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

Sexually transmitted infections and health seeking behaviour among Ghanaian women in Accra

The study was to measure the prevalence of sexually transmitted infection (STI) symptoms among women in Accra, Ghana, to identify characteristics that predispose to STI symptoms and to identify factors that influence health-seeking behaviour of women with STI symptoms. Data were collected by trained interviewers through questionnaire interviews of 3183 women. Data analysis was restricted to 1329 women with complete data. Only 19% of our study group had STI symptoms. Only 35% of the women with STI symptoms received care. Having high wealth index, being older and having no history of condom use were protective factors for experiencing STI symptoms. Seeking care was associated with increased by high wealth index and the presence of an offensive vaginal odour. Income level on its own did not affect health seeking behavior. Wealth index is the most significant determinant of a woman having STI symptoms and seeking care in Accra (Afr J Reprod Health 2008; 12[3]:151-158)

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 (

Explaining inconsistencies between data on condom use and condom sales

BACKGROUND: Several HIV prevention programs use data on condom sales and survey-based data on condom prevalence to monitor progress. However, such indicators are not always consistent. This paper aims to explain these inconsistencies and to assess whether the number of sex acts and the number of condoms used can be estimated from survey data. This would be useful for program managers, as it would enable estimation of the number of condoms needed for different target groups. METHODS: We use data from six Demographic and Health Surveys to estimate the total annual number of sex acts and number of condoms used. Estimates of the number of sex acts are based on self-reported coital frequency, the proportion reporting intercourse the previous day, and survival methods. Estimates of the number of condoms used are based on self-reported frequency of use, the proportion reporting condom use the previous day and in last intercourse. The estimated number of condoms used is then compared with reported data on condom sales and distribution. RESULTS: Analysis of data on the annual number of condoms sold and distributed to the trade reveals very erratic patterns, which reflect stock-ups at various levels in the distribution chain. Consequently, condom sales data are a very poor indicator of the level of condom use. Estimates of both the number of sexual acts and the number of condoms used vary enormously based on the estimation method used. For several surveys, the highest estimate of the annual number of condoms used is tenfold that of the lowest estimate. CONCLUSIONS: Condom sales to the trade are a poor indicator of levels of condom use, and are therefore insufficient to monitor HIV prevention programs. While survey data on condom prevalence allow more detailed monitoring, converting such data to an estimated number of sex acts and condoms used is not straightforward. The estimation methods yield widely different results, and it is impossible to determine which method is most accurate. Until the reliability of these various estimation methods can be established, estimating the annual number of condoms used from survey data will not be feasible. Collecting survey data on the number of sex acts and the number of condoms used in a fixed time period may enable the calculation of more reliable estimates of the number of sex acts and condoms used

Role of Condom Negotiation on Condom use among Women of Reproductive Age in three Districts in Tanzania.

ABSTRACT: BACKGROUND: HIV/AIDS remains being a disease of great public health concern worldwide. In regions such as sub-Saharan Africa (SSA) where women are disproportionately infected with HIV, women are reportedly less likely capable of negotiating condom use. However, while knowledge of condom use for HIV prevention is extensive among men and women in many countries including Tanzania, evidence is limited about the role of condom negotiation on condom use among women in rural Tanzania. METHODS: Data originate from a cross-sectional survey of random households conducted in 2011 in Rufiji, Kilombero and Ulanga districts in Tanzania. The survey assessed health-seeking behaviour among women and children using a structured interviewer-administered questionnaire. A total of 2,614 women who were sexually experienced and aged 15--49 years were extracted from the main database for the current analysis. Linkage between condom negotiation and condom use at the last sexual intercourse was assessed using multivariate logistic regression. RESULTS: Prevalence of condom use at the last sexual intercourse was 22.2% overall, ranging from12.2% among married women to 54.9% among unmarried (single) women. Majority of the women (73.4%) reported being confident to negotiate condom use, and these women were significantly more likely than those who were not confident to have used a condom at the last sexual intercourse (OR = 3.13, 95% CI 2.22-4.41). This effect was controlled for marital status, age, education, religion, number of sexual partners, household wealth and knowledge of HIV prevention by condom use. CONCLUSION: Confidence to negotiate condom use is a significant predictor of actual condom use among women in rural Tanzania. Women especially unmarried ones or those in multiple partnerships should be empowered with condom negotiation skills to enhance their sexual and reproductive health outcomes

