Ghana Health Research Articles

Building resilience of the Ghanaian healthcare system: Lessons from a global health stage: Preparedness for the next pandemic: A scoping review

Background The coronavirus disease (COVID-19) pandemic has underscored the need for resilient health systems. However, Ghana does not seem to achieve commensurate results, suggesting potential gaps in critical interventions. This study examines these gaps by drawing on global experiences to guide Ghana's preparedness for future emergencies. Methods A scoping review based on the synthesis of published journal articles and grey literature was used to gather relevant evidence to address the study’s objective. Peer-reviewed literature searches were conducted in databases, including Medline, Scopus, and Health Sources, supplemented by searches on organizational websites to identify grey literature. We adopted the Organization for Economic Co-operation and Development (OECD) framework to explore how health systems responded to the COVID-19 pandemic globally and draw lessons for strengthening Ghana's health system resilience. We analyzed policy responses in three main areas: pandemic preparedness, crisis management, and response and recovery. Results Ten strategies emerged from the study as critical in strengthening health system resilience against future pandemics. These strategies include whole-of-government engagement, financing for preparedness, community engagement and trust, robust surveillance systems, emergency medical care, diverse workforce development, digital health integration, critical health infrastructure, well-planned commodities/products, and social capital. Each strategy plays a vital role in enhancing preparedness, response, and recovery efforts, highlighting the multifaceted approach needed to mitigate the impact of future pandemics on health systems. Conclusions The identified strategies align with the attributes of a resilient healthcare system. By adopting these strategies, Ghana can build a resilient healthcare system that effectively addresses future challenges, guided by global insights and experiences.

Breaking the silence of female genital schistosomiasis in Ghana's health system: A case of health workers within the FAST project.

Female Genital Schistosomiasis (FGS) remains a critical and yet neglected topics in Neglected Tropical Diseases (NTDs), significantly affecting the health of women and girls worldwide. Health workers' knowledge of FGS is vital to the prevention and management of the disease. This study adopted an implementation research approach to identify and address the existing knowledge gap regarding FGS among healthcare workers in Ghana. This study was a 3-year (2020-2022) implementation research applying a pragmatic uncontrolled quasi-experimental study design. The study involved a baseline assessment, FGS training intervention for health workers and student nurses, distribution of FGS educational materials, and an endline assessment. A mixed-method approach was applied to data collection involving health workers from two schistosomiasis endemic districts and across the country. NVIVO 12 and STATA 14 were used for qualitative and quantitative data analysis, respectively. Prior to the intervention, the level of awareness about FGS among health workers was less than 8%, and most participants only understood FGS as merely urogenital schistosomiasis in females. In response to this gap, an FGS education intervention in the form of training of health workers, student nurses alongside the distribution of FGS educational materials were carried out. The intervention enhanced health workers' awareness of FGS to more than 61%, encompassing an enhanced understanding of the disease's signs and symptoms to more than 60%, as well as its management strategies. However, access to praziquantel, the primary treatment, remained a significant challenge. The FGS intervention effectively raised healthcare workers' awareness and knowledge. Expanding training and improving praziquantel access are essential for optimal FGS management. A multi-faceted approach involving individuals, communities, and the healthcare system is necessary for comprehensive FGS prevention and control.

Impact of COVID-19 on the management of hypertension: a perspective on disease severity, service use patterns and expenditures from Ghana's health insurance claims data.

Hypertension is a leading cause of morbidity in Ghana and other sub-Saharan African countries, but management has historically suffered from the fragility of health systems in these countries. This has been exacerbated by the COVID-19 pandemic and its associated measures. Our study examines and quantifies the effect of the pandemic on the management of hypertension in Ghana by determining changes in disease severity and presentation, as well as changes in health service use patterns and expenditures. We used cross-sectional data to perform an impact evaluation of COVID-19 on hypertension management before and during the pandemic. We employed statistical tests including t-tests, z-tests, and exact Poisson tests to estimate and compare hypertension episode intensity and related claim expenditures before and during the pandemic using medical claims data from Ghana's National Health Insurance Authority database. The study duration includes a 12-month reference/pre-pandemic period (March 2019-February 2020) relative to the target/pandemic period (March 2020-February 2021). We observed that although there was a 20% reduction in the number of hypertension claimants in the pandemic year, there was an increase in hypertension severity as measured by the number of hypertension episodes per claimant. There was also an 18.64% or $22.88 (95% CI: $21-$25, p = 0.01042) increase in the average cost per hypertension claimant in the pandemic year. The increase in episodes per claimant had the largest financial impact on the average cost per claimant. The findings from our studies are relevant for future policymaking and strategy implementation for hypertension control in Ghana.

