Women In Rural Ghana Research Articles

Exploring the experiences of the overburden of water collection responsibility of rural women in Ghana

ABSTRACT Despite evidence emphasizing women's responsibility for collecting water in sub-Saharan Africa, more needs to be known about the gender-specific consequences of this obligation, especially in rural Ghana, where water inaccessibility is a persistent issue. Employing a community-based case study, this research aimed to explore the gendered consequences of women's water collection responsibility, using a coupled systems framework. Data were gathered from surveys and focus groups and analysed statistically and thematically, respectively. Key findings highlighted intersecting influences in women's water access and collection difficulties, including distance to water sources, poverty, and health issues. Results revealed that over 50% of women experienced multiple consequences, including physical and psychological injuries (>80%), animal attacks (≤12%), spousal violence (>40%), nutritional challenges (>30%), hygiene problems (>40%), and socioeconomic issues (>50%). Over half faced three to seven intersecting water-related consequences, which intensified their difficulty in accessing and collecting water. Differences were observed across sub-communities. Interestingly, not all men had knowledge of these consequences, highlighting the crucial need to broaden their understanding as part of the solution to ease women's burdens. Addressing sociocultural norms and the various factors influencing access through effective and gendered water management and planning is imperative to alleviate women's burdens and improve equitable access.

Determinants of Open Defecation Among Rural Women in Ghana: Analysis of Demographic and Health Surveys.

Open defecation continuously remains a major global sanitation challenge, contributing to an estimated 1.6 million deaths per year. Ghana ranks second in Africa for open defecation and had the fourth-lowest sanitation coverage in 2010. Evidence indicates that about 32% of the rural Ghanaian population still practice open defecation due to lack of access to basic sanitation facilities, drifting the country from achieving universal access to sanitation by 2030. Women, particularly those in rural areas, are disproportionately affected by open defecation, facing heightened health risks, harassment, and a loss of dignity. Even though previous studies on open defecation in Ghana exist, they lack national representation and neglect women in rural residents who are disproportionally affected by the repercussions of open defecation. Examining that rural women will contribute to heightening their own vulnerability to health risks by practising open defecation is essential to bridging the literature gap on open defecation practices among rural women. The study investigated determinants of open defecation among rural women in Ghana using data from the female files of the 2003, 2008 and 2014 Demographic and Health Surveys (DHS). A total of 4,284 rural women with complete information on variables of interest were included in the study. The outcome variable was 'open defecation', whilst 14 key explanatory variables (e.g., age, education, wealth status, among others) were used. Two logistic regression models were built, and the outputs were reported in odds ratio. Descriptively, 42 in every 100 women aged 15 to 49 practiced open defecation (n = 1811, 95% CI = 49-52). Open defecation (OD) significantly correlated with educational attainment, wealth status, religion, access to mass media, partner's education, and zone of residence. The likelihood of practicing open defecation reduced among those with formal education [aOR = 0.69, CI = 0.56-0.85], those whose partners had formal education [aOR = 0.64, CI = 0.52-0.80], women in the rich wealth quintile [aOR = 0.12, CI = 0.07-0.20], the traditionalist [aOR = 0.33, CI = 0.19-0.57], and those who had access to mass media [aOR = 0.70, CI = 0.57-0.85]. Residents in the Savannah zone had higher odds of openly defecating [aOR = 21.06, CI = 15.97-27.77]. The prevalence of open defecation is disproportionately pro-poor, which indicates that impoverished rural women are more likely to perform it. Public health initiatives should aim to close the rich-poor divide in OD practice among rural women.

Cassava-gari value chain participation and rural women’s wellbeing: An exploratory study

