Correlates of sexual inactivity and met need for contraceptives among young women in Ghana

Abstract Background Young women in sub-Saharan Africa continue to experience unintended pregnancies despite effective contraceptive methods being more readily available than ever. This study sought to determine the correlates of met need for contraceptives and sexual inactivity among young women in Ghana who want to postpone childbearing. We examine this among all women and then separately by marital status. Methods Using data from 1532 females aged 15–24 years from the 2014 Ghana Demographic and Health Survey, we conducted descriptive and multinomial logistic regression analyses to assess sociodemographic, economic and obstetric determinants of the type of family planning method (current abstinence, modern contraceptive method) used by married and unmarried young women. Results A higher proportion (~ 44%) of the respondents was currently abstinent compared to those with met need (~ 25%). Abstinence was higher among single young women while unmet and met need were higher among the married. Having at least senior high school education was significantly associated with the likelihood of current abstinence (especially among single women) and with met need. Being in the middle and rich categories, on the other hand, was associated with lower likelihood of current abstinence and a met need. Compared with multiparous women, those with one or no surviving child had a lower likelihood of being abstinent and having a met need. Other correlates of both current abstinence and met need are region of residence and ethnicity, while previous pregnancy termination and age were associated with abstinence and contraceptive use, respectively. Conclusions Unmet need is high among young women but abstinence is an option they are using. As reproductive health programmes target the at-risk groups, the secondary and higher educational levels must be attained by most women as this is associated with use of abstinence and met need

Misperception of drivers of risk alters willingness to adapt in the case of sargassum influxes in West Africa

Since 2011, large influxes of a brown macroalgae (pelagic sargassum seaweed) have proliferated across the Tropical Atlantic basin, its dispersal and seasonality theorized to be driven by localized and large scale winds and currents, in combination with changes in the Atlantic Meridional Mode and ocean upwelling. These influxes seasonally affect coastal populations across the breadth of the Tropical Atlantic (from central America to West Africa), causing damage to: economies, marine-based and non-marine coastal livelihoods, social functioning, health, ecology, and the aesthetics of the local environment. We use the ongoing sargassum influx in West Africa as a case study of adaptation to an emergent (and compound) risk in progress that also contributes to the empirical gap in sargassum adaptation research in West Africa. The research, in four sites in the Western Region of Ghana employs data from 16 focus group discussions, six key informant interviews, and participant observation. We finds that due to a series of coincidences, participant communities perceive that sargassum influxes were seeded by and then annually driven by oil and gas exploration in Western Ghana. This is in contrast to scientific research that indicates that pelagic sargassum was initially seeded in the tropical Atlantic basin (from the Sargasso Sea) in 2010 following an anomalous weather event in winter 2009–2010. Following Rogers’ Protection Motivation Theory, we explore the sources of information and the processing of that information to understand the divergence between scientific and community perceptions of the physical drivers. We find that community perceptions of oil and gas company responsibility for causing the sargassum problem leads the communities to perceive that the oil and gas companies should be responsible for the clean-up activities. Communities are further constrained by a perceived lack of capacity to act. Solutions to address this adaptation impasse could involve the government working with communities and the oil and gas industry to clarify the actual drivers of sargassum. Such guidance may open opportunities for the government and industry to work with communities to address misperceptions of the scientific nature of the influxes. Collaborative approaches, while addressing extant tensions, may also change the narrative about the problem, support affected communities to engage with adaptive measures, including re-use opportunities, and enhance community capacity to act. As a present-day emergent risk, pelagic sargassum provides an unusual yet contemporary empirical study of real-time adaptation and the central role of perceptions in shaping proactive adaptation and seeking exploitable opportunities from new environmental risks

Women's empowerment, children's nutritional status, and the mediating role of household headship structure: Evidence from sub‐Saharan Africa

Abstract We aimed to examine the association between women's empowerment and childhood nutritional status while accounting for the mediating role of household headship structure. Cross‐country, cross‐sectional quantitative data from the most recent Demographic and Health Surveys (2015–2018) were used. Women's empowerment was measured as a composite index of participation in household decision‐making, attitude towards domestic violence, and asset ownership. Childhood nutrition status was measure as anaemia (haemoglobin concentration < 110g/L), stunting (height‐for‐age z‐scorescore <−2) and the co‐occurrence of anaemia and stunting. Applying the Lewbel two‐stage least squares, women's migration status was used as an instrumental variable. We used data on 25,665 woman‐child dyads from eight sub‐Saharan African countries: Burundi (2016), Ethiopia (2016), Guinea (2018), Malawi (2016), Mali (2018), Zimbabwe (2015), Uganda (2016), and Tanzania (2015). The women were in their reproductive ages (15–49 years) and children were under 5 years old. The findings showed that an increase in women's empowerment index reduces children's likelihood of being anaemic and having a co‐occurrence of anaemia and stunting [coeff (SE), −0.114 (0.025) and −0.072 (0.032), respectively]. Specifically, an increase in asset ownership or decision‐making dimensions of empowerment significantly reduces the likelihood of anaemia and the co‐occurrence of anaemia and stunting among children. Children of empowered women from male‐headed households were more likely to be anaemic and be concurrently anaemic and stunted compared to their counterparts whose mothers were from female‐headed households. Interventions designed to improve childhood nutrition through women's empowerment approaches need to consider asset ownership and instrumental agency of women while acknowledging the mediating effect of household headship typology

