Health In Ghana Research Articles

Factors associated with parental communication with young people about sexual and reproductive health

Purpose Available studies on parent-child communication about sexual and reproductive health in Ghana have largely focused on assessing communication frequency, barriers, and who communicates with whom within the family. The purpose of this paper is to examine parental and family contextual factors that predict parental communication with young people about sexual and reproductive health. Design/methodology/approach A cross-sectional interviewer-administered survey was conducted among 790 parents selected through a multistage sampling technique. The Cronbach’s α statistic was used to assess various parental and family contextual constructs on parent-child communication about sexual and reproductive health. Separate hierarchical multiple regression models for mothers and fathers were constructed to assess predictors of parental communication about sexual and reproductive health. Findings Nearly the same factors predicted mothers’ and fathers’ communication with young people about sexual and reproductive health matters. The predictors for both mothers and fathers included high socioeconomic status (SES), family religiousity, parent discipline, perceived parent sexual knowledge and parent trustworthiness. Parent permissiveness predicted only for fathers. Social implications Parental communication on sexual and reproductive health is influenced by high SES, family religiousity, parent sexual knowledge, parent discipline and trustworthiness. Interventional programmes on communication about sexual and reproductive health need to take cognisance of these factors to improve parent-child communication about sexual and reproductive health. Originality/value This paper adds to the limited evidence on parent-child communication about sexual and reproductive health in Ghana, by examining parental and family contextual factors that influence parental communication with young people about sexual and reproductive health.

The breast cancer fanfare: Sociocultural factors and women's health in Ghana

ABSTRACTTraditional notions of the “full” woman and sociocultural beliefs about gender roles contribute to a unique experience of breast cancer in Africa. I used the critical feminist lens to analyze dis-courses about breast cancer in mainstream Ghanaian media. I found that breast cancer awareness is promoted amidst fanfare and that cultural notions of the female breasts, including their sexual appeal, are implied in breast cancer discourse. This obscures a nuanced understanding of the disease and women's health globally, limits the power of women to name their experiences, and contributes to the late presentation of the dis-ease in sub-Saharan Africa. I discuss the implications of the findings for international, interdisciplinary scholarship.

Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana.

BackgroundIn Ghana, malaria is endemic and perennial (with significant seasonal variations in the three Northern Regions), accounting for 33 % of all deaths among children under 5 years old, with prevalence rates in children under-five ranging from 11 % in Greater Accra to 40 % in Northern Region. Ghana adopted the WHO-recommended Seasonal Malaria Chemoprevention (SMC) strategy with a trial in the Upper West Region in 2015. The objective of this study was to estimate the cost-effectiveness of seasonal malaria chemoprevention.MethodsCosts were analysed from provider and societal perspectives and are reported in 2015 US$. Data on resource use (direct and indirect costs) of the SMC intervention were collected from intervention records and a survey in all districts and at regional level. Additional numbers of malaria cases and deaths averted by the intervention were estimated based on prevalence data obtained from an SMC effectiveness study in the region. Incremental cost-effectiveness ratios (ICERs) were estimated for the districts and region. Sensitivity analyses were conducted to test the robustness of the ICERs.ResultsThe total financial cost of the intervention was US$1,142,040.80. The total economic cost was estimated to be US$7.96 million and US$2.66 million from the societal and provider perspectives, respectively. The additional numbers of cases estimated to be averted by the intervention were 24,881 and 808, respectively. The economic cost per child dosed was US$67.35 from societal perspective and US$22.53 from the provider perspective. The economic cost per additional case averted was US$107.06 from the provider perspective and US$319.96 from the societal perspective. The economic cost per additional child death averted by the intervention was US$3298.36 from the provider perspective and US$9858.02 from the societal perspective. The financial cost per the SMC intervention delivered to a child under-five was US$9.66. The ICERs were sensitive to mortality rate used.ConclusionsThe SMC intervention is economically beneficial in reducing morbidity in children under-5 years and presents a viable approach to improving under-five health in Ghana.

Child Development and Migrant Transnationalism: The Health of Children Who Stay Behind in Ghana and Nigeria

This paper examines the relation between parental migration and children’s health in Ghana (N = 2760) and Nigeria (N = 2168) and considers four dimensions of parental migration: the type of separation, parental migration and the caregiver, stability of care arrangements, and the availability of remittances. By employing an ordered scale of children’s self-rated health, we found that children with international migrant parents who are divorced/separated are less likely than children in non-migrant families to have good health. The magnitude of the effects are higher in Nigeria, attesting for a greater vulnerability of Nigerian children in divorced migrant families. Among children with parents living abroad who are stably married, specific dimensions of children’s transnational life are associated with negative health, while others are not. This study highlights the sensitivity of results to the context of parent-child separation and to the transnational dimension being measured.

