Ghana Health Research Articles

Multidimensional Child Poverty in Ghana: Measurements, Determinants, and Inequalities

Early childhood deprivations and inequalities have social and economic implications in adulthood and thus, their elimination is essential for child development. However, child-level estimates of poverty are rare in low income countries. Using data from two recent rounds of the Ghana Demographic and Health Survey, we measure the extent and sources of childhood deprivations in Ghana and examine subgroup differentials in child poverty. In addition, we examine the child quality-quantity by estimating the causal relationship between number of children and child poverty. Finally, we assess the sources of rural-urban inequalities in child poverty. We find that despite declining incidence and intensity of multidimensional child poverty, significant subgroup differentials persist in Ghana. The findings of the paper reveal that living standards is the main contributor to multidimensional poverty in early childhood in Ghana. Our findings also confirm a significant causal relationship between child quality and quantity in Ghana, there exist a positive relationship between the number of children and the intensity of child poverty in Ghana. Finally, we find that rural-urban inequalities in child multidimensional poverty in Ghana are attributable to differences in observed maternal and household characteristics between rural and urban areas. The persistence of subgroup disparities in child poverty may be detrimental to achieving equitable and inclusive growth in the country. There is the need for considerations of equity, fairness and social justice in the distribution and development of social services and economic infrastructure to ensure even distribution of social and economic opportunities and promote social mobility across groups.

Geostatistical analysis and mapping: social and environmental determinants of under-five child mortality, evidence from the 2014 Ghana demographic and health survey

BackgroundUnder-five mortality (U5M) rates are among the health indicators of utmost importance globally. It is the goal 3 target 2.1 of the Sustainable Development Goals that is expected to be reduced to at least 25 per 1000 livebirths by 2030. Despite a considerable reduction in U5M observed globally, several countries especially those in sub-Saharan Africa (SSA) like Ghana are struggling to meet this target. Evidence-based targeting and utilization of the available limited public health resources are critical for effective design of intervention strategies that will enhance under-five child survival. We aimed to estimate and map U5M risk, with the ultimate goal of identifying communities at high risk where interventions and further research can be targeted.MethodsThe 2014 Ghana Demographic and Health Survey data was used in this study. Geostatistical analyses were conducted on 5884 children residing in 423 geographical clusters. The outcome variable is child survival status (alive or dead). We employed a geostatistical generalised linear mixed model to investigate both measured and unmeasured child specific and spatial risk factors for child survival. We then visualise child mortality by mapping the predictive probability of survival.ResultsOf the total sampled under 5 children, 289 (4.91%) experienced the outcome of interest. Children born as multiple births were at increased risk of mortality with an adjusted odds ratio (aOR) (aOR: 8.2532, 95% CI: [5.2608–12.9477]) compared to singletons. Maternal age increased risk of mortality (aOR: 1.0325, 95% CI: [1.0128–1.0527]). Child’s age (aOR: 0.2277, 95% CI: [0.1870–0.2771]) and number of children under 5 within each household (aOR: 0.3166, 95% CI: [0.2614–0.3835]) were shown to have a protective effect. Additionally, mothers with secondary education level (aOR: 0.6258, 95% CI: [0.4298–0.9114]) decreased the risk of U5M. The predicted U5M risk in 2014 was at 5.98%. Substantial residual spatial variations were observed in U5M.ConclusionThe analysis found that multiple births is highly associated with increased U5M in Ghana. The high-resolution maps show areas and communities where interventions and further research for U5M can be prioritised to have health impact.

Predictors of home births among rural women in Ghana: analysis of data from the 2014 Ghana Demographic and Health Survey

