The stated preferences of community-based volunteers for roles in the prevention of violence against women and girls in Ghana: a discrete choice analysis

Violence against women and girls (VAWG) is a human rights violation with substantial health-related consequences. Interventions to prevent VAWG, often implemented at the community level by volunteers, have been proven effective and cost-effective. One such intervention is the Rural Response System in Ghana, a volunteer-run program which hires community based action teams (COMBATs) to sensitise the community about VAWG and to provide counselling services in rural areas. To increase programmatic impact and maximise the retention of these volunteers, it is important to understand their preferences for incentives. We conducted a discrete choice experiment (DCE) among 107 COMBAT volunteers, in two Ghanaian districts in 2018, to examine their stated preferences for financial and non-financial incentives that could be offered in their roles. Each respondent answered 12 choice tasks, and each task comprised four hypothetical volunteering positions. The first three positions included different levels of five role attributes. The fourth option was to cease volunteering as a COMBAT volunteer (opt-out). We found that, overall, COMBAT volunteers cared most for receiving training in volunteering skills and three-monthly supervisions. These results were consistent between multinomial logit, and mixed multinomial logit models. A three-class latent class model fitted our data best, identifying subgroups of COMBAT workers with distinct preferences for incentives: The younger ‘go getters’; older ‘veterans’, and the ‘balanced bunch’ encompassing the majority of the sample. The opt-out was chosen only 4 (0.3%) times. Only one other study quantitatively examined the preferences for incentives of VAWG-prevention volunteers using a DCE (Kasteng et al., 2016). Understanding preferences and how they vary between sub-groups can be leveraged by programme managers to improve volunteer motivation and retention. As effective VAWG-prevention programmes are scaled up from small pilots to the national level, data on volunteer preferences may be useful in improving volunteer retention

Prevention of violence against women and girls: a cost-effectiveness study across 6 low- and middle-income countries

Background Violence against women and girls (VAWG) is a human rights violation with social, economic, and health consequences for survivors, perpetrators, and society. Robust evidence on economic, social, and health impact, plus the cost of delivery of VAWG prevention, is critical to making the case for investment, particularly in low- and middle-income countries (LMICs) where health sector resources are highly constrained. We report on the costs and health impact of VAWG prevention in 6 countries. Methods and findings We conducted a trial-based cost-effectiveness analysis of VAWG prevention interventions using primary data from 5 randomised controlled trials (RCTs) in sub-Saharan Africa and 1 in South Asia. We evaluated 2 school-based interventions aimed at adolescents (11 to 14 years old) and 2 workshop-based (small group or one to one) interventions, 1 community-based intervention, and 1 combined small group and community-based programme all aimed at adult men and women (18+ years old). All interventions were delivered between 2015 and 2018 and were compared to a do-nothing scenario, except for one of the school-based interventions (government-mandated programme) and for the combined intervention (access to financial services in small groups). We computed the health burden from VAWG with disability-adjusted life year (DALY). We estimated per capita DALYs averted using statistical models that reflect each trial’s design and any baseline imbalances. We report cost-effectiveness as cost per DALY averted and characterise uncertainty in the estimates with probabilistic sensitivity analysis (PSA) and cost-effectiveness acceptability curves (CEACs), which show the probability of cost-effectiveness at different thresholds. We report a subgroup analysis of the small group component of the combined intervention and no other subgroup analysis. We also report an impact inventory to illustrate interventions’ socioeconomic impact beyond health. We use a 3% discount rate for investment costs and a 1-year time horizon, assuming no effects post the intervention period. From a health sector perspective, the cost per DALY averted varies between US$222 (2018), for an established gender attitudes and harmful social norms change community-based intervention in Ghana, to US$17,548 (2018) for a livelihoods intervention in South Africa. Taking a societal perspective and including wider economic impact improves the cost-effectiveness of some interventions but reduces others. For example, interventions with positive economic impacts, often those with explicit economic goals, offset implementation costs and achieve more favourable cost-effectiveness ratios. Results are robust to sensitivity analyses. Our DALYs include a subset of the health consequences of VAWG exposure; we assume no mortality impact from any of the health consequences included in the DALYs calculations. In both cases, we may be underestimating overall health impact. We also do not report on participants’ health costs. Conclusions We demonstrate that investment in established community-based VAWG prevention interventions can improve population health in LMICs, even within highly constrained health budgets. However, several VAWG prevention interventions require further modification to achieve affordability and cost-effectiveness at scale. Broadening the range of social, health, and economic outcomes captured in future cost-effectiveness assessments remains critical to justifying the investment urgently required to prevent VAWG globally

Dietary patterns among adults in three low-income urban communities in Accra, Ghana.