Gender disparity has a severe and long-term consequence on women especially in developing African countries such as Ghana. The socio-economic effect of gender inequality is harsher on rural women dwellers in Ghana due to lack of access to business and livelihood empowering opportunities. One way to deal with the above and improve the economic wellbeing of rural women dwellers is to create economic opportunities from which they can earn a good income. In Ghana, rural women could participate in the entire value chain of food crops such as cassava as they already participate in its cultivation (upstream activities of the supply chain). The current study adopts the approach of literature review on cassava and gari production in Ghana; and conducts interviews and observations on gari processing in Ghana to share useful lessons on how to deal with socio-economic effect of gender disparity among rural women dwellers. This study interviewed women in two gari processing enclaves in the country to provide useful insight on how women wellbeing could be enhanced. A total of 17 women entrepreneurs, 33 female workers and 7 farmers from 10 communities were interviewed and observed. Firstly, this study provides an understanding of the cassava-gari (roasted fermented cassava in a form of tiny grains) value chain, and the role rural women entrepreneurs can play to enrich their livelihood. Secondly, the study highlights the key activities of gari processing by women in rural Ghana, the challenges faced, and provides valuable conclusions on how to bridge the gender gap through women’s participation in an enhanced cassava-gari value chain. Lastly, two important issues are highlighted with respect to rural women’s participation in an enhanced gari value chain: (1) the opportunity for affordable nutrition through a common local farm produce, and (2) the economic livelihood of rural women. While rural women possess enough capacity to participate meaningfully in the value chain, there are still constraints that can be dealt with by any enterprise that seeks to venture into large-scale commercial fortified gari production. Such ventures, be it a social (businesses for social good) or commercial (profit centered businesses) enterprise, will enhance access to affordable nutrition as well as economic empowerment. Key words: Value Chain, Food-processing, Gari, Women Entrepreneurship, Wellbeing, Africa

“We know it is not good, but we are constrained”: A study on quality of emergency obstetric and newborn care in Northern Ghana

ObjectiveTo explore the quality of emergency obstetric and newborn care provided to newly delivered women in rural Ghana. MethodsA multiple case study design, involving in-depth face to face interviews, was deployed to draw evidence from essential health providers, clients and caretakers. Data were further derived from non-participant observation by means of an observation guide and analysis of physical artifacts using the room-by-room walk-through tool. Data analysis followed Yin’s five phase process to case study analysis. ResultsQuality of care was compromised by non-adherence to standard practices, inadequate monitoring, crude treatment procedures, lack of basic care needs and poor health providers' relational behaviours. Limited supplies of drugs, equipment and essential care providers further weakened the provision of quality emergency obstetric and newborn care. ConclusionInadequate supply of essential logistics and skill gaps on the part of health providers in some maternal and newborn care components adversely produced poor maternal and neonatal outcomes in rural Ghana. Elements of disrespectful care for women suggest violations of their rights in the maternal and newborn care encounter.

English

This survey study examines the effectiveness of a Rural Enterprise Programme (REP) in improving the livelihood of rural women in Ghana, using ex-anti and ex-post income determinants of the programme. Some 217 beneficiary women drawn from farm-based, agro-processing, traditional craft, agro industrial and petty trading economic sub-sectors selected to participate in the survey using snow-ball sampling method. Using cross-sectional design, questionnaire with open and closed ended items was used to collect data. The IBM SPSS Statistics (SPSS version 20) was used to analyze the data and the results were qualitatively presented in tables and charts. The study found that the various inputs and strategies used in the Rural Enterprise Programme to empower women included education and training that equipped beneficiary with literacy skills to enhance their entrepreneurial roles and labour market. The result showed that the women empowerment strategies employed by the programme produced intermediate and long-term outcomes increasing the nominal income of the participants, indicating improvement in the well-being of the rural women. However, the study identified a gap in accessing affordable finance (credit) and high cost of inputs which presented challenge to the responsiveness of the REP to the beneficiary rural women economic well-being. The study corroborates the literature on rural women empowerment in West African that evidence a high degree of vulnerabilities of rural women’s access to economic resources which are predominantly owned by men. The study recommends future ethnographically informed case study to investigate culturally responsive strategies that can work best in economically empowering women in African traditional rural men-dominated cultural and economic context. Key words: Rural women, economic empowerment, livelihood, well-being, strategies, rural enterprise programme, Ghana West Africa.

Women Empowerment and Skilled Birth Attendants among Women in Rural Ghana.