BackgroundHome births is one of the factors associated with maternal mortality. This study examined the predictors of home births among rural women in Ghana.MethodsData for this study was obtained from the 2014 Demographic and Health Survey (DHS) of Ghana. For the purpose of this study, a sample size of 2,101 women in the rural areas who had given birth within five years prior to the survey and had responses on variables was considered. Data processing, management and analysis were carried out using STATA version 14.0. This study carried out bivariate and multivariate analyses and results were tested at 95% confidence interval. The Adjusted odds ratios were used to present the results and the level of statistical significance was assessed using 95% confidence intervals.ResultsHome births was found to be high among women who resided in the Northern region compared to those in the Western region [AOR, 1.81 CI = 1.10–2.98]. Similarly, the likelihood of home birth was high among women with four or more births [AOR, 1.46 CI = 1.03–2.05] and Traditionalists [AOR, 2.50 CI = 1.54–4.06]. Conversely, giving birth at home was low among women with higher level of education [AOR = 0.58, CI = 0.43–0.78], those with rich wealth status [AOR = 0.19, CI = 0.10–0.38], those with four or more ANC visits [AOR = 0.11, CI = 0.15–0.23] and those who were covered by NHIS [AOR = 0.58, CI = 0.46–0.72].ConclusionsOver the years, there have been efforts by governments in Ghana to make maternal health services free in the country. However, a substantial proportion of women still undergo home births. To reduce the utilization of home births in Ghana, it is essential that government and non-governmental organisations make the cost of delivery services part of the free maternal health care policy and take into consideration the factors associated with the high rates of home births among rural women in Ghana.

Contraceptive use among women with a history of induced abortion: findings from a national sample of sexually active, non-pregnant women in Ghana

Objective The aim of the study was to examine the relationship between a history of induced abortion and current use of contraception among reproductive-aged women in Ghana. Methods The analysed data were a weighted sample of 6544 sexually active, non-pregnant women aged 15–49 years, obtained from the 2014 Ghana Demographic and Health Survey. Survey logistic regression analysis was used to estimate the odds of currently using any contraception and of using a modern method of contraception, given a history of induced abortion in the period 2009–2014. Results A history of induced abortion between 2009 and 2014 was reported by 17.4% of women (95% CI 16.0%, 18.9%); 28.7% (95% CI 26.9%, 30.6%) were currently using a method of contraception and 23.0% (95% CI 21.4%, 24.7%) were currently using a modern method of contraception. The majority (80.1%) of current contraceptive users were using a modern method. The adjusted analysis revealed no statistically significant association between a history of induced abortion and current contraceptive behaviour. Other factors were associated with modern contraceptive use. Conclusion Overall, the use of contraception among sexually active women in Ghana was found to be low. Our findings showed that women’s experience of induced abortion was unlikely to influence their current use of modern contraception.

Individual and contextual predictors of comprehensive HIV and AIDS knowledge among young females in Ghana

Sub-Saharan Africa is a region that is severely affected by the HIV and AIDS pandemic with females disproportionately affected. Having accurate and comprehensive knowledge about HIV and AIDS is a major strategy in the fight against the pandemic. This study sought to examine the individual and contextual predictors of comprehensive HIV and AIDS knowledge among young women in Ghana. The study used the females’ file from the 2014 Ghana Demographic and Health Survey dataset. A total of 1 407 young women were used for the analysis. Both bivariate and multivariate analyses were done. The results showed that about 22% of the respondents had comprehensive HIV and AIDS knowledge. Young women with secondary and higher levels of education (AOR = 2.85, p < 0.01) and those from the Upper East Region (AOR = 7.15, p < 0.001) had higher odds of comprehensive HIV and AIDS knowledge. However, those cohabiting (AOR = 0.57, p < 0.01) and those who do not watch TV at all (AOR = 0.50, p < 0.01) had lower odds of comprehensive HIV and AIDS knowledge. Comprehensive HIV and AIDS knowledge is low among young women in Ghana and the predictors are both individual (marital status and education) and contextual (region, watching television and listening to radio). A concerted effort is needed to improve the HIV and AIDS knowledge of young people. Mass media campaigns aimed at improving comprehensive HIV and AIDS knowledge should appreciate the individual and contextual factors that influence the comprehensive HIV & AIDS knowledge of young women.

Do Health Insurance Scheme affect the Livelihood of People in the Rural Area of Ghana: Empirical Evidence from Adaklu Anyigbe

The main objective of establishing the National Health Insurance Scheme (NHIS) is to protect the poor and put health in the hands of the people. It also aims to provide health services for all by abolishing the "cash and carry" system in which patients are asked to pay before they are treated. This study was conducted to assess a new method of financing Health Care in Ghana, evaluation of Mutual Health Insurance Scheme in Adaklu Anyigbe. A questionnaire was designed using structured questions to collect primary data from health facilities and clients of the NHIS. Personal interviews were held to solicit views and comments from some respondents. The results show that the availability of adequate funds for health care services is very important for the survival of the health insurance scheme. Adequate funding for health care services will assist in meeting health care services and delivery requirements for health service facilities and clients in Ghana. Meeting Ghana's health requirements will require the adoption of effective policies and guiding principles that integrate the input and concerns of all stakeholders from the health care business.

