A Competing Risk Analysis of Women Dying of Maternal, Infectious, or Non-Communicable Causes in the Kintampo Area of Ghana

Background: Maternal, infectious, and non-communicable causes of death combinedly are a major health problem for women of reproductive age (WRA) in sub-Saharan Africa (SSA). Little is known about the relative risks of each of these causes of death in their combined form and their demographic impacts. The focus of studies on WRA has been on maternal health. The evolving demographic and health transitions in low- and middle-income countries (LMICs) suggest a need for a comprehensive approach to resolve health challenges of women beyond maternal causes.Methods: Deaths and person-years of exposure (PYE) were calculated by age for WRA within 15–49 years of age in the Kintampo Health and Demographic Surveillance System (KHDSS) area from January 2005 to December 2014. Causes of death were diagnosed using a standard verbal autopsy questionnaire and the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Identified causes of death were categorized into three broad areas, namely, maternal, infectious, and non-communicable diseases. Multiple decrements and associated single decrement life table methods were used.Results: Averting any of the causes of death was seen to lead to improved life expectancy, but eliminating infectious causes of death leads to the highest number of years gained. Infectious causes of death affected all ages and the gains in life expectancy, assuming that these causes were eliminated, diminished with increasing age. The oldest age group, 45–49, had the greatest gain in reproductive-aged life expectancy (RALE) if maternal mortality was eliminated.Discussion: This study demonstrated the existence of a triple burden. Infectious causes of death are persistently high while deaths from non-communicable causes are rising and the level of maternal mortality is still unacceptably high. It recommends that attention should be given to all the causes of death among WRA

Potential gains in reproductive-aged life expectancy if maternal mortality were eradicated from the Kintampo districts of Central Ghana.

BACKGROUND: Almost 99% of pregnancy or childbirth-related complications globally is estimated to occur in developing regions. Yet, little is known about the demographic impact of maternal causes of death (COD) in low-and middle-income countries. Assuming that critical interventions were implemented such that maternal mortality is eradicated as a major cause of death, how would it translate to improved longevity for reproductive-aged women in the Kintampo districts of Ghana? METHODS: The study used longitudinal health and demographic surveillance data from the Kintampo districts to assess the effect of hypothetically eradicating maternal COD on reproductive-aged life expectancy by applying multiple decrement and associated single decrement life table techniques. RESULTS: According to the results, on the average, women would have lived an additional 4.4 years in their reproductive age if maternal mortality were eradicated as a cause of death, rising from an average of 28.7 years lived during the 2005-2014 period to 33.1 years assuming that maternal mortality was eradicated. The age patterns of maternal-related mortality and all-cause mortality depict that the maternal-related mortality is different from the all-cause mortality for women of reproductive age. CONCLUSION: This observation suggests that other COD are competing with maternal mortality among the WRA in the study area and during the study period

Health, well-being and mortality in Africa

This dissertation is made up of three separate but related papers. The first two utilize verbal autopsy data to examine causes of death in a rural African setting while the third one employs census data to examine household socio-economic status and its relationship to childhood mortality in Africa. In the first paper, I evaluate the data using demographic and statistical techniques and examine the causes of death patterns resulting thereof, comparing these to standard patterns of mortality based on data from areas with similar socio-economic and ecological conditions. In the second paper, I estimate the impact of malaria mortality, the leading cause of death in this population by attempting to answer the question “how many person-years could be saved if malaria was eliminated from the population and how would that contribute to increases in human longevity?” Assuming that mortality conditions of the period prevailed, it is estimated that well over 22 percent of the total population may have been saved if malaria were eliminated as a major cause of death in the population. This could have resulted in extending life expectancy at birth by more than 6 years. The third paper explores the extent to which housing and household characteristics, including asset possessions could be used to proxy for income and consequently, socioeconomic status within households in Africa where direct measures of income are not usually available. Employing census data from Botswana, Lesotho and Zambia, we establish that these measures are useful for providing reliable information that can be used to differentiate populations within households by poverty groups. The results indicate clearly that there are persistent health inequities in the countries covered, with children from better-off households experiencing lower mortality levels than their counterparts from poorer households

Health, well-being and mortality in Africa

This dissertation is made up of three separate but related papers. The first two utilize verbal autopsy data to examine causes of death in a rural African setting while the third one employs census data to examine household socio-economic status and its relationship to childhood mortality in Africa. In the first paper, I evaluate the data using demographic and statistical techniques and examine the causes of death patterns resulting thereof, comparing these to standard patterns of mortality based on data from areas with similar socio-economic and ecological conditions. In the second paper, I estimate the impact of malaria mortality, the leading cause of death in this population by attempting to answer the question “how many person-years could be saved if malaria was eliminated from the population and how would that contribute to increases in human longevity?” Assuming that mortality conditions of the period prevailed, it is estimated that well over 22 percent of the total population may have been saved if malaria were eliminated as a major cause of death in the population. This could have resulted in extending life expectancy at birth by more than 6 years. The third paper explores the extent to which housing and household characteristics, including asset possessions could be used to proxy for income and consequently, socioeconomic status within households in Africa where direct measures of income are not usually available. Employing census data from Botswana, Lesotho and Zambia, we establish that these measures are useful for providing reliable information that can be used to differentiate populations within households by poverty groups. The results indicate clearly that there are persistent health inequities in the countries covered, with children from better-off households experiencing lower mortality levels than their counterparts from poorer households

