methods. It is believed that multiple risk factors interplay to increase the risk of neonatal mortality. To understand the risk factors of neonatal mortality in Ghana, the current study carefully evaluated and compared the predictive accuracy and performance of two classification models.MethodsThis study reviewed the birth history data collected on 5884 children born in the 5 years preceding the 2014 Ghana Demographic and Health Survey (GDHS). The 2014 GDHS is a cross‐sectional nationally representative household sample survey. The relevant variables were selected using leaps‐and‐bounds method, and the area under curves were compared to evaluate the predictive accuracy of unweighted penalized and weighted single‐level multivariable logistic regression models for predicting neonatal mortality using the 2014 GDHS data.ResultsThe study found neonatal mortality prevalence of 2.8%. A sample of 4514 children born in the 5 years preceding the 2014 GDHS was included in the inferential analysis. The results of the current study show that for the unweighted penalized single‐level multivariable logistic model, there is an increased risk of neonatal death among babies born to mothers who received prenatal care from non‐skilled worker [OR: 3.79 (95% CI: 2.52, 5.72)], multiple births [OR: 3.10 (95% CI: 1.89, 15.27)], babies delivered through caesarian section [OR: 2.24 (95% CI: 1.30, 3.85)], and household with 1 to 4 members [OR: 5.74 (95% CI: 3.16, 10.43)], respectively. The predictive accuracy of the unweighted penalized and weighted single‐level multivariable logistic regression models was 82% and 80%, respectively.ConclusionThe study advocates that prudent and holistic interventions should be institutionalized and implemented to address the risk factors identified in order to reduce neonatal death and, by large, improve child and maternal health outcomes to achieve the SDG target 3.2.

Postnatal care utilisation among women in rural Ghana: analysis of 2014 Ghana demographic and health survey

BackgroundMaternal mortality is high in Ghana, averaging 310 maternal deaths per 100,000 live births in 2017. This is partly due to inadequate postnatal care especially among rural communities. Ghana can avert the high maternal deaths if women meet the World Health Organisation’s recommended early postnatal care check-up. Despite the association between geographical location and postnatal care utilisation, no study has been done on determinants of postnatal care among rural residents in Ghana. Therefore, this study determined the prevalence and correlates of postnatal care utilization among women in rural Ghana.MethodsThe study utilised women’s file of the 2014 Ghana Demographic and Health Survey (GDHS). Following descriptive computation of the prevalence, binary logistic regression was fitted to assess correlates of postnatal care at 95% confidence interval. The results were presented in adjusted odds ratio (AOR). Any AOR less than 1 was interpreted as reduced likelihood of PNC attendance whilst AOR above 1 depicted otherwise. All analyses were done using Stata version 14.0.ResultsThe study revealed that 74% of the rural women had postnatal care. At the inferential level, women residing in Savanna zone had higher odds of postnatal care compared to those in the Coastal zone [AOR = 1.80, CI = 1.023–3.159], just as among the Guan women as compared to the Akan [AOR = 7.15, CI = 1.602–31.935]. Women who were working were more probable to utilise postnatal care compared to those not working [AOR = 1.45, CI = 1.015–2.060]. Those who considered distance as unproblematic were more likely to utilise postnatal care compared to those who considered distance as problematic [AOR = 1.63, CI = 1.239–2.145].ConclusionsThe study showed that ethnicity, ecological zone, occupation and distance to health facility predict postnatal care utilisation among rural residents of Ghana. The study points to the need for government to increase maternal healthcare facilities in rural settings in order to reduce the distance covered by women in seeking postnatal care.

Spatial analysis of the prevalence of obesity and overweight among women in Ghana

ObjectiveIdentifying hot spots for the overweight aids in effective public health interventions due to the associated public health burden and morbidities. This study, therefore aimed to explore and determine the...

Measuring the Overall Burden of Early Childhood Malnutrition in Ghana: A Comparison of Estimates From Multiple Data Sources.

Childhood malnutrition contributes to nearly half (45%) of all deaths among children under 5 globally. The United Nations' Sustainable Development Goals (SDGs) aims to end all forms of malnutrition by 2030; however, measuring progress towards these goals is challenging, particularly in countries with emerging economies where nationally-representative data are limited. The primary objective of this study was to estimate the overall burden of childhood malnutrition in Ghana at national and regional levels using 3 data sources. Using data from the long-standing Ghana Demographic and Health Surveys (GDHS), Ghana Multiple Indicator Cluster Survey (GMICS), and the emerging Ghana Socioeconomic Panel Survey (GSPS), we compared the prevalence of malnutrition using the extended composite index of anthropometric failure (eCIAF) for the period 2008- 2011. This study included data for children aged 6-59 months and calculated all anthropometric z-scores based on the World Health Organization (WHO) Growth Standards. We tested for differences in malnutrition subtypes using two-group configural frequency analysis (CFA). Of the 10 281 children (6532 from GMICS, 2141 from GDHS and 1608 from GSPS) included in the study, the only demographic difference observed was the children included in the GSPS were slightly older than those included in the GDHS and GMICS (median age of 36 vs 30 vs 33 months, P<.001). Based on the eCIAF, the overall prevalence of malnutrition at the national level was higher among children in the GSPS (57.3%, 95% CI: 53.9%-60.6%), followed by the GDHS (39.7%, 95% CI: 37.0%-42.5%), and then those in the GMICS (31.2%, 95% CI: 29.3%-33.1%). The two-group CFA showed that the 3 data sources also estimated different prevalence rates for most of the malnutrition subtypes included in the eCIAF. Depending on the data source adopted, our estimates of eCIAF showed that between one-third and half of all Ghanaian children aged 6-59 months had at least one form of malnutrition over the period 2008-2011. These eCIAF estimates should complement the commonly reported measures such as stunting and wasting when interpreting the severity of malnutrition in the country to inform policy decisions.