ObjectiveDietary patterns describe the dietary behaviour and habits of individuals. Unhealthy dietary patterns provide individuals with limited nutrients while increasing the risk of nutrition-related diseases. Unhealthy dietary patterns are high in urban areas, especially among low-income urban residents. This study examined dietary patterns in three low-income urban communities in Accra, Ghana, between 2011 and 2013.MethodsThis study used Wave 2 and 3 data from the Urban Health and Poverty Survey (EDULINK 2011 and 2013). The sample size was 960 in 2011 and 782 in 2013. Dietary pattern was examined using factor analysis and the NOVA food classification system. Summary statistics were computed for sociodemographic characteristics and diet frequency and pattern. Differences in dietary behaviours between 2011 and 2013 were also estimated. Three logistic regression models were computed to determine the predictors of dietary patterns.ResultsThe frequency of consumption of animal-source foods (ASF) and fruits was higher in 2013 compared with 2011. The intake of processed culinary ingredients (NOVA Group 2), processed foods (NOVA Group 3) and ultra-processed foods (NOVA Group 4) was higher in 2013 versus 2011. In 2013, 29% consumed ultra-processed foods compared to 21% in 2011. Three dietary patterns (rice-based, snack-based, and staple and stew/soup) were identified. About two out of every five participants consumed the food items in the rice (43%) and staple and sauce patterns (40%). The proportion of participants who consumed the food items in the snack pattern was 35% in 2011 but 41% in 2013. Respondents aged 25-34 and those with higher education often consumed the snack-based and rice-based dietary patterns. In 2013, participants in Ussher Town had a higher probability of consuming food items in the snack pattern than those living in Agbogbloshie.ConclusionsThis study found that between 2011 and 2013, more participants consumed ASFs, fruits, and processed foods. A complex interplay of personal and socio-cultural factors influenced dietary intake. The findings of this study mirror global changes in diet and food systems, with important implications for the primary and secondary prevention of NCDs. Health promotion programs at the community level are needed to address the increasing levels of processed food consumption

Predictors of HIV testing among women experiencing intimate partner violence in the Central Region of Ghana.

HIV testing, which is important for the control of the HIV pandemic, has been hampered by several factors including Intimate Partner Violence (IPV), resulting in low uptake. This study sought to determine the predictors of HIV testing among women experiencing IPV. Secondary analysis of data generated from a cross-sectional mixed-method unmatched cluster-randomized controlled trial designed to evaluate a multi-faceted community intervention to reduce the incidence of IPV in Ghana was done (N = 2000). Logistic regressions were performed to determine the predictors of HIV testing among women experiencing IPV, using the trial baseline data. The prevalence of HIV testing among women exposed to IPV in the study setting was 42.4%. Less than a third of the respondents (30.2%) had ever used condom and 96.6% had unemployed partners. Age, educational attainment, employment, residence and condom use were found to be significant predictors of HIV testing among women experiencing IPV. Women aged 25-39 years were more than twice as likely to test for HIV (AOR:2.41; 95%CI:1.45-4.02) than those above 45 years. Women with formal education (Junior-High-AOR:2.10; 95%CI:1.42-3.12; Senior-High-AOR:3.87; 95%CI:2.07-7.26); who had ever used condom (AOR:1.42; 95%CI:1.05-1.93); those reporting life satisfaction (AOR:1.44; 95%CI:1.08-1.92); and coastal residents (AOR:1.97; 95%CI:1.45-2.67) were more likely to test for HIV than those who did not and inland residents. However, employed women (AOR:0.66; 95%CI:0.45-0.96) were less likely to test for HIV than unemployed women. Less than half of the women exposed to IPV had tested for HIV. Socioeconomic disadvantages related to age, education, employment, residence and life satisfaction predicted HIV testing among women exposed to IPV. Considering the vulnerability of women experiencing IPV to HIV infection, strategies to improve uptake of HIV testing must tackle contextual socioeconomic factors that hinder access to services

HIV Status Disclosure and Quality of Life of People Living with HIV/AIDS in the Ho Municipality, Ghana

Background. Quality of life (QoL) and HIV/AIDS serostatus disclosure are vital HIV outcome indicators. This study examined factors associated with QoL, HIV status disclosure, and the relationship between QoL and disclosure among people living with HIV (PLWHIV) at the Ho Teaching Hospital. Methods. We conducted a hospital-based cross-sectional survey among 311 PLWHIV. The World Health Organization WHOQOL-HIV BREF questionnaire was used to measure QoL. A semistructured questionnaire was used to gather information on socio-demographics and HIV serostatus disclosure. Multivariate logistic and multiple linear regressions were used to determine predictors of HIV serostatus disclosure and QoL in six domains, respectively. Results. Overall, 88.7% of participants disclosed their HIV status to a significant relation. The majority (98.1%) presented with good QoL, high (83.3%) among participants who disclosed their HIV seropositive status. Patients on antiretroviral therapy (ART) for more than a year were 8.64 times more likely to disclose their HIV status as compared to those on ART for less than a year (AOR = 8.64 (95% CI: 2.00–37.27), p=0.004). Increasing years on ART (β = 0.37) and being employed (β = 1.31) positively predicted good QoL in the physical domain, whereas higher educational level positively predicted good QoL in the social domain (β = 0.66). QoL was not associated with HIV serostatus disclosure. Conclusion. HIV status disclosure was high. Increasing years on ART increased the odds of disclosure. Although there was no significant relationship between QoL and disclosure, good QoL was high among those who disclosed their HIV status. Increasing years on ART, higher education, and being employed predicted good QoL