Background A critical public health issue is maternal mortality. Around 810 women die per day from pregnancy and childbirth, with approximately 99 percent of these deaths recorded in low-and middle-income countries (LMICs). In sub-Saharan Africa (SSA), more than half of these mortalities are registered. The situation is remarkably similar in Ghana, with maternal mortality standing at 319 deaths per 100,000 live births in 2015. Methods Using data from 2014 Demographic and Health Surveys, the study examined the association between women empowerment and skilled birth attendance among women in rural Ghana. Results Women with medium decision-making (OR = 0.75, CI = 0.61, 0.93), low knowledge level (OR = 0.55, CI = 0.40, 0.76), high acceptance of wife beating (OR = 0.68, CI = 0.51, 0.90), with less than 4 ANC visits (OR = 0.25, CI = 0.19, 0.32), whose partner had higher education (OR = 1.96, CI = 1.05, 3.64), and who had a big problem with the distance getting to the health facility (OR = 0.63, CI = 0.50, 0.78) had a significant association with skilled birth attendants. Decision-making power, women's knowledge level, acceptance of wife beating, antenatal care visit, partner's education, getting medical help for self, and distance to health facility were seen to have a significant association with skilled birth attendants among women in Ghana. Conclusion Efforts to increase the current SBA should concentrate on the empowerment of women, male involvement in maternal health problems, women's education, and participation in the ANC. There is a need to review current policies, strategies, and services to improve maternal health conditions.

Barriers to the participation of women in community development process in rural Ghana: a regression analysis

ABSTRACT Women across the world face a myriad of barriers in every sphere of their socio-economic life, negatively affecting their ability to utilise available societal resources to achieve their full potential. They are often relegated to the background when it comes to participation in community development and decision-making. The present study seeks to examine the relative strength of barriers to women’s involvement in the community development processes in rural Ghana. A multistage sampling technique was used to recruit 210 women from three rural communities in Ghana. A questionnaire comprising a series of scales was used to collect the data. The study found that the most critical barriers faced by women in rural Ghana include the patriarchal norms of Ghanaian society, as well as behavioural, and idiosyncratic patterns associated with their socialisation. The study recommends the provision of opportunities to communities to be able to empower and encourage themselves to make the cultural shifts necessary to overcome and address the key barriers women face. Community development processes must incorporate meaningful participatory approaches geared towards greater equality, freedom, and advancement of local community members, especially women.

Women’s participation in community development in rural Ghana: The effects of colonialism, neoliberalism, and patriarchy

ABSTRACT Women’s empowerment and gender equality have been given attention by development practitioners and communities over the last two decades. Studies show, however, that in the face of the increase attention to gender equality in community development, women’s advancement, and participation in both developed and developing countries are restricted. The situation of women involvement in the community development process in Ghana is abysmal. The purpose of this study was to ascertain how colonialism, patriarchy and neoliberalism serve as barriers to women within community development processes in rural Ghana. This paper is approached from transnational feminist perspective. A total of twelve (12) women from three randomly selected rural communities in Ghana were interviewed about their community development experiences. The findings implicate Western influence and structural factors in the low participation of women in community development processes in rural Ghana. This study found that Western interference in the form of the superimposition of a neoliberal capitalist agenda has had a negative consequence on the level of participation of women in their communities. This ideology has imbued in women individualistic ideals to the detriment of traditional communal life. The women were particularly disadvantaged by the reliance on level of education and fluency in English, as requirements for local government positions since English is the national business language. The existing patriarchal norms and values in rural communities such as traditional gender roles and “name calling” militate against women within the context of community development. Western interference, colonialism, patriarchy, and capitalist ideologies continue to hinder the involvement of women in the development of their communities. It is therefore important to address these issues to help better the lives of women in rural Ghana.

Explanations for infertility: The case of women in rural Ghana.

Infertility is a troubling condition for couples, especially for women, in pronatalist cultures. The ways in which infertility is explained have important effects on the stigma associated with childlessness and thus on the suffering it causes. This article explored the explanations for infertility among involuntarily childless women in the North-East and Ashanti regions of Ghana. Thirty infertile married women were interviewed, 15 from each region, by using a semi-structured interview protocol. A phenomenological study design and thematic analysis were used to explore the aetiological explanations of their infertility. The data from the Ashanti region was transcribed verbatim from Twi to English, coded, and analysed into themes unlike the data from the North-East which was already in English. Most of these infertile women attributed their condition to supernatural factors irrespective of their settings, level of education, and religion. They proffered such explanations for conditions for which they could not readily pinpoint causes or when these were for them beyond comprehension. Other explanations of infertility were medical, such as fluid in the ovaries and hormonal imbalance. Moreover, lifestyle factors such as the use of contraceptives or having had an abortion were mentioned. Some women mentioned that the cause of their infertility had not been found. Health professionals should educate women on reproductive health issues. Counsellors and therapists should educate would-be couples on the possible challenges in marriages, especially concerning childlessness and infertility. Moreover, to reduce stigma, it is essential that the communities are educated on the documented causes of infertility.