0966 Sleep-Wake Patterns in Mothers and Children in a Rural Community With Limited Access to Electricity: Results from the Ghana Randomized Air Pollution and Health Study

Abstract Introduction Studies measuring objective sleep duration in rural/indigenous populations are limited, showing sleep duration similar to that of industrialized countries. Little is known about sleep duration in women of reproductive age, and children within these populations. Our study is the first to objectively characterize sleep in mothers and children in an agrarian community with limited access to electricity, utilizing data from the Ghana Randomized Air Pollution and Heath Study (GRAPHS). Methods The GRAPHS cohort, a cluster-randomized trial, evaluated the efficacy of clean fuels on birthweight and infant pneumonia incidence in central Ghana. The study initially recruited pregnant women and newborns in 2013. This study is now utilizing wrist-actigraphy to analyze sleep-wake patterns among mothers and children of GRAPHS. We have thus far analyzed actigraphy in 39 mothers and 49 children (including 25 mother-child pairs), using the Motionlogger-MicroWatch with the Cole-Kripke algorithm to assess total sleep time (TST). We report baseline characteristics and sleep-wake patterns of our sample. Results Mean age of mothers was 33.5 years, (range 22-48), and mean age of children was 3.9 years (3-4). Average nights recorded were 4 (standard deviation [SD] 2.1). For mothers, average median time-in-bed was 7.9 (SD 1.2) hours, TST was 6.4 (SD .9) hours, and sleep efficiency was 82% (SD 7.9). Median bedtime was 9:33pm (SD 1.5 hours), and median wake-time was 5:56am (SD 1.4 hours). For children, average median time-in-bed was 9.9 (SD 1.0) hours, TST was 8.2 (SD 0.9) hours, and sleep efficiency was 83% (SD 6). Median bedtime was 8:03pm (SD 0.8 hours), and median wake-time was 6:06am (SD 0.6 hours). There was no correlation between sleep measures in mother-child pairs. Conclusion In an agrarian Ghanaian community with limited access to electricity, objective sleep measures in women were similar to prior studies conducted in indigenous/rural populations of developing African countries (Ndiaye et.al.2007, Samson et.al.2016), though data in children is lacking for comparison. When compared with post-industrialized countries, objective sleep measures for this age group of non-gravid women are sparse. In toddlers however, TST was lower in our cohort when compared with objective sleep amongst toddlers in industrialized nations. Support 2K24HL109156-06A1

Determinants of normal haemoglobin concentration among children in Ghana: a positive deviance analysis of nationally representative cross-sectional survey data

Anaemia among children under 5, is a public health problem of serious concern. In Ghana, an estimated 8 out of every 10 children are anaemic. This study employed a novel approach to investigate the determinants of normal haemoglobin (Hb) concentration among children aged 6 to 59 months, using data from the Ghana Demographic and Health Surveys. The results showed that maternal schooling was positively associated with normal Hb concentration among children. Children of non-anaemic mothers were 1.67 (CI = 1.32, 2.10; P < 0.001) times more likely to have normal Hb concentration relative to children of anaemic mothers. Compared to mothers who had less than 4 antenatal care (ANC) visits, mothers who had at least 4 ANC visits increased the odds of their children having a normal Hb concentration by 1.62 (CI = 1.09, 2.40; P < 0.018). Children living in middle and rich households had respectively 1.48 (CI = 1.06, 2.07; p < 0.021) and 1.59 (CI = 1.08, 2.33; p < 0.018) increased odds of having a normal Hb concentration relative to those living in poor households. Maternal education, anaemia, ANC attendance, and household wealth index are strong determinants of normal Hb concentration among children in Ghana. Strategies aimed at addressing childhood anaemia should take into account maternal anaemia, education, poverty and ANC attendance.