Seeking Paths for Collaboration between Religious Leaders and Mental Health Professionals in Ghana

The treatment gap for mental illness is wide between low- and middle-income countries. The World Health Organization and other relevant bodies are seeking to reduce this gap through culturally innovative and sensitive programming. In Ghana, for example, only 2 % of the mentally ill access treatment, which means that 98 % do not receive care. Various discourses are ongoing to scale up mental health services in Ghana. One of these is the fostering of a collaborative framework between lay mental health workers (such as religious leaders or faith healers) and professional mental health workers. This article seeks to provide a framework within which collaborative linkages between religious leaders (e.g., the clergy, traditional healers) and professional mental health workers can be established. The article begins with a brief overview of Ghana’s mental health landscape, followed by a description of the challenges that make collaboration a difficult task. Next, the need for a holistic view of health in Ghana is addressed by examining Engel’s biopsychosocial model and Twumasi’s work on the complementary role of traditional systems. The essay ends by providing a three-step approach—understanding, task shifting, and broadened curricula—as a model to guide any collaboration between religious leaders and health practitioners in Ghana.

Community engagement to inform the development of a sickle cell counselor training and certification program in Ghana.

Sickle cell disease (SCD) and sickle cell trait (SCT) are highly prevalent in Africa. Despite public health implications, there is limited understanding of community issues for implementing newborn screening and appropriate family counseling. We conducted a 3-day workshop in Kumasi, Ghana, with community leaders as lay program development advisors to assist the development and implementation of a Sickle Cell Counselor Training and Certification Program. We employed qualitative methods to understand cultural, religious, and psychosocial dimensions of SCD and SCT, including the advisors' attitudes and beliefs in relation to developing a culturally sensitive approach to family education and counseling that is maximally suited to diverse communities in Ghana. We collated advisors' discussions and observations in order to understand community issues and potential challenges and guide strategies for advocacy in SCD family education and counseling. Results from the workshop revealed that community leaders representing diverse communities in Ghana were engaged constructively in discussions about developing a culturally sensitive counselor training program. Key findings included the importance of improved knowledge about SCD among the public and youth in particular, the value of stakeholders such as elders and religious and traditional leaders, and government expectations of reduced SCD births. We submitted a report to the Ministry of Health in Ghana with recommendations for the next steps in developing a national sickle cell counselor training program. We named the program "Genetic Education and Counseling for Sickle Cell Conditions in Ghana" (GENECIS-Ghana). The first GENECIS-Ghana Training and Certification Program Workshop was conducted from June 8 to 12, 2015.

Exploring the use of smartphones and tablets by medical House Officers in Korle-Bu Teaching Hospital.

Smartphones and tablets are being used widely in the Western World creating benefits in healthcare. The Ministry of Health in Ghana has an e-Health strategy, with the aim of integrating such resources into healthcare. Whilst there are numerous mHealth projects going on in Ghana, there is little evidence of doctors using such devices in their practice. A qualitative study was undertaken in Korle-Bu Teaching Hospital. Random sampling was used to identify House Officers, who engaged in semi-structured interviews. Interviews were recorded, transcribed and analysed using thematic content analysis. Consent was gained from all participants and the University of Leeds granted ethical approval. The results demonstrate that current House Officers began using smartphones and tablets at various stages during medical school. Their use has increased since qualification. Although the overall use has increased, some staff remain resistant to the use of smartphones and tablets. In the future, the integration of smartphones and tablets into medical practice can be improved by integration with the medical curriculum and accepted practice. House Officers are routinely using smartphones and tablets to assist them in their daily practice. The use is informal and is peer led. Whilst they bring many benefits, there are issues, which need to be addressed. In Korle-Bu Teaching Hospital integrating smartphone and tablet use into practice is feasible and would prove beneficial.