Crowding-out or crowding-in? Effects of LEAP 1000 unconditional cash transfer program on household and community support among women in rural Ghana

Abstract Social protection programs are not introduced in a vacuum and it is important to understand what effects such programs have on existing informal support networks of family, friends and community members. A social cash transfer may reduce receipt of informal financial support, which can water down part of the program’s impact. However, cash transfers can also reduce barriers to social participation and enable participants to engage in reciprocal support systems. We use data from the quasi-experimental mixed method impact evaluation of Ghana’s Livelihood Empowerment Against Poverty (LEAP) 1000 program, a social cash transfer program for pregnant women and mothers of children under one year living in poverty, to estimate program effects on social support and participation. Using a difference-in-differences approach we find that LEAP 1000 increases overall social support, as well as both emotional and instrumental support. In addition, program beneficiaries are more likely to participate in community groups. In in-depth interviews, participants confirmed increased support with descriptions of improved access to financial markets, such as borrowing money or contributing to local savings schemes, and strengthening of social participation in local groups and gatherings. Beneficiary women also highlighted reduced need for economic support and new opportunities to support others. By creating opportunities for additional social support within the household and community, LEAP 1000 crowded-in support, rather than reducing existing sources of support or crowding-out support.

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

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

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.

Women's knowledge and its associated factors regarding optimum utilisation of antenatal care in rural Ghana: A cross-sectional study.

Improving maternal health is a global public health challenge especially in sub-Saharan Africa. The optimum utilisation of antenatal care (ANC) by pregnant women is known to improve maternal health outcomes. Maternal morbidity and mortality rates in Ghana remain unacceptably high, particularly in rural settings where skilled delivery care often times is disproportionally low. This study assessed factors associated with optimum utilisation of antenatal care in rural Ghana. A cross-sectional design was applied to collect data among eligible participants between October 2018 and January 2019. A total of 322 women who gave birth and attended the postnatal clinic were recruited for the study. Consecutive sampling was employed in recruiting participants. The associations between the dependent variables (ANC service utilisation and knowledge of ANC) and independent variables (socio-demographic characteristics) were examined using ordinary least squares logistic regression at 95% confidence interval in STATA version 14.0. Of the 322 participants, 69.0% reported utilising at least four or more times ANC services. Determinants of women attending ANC for four or more times was significantly associated with age [OR = 4.36 (95%CI: 2.16-8.80), p<0.001], educational level [OR = 10.18 (95%CI: 3.86-26.87), p<0.001], and insured with National Health Insurance Scheme [OR = 3.42 (95%CI: 1.72-6.82), p<0.001]. Not married [OR = 0.65 (0.39-1.09), p = 0.011] or divorced [OR = 0.33 (95%CI: 0.13-0.83), p = 0.019] was negatively associated with utilisation of four or more ANC services. The majority (79.0%) of the participants had a good level of knowledge regarding antenatal care. Although the majority of women in this study had good knowledge of ANC services, a significant number of them did not complete the recommended number of ANC visits for at least four times during a normal pregnancy. Awareness and further education to reproductive-age women on the significant role adequate ANC attendance plays in advancing health and well-being require further investments, particularly among rural women in Ghana.

Effect of religion on the risk behaviour of rural Ghanaian women: evidence from a controlled field experiment

ABSTRACT Religious doctrines may guide individual attitudes and preferences, including risk behaviour among others. We estimate the effect of religion on the willingness to take risk amongst 1209 rural women in Ghana, and observe that, whereas religious affiliation influences the decision to engage in risk, it does not in any way influence the level of risk taking thereafter. Specifically, we find that relative to the non-religious, religious affiliation of a woman influences her willingness to engage in risk negatively; however, we find very little difference in such willingness to engage in risk between the different religious groups.