Patterns of access to reproductive health services in Ghana and Nigeria: results of a cluster analysis

BackgroundInequalities in access to health care result in systematic health differences between social groups. Interventions to improve health do not always consider these inequalities. To examine access to reproductive health care services in Ghana and Nigeria, the patterns of use of family planning and maternal care by women in these countries are explored.MethodsWe used population-level data from the Ghana and Nigeria Demographic Health Surveys of 2014 and 2013 respectively. We applied a two-step cluster analysis followed by multinomial logistic regression analysis.ResultsThe initial two-step cluster analyses related to family planning identified three clusters of women in Ghana and Nigeria: women with high, medium and poor access to family planning services. The subsequent two-step cluster analyses related to maternal care identified five distinct clusters: higher, high, medium, low and poor access to maternal health services in Ghana and Nigeria. Multinomial logistic regression showed that compared to women with secondary/higher education, women without education have higher odds of poor access to family planning services in Nigeria (OR = 2.54, 95% CI: 1.90–3.39) and in Ghana (OR = 1.257, 95% CI: 0.77–2.03). Compared to white-collar workers, women who are not working have increased odds of poor access to maternal health services in Nigeria (OR = 1.579, 95% CI: 1.081–2.307, p ≤ 0.01). This association is not observed for Ghana. Household wealth is strongly associated with access to family planning services and maternal health care services in Nigeria. Not having insurance in Ghana is associated with low access to family planning services, while this is not the case in Nigeria. In both countries, the absence of insurance is associated with poor access to maternal health services.ConclusionsThese differences confirm the importance of a focused context-specific approach towards reproductive health services, particularly to reduce inequality in access resulting from socio-economic status. Interventions should be focused on the categorization of services and population groups into priority classes based on needs assessment. In this way, they can help expand coverage of quality services bottom up to improve access among these vulnerable groups.

Assessing healthcare digitalisation in Ghana: A critical realist's approach

BackgroundThe emergence of digital technologies within the health sector has presented opportunities for improving medical care while strengthening health systems across the globe. Despite this promise, the extent of digitalisation, especially in developing countries, somewhat remains undetermined. Such knowledge is needed to learn and shape future advances in the sector. The purpose of this study, therefore, is to explore the generative mechanisms of digitalisation in the Ghanaian health sector, in order to understand and assess the extent of digitalisation, based on the digitalisation outcomes of the respective generative mechanisms. MethodsUnderpinned by the critical realism philosophy, a single case study approach was adopted to explore the generative mechanisms of digitalisation in the Ghanaian health sector, and how the varying degrees of digitalisation are interpreted and explained in the empirical world. ResultsThe study found five generative mechanisms of digitalisation in the Ghanaian health sector. These were Standardisation, Convergence and Connectivity, Storage Systems, Financial Transparency, and Data Security. Full activation of these mechanisms revealed that the first three generative mechanisms achieved high levels of digitalisation based on the extent of organisational transformations observed after the digitalisation process, as compared to the last two generative mechanisms which were rated as average. DiscussionThis study concludes that the extent of digitalisation in Ghana's health sector is more of reality than mere perception. The demonstration of how critical realism can be used to unearth insights into the extent of healthcare digitalisation in a developing country context spells the contribution of this paper.

Factors That Determine the Likelihood of Giving Birth to the First Child within 10 Months after Marriage.

Background One of the major aims of marriage is to procreate or give birth to a child. Childbirth is so crucial in marriage that it often determines the happiness of the couple. Too much delay in childbirth after marriage or the likelihood that one cannot give birth after marriage can lead to divorce. However, causes of delay in childbirth are often difficult to detect by both the Gynaecologist and the couple involved. This makes proposing solutions to issues related to childbirth usually unsuccessful. Methods It is against this background that we conducted this study to identify factors that determine childbirth within 10 months or after 10 months of marriage (birth length) among women in Ghana. This was achieved by using a logistic regression model for the dichotomous birth length variable, adjusting for risk factors/predictors of birth length. The data used for the study were obtained from the 2014 Ghana Demographic and Health Survey, consisting 6,525 complete cases with 18 predictor variables. Statistical analyses were carried out using STATA version 14.1. Results The results show that respondents who have ever terminated pregnancy are more likely (OR = 0.178, 95%CI = 0.044, 0.312) to deliver after 10 months, wives whose husbands have higher education are less likely (OR = ‐0.162, 95%CI = ‐0.236, ‐0.088) to give birth after 10 months of marriage, wives who reported that beating is justified if she goes out without her husband's notice are more likely (OR = 0.466, 95%CI = 0.305, 0.628) to give birth after 10 months, wives who reported that beating is justified if she neglects the child are more likely (OR = ‐0.305, 95%CI = ‐0.461, ‐0.149) to give birth within 10 months, and wives who reported that beating is justified when she argues with her husband are less likely (OR = ‐0.301, 95%CI = ‐0.451, ‐0.152) to give birth after 10 months of marriage. Every unit increase in the age of the respondent at marriage increases the likelihood of giving birth after 10 months of marriage, and a unit increase in the age of the respondent at first sex decreases the likelihood of giving birth after 10 months in marriage. Conclusions For conception within 1 month of marriage, wives and husbands should/are encouraged to have frequent sex, any negative social behaviour or policies must be discouraged, experts' advice on contraceptive use must be sought, and women are encouraged to desist from termination of pregnancy at any time of their life. Husbands should openly express their desire and love for their children since this increases the likelihood of wives' desire to give birth. This leads to frequent sex, which then reduces conception time, and hence childbirth within the shortest possible time.