Ghana mental health Act 846 2012: a qualitative study of the challenges and priorities for implementation

Objectives : This study aims to describe the views of key stakeholders in mental health in Ghana on the challenges faced with regard to the implementation of, and priorities for implementation of, the 2012 Mental Health Act of Ghana. Design : A cross-sectional qualitative study with 12 participants, using semi-structured interviews. Setting : Greater Accra Region. Participants : The study population consisted of three groups; Members of the Mental Health Authority Board (MHAB), Providers of Mental Health Care working for the Mental Health Authority and Representatives of non-governmental and educational organisations working in mental health, Four participants were identified from each group. Interventions : Not Available Main outcome measures : The interviews, subsequent analysis and output were based around three main topics of discussion: awareness of the Act, challenges to the implementation of the Act, and priorities for implementation. Results : Challenges identified include: financial limitations, the limited dissemination of the act, delays in the approval of the Legislative Instrument by the Attorney General’s Department, losing access to patients in non-orthodox mental health facilities, inadequate resources for implementation, legal infrastructure, timeframe, and the lack of a physical presence for the new Mental Health Authority. Suggested priorities for implementation include: development of human and financial resources, education, passing of the LI (Legislative Instrument), infrastructure development and human rights protection. Conclusions : Challenges identified in this study are likely to be applicable to other nations seeking to implement modern Mental Health Legislation. Key stakeholders in the mental health system showed broad concordance in the immediate priorities for Ghana’s Mental Health System. Keywords : Mental health, Psychiatry, Ghana, Mental health legislation, Policy implementation

Stigma and the Social Environment of Adolescent Sexual and Reproductive Health in Ghana: Understanding “Bad Girl”

Stigma and the Social Environment of Adolescent Sexual and Reproductive Health in Ghana: Understanding “Bad Girl”

Social Factors Influencing Child Health in Ghana.

ObjectivesSocial factors have profound effects on health. Children are especially vulnerable to social influences, particularly in their early years. Adverse social exposures in childhood can lead to chronic disorders later in life. Here, we sought to identify and evaluate the impact of social factors on child health in Ghana. As Ghana is unlikely to achieve the Millennium Development Goals’ target of reducing child mortality by two-thirds between 1990 and 2015, we deemed it necessary to identify social determinants that might have contributed to the non-realisation of this goal.MethodsScienceDirect, PubMed, MEDLINE via EBSCO and Google Scholar were searched for published articles reporting on the influence of social factors on child health in Ghana. After screening the 98 articles identified, 34 of them that met our inclusion criteria were selected for qualitative review.ResultsMajor social factors influencing child health in the country include maternal education, rural-urban disparities (place of residence), family income (wealth/poverty) and high dependency (multiparousity). These factors are associated with child mortality, nutritional status of children, completion of immunisation programmes, health-seeking behaviour and hygiene practices.ConclusionsSeveral social factors influence child health outcomes in Ghana. Developing more effective responses to these social determinants would require sustainable efforts from all stakeholders including the Government, healthcare providers and families. We recommend the development of interventions that would support families through direct social support initiatives aimed at alleviating poverty and inequality, and indirect approaches targeted at eliminating the dependence of poor health outcomes on social factors. Importantly, the expansion of quality free education interventions to improve would-be-mother’s health knowledge is emphasised.

The effect of maternal education on child health: some evidence from Ghana

Ghana has witnessed marked improvement in child health over the past three decades, albeit the progress has been slow and unevenly distributed across the country. The country's under-five mortality rate, though better than the average for sub-Saharan Africa, lags behind that of some low and middle-income countries in the sub-region. The situation is not different from the incidence of diseases such as acute respiratory infection (ARI), diarrhoeal diseases and fever among children in Ghana. While a number of studies have been conducted to investigate the factors that influence child health, there is limited evidence regarding the effect of maternal education on child health in Ghana. This paper seeks to examine the effect of maternal education on under-five morbidity particularly the incidence of ARI, diarrhoea and fever in Ghana. Using the 2008 Ghana Demographic and Health Survey (GDHS) and employing logistic regression, the paper shows that higher maternal education significantly and consistently reduces the incidence of diarrhoea, ARI and fever among children aged under-five in Ghana. The paper recommends the integration of maternal education in maternal and child health policies in Ghana.