Barriers to the Uptake of Cervical Cancer Screening and Treatment among Rural Women in Ghana.

Background This study sought to explore the barriers to the uptake of cervical cancer screening and treatment in the North Tongu district of Ghana. Methods Twenty-five in-depth interviews were conducted, while three focus group discussions were held among respondents. The data were analysed with the R package for qualitative data analysis using a thematic analytical approach. Results Low level of knowledge about the disease and screening services, personal or psychological convictions, and cost of screening and treatment coupled with a low level of income were the barriers at the individual level. Perceived health personnel attitude, perceived lack of privacy, and misdiagnosis were the barriers at the institutional level while the sociocultural belief system of the communities about the etiology of the disease was the barrier at the community level. Inadequate education about the disease, lack of funding and access to screening facilities also constrained screening and treatment at the policy level. Conclusions Cervical cancer screening and treatment are constrained at multiple levels in rural Ghana. This study underscores the need to address the low uptake of cervical cancer screening and treatment at the individual, community, institutional, and policy levels simultaneously.

Intimate Partner Violence: The Lived Experiences of Economic and Financial Violence of Rural Women in Ghana

Economic violence (EV) or financial violence (FV) is one form of intimate partner violence (IPV), which has received less attention from scholars, policymakers, and social work practitioners. This study explores and describes the lived experiences of 24 rural Ghanaian women with economic violence within intimate partner relationships as wives, mothers, co-wives, and girlfriends. A qualitative methodology utilized a purposeful sample of 24 self-identified female victims as participants aged 20–50 years from three different rural communities in the southeastern region of Ghana. Data collected through individual semi-structured in-depth face-to-face interviews and data analysis utilized a qualitative thematic content analysis approach using Miles, Huberman, and Saldana (2014)'s thematic process. Data analysis identifies four main themes namely: (1) Exploitation of family resources; (2) Refusal of spouse/partner to support economic activities; (3) Not benefiting from commonly acquired marital properties; and 4) Inadequate reward for contributions. The article discusses policy implications, mental health interventions and suggestions for the provision of professional services and programs to increase the socioeconomic development of rural communities in Ghana.

Measuring and explaining changing patterns of inequality in institutional deliveries between urban and rural women in Ghana: a decomposition analysis

BackgroundDespite recent progress in improving access to maternal health services, the utilization of these services remains inequitable among women in developing countries, and rural women are particularly disadvantaged. This study sought to measure i) disparities in the rates of institutional births between rural and urban women in Ghana, ii) the extent to which existing disparities are due to differences in the distribution of the determinants of institutional delivery between rural and urban women, and iii) the extent to which existing disparities are due to discrimination in resource availability.MethodsUsing Demographic and Health Survey data from 2003, 2008, and 2014, this study decomposed inequalities in institutional delivery rates among urban and rural Ghanaian woman using the Oaxaca, the Blinder, and related decompositions for non-linear models. The determinants of the observed inequalities were also analyzed.ResultsInstitutional delivery rates in urban areas exceeded those of rural areas by 32.4 percentage points due to differences in distribution of the determinants of institutional delivery between the two areas. The main determinants driving the observed disparities were wealth, which contributed to about 16.1% of the gap, followed by education level, and number of antenatal visits.ConclusionRelative to urban women, rural women have lower rates of institutional deliveries due primarily to lower levels of wealth, which results in financial barriers in accessing maternal health services. Economic empowerment of rural women is crucial in order to close the gap in institutional delivery between urban and rural women.

Cultural beliefs and practices of women influencing home births in rural Northern Ghana.