Evaluating if Ghana's Health Institutions and Facilities Act 2011 (Act 829) Sufficiently Addresses Medical Negligence Risks from Integration of Artificial Intelligence Systems

With artificial intelligence (AI) integrated increasingly to enhance personalized diagnosis and data-driven treatment recommendations, this analysis examines the legal sufficiency of Ghana’s Health Institutions and Facilities Act 2011 (Act 829) to address medical negligence risks from reliance on AI systems in clinical settings. The CREAC framework structures evaluating gaps where existing health regulations may lack clarity for emerging issues of accountability. Explanation contextualizes the probabilistic nature of AI inferences and how general principles of medical negligence could have ambiguous application currently if erroneous AI contributions result in patient harm. Application to a hypothetical scenario assesses if adequate protections for appropriate integration exist across developers, systems, healthcare facilities, and practitioners under applicable interpretations of existing laws. Finding liability rules insufficient absent targeted AI governance, conclusions recommend amending Act 829 in key areas to codify expectations for responsible innovation and prevent ambiguity in liability.
 This work carries scientific novelty as one of the first structured jurisdictional analyses internationally of healthcare AI accountability gaps through a legal lens. Practical significance lies in setting the stage for strengthening protections in Ghana through proposed statutory reforms that reduce uncertainty around this crucial area for quality care. The method and recommendations offer a model for modernizing medical negligence law and AI policy amidst ongoing digitization in healthcare worldwide.

Healthcare providers' perception towards utilization of health information applications and its associated factors in healthcare delivery in health facilities in Cape Coast Metropolis, Ghana.

Information and communication technology (ICT) has significantly advanced global healthcare, with electronic health (e-Health) applications improving health records and delivery. These innovations, including electronic health records, strengthen healthcare systems. The study investigates healthcare professionals' perceptions of health information applications and their associated factors in the Cape Coast Metropolis of Ghana's health facilities. We used a descriptive cross-sectional study design to collect data from 632 healthcare professionals (HCPs), in the three purposively selected health facilities in the Cape Coast municipality of Ghana, in July 2022. Shapiro-Wilk test was used to check the normality of dependent variables. Descriptive statistics were used to report means with corresponding standard deviations for continuous variables. Proportions were also reported for categorical variables. Bivariate regression analysis was conducted to determine the factors influencing the Benefits of Information Technology (BoIT); Barriers to Information Technology Use (BITU); and Motives of Information Technology Use (MoITU) in healthcare delivery. Stata SE version 15 was used for the analysis. A p-value of less than 0.05 served as the basis for considering a statistically significant accepting hypothesis. Healthcare professionals (HCPs) generally perceived moderate benefits (Mean score (M) = 5.67) from information technology (IT) in healthcare. However, they slightly agreed that barriers like insufficient computers (M = 5.11), frequent system downtime (M = 5.09), low system performance (M = 5.04), and inadequate staff training (M = 4.88) hindered IT utilization. Respondents slightly agreed that training (M = 5.56), technical support (M = 5.46), and changes in work procedures (M = 5.10) motivated their IT use. Bivariate regression analysis revealed significant influences of education, working experience, healthcare profession, and IT training on attitudes towards IT utilization in healthcare delivery (BoIT, BITU, and MoITU). Additionally, the age of healthcare providers, education, and working experience significantly influenced BITU. Ultimately, age, education, working experience, healthcare profession, and IT training significantly influenced MoITU in healthcare delivery. Healthcare professionals acknowledge moderate benefits of IT in healthcare but encounter barriers like inadequate resources and training. Motives for IT use include staff training and support. Bivariate regression analysis shows education, working experience, profession, and IT training significantly influence attitudes towards IT adoption. Targeted interventions and policies can enhance IT utilization in the Cape Coast Metropolis, Ghana.