Enhancing healthy ecosystems in northern Ghana through eco-friendly farm-based practices: insights from irrigation scheme-types

Abstract Background Farming practices vary from farmer to farmer and from place to place depending on a number of factors including the agroclimatic condition, infrastructure (e.g. irrigation facilities) and management mechanisms (private versus state management). These together affect the functioning and sustainability of the ecosystems. For the sustainability of ecosystems, farmers need to employ ecosystem-based farm practices. This paper examines the ecosystem-based farm management practices (EBFMPs) in private and state-managed irrigation schemes. It also analyses the drivers of farmers’ willingness to pay for EBFMPs sustainability. The study employed mixed methods design, using both qualitative and quantitative techniques of data collection through key informant interviews, focus group discussions and semi-structured questionnaires administered to 300 households. The various EBFMPs adopted by farmers were examined and descriptively presented. The Chi-square automatic interaction detector (CHAID) and multiple linear regression were used to assess the predictors of farmers’ willingness to pay for EBFMPs to enhance the health of agroecosystems. Compost application, conservative tilling, conservation of vegetation, mulching, crop rotation, intercropping with legumes, efficient drainage systems and bunding were the EBFMPs captured in this paper. Results Farmers in privately-managed irrigation schemes (PIS) more often apply EBFMPs compared with those in state-managed irrigation schemes (SIS). The paper also found that farmers’ willingness to pay to sustain EBFMPs for healthy ecosystems is significantly determined by the type of irrigation scheme they cultivate in (that is, PIS or SIS), their level of education, marital status and perception of soil fertility. Conclusions Policy makers, implementers, and other stakeholders need to consider the capacity building of irrigation farmers, especially those in SIS in northern Ghana by educating them on agricultural production and ecosystem nexus to enhance the level of usage and willingness to pay for EBFMPs sustainability

Postpartum contraceptive initiation and use: Evidence from Accra, Ghana

Background: Postpartum contraceptive use reduces unintended pregnancies and results in better health outcomes for children and women. However, there is a dearth of knowledge on postpartum contraceptive use in Ghana, particularly among women in low-income urban settings. To shed light on strategies that might enhance access to postpartum family planning services in low-income urban settings, we examined contraceptive use among postpartum women in Accra, Ghana, at 1, 3, 6, and 12 months following the birth and the methods used. The predictors of modern contraceptive use in the 12-month postpartum period were also examined. Methods: Data come from a cross-sectional survey conducted in 2018 among 624 women aged 16–44 years who reported giving birth in the past 13–31 months prior to the interview. We generated descriptive statistics to examine the prevalence of contraceptive use among postpartum women at 1, 3, 6, and 12 months after birth. We further estimated a binary logistic regression to examine the predictors of modern contraceptive use at 12 months postpartum. Results: Forty percent of postpartum women never used any contraceptive method during 1 year after birth and of those who used a method, 40% relied on traditional methods. Moreover, 29% of women started using a method the immediate 1 month post-birth. Results further show that postpartum modern contraceptive uptake was positively associated with higher education, having more live births, and being currently in a union. Conclusions: Findings highlight that there may be opportunities to improve the quality of counseling during antenatal and postnatal care visits by clients to ensure fully informed choices regarding postpartum contraception. Community outreach by health providers/promoters or similar models should be promoted in low-income population settings to educate postpartum women on modern contraceptive use. Women who plan to use traditional methods should be provided with information on the consistent and correct use of these methods

Contraception before and after induced abortion: Trajectories of women in selected urban-poor settlements of Accra, Ghana

This paper examined women‘s pre- and post-induced abortion contraceptive use and predictors of post-abortion modern contraceptive uptake in selected poor settlements of Accra, Ghana. Data from a cross-sectional study of 251 women aged 16-44 years were used. Patterns of contraceptive use were analysed descriptively while the predictors of modern contraceptive use in the month following induced abortion were examined using a binary logistic regression model. Majority of women (60%) were not using any method of contraception when they became pregnant before their abortion. Just over 30% of these women switched to using any method in the month immediately after abortion (22% modern and 9% traditional). Women who had became pregnant while using a modern method before their abortion had higher odds of using a modern method post-abortion than women who had not been using any method of contraception when they became pregnant. Following induced abortion, many women remained at potential risk of future unintended pregnancy. Our findings suggest the need for improved contraceptive counselling for women who seek abortion services, both during post-abortion care for facility-based abortions or at the time of obtaining medication abortion pills for those who are self-managing their abortion. (Afr J Reprod Health 2021; 25[6]: 20-31)

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-a-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

sj-docx-1-whe-10.1177_17455057221141290 – Supplemental material for Postpartum contraceptive initiation and use: Evidence from Accra, Ghana

Supplemental material, sj-docx-1-whe-10.1177_17455057221141290 for Postpartum contraceptive initiation and use: Evidence from Accra, Ghana by Caesar Agula, Elizabeth G Henry, Patrick O Asuming, Akua Obeng-Dwamena, Theophilus Toprah, Martin Wiredu Agyekum, Iqbal Shah and Ayaga A Bawah in Women’s Health</p