Sense of community and willingness to support malaria intervention programme in urban poor Accra, Ghana

Abstract Background The extensive research on community members’ willingness to support malaria interventions ignores the role of psychosocial determinants. This study assesses the impact of individuals’ sense of community (perceptions of community cohesion, altruism, seeking help from neighbours and migrant status) on their willingness to participate in a mosquito control programme using data on 768 individuals from the 2013 RIPS Urban Health and Poverty Survey in poor coastal communities in Accra, Ghana. A contingent valuation experiment was employed to elicit individuals’ willingness to support the programme by contributing nothing, labour time/money only or both. Results Findings show that different dimensions of sense of community related differently with willingness to support the programme. Perceived community cohesion was associated with lower odds while help-seeking from neighbours and being a migrant were associated with higher odds of supporting the programme. Altruism was the only dimension not linked to willingness to participate. Conclusions Different dimensions of sense of community are associated with community members’ willingness to provide labour, time or both to support the malaria eradication programme. The findings of this study have implications for targeting social relational aspects, in addition to geographical aspects, of communities with malaria-resilient policy and intervention. They also warrant further research on psychosocial factors that predict willingness to support health programmes in urban poor settings

Household food sources and diarrhoea incidence in poor urban communities, Accra Ghana.

Diarrhoeal diseases remain a significant cause of morbidity and mortality, particularly in poor urban communities in the Global South. Studies on food access and safety have however not considered the sources of discrete food categories and their propensity to harbour and transmit diarrhoeal disease pathogens in poor urban settings. We sought to contribute to knowledge on urban food environment and enteric infections by interrogating the sources and categories of common foods and their tendency to transmit diarrhoea in low-income communities in Accra. We modelled the likelihood of diarrhoea transmission through specific food categories sourced from home or out of home after controlling for alternate transmission pathways and barriers. We used structured interviews where households that participated in the study were selected through a multi-stage systematic sampling approach. We utilized data on 506 households from 3 low-income settlements in Accra. These settlements have socio-economic characteristics mimicking typical low-income communities in the Global South. The results showed that the incidence of diarrhoea in a household is explained by type and source of food, source of drinking water, wealth and the presence of children below five years in the household. Rice-based staples which were consumed by 94.5% of respondents in the week preceding the survey had a higher likelihood of transmitting diarrhoeal diseases when consumed out of home than when eaten at home. Sources of hand-served dumpling-type foods categorized as "staple balls" had a nuanced relationship with incidence of diarrhoea. These findings reinforce the need for due diligence in addressing peculiar needs of people in vulnerable conditions of food environment in poor urban settlements in order to reap a co-benefit of reduced incidence of diarrhoea while striving to achieve the global development goal on ending hunger

Impact of extreme weather conditions on healthcare provision in urban Ghana

Extreme weather events pose significant threats to urban health in low- and middle-income countries, particularly in sub-Saharan Africa where there are systemic health challenges. This paper investigates health system vulnerabilities associated with flooding and extreme heat, along with strategies for resilience building by service providers and community members, in Accra and Tamale, Ghana. We employed field observations, rainfall records, temperature measurements, and semi-structured interviews in health facilities within selected areas of both cities. Results indicate that poor building conditions, unstable power supply, poor sanitation and hygiene, and the built environment reduce access to healthcare for residents of poor urban areas. Health facilities are sited in low-lying areas with poor drainage systems and can be 6 °C warmer at night than reported by official records from nearby weather stations. This is due to a combination of greater thermal inertia of the buildings and the urban heat island effect. Flooding and extreme heat interact with socioeconomic conditions to impact physical infrastructure and disrupt community health as well as health facility operations. Community members and health facilities make infrastructural and operational adjustments to reduce extreme weather stress and improve healthcare provision to clients. These measures include: mobilisation of residents to clear rubbish and unclog drains; elevating equipment to protect it from floods; improving ventilation during extreme heat; and using alternative power sources for emergency surgery and storage during outages. Stakeholders recommend additional actions to manage flood and heat impacts on health in their cities, such as, improving the capacity of drainage systems to carry floodwaters, and routine temperature monitoring to better manage heat in health facilities. Finally, more timely and targeted information systems and emergency response plans are required to ensure preparedness for extreme weather events in urban areas