Examining Ghana's Health Professions Regulatory Bodies Act, 2013 (Act 857) To Determine Its Adequacy in Governing the Use of Artificial Intelligence in Healthcare Delivery and Medical Negligence Issues

This analysis examines Ghana’s Health Professions Regulatory Bodies Act, 2013 (Act 857) to assess its fitness to govern the ascent of artificial intelligence (AI) in reshaping healthcare delivery. As advanced algorithms supplement or replace human judgments, dated laws centered on individual practitioner liability struggle to contemplate emerging negligence complexities. Act 857 lacks bespoke provisions for governing this new era beyond outdated assumptions of human-centric care models. With AI projected to transform medicine, proactive reforms appear vital to enable innovation gains while upholding accountability.
 Through an IRAC legal analysis lens supplemented by case law spanning from the United States to Ghana, this paper demonstrates how judiciaries globally are elucidating risks from legal uncertainty given increasingly autonomous health technologies. Findings reveal governance gaps impeding equitable access to remedy where algorithmic activities contribute to patient harm. Calls for stringent training, validation and monitoring prerequisites before deploying higher-risk AI systems signal a reframed standard of care is warranted.
 Detailed recommendations to modernize Act 857 and adjacent regulation are provided, covering practitioner codes, product safety, ongoing evaluation duties, and crucially, updated liability rules on apportioning fault between disparate enterprises enabling flawed AI. Beyond protecting patients and practitioners, enhanced governance can boost investor confidence in Ghana’s AI healthcare ecosystem. Ultimately astute reforms today can reinforce innovation gains tomorrow across a more ethical, accountable industry.

Analysis of the Ghanaian Public Health Act, AI Regulatory Regimes and Vaccine Manufacturing and Distribution Channels in Ghana

Objective: Analyze Ghana's public health law comprehensiveness, responsiveness, uniformity and accountability regarding complex modern risks at the intersection of infectious disease, medical AI and vaccine equity. Method: Doctrinal legal review (CRuPAC) of the 2012 Public Health Act combined with sociolegal analysis of judicial cases, academic literature and comparative governance on emerging technologies. Results: Gaps exist regarding infectious disease forecasting, transparency duties, decentralized flexibility and technology regulation that constrained pandemic response. Conclusions: Ghana's outdated health law requires modernization to address twenty-first century convergence of biotechnology, data usage and human rights. Recommendations: Parliament should amend legislation to embed oversight, participatory mechanisms and binding duties around accountable and rights-respecting development and deployment of AI tools supporting vaccine delivery. Contributions: Provides novel interdisciplinary framework assessing legal readiness for scientific healthcare priorities. Significance: Analyzes institutional deficiencies and reform options for life-saving technology integrations.

Modeling the economic burden of postpartum hemorrhage due to substandard uterotonics in Ghana.

Uterotonics are essential in preventing postpartum hemorrhage (PPH), the leading direct cause of maternal death worldwide. However, uterotonics are often substandard in low- and middle-income countries, contributing to poor maternal health outcomes. This study examines the health and economic impact of substandard uterotonics in Ghana. A decision-tree model was built to simulate vaginal and cesarean section births across health facilities, uterotonic quality and utilization, PPH risk and diagnosis, and resulting health and economic outcomes. We utilized delivery data from Ghana's maternal health survey, risks of health outcomes from a Cochrane review, and E-MOTIVE trial data for health outcomes related to oxytocin quality. We compared scenarios with and without substandard uterotonics, as well as scenarios altering uterotonic use and care-seeking behaviors. We found that substandard uterotonic use contributes to $18.8 million in economic burden annually, including $6.3 million and $4.8 million in out-of-pocket expenditures in public and private sectors, respectively. Annually, the National Health Insurance Scheme bears $1.6 million in costs due to substandard uterotonic use. Substandard uterotonics contribute to $6 million in long-term productivity losses from maternal mortality annually. Improving the quality of uterotonics could reduce 20,000 (11%) PPH cases, 5,000 (11%) severe PPH cases, and 100 (11%) deaths due to PPH annually in Ghana. Ensuring the quality of uterotonics would result in millions of dollars in cost savings and improve maternal health outcomes for the government and families in Ghana. Cost savings from improving uterotonic quality would provide financial protection and help Ghana advance toward Universal Health Coverage.

Modelling the Wage Bill and Budget Space for Health Workforce in Ghana: Implications for Sustainable Health Professions Education Policy.