Willingness to work in rural areas and the role of intrinsic versus extrinsic professional motivations - a survey of medical students in Ghana

<p>Abstract</p> <p>Background</p> <p>Retaining health workers in rural areas is challenging for a number of reasons, ranging from personal preferences to difficult work conditions and low remuneration. This paper assesses the influence of intrinsic and extrinsic motivation on willingness to accept postings to deprived areas among medical students in Ghana.</p> <p>Methods</p> <p>A computer-based survey involving 302 fourth year medical students was conducted from May-August 2009. Logistic regression was used to assess the association between students' willingness to accept rural postings and their professional motivations, rural exposure and family parental professional and educational status (PPES).</p> <p>Results</p> <p>Over 85% of students were born in urban areas and 57% came from affluent backgrounds. Nearly two-thirds of students reported strong intrinsic motivation to study medicine. After controlling for demographic characteristics and rural exposure, motivational factors did not influence willingness to practice in rural areas. High family PPES was consistently associated with lower willingness to work in rural areas.</p> <p>Conclusions</p> <p>Although most Ghanaian medical students are motivated to study medicine by the desire to help others, this does not translate into willingness to work in rural areas. Efforts should be made to build on intrinsic motivation during medical training and in designing rural postings, as well as favour lower PPES students for admission.</p

Sexuality of the Aged and People with Disability: Challenging Popular Folkways

In Sub-Saharan Africa sex is nearly a taboo subject, although in this region HIV is mostly transmitted through the expresssion of sexuality. Given this, our study aimed primarily at opening up comminication on sexuality and to garner sexuality-related information that have implications for HIV and AIDS. Eighty-one qualitative interviews were conducted across all ecologicalzones of Ghana. This paper teases out the findings on the aged and the physically challenged. All the respondents indicated that sexual activityamongst the aged is normal and acceptable, and all but one of them approved of having multiple sexual partners for males, but not forfemales. Similarly, all the respondents expected people with disabilities toexpress their sexuality by having sexual intercourse and marrying, although people with disabilities are discriminated against when it comes to choosing their sexual partners. Our findings have implications for the spread of HIV and AIDS heterosexually.Keywords: Sexuality, the aged, people with disabilities, sexualexpression, GhanaRésuméEn Afrique subsaharéenne, le sexe est presque un sujet tabou bien que leprincipal moyen de transmission du VIH soit par l’expression de la sexualité. C’est dans ce contexte que notre étude se fixe, comme objectifprimaire, d’engendrer la communication sur la sexualité et de collecter des informations liées à la sexualité ayant des conséquences par rapport au VIH et au SIDA. Quatre-vingts-et-un entretiens qualitatifs ont été menés à travers toutes les zones écologiques du Ghana. Les conclusions de cette étude sont tirées des reponses fournies par des personnes âgées et des personnes handicappées. Toutes les personnes interrogées trouvent normal et acceptable l’activité sexuelle chez les personnes âgées, et à l’exception d’une seule personne, toutes acceptent que les hommes puissent avoir plusieurs partenaires sexuels mais pas les femmes. De même, toutes les personnes interrogées trouvent normal que les personnes handicappées vivent leur sexualité par les relations sexuelleset par le marriage bien que les personnes handicappées soient victimes de discrimination en ce qui concerne le choix de partenaires sexuels.Nos conclusions ont des conséquences sur la propagation hétérosexuelle du VIH/SIDA

Patterns of Cardiovascular Disease Mortality in Ghana: A 5-Year Review of Autopsy Cases at Korle-Bu Teaching Hospital