“I was on the way to the hospital but delivered in the bush”: Maternal health in Ghana's Upper West Region in the context of a traditional birth attendants' ban

This study examines perceptions and experiences of mothers, traditional birth attendants (TBA), and skilled birth attendants (SBA) regarding Ghana's recent policy that forbids TBAs from undertaking deliveries and restricts their role to referrals. In the larger context of Ghana's highly underdeveloped and geographically uneven health care system, this study draws on the political ecology of health framework to explore the ways global safe motherhood policy discourses intersect with local socio-cultural and political environments of Ghana's Upper West Region (UWR). This study reveals that futile improvements in maternal health and the continued reliance on TBAs illustrate the government's inability to understand local realities marked by poor access to SBAs or modern health care services. Using focus group discussions (FGDs) (n = 10) and in-depth interviews (IDIs) (n = 48) conducted in Ghana's UWR, the findings suggest that mothers generally perceive TBAs as better placed to conduct deliveries in rural isolated communities, where in most cases no SBAs are present or easily accessible. The results indicate that by adhering to the World Health Organization's guidelines, the local government may be imposing detrimental, unintended consequences on maternal and child health in remote rural locations. In addition, the findings suggest that the new policy has resulted in considerable confusion among TBAs, many of whom remain oblivious or have not been officially notified about the new policy. Furthermore, participant accounts suggest that the new policy is seen as contributing to worsening relations and tensions between TBAs and SBAs, a situation that undermines the delivery of maternal health services in the region. The study concludes by suggesting relevant policy recommendations.

Understanding “Bad Girl:” qualitative findings on stigma and adolescent sexual and reproductive health in Ghana

Understanding “Bad Girl:” qualitative findings on stigma and adolescent sexual and reproductive health in Ghana

The Use of Evidence Within Policy Evaluation in Health in Ghana: Implications for Accountability and Democratic Governance

The use of evidence in policymaking is commonly considered a good practice of democratic governance by improving accountability, effectiveness, and stakeholders’ involvement in policy decisions. The features of this practice, however, remain vague in the general discourse of evidence‐based policymaking (EBPM) with the risk of obscuring important governance and legitimacy implications. In policy evaluation especially, the use of evidence can be critical to translate technical measurements of policy achievements into political values for shaping future policy directions. We present a case study based on the health policy review process in Ghana in order to discuss how institutionalized evidentiary practices used in policy evaluation affect structures and processes of democratic governance. Drawing on qualitative interviews with international and local actors, we reflect on how the evidence review process—a process agreed in collaboration with development partners—links to the evidence advisory system and the accountability systems in place. We find that the uses of evidence promoted by international donors within the evaluation process actually creates disconnect with the national accountability system in place, with implications for democratic governance.

An evaluation of the current state of sexual and reproductive health and rights of women in Ghana

Objective: To provide a current account of women’s sexual and reproductive health and rights (SRHR) in Ghana (West Africa), a priority area in achieving the World Health Organization’s Millennium Development Goals.Method: The study was observational. Three-hundred ninety Ghanaian women attending cervical cancer screening were surveyed about their SRHR. The data were analyzed with chi-squared test (p ≤ 0.05, two-sided).Results: 22.1% had a life-time history of non-consensual sexual experience and 55.4% a previous history of abortion, mostly using services of a registered clinic (68.5%). Experience of sexual violence increased life-time risk of abortion (p = 0.018). The overall use of contraceptives was high (>60%); however, condom use during sexual intercourse with a new partner was low (23%), even among the highly educated women (32.7%) and women who stated to have received information on the risks and benefits of condom use (26.0%). Although condom use among the highly educated women was low, it was still 2 times higher than among the lower educated women, 15.7% (p < 0.001). There was also less condom use among the women with multiple sexual partners compared to single-partnered women (p = 0.001).Conclusion: More than a decade after the inception of the Millennium Development Goals, there is still work to be done in Ghana, especially on education and sexual violence.

Gender disparities of chronic musculoskeletal disorder burden in the elderly Ghanaian population: study on global ageing and adult health (SAGE WAVE 1).