Global discussions on health systems strengthening have lately tilted towards increasing investments in human resources for health to address health workforce challenges, especially shortages and employment. Countries have, as a result, increased investments in the health workforce by expanding the production and recruitment of the needed health workforce, with the resultant effects of increasing health workforce budget space and the unending clamour by health policy actors for further increases. Despite these calls, there has been no wage bill affordability and budget space analysis to rationalise the sustainable production of and demand for health workers, which is the thrust of Ghana's current health workforce policy and strategy. Using an adapted approach (the Asamani approach), the study modelled the supply of some essential health workers and their associated cost of employment, compared it with the modelled budget space for health workforce employment and then drew conclusions on the wage bill sustainability for policy consideration. Of the seven cadres considered in the study (doctors, professional nurses, midwives, enrolled nurses, community health nurses, pharmacists and biomedical scientists), who constitute about 97% of the wage bill, the study found the baseline stock to be 129 378 in 2022, which was estimated to increase to 199 715 by 2027 and 254 466 by 2032 with corresponding wage bills of US$869.4 million and US$ 1.1 billion, respectively, holding routine salary increases constant. The budget space for health was, meanwhile, projected to be US$899.3 million and US$1.1 billion in 2022 and 2032 respectively, out of a projected overall government fiscal space of US$7 billion per year. This study concludes that, given current levels and mix of production, Ghana was estimated to expend an average of 88% of its health budget space as wage bill cost. This was 54.4% over the global median and 95.6% over the African Region's median, making the current regime unsustainable.

Knowledge about unintended pregnancy shortly after childbirth: An issue of ineffective counseling or adherence?

Being aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period is often overlooked but remains a significant contributor to unintended pregnancies and may lead to maternal and neonatal comorbidities. Exploring the extent of awareness and associated factors could help tailor more interventions toward reducing the rates of short-interval unplanned pregnancies. This study explores the extent to which Ghanaian women are aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period and its associated factors. A cross-sectional study was conducted using the 2017 Ghana Maternal Health Survey. The women participants were sampled using a two-stage cluster sampling design. We analyzed the 2017 Ghana Maternal Health Survey data of 8815 women who had given birth and received both antenatal care and postnatal checks after delivery in health facilities (private and public) and responded to questions on being aware of short interpregnancy intervals. A multivariable survey logistic regression was used for the analysis. Of the 8815 women, approximately 62% of women who received both antenatal care and postnatal examinations before discharge reported being aware of short interpregnancy intervals. Postnatal examination before discharge but not antenatal care was associated with a higher awareness of short interpregnancy intervals. Women who received a postnatal examination were more aware of short interpregnancy intervals than their counterparts (adjusted odds ratio = 1.29, 95% confidence interval: 1.03-1.61). Also, awareness of short interpregnancy intervals increased with age, education, knowledge of the fertile period, contraceptive use, and delivery via cesarean section. Over a decade following the initiation of Ghana's free maternal health policy, there remains a significant gap in the awareness of short interpregnancy intervals, even among women who received both antenatal pregnancy care and postnatal examinations before discharge. The unawareness of the short interpregnancy interval observed in approximately 38% of women raises concerns about the effectiveness of counseling or education provided during antenatal care and immediate post-partum care regarding birth spacing, contraceptive use, the timing of resumption of sexual activity, and the extent to which women adhere to such guidance.

Under-reporting of adverse drug reactions: Surveillance system evaluation in Ho Municipality of the Volta Region, Ghana.

Adverse Drug Reactions (ADRs) can occur with all medicines even after successful extensive clinical trials. ADRs result in more than 10% of hospital admissions worldwide. In Ghana, there has been an increase of 13 to 126 ADR reports per million population from 2012 to 2018. ADR Surveillance System (ADRSS) also known as pharmacovigilance has been put in place by the Ghana Food and Drugs Authority (FDA) to collect and manage suspected ADR reports and communicate safety issues to healthcare professionals and the general public. The ADRSS in Ho Municipality was evaluated to assess the extent of reporting of ADRs and the system's attributes; determine its usefulness, and assess if the ADRSS is achieving its objectives. We evaluated the ADRSS of the Ho Municipality from January 2015 to December 2019. Quantitative data were collected through interviews and review of records. We adapted the updated CDC guidelines to develop interview guides and a checklist for data collection. Attributes reviewed included simplicity, data quality, acceptability, representativeness, timeliness, sensitivity, predictive value positive and stability. We found a total of 1,237 suspected ADR during the period, of which only 36 (3%) were reported by healthcare professionals in the Ho Municipality to the National Pharmacovigilance Centre (NPC). Only 43.9% of health staff interviewed were familiar with the ADRSS and its reporting channel. Staff who could mention at least one objective of the ADRSS were 34.2%, and 12.2% knew the timelines for reporting ADR. Reports took a median time of 41 (IQR = 25, 81) days from reporter to NPC. Reports sent on time constituted 37.5%. Fully completed case forms constituted 77.1% and the predictive value positive (PVP) was 20%. About 53% of ADRs were reported for female patients. Up to 88.9% of ADRs were classified as drug related. Anti-tuberculosis agents and other antibiotics constituted (40.6%) and (18.8%) of all reports. The ADRSS was not integrated into the disease surveillance and response system of Ghana's Health Service and so was not flexible to changes. A dedicated ADR surveillance officer in regions helped with the system's stability. Data from Ghana feeds into a WHO database for global decision making. There was under-reporting of ADRs in the Ho Municipality from January 2015 to December 2019. The ADR surveillance system was simple, stable, acceptable, representative, had a strong PVP but was not flexible or timely. The ADRSS was found useful and partially met its objectives.