Not just numbers: beyond counting caesarean deliveries to understanding their determinants in Ghana using a population based cross-sectional study

BackgroundThe increasing rate of caesarean deliveries (CD) has become a serious concern for public health experts globally. Despite this health concern, research on factors associated CD in many low- and -middle countries like Ghana is sparse. This study, therefore, assessed the prevalence and determinants of CD among child-bearing women aged 15–49 in Ghana.MethodsThe study used data from the 2014 Ghana Demographic and Health Survey. The analysis was limited to mothers (n = 2742) aged 15–49 , who had given birth in health facilities 5 years preceding the survey. Association between CD and its determinants was assessed by calculating adjusted odds ratios (AOR) with their respective 95% confidence intervals using a binary logistic regression.ResultsThe percentage of mothers who delivered their babies through caesarean section (CS) was 18.5%. Using multivariable logistic regression, the results showed that women aged 45–49 (AOR = 10.5; 95% CI: 3.0–37.4), and women from a household that are headed by a female (AOR = 1.3; 95% CI = 1.1–1.7) had higher odds to deliver through CS. Women from the Upper East (AOR =0.4; 95% CI = 0.2–0.7) and Upper West (AOR = 0.4; 95% CI = 0.2–0.8) regions had lower odds to deliver their children through CS. Women with parity 4 or more (AOR = 0.3; 95% CI = 0.2–0.5) had lower odds of CD compared to those with parity 1. Women with female babies had lower odds (AOR = 0.8; CI = 0.7–0.9) of delivering them through CS compared to those with male children.ConclusionThe percentage of women delivering babies through the CS in Ghana is high. The high rates of CD noted do not essentially indicate good quality care or services. Hence, health facilities offering this medical protocol need to adopt comprehensive and strict measures to ensure detailed medical justifications by doctors for performing these caesarean surgeries.

Geostatistical Analysis, Web-Based Mapping and Environmental Determinants of Under-Five Chronic Malnutrition (Stunting): Evidence from the 2014 Ghana Demographic and Health Survey

Geostatistical Analysis, Web-Based Mapping and Environmental Determinants of Under-Five Chronic Malnutrition (Stunting): Evidence from the 2014 Ghana Demographic and Health Survey

Prevalence, behavioral and socioeconomic factors associated with human immunodeficiency virus in Ghana: a population-based cross-sectional study

# Background Human immunodeficiency virus (HIV) is a serious public health problem and cause of death in many parts of Africa, including Ghana. Ghana has one of the highest rates of HIV in West Africa, yet factors associated with the prevalence of HIV infection are not well characterized. # Objectives This study aimed to assess HIV prevalence and associated knowledge, attitudes, and behavioral factors among men and women in Ghana. # Methods This a population-based cross-sectional study of 4,687 women between the ages of 15-49 years and 4,161 men between the ages of 15-59 years who participated in the Ghana Demographic and Health Surveys 2014 (GDHS-2014). The outcome variable was HIV status assessed through a blood test. Multivariable logistic regression was used to identify potential factors that were associated with HIV. # Results The overall prevalence of HIV in this study was 2%. Among women, the prevalence was 2.5%, and among men the prevalence was 1.1%. Increasing age was positively associated with the likelihood of HIV infection. Women between the ages of 35-49 years (adjusted odds ratio, aOR=3.51, 95% confidence interval, CI=1.65-7.47) and men between the ages of 35-49 years (aOR=7.07, 95% CI=1.48-33.80) were at a higher odds for HIV compared with women and men between the ages 15-24 years. Widowed, divorced, or separated women and men were more likely to test positive for HIV infection (aOR=1.78, 95% CI=1.00-3.15) and (aOR=2.95, 95% CI=1.26-6.91) when compared with never married women and men, respectively. # Conclusions In Ghana, the prevalence of HIV among women was approximately twice that of men. Factors such as increasing age, marital status, ever been tested for HIV, having one sex partner, and religion were significantly and independently associated with higher odds of HIV infection in Ghana.