Objectives: Our study examined age and sex patterns of cardiovascular disease (CVD) mortality among autopsy cases at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana from 2006 to 2010. Design: All cardiovascular deaths diagnosed at autopsy in the 5-year period beginning January 2006 and ending December 2010 located in the autopsy logbooks of the Department of Pathology, KBTH, were analyzed for this study. A total of 20,706 autopsy cases were done at KBTH within the five-year period out of which 19,289 (93.2%) were analyzed for this study. Chi-square tests were used to show the association between sex and CVD deaths. Results: The results show that CVD constituted more than one-fifth (22.2%) of all causes of deaths from autopsy cases at KBTH within the 5-year period. The proportionate mortality ratio (PMR) for CVD increased with age, rising steeply in mid-life to peak in the very old, accounting for almost 50% of deaths examined by age 85 years. Also, the findings showed that for the five year period, males had higher proportion of CVD death compared to females (x2=27.284, P=.000). Conclusions: In the absence of populationbased data, hospital records may serve as a useful tool in epidemiologic surveillance of disease. Thus, efforts should be made at health facilities to document minimal patient characteristics such as the socioeconomic and demographic characteristics to facilitate such studies in the future. In conclusion, further studies may be needed to primarily help in formulating strategies/policies for prevention of cardiovascular disease. (Ethn Dis. 2014;24[1]:55–59

Contraceptive use by women in Accra, Ghana: results from the 2003 Accra women’s health survey

The study was to determine the predictors of use of modern contraception among women in Accra, Ghana. Data were collected by trained interviewers using questionnaires. Complete data for 2199 women were analysed using Stata 8.2. The study showed that educational status was the most significant predictor of contraceptive use. Women with no formal education had a 48% reduction in the odds of having ever used contraception and a 66% reduction in the odds of currently using contraception. Regular use of health facilities did not affect contraceptive use. Female education should continue to be a priority of the Ghanaian government. Education about family planning and the effects of having large families should be integrated into the school curriculum. Ghanaian health workers need to be active in promoting the use of modern contraceptive methods (Afr J Reprod Health 2009; 13[1]:123-133)

Coming home to die? The association between migration and mortality in rural South Africa

Background: studies on migration often ignore the health and social impact of migrants returning to their rural communities. Several studies have shown migrants to be particularly susceptible to HIV infection. This paper investigates whether migrants to rural households have a higher risk of dying, especially from HIV, than non-migrants.Methods: using data from a large and ongoing Demographic Surveillance System, 41,517 adults, enumerated in bi-annual rounds between 2001 and 2005, and aged 18 to 60 years were categorized into four groups: external in-migrants, internal migrants, out-migrants and residents. The risk of dying by migration status was quantified by Cox proportional hazard regression. In a sub-group analysis of 1212 deaths which occurred in 2000 – 2001 and for which cause of death information was available, the relationship between migration status and dying from AIDS was examined in logistic regression.Results: in all, 618 deaths were recorded among 7,867 external in-migrants, 255 among 4,403 internal migrants, 310 among 11,476 out-migrants and 1900 deaths were registered among 17,771 residents. External in-migrants were 28% more likely to die than residents [adjusted Hazard Ratio (aHR) = 1.28, P &lt; 0.001, 95% Confidence Interval (CI) (1.16, 1.41)]. In the sub-group analysis, the odds of dying from AIDS was 1.79 [adjusted Odd ratio (aOR) = 1.79, P = 0.009, 95% CI (1.15, 2.78)] for external in-migrants compared to residents; there was no statistically significant difference in AIDS mortality between residents and out-migrants, [aOR = 1.25, P = 0.533, 95% CI (0.62–2.53)]. Independently, females were more likely to die from AIDS than males [aOR = 2.35, P &lt; 0.001, 95% CI (1.79, 3.08)].Conclusion: external in-migrants have a higher risk of dying, especially from HIV related causes, than residents, and in areas with substantial migration this needs to be taken into account in evaluating mortality statistics and planning health care service