Background: One of the maternal health care strategies identified by the World Health Organization as being crucial for saving lives of pregnant women, which also serves as an indicator for progress in reducing maternal mortality, is the provision and utilization of skilled birth care. Despite the importance of skilled birth care in preventing maternal morbidity and mortality, many women continue to give birth at home without the assistance of skilled birth attendants in rural communities of Ghana.Purpose: The purpose of this study was to explore the cultural beliefs that potentially influenced the choice of home births among rural women in Ghana.Methods: A qualitative approach was utilized to conduct this study. Twenty participants who delivered at home were purposefully selected and interviewed individually. Semistructured interviews were used to explore the cultural belief patterns that potentially influenced the choice of home births among women in rural Ghana. Thematic analysis approach was used to analyze the data.Results: Four major themes emerging from the data analysis which influenced rural women’s decision to give birth at home are namely: opportunity to access psychological support through family members, opportunity to access culturally acceptable food, opportunity to adopt a birthing position of choice, and opportunity for safe and culturally accepted disposal of placenta.Conclusion: This study concluded that the cultural beliefs held by these women greatly affected their decision to deliver at home. Hence, there is a need for health care managers to facilitate collaborative practices between the skilled birth attendants and traditional birth attendants. This is because this approach could enhance the integration of the cultural beliefs and practices of women in the orthodox health care delivery system to facilitate the utilization of skilled birth care.

The relationship between perceived service quality of antenatal care and use among rural women in Ghana

PurposeThe purpose of this paper was to examine rural women’s perceived quality of antenatal care (ANC) and its influence on the extent of ANC in the Amansie Central District in the Ashanti Region of Ghana.Design/methodology/approachA quantitative cross-sectional study was conducted with 120 women attending postnatal care at selected public health facilities. Structured interviews were used to obtain data. Crude odds ratio with 95% confidence interval (CI) was generated to determine the odds of women’s utilisation of ANC with their perceived service quality. The association between women’s background characteristics and ANC use was determined and assessed using Pearson’s χ2 (2) test.FindingsMajority of the women (58.3 percent) utilised ANC for at least four times during pregnancy. Women’s education (p=0.027), religious affiliation (p=0.006), source of income (p=0.012) and insurance status (p=0.023) all had a positive relationship with ANC use. Women who perceived ANC quality as good were three times more likely to have four or more ANC visits than those who perceived quality as poor (OR= 3.042, 95% CI=0.181–0.647, p=0.001).Originality/valueGhana has had numerous policy interventions that address the accessibility and quality of ANC service. However, little is known about the extent to which they are observed and about the quality of service from users’ perspective. Most existing literature on ANC use in Ghana focusses on socio-economic factors that influence utilisation. This paper will be the first to examine the perceived quality of ANC provided, and its influence on the extent of ANC visits among rural women in Ghana.

Current respiratory symptoms and risk factors in pregnant women cooking with biomass fuels in rural Ghana

BackgroundMore than 75% of the population in Ghana relies on biomass fuels for cooking and heating. Household air pollution (HAP) emitted from the incomplete combustion of these fuels has been associated with adverse health effects including respiratory effects in women that can lead to chronic obstructive pulmonary disease (COPD), a major contributor to global HAP-related mortality. HAP is a modifiable risk factor in the global burden of disease, exposure to which can be reduced. ObjectiveThis study assessed the prevalence of respiratory symptoms, as well as associations between respiratory symptoms and HAP exposure, as measured using continuous personal carbon monoxide (CO), in nonsmoking pregnant women in rural Ghana. MethodsWe analyzed current respiratory health symptoms and CO exposures upon enrollment in a subset (n = 840) of the population of pregnant women cooking with biomass fuels and enrolled in the GRAPHS randomized clinical control trial. Personal CO was measured using Lascar continuous monitors. Associations between CO concentrations as well as other sources of pollution exposures and respiratory health symptoms were estimated using logistic regression models. ConclusionThere was a positive association between CO exposure per 1 ppm increase and a composite respiratory symptom score of current cough (lasting >5 days), wheeze and/or dyspnea (OR: 1.2, p = 0.03). CO was also positively associated with wheeze (OR: 1.3, p = 0.05), phlegm (OR: 1.2, p = 0.08) and reported clinic visit for respiratory infection in past 4 weeks (OR: 1.2, p = 0.09). Multivariate models showed significant associations between second-hand tobacco smoke and a composite outcome (OR: 2.1, p < 0.01) as well as individual outcomes of cough >5 days (OR: 3.1, p = 0.01), wheeze (OR: 2.7, p < 0.01) and dyspnea (OR: 2.2, p = 0.01). Other covariates found to be significantly associated with respiratory outcomes include involvement in charcoal production business and dyspnea, and involvement in burning grass/field and wheeze. Results suggest that exposure to HAP increases the risk of adverse respiratory symptoms among pregnant women using biomass fuels for cooking in rural Ghana.