Group boundary salience and nonaccommodation between healthcare workers and community members in Ghana

Over the past decades, public health policy and initiatives have shifted away from individual interventions to focus more broadly on community-based and social determinants of health. Community-based health initiatives are health programs developed to be implemented at the community level, especially amongst poor rural populations and urban slums that may be excluded from traditional healthcare models. However, evidence regarding the success of community-based health initiatives remains mixed, perhaps due to lack of research focused on the social identity and communication experiences of community members and healthcare workers. Mobilizing communication accommodation theory, the current study analyzes healthcare discourses in the context of Ghana's Community-Based Health Planning and Service initiative. Critical discourse analysis of forty-four focus group interviews revealed significant tensions regarding patient-practitioner roles and expectations, organizational role constraints experienced by healthcare workers, and ethnolinguistic group boundaries. As a result, community members frequently express feelings of nonaccommodation from healthcare workers, leading to poor evaluations of healthcare workers' communication accommodation competence. Theoretical and practical implications of the findings are discussed.

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.

Safer Sex Negotiation Among Ghanaian Women in Sexual Unions: Does Women's Household Decision-Making Capacity Matter?

Women's ability to negotiate for safer sex has been found to be dependent on their household decision making power. However, there is paucity of studies investigating the association between women's household decision making power and safer sex negotiation in Ghana. Thus, we examined the association between women's household decision making autonomy and safer sex negotiation among Ghanaian women in sexual unions using the 2014 Ghana's Demographic and Health Survey. Descriptive statistics, Chi-square test, and multivariable logistic regression models were performed. Statistical significance was set at p < .05at 95% confidence interval.The results showed high prevalence of safer sex negotiation among women with high household decision-making capacity (91.6%). Compared to women with low household decision making autonomy, those with high autonomy in household decision making were more likely to negotiate for safer sex (aOR = 2.06; CI = 1.32-3.21). Women aged 25-34 were more likely to negotiate for safer sex compared to those aged 15-24 (aOR = 1.50; CI = 1.07-2.11). Higher odds of safer sex negotiation were found among women with comprehensive HIV and AIDS knowledge (aOR = 1.49; CI = 1.09-2.05), women who had tested for HIV (aOR = 1.57; CI = 1.27-1.95) and those exposed to newspaper (aOR = 1.80; CI = 1.17-2.78) compared to those who had no comprehensive knowledge on HIV and AIDS, those who had never tested for HIV and those who were not exposed to newspaper, respectively. However, women who belonged to other ethnic groups and the Islamic religion had lower odds of safer sex negotiation compared to Akans (aOR = 0.68; CI = 0.48-0.96) and Christian women (aOR = 0.63; CI = 0.46-0.85). Women empowerment programmes need to be intensified to enable Ghanaian women with low household decision making autonomy to negotiate for safer sex with their partners. Ghana could achieve the Sustainable Development Goals (SDGs), particularly, SDG 3.7 (universal access to sexual and reproductive health services), and SDG 5 (achieve gender equality and empower all women and girls) when household decision-making capacity among women is further strengthened.

Health system access challenges of people with disabilities increased during Covid-19 pandemic

BackgroundPeople with disabilities (PWDs) have unequal access to health services compared with the general population and this disparity is worsening during the Covid-19 pandemic. Evidence supports the importance of policy development and legislation for addressing the unmet health needs of PWDs, but little is known about the impact of these efforts in Ghana. ObjectiveThis study examined health system experiences of PWDs in Ghana within the context of existing disability legislation and related policies prior to and during the Covid-19 pandemic. MethodsNarrative analysis of data from qualitative research approaches of focus group discussions, semi-structured interviews, and participant observations were used to examine the experiences of fifty-five PWDs, four staff of the Department of Social Welfare, and six leaders of disability-focused non-governmental organizations in Ghana. ResultsStructural and system barriers hinder PWDs access to health services. Bureaucratic bottlenecks hinder PWDs access to Ghana's free health insurance policy and health workers' disability stigma impedes accessibility to health services. ConclusionsAccess barriers and disability stigma increased accessibility challenges for PWDs in Ghana's health system during the Covid-19 pandemic. My findings support the need for increased efforts toward making Ghana's health system more accessible to address health disparities experienced by PWDs.

