Sexual and reproductive health in Accra, Ghana

Objective: To describe sexual and reproductive health among women in Accra and explore the burden of sexual and reproductive ill health among this urban population.Design: Cross-sectional study.Methods: We analysed data from the WHSA-II (n=2814), a cross-sectional household survey on women’s health, and supplemental data from an in-depth survey (n=400), focus groups discussions (n=22) and in-depth interviews (n=20) conducted among a subsample of women which focused specifically on reproductive health issues.Results: Modern contraceptive use was uncommon. More than one third of women reported ever using abstinence; condoms, injectables and the pill were the most commonly reported modern methods ever used. The total fertility rate among this sample of women was just 2.5 births. We found a considerable burden of sexual and reproductive ill health; one in ten women reported menstrual irregularities and almost one quarter of women reported symptoms of a Sexually Transmitted Infection (STI) or Reproductive Tract Infection (RTI) in the past 6 months. Focus group results and indepth interviews reveal misperceptions about contraceptionside-effects and a lack of information.Conclusion: In urban Ghana, modern contraceptive use is low and a significant proportion of women experience reproductive ill health (defined here as menstrual irregularity or RTI, UTI, STI symptoms). Increasedaccess to information, products and services about for preventive care and contraception could improve reproductive health. More research on healthy sexuality and the impact of reproductive ill health on sexual experienceis needed

Prevalence of Obesity in Women of Accra, Ghana

The Women\'s Health Study of Accra, Ghana measured the burden of obesity and obesitylinked illnesses in urban women. This is a Cross-sectional community based study. 1328 adult women, age 18 years and older, were selected as a representative sampling of the women of Accra. A comprehensive medical history, physical examination and laboratory tests were performed. Overweight and obesity status was determined by calculating the body mass index (BMI) (kg/m2). BMI measurements are available for 1237 non-pregnant women. A total of 430 women (34.8%) were obese; 340 (27.4%) were overweight; 369 (29.8%) were normal weight; and 98 (8.0%) were underweight. Risk factors for obesity include age 50 to 70 years, OR 2.12 [1.72 -2.62], p 5 (p 34 years (

Incidence, causes and correlates of maternal near‐miss morbidity: a multi‐centre cross‐sectional study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/1/bjo15578-sup-0009-ICMJES9.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/2/bjo15578-sup-0008-ICMJES8.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/3/bjo15578-sup-0002-ICMJES2.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/4/bjo15578-sup-0003-ICMJES3.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/5/bjo15578_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/6/bjo15578-sup-0004-ICMJES4.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/7/bjo15578-sup-0005-ICMJES5.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/8/bjo15578.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/9/bjo15578-sup-0007-ICMJES7.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/10/bjo15578-sup-0006-ICMJES6.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149236/11/bjo15578-sup-0001-ICMJES1.pd

Evidence for a downward secular trend in age of menarche in a rural Gambian population.

Menarcheal age is a key indicator of female maturity and development. Studies in many countries have reported a downward secular trend in age of menarche over the past century. This study presents data gained using the 'status quo' method and interval regression to estimate median menarcheal age of girls in a rural Gambian community. Cross-sectional studies carried out in 1989, 2000 and 2008 revealed a median menarcheal age of 16.06 (95% CI 15.67-16.45), 15.03 (95% CI 14.76-15.30) and 14.90 (95% CI 14.52-15.28), respectively. The average rate of decline of median age of menarche was amongst the most rapid yet reported, at 0.65 years of age per decade (p < 0.00001). There was no evidence for a change in the rate of decline over the two decades studied. These results probably reflect ongoing socio-economic development within the region

Family Planning Needs of Women Experiencing Severe Maternal Morbidity in Accra, Ghana: Another Missed Opportunity?

Women with severe maternal morbidity represent an important group to target for increasing contraceptive uptake. Our objective was to explore the future fertility intentions, use of family planning including methods and reasons for not wanting to use contraception among a group of women who had traumatic delivery experience at a tertiary teaching hospital in Accra, Ghana. Our results show that despite higher educational attainment, longer hospital stays and intention to limit or stop childbearing among women, there is a missed opportunity for family planning among women with  severe maternal morbidity in this urban African hospital setting. Integrating postpartum family planning consultations by linking available services such as reproductive health clinics at the facilities rather than including  additional tasks for the midwives and the doctors in the wards could be a sustainable solution in such urban, high-volume settings.Keywords: near miss, maternal morbidity, family planning, postpartum contraception, Africa, integration, facility deliver

Shifting norms: pregnant women’s perspectives on skilled birth attendance and facility–based delivery in rural Ghana

Skilled birth attendance (SBA) and healthcare facility (HCF) delivery are effective means of reducing maternal mortality. However, their uptake remains low in many low-income countries. The present study utilized semi-structured interviews with 85 pregnant women attending an antenatal clinic in Akwatia, Ghana (May-July 2010) to better understand the barriers to SBA and HCF delivery through the underrepresented perspective of pregnant women. Interview transcripts were analyzed using grounded theory methodology. Participants described community support for and uptake of HCF delivery as increasing and becoming normalized, but barriers remain: (1) maltreatment by midwives; (2) cost associated with HCF delivery despite waived facility fees; (3) the need for a support person for HCF delivery; (4) difficulties in transportation; and (5) precipitous labor. Given the importance of community in Ghanaian health care decision-making, increasing community support for HCF delivery suggests progress toward increasing uptake of SBA and HCF delivery, however important actionable barriers remain.RésuméLes services des accoucheuses qualifiés (SAQ) et des établissements de santé (SES) sont des moyens efficaces de réduire la mortalité maternelle. Cependant, leur acceptation reste faible dans de nombreux pays à faible revenu. La présente étude s’est servie des entretiens semi-structurés recueillis auprès des 85 femmes enceintes qui fréquentaient un dispensaire prénatal à Akwatia, Ghana (entre les mois de mai et juillet 2010) afin de mieux comprendre les obstacles à la prestation des SAQ et SES à travers les perspectives sous-représentées chez les femmes enceintes. Les transcriptions des entrevues ont été analysées en utilisant une méthodologie basée sur le « grounded theory ». Les participants ont signalé que le soutien communautaire pour l’accouchement dans les SES et de l’adoption des SES augmentent et se normalisent, mais que des obstacles demeurent: (1) les mauvais traitements infligés par des sages-femmes, (2) le coût associé à la prestation des SES en dépit des fraisd'établissement supprimés; (3) la nécessité d'une personne de soutien pour l’accouchement dans les SES, (4) des difficultés de transport, et (5) du travail précipité. Compte tenu de l'importance de la communauté concernant la prise de décision en matière de soins de santé au Ghana la hausse du soutien communautaire pour l’accouchement dans les SES est une indication du progrès vers l’utilisation croissante de la prestation des SAQ et des SES mais il reste toujours d’importants obstacles réalisables.Keywords: qualitative, grounded theory, childbirth, delivery location, sub-Saharan Afric