Spatio-temporal variations in unmet need for family planning in Ghana: 2003\u20132014

Ghana has long prioritized family planning as a key strategy for improving health and socioeconomic development. However, despite the heavy investments in the sector over the last decade, the family planning program has not successfully improved the country’s family planning indicators. In this study, we describe the spatial and temporal patterns of unmet need for family planning from 2003 to 2014 and mainly estimate the socioeconomic factors affecting it. Using data from the 2003, 2008, and 2014 Ghana Demographic and Health Surveys, we map the regional and temporal trends in unmet need for family planning and used Bayesian multilevel logistic regression models to estimate the effects of individual-level socioeconomic characteristics on unmet need for family planning. The results show that there are considerable regional disparities in unmet need for family planning for the study period. These disparities show diverse trends among the ten regions in the country over the study period. The patterns of unmet need for family planning are considerably affected by socioeconomic factors such as educational attainment, household wealth, marital, and work status, as well as age, ethnicity, parity, and time (year). Both socioeconomic and demographic factors play a significant role in the patterns of unmet need for family planning in Ghana. There is the need to formulate consistently effective family planning policies focusing mainly on the higher risk groups of women in the country.

Risk factors for hypertension among Ghanaian: Evidence from Ghana demographic and health survey

Background: Hypertension is considered an important challenge in public health due to its high risk of cardiovascular disease, kidney disease and death. Despite interventions aimed at reducing the prevalence of hypertension, it still remains the leading cause of stoke and other related diseases and it accounts for 12.8% of all deaths worldwide. The goal of this paper is to explore factors that influences hypertension among men in Ghana. Knowledge of these factors will help public health practitioners provide targeted interventions which will result in a significant reduction of hypertension among the population.Methods: Data source is a survey aimed at collecting data on the indicators of the millennium development goals. Hypertension was the main outcome. Socioeconomic status (primary exposure variable) as well as other potential determinants were assessed. Analytic techniques included multiple Poisson regression that assessed the effects of potential covariates on hypertension in a hierarchical manner. Crude and adjusted prevalent rate ratios are reported with their corresponding 95% confidence intervals at 5% level of significance.Results: The overall prevalence rate of hypertension among Ghanaian men is 8%. Age was found to be a significant predictor of hypertension. Wealth index is also a significant predictor of hypertension with men in levels 4 and 5 more likely to develop hypertension compared to those belonging to level one after adjusting for other covariates. Men with secondary education were 23% more likely to develop hypertension compared to those with higher education, however those with no formal education were 32% less likely to develop hypertension compared to those with higher education after adjusting for other covariates. After adjusting for other covariates, professionals/technical/managerial workers were 35% more likely to be hypertensive compared to those engaged in farming. Men who visited some health facility within the last six months preceding the study were more likely to be hypertensive against those who did not visit any health facility within the same period. Hypertension is more prevalent among parents who lost two or more children compared to parents who were not bereaved. After adjusting for confounders, men with two or more lifetime partners were 13% more likely to be hypertensive as against those with only one lifetime partners.Conclusion: The rate of hypertension in Ghana is high. Factors such as age, wealth index, occupation, bereavement and number of lifetime partners are significant predictors of hypertension after adjusting for potential covariates.

Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data

BackgroundInappropriate use of Caesarean Section (CS) delivery is partly to blame for Ghana’s high maternal mortality rate. However, previous research offered mixed findings about factors associated with CS use. The goal of this study is to examine use of CS in Ghana and the socioeconomic factors associated with it.MethodsData from the nationally representative 2014 Ghana Demographic and Health Survey (GDHS) was used after permission from the Monitoring and Evaluation to Assess and Use Results (MEASURE) Demographic and Health Survey (DHS) program. Univariable and multivariable logistic regression models were fitted to examine the socioeconomic inequalities in CS use. The independent variables included maternal age, marital status, religion, ethnicity, education, place of residence, wealth quintile, and working status. Concentration index (CI) and rate-ratios were computed to ascertain the level of CS inequalities.ResultsOut of the 4294 women, 11.4% had CS delivery. However, the percentage of CS delivery ranged from 5% of women in the poorest quintile to 27.5% of women in the richest qunitle. Significant associations were detected between CS delivery and maternal age, parity, education, and wealth quintile .ConclusionsThis study revealed that first, even though Ghana has achieved an aggregate CS rate consistent with WHO recommendations, it still suffers from inequities in the use of CS. Second, both underuse of CS among poorer women in Ghana and overuse among rich and educated women are public health concerns that need to be addressed. Third, the results show in spite of Ghana’s free maternal care services policies, wealth status of women continues to be strongly and signtificantly associated with CS delivery, indicating that there are indirect health care costs and other reasons preventing poorer women from having access to CS which should be understood better and addressed with appropriate policies.