BackgroundTraditionally, non-communicable diseases including musculoskeletal disorders have not been a priority in low-and-middle income countries. The main aim of this paper is to assess age and gender specific burden by estimating the current prevalence of musculoskeletal disorders and associated risk factors in the elderly Ghanaian population.MethodsBetween May 2007 and June 2008, the World Health Organization conducted a nationwide study on AGEing (SAGE) and Adult Health in Ghana. The study employed a multistage cluster sampling strategy to identify participants by stratifying the population by age and setting. A structured questionnaire was used for data collection. A Poisson regression model was fitted with robust error variance. Prevalence estimates took into account the complex survey design and sampling weights. Statistical significance was considered at p ≤ 0.05 significance level. Statistical analysis was performed with STATA version 11.2.ResultsThe prevalence rates of chronic back pain and chronic arthritis/joints pain were higher in women than men. The overall crude prevalence’s rates were 28.2 and 10.7 % for chronic back pain and chronic arthritis/joints pain respectively. Substantial differences existed between men and women in terms of socio-economic status, education level and occupational status. Women with primary education had a chronic back pain prevalence of 36.2 % (95 % CI; 29.2, 43.3) and chronic arthritis/joints pain prevalence of 15.8 % (95 % CI; 11.1, 20.6) while their male counterparts had prevalence rates of 29.0 % (95 % CI; 23.4, 34.5) and 9.8 % (95 % CI; 6.4, 13.2) respectively. Residence (rural and urban) did not appear to influence the prevalence of chronic back pain and arthritis/joints pain.ConclusionOur findings suggest the existence of sex differences in chronic back pain and chronic arthritis/joint pain in the elderly population in Ghana after adjustment for demographic and socio-economic factors. It indicates the existence of inequalities in health between elderly men and women with women suffering more from chronic back pain and chronic arthritis/joints pain.

A qualitative analysis of levels of influence on adolescent sexual and reproductive health in Ghana

A qualitative analysis of levels of influence on adolescent sexual and reproductive health in Ghana

Effect of timely initiation of breastfeeding on child health in Ghana.

BackgroundEarly initiation of breastfeeding and exclusive breastfeeding practices have been argued to be one of the important ways of ensuring child health. Unfortunately, owing to modernization, most nursing mothers fail to adhere to such practices. This is believed to be a factor contributory to poor child health in Ghana. Thus, this study investigated the effect of timely initiation of breastfeeding on child health in Ghana.MethodsCross sectional data using secondary data based on the positivism approach to research was employed. The Ordinary least squares and the Instrumental variables approach were used in estimating the effect of breastfeeding and other socio demographic indicators on the health of the child. Data for the study was sourced from the 2008 round of the Ghana Demographic and Health Survey.ResultsThe results indicate that timely initiation of breastfeeding, both immediately and hours after birth are important factors that influence the child’s health. Additionally, factors such as the wealth of the household, mother’s education, age and size of the child at birth and age of the mother are important factors that also influence the health of the child in Ghana.ConclusionThe findings imply that efforts should be made on encouraging appropriate breastfeeding practices among nursing mothers to ensure proper child development and growth in Ghana.

Textual prediction of attitudes towards mental health

A simple search on Google with the phrase 'Mental Health in Ghana' will produce lots of hits including news items through publications to mental health bills. A lot of information is hidden in such unstructured data and could be mined to improve mental health in Ghana. For this reason, lexicon-based sentiment analysis and supervised machine learning was applied on a corpus of 28 journal articles and two news items in mental health. The sentiment score for the lexicon-based text analysis was negative indicating negative impression on mental health. SVM classification outperformed other algorithms with accuracy of 0.839. MAXENT was the worst performer accuracy 0.774. F-score for SVM was 0.67; 0.64 for MAXENT and 0.59 for RF. 83.9% accuracy means that we can effectively predict human behaviour towards mental health via text mining because our behaviours are influenced by opinions we carry.

Informing evidence-based policies for ageing and health in Ghana.

ProblemGhana’s population is ageing. In 2011, the Government of Ghana requested technical support from the World Health Organization (WHO) to help revise national policies on ageing and health.ApproachWe applied WHO’s knowledge translation framework on ageing and health to assist evidence based policy-making in Ghana. First, we defined priority problems and health system responses by performing a country assessment of epidemiologic data, policy review, site visits and interviews of key informants. Second, we gathered evidence on effective health systems interventions in low- middle- and high-income countries. Third, key stakeholders were engaged in a policy dialogue. Fourth, policy briefs were developed and presented to the Ghana Health Services.Local settingGhana has a well-structured health system that can adapt to meet the health care needs of older people. Relevant changesSix problems were selected as priorities, however after the policy dialogue, only five were agreed as priorities by the stakeholders. The key stakeholders drafted evidence-based policy recommendations that were used to develop policy briefs. The briefs were presented to the Ghana Health Service in 2014.Lessons learntThe framework can be used to build local capacity on evidence-informed policy-making. However, knowledge translation tools need further development to be used in low-income countries and in the field of ageing. The terms and language of the tools need to be adapted to local contexts. Evidence for health system interventions on ageing populations is very limited, particularly for low- and middle-income settings.