Doctorpreneurship in the Digital Age

Many of the challenges faced by the various sectors of the economy are seen as opportunities by entrepreneurs. Yet, entrepreneurs are by definition excluded from a large part of the health sector due to the specialised nature of the medical profession and the complexities associated with service provision in the area of healthcare. In this paper, the term ‘Doctorpreneur' is used to connote doctors who engage in entrepreneurship in the health sector. The study adopts the Maslow's theory of motivation, the Herzberg's two-factor theory, and the theory of affordance to explore factors that promote ‘doctorpreneurship' in the digital age, using Ghana's health sector as a case. The findings of this qualitative study suggest that besides the monetary gains that primarily motivate doctors to engage in doctorpreneurship, other individual, organizational, and technological factors also underpin the phenomenon. Furthermore, the findings underscore the role of technology in consolidating doctorpreneurship in the digital age. The study presents several implications for research, policy, and practice.

Demographic Effects on Fertility Among Reproductive Aged Women in Ghana. A Demographic and Health Survey Analysis

In this paper, we argue that fertility is among the key components in the demographic transition process of many global economies. The study used the 2014 Ghana Demographic and Health Survey. We applied the conventional neo-classical consumer-theoretic approach to model the demand of children. The study aimed to estimate the demographic effects on fertility among women of reproductive age 15-49 in Ghana using the negative binomial regression. The results indicated that the age of women at first births, mother&amp;rsquo;s years of education, number of unions, wealth level, women occupations, Partners occupation, contraceptive use and intention, marital status, are significant and negatively associated with the number of children ever born. However, current age of the woman, fertility preference, decision maker on contraceptive use, child sex, number of living children and experienced of the death of a son and/or daughter resulting from replacement effect and hoarding effects and residing in rural areas have positively and significantly influence fertility in Ghana. We recorded variations in the effects of some variables in total, urban and rural samples. We conclude that reduction in child mortality, increasing women access of formal education, increasing women power in decision making on contraceptive use, increasing access to and use of contraceptives as well as reducing income disparity between urban and rural population by providing employment opportunities in rural areas are keys policy issues that could help achieve fertility reduction in Ghana.

Socioeconomic determinants of use and choice of modern contraceptive methods in Ghana

BackgroundThe slow pace of fertility decline in Africa relative to other parts of the world has important implications for the region’s economic development. Modern contraceptive use is seen as important population control and family planning strategy by governments worldwide. This paper examines the socioeconomic determinants of modern contraceptive use and choice among Ghanaian men and women.MethodsWe use the most recent and nationally representative Ghana Demographic and Health Survey conducted in 2014. The analysis is observational, with no causal implications. Bivariate and multivariate methods are used to analyse the data. We first use logistic regression to explore the correlates of modern contraceptive use among Ghanaian men and women. Second, we explore the socioeconomic factors influencing the choice of modern contraceptive methods among contraceptive users using multinomial logistic regression. We classify the modern methods of contraception into three groups: long-acting reversible contraceptives (LARC), short-acting contraceptives (SAC), and permanent contraceptives.ResultsMarital status proves to be the most significant predictor for both men and women, with women in monogamous unions having a greater propensity to use modern methods of contraception (OR = 1.4, p < 0.00). We also find that different factors affect the use and choice of modern methods of contraception among men and women in Ghana. Muslim men had a higher likelihood than Catholics to choose the permanent (sterilisation) method (OR = 11.9, p < 0.05), while their female counterparts were 0.25 times less likely to choose sterilisation over SAC (p < 0.05). Moreover, women who ever tested for HIV had higher use of LAC than the SAC ((RRR = 1.6, p < 0.01). The modern contraceptive users (women) with at most basic education were more likely than those with tertiary education to choose LAC over SAC. Finally, rural women with health insurance were 0.75 times (p < 0.01) less likely to use modern methods of contraception.ConclusionsThe paper reiterates the need to intensify and sustain public health education on the health benefits of using modern methods of contraception among the adult population. The paper suggests that including family planning services on Ghana’s national health insurance benefits package is commendable. It can promote modern contraceptive use and curtail unwarranted population growth.

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.