Childhood mortality, intra-household bargaining power and fertility preferences among women in Ghana

BackgroundContinuing population growth could be detrimental for social and economic wellbeing. Understanding the factors that influence family planning decisions will be important for policy. This paper examines the effect of childhood mortality and women’s bargaining power on family planning decisions.MethodsData was from the 2014 Ghana Demographic and Health Survey (DHS). A sample of 3313 women in their reproductive age were included in this study. We created variables on women’s exposure to and experience of child mortality risks. Three different indicators of women’s bargaining power in the household were also used. Probit models were estimated in accordance with the nature of the dependent variable.ResultsResults from the probit models suggest that child mortality has a positive association with higher fertility preference. Also, child mortality risks and woman’s bargaining power play important roles in a woman’s fertility choices in Ghana. Women with higher bargaining power were likely to prefer fewer children in the face of child mortality risks, compared to women with lower bargaining power.ConclusionIn addition to public sensitization campaigns on the dangers of high fertility and use of contraceptives, the findings of this study emphasize the need to focus on reducing child mortality and improving women bargaining power in developing countries.

“Do Health Insurance Scheme’’ Affect the Livelihood of People in the Rural Area of Ghana: Emperical Evidence from Adaklu Anyigbe

The main objective of establishing the National Health Insurance Scheme (NHIS) is to protect the poor and put health in the hands of the people. It also aim to provide health services for all by abolishing the "cash and carry" system in which patients are asked to pay before they are treated. This study was conducted to assess a new method of financing Health Care in Ghana, evaluation of Mutual Health Insurance Scheme in Adaklu Anyigbe. A questionnaire was designed using structured questions to collect primary data from health facilities and clients of the NHIS. Personal interviews were held to solicit views and comments from some respondents. The results show that the availability of adequate funds for health care services is very important for the survival of the health insurance scheme. Adequate funding for health care services will assist in meeting health care services and delivery requirements for health service facilities and clients in Ghana. Meeting Ghana's health requirements will require the adoption of effective policies and guiding principles that integrate the input and concerns of all stakeholders from the health care business. Keywords; Health insurance scheme; Health care delivery; rural people; Adaklu Anyigbe DOI : 10.7176/EJBM/11-26-11 Publication date :September 30 th 2019

Out-of-pocket payment for primary healthcare in the era of national health insurance: Evidence from northern Ghana.

BackgroundGhana introduced a national health insurance program in 2005 with the goal of removing user fees, popularly called “cash and carry”, along with their associated catastrophic and impoverishment effects on the population and ensuring access to equitable health care. However, after a decade of implementation, the impact of this program on user fees and out-of-pocket payment (OOP) is not properly documented. This paper contributes to understanding the impact of Ghana’s health insurance program on out-of-pocket healthcare payments and the factors associated with the level of out-of-pocket payments for primary healthcare in a predominantly rural region of Ghana.MethodsUsing a five-year panel data of revenues accruing to public primary health facilities in seven districts, We employed mean comparison tests (t-test) to examine the trend in revenues accruing from out-of-pocket payments vis-à-vis health insurance claims for health services, medication, and obstetric care. Furthermore, generalized estimation equation regression models were used to assess the relationship between explanatory variables and the level of out-of-pocket payments and health insurance claims.ResultsOut-of-pocket payment for health services and medications declined by 63% and 62% respectively between 2010 and 2014. Insurance claims however increased by 16% within the same period. There was statistically a significant mean reduction in out-of-pocket payment over the period. Factors significantly associated with out-of-pocket payments in a given district are the number of community health facilities, availability of a district hospital and the year of observation.ConclusionThe study provides evidence that Ghana’s national health insurance program is significantly contributing to a reduction in out-of-pocket payment for primary healthcare in public health facilities. Efforts should therefore be put in place to ensure the sustainability of this policy as a major pathway for achieving universal health coverage in Ghana.