Dietary patterns and associated risk factors among school age children in urban Ghana

Abstract Background Understanding dietary patterns in the study of diet-disease relationships is crucial for designing dietary behaviour interventions. This study aimed to determine associations between dietary patterns and background characteristics among school age children (9–15 years) in Ghana. Methods A cross-sectional sample of 487 urban-dwelling children age 9–15 years was recruited using simple random sampling from 24 schools (12 private and 12 public) in the Ga-East Municipality in Southern Ghana. A 7-day food frequency questionnaire was used to record children’s consumption of over 100 unique food items. Principal component analyses based on 14 food groups was used to describe emerging dietary patterns (DP). BMI-for-age z-scores segregated by sex were derived using WHO Anthro plus software. Linear regression was used to test associations between ‘diet factor’ scores, and weight status controlling for age. Results Four DPs were identified that explained 53.2% of variation in the diets of children: (1) energy dense; (2) starchy root staple and vegetables; (3) cereal-grain staples and poultry; and (4) fish & seafoods. Energy dense DP characterised by processed meat, fried foods, and sugary foods was associated with child overweight/obese status after controlling for age, sex, SES and school type [F(5, 484) = 6.868, p < 0.001]. Starchy root with vegetable DP was negatively associated with overweight/obese status, private school attendance and higher SES after controlling for age at bivariate level. However, relationship between ‘starchy root staples and vegetables’ DP and overweight/obese status lost significance after controlling for other covariates. Conclusion Our data identified energy-dense dietary pattern to be significantly associated with childhood overweight and obesity. Targeted dietary messages are required to address energy-dense dietary patterns among school-age children

Male characteristics and contraception in four districts of the central region, Ghana

Abstract Background A lack of male involvement in contraception can negatively affect its practice. To promote male participation in family planning, there is a dire need to understand male attributes that play a role in contraception. This study focuses on the male characteristics that influence the practice of traditional and modern methods of contraception. Methods This study is a secondary analysis of quantitative data obtained from the baseline assessment of the Ghana Community-Based Action Teams Study that aimed to prevent violence against women in the Central Region of Ghana in 2016. The analysis included 1742 partnered males aged 18–60 years. Chi-square test, t-test and logistic regression analyses were used to assess the association between male characteristics and the practice of contraception (significance level = 0.05). Results The prevalence of contraception was 24.4% (95% CI = 20.8–28.5). Significant male characteristics that were positively associated with the practice of contraception in adjusted models were: post-primary education (AOR = 1.96, 95% CI = 1.27–3.04), perpetration of Intimate Partner Violence (AOR = 1.83, 95% CI = 1.49–2.26), and the number of main sexual partners (AOR = 1.78, 95% CI = 1.15–2.75). However, wanting the first child (AOR = 0.71, 95% CI = 0.54–0.94) and male controlling behaviour (AOR = 0.7, 95% CI = 0.49–0.99) statistically significantly associated with reduced odds of practicing contraception. Conclusion Male partner characteristics influence the practice of contraception. Family planning sensitization and education programs should target males who are less likely to practice contraception

Young people's attitudes towards wife-beating: Analysis of the Ghana demographic and health survey 2014.

IntroductionIntimate Partner Violence is a global public health problem. Attitude towards wife-beating is a major determinant of both intimate partner violence perpetration and victimization. However, little is known about the attitudes of Ghanaian young people towards wife-beating. The objectives of this study were to assess young people's attitudes towards wife-beating, and identify salient factors influencing young people's acceptance of wife-beating.MethodsData used in this study were obtained from the 2014 Ghana Demographic and Health Survey. The survey was nationally representative and provides estimates for population and health indicators across the former ten regions of Ghana, including rural and urban areas. Data were analyzed with Stata/SE version 16.ResultsWe found that 32% of young women and 19% of young men accepted wife-beating. Among young women, acceptance of wife-beating was significantly influenced by younger age, wealth index, low educational status, religion, the region of residence, ethnicity, frequency of reading newspaper and frequency of listening to radio (p ConclusionThis study demonstrates that a substantial proportion of young people in Ghana accept wife-beating. Young women were more likely to accept wife-beating compared to young men. Acceptance of wife-beating was influenced by socio-demographic and behavioral factors. Efforts to end violence against women and girls in Ghana should focus on promoting girl education, economic empowerment of women and public education on laws that prohibit Intimate Partner Violence

Basic school pupils' food purchases during mid-morning break in urban Ghanaian schools.

BackgroundUnhealthy food vending can expose children to malnutrition and other diet related challenges such as obesity. This study sought to describe types and sources of food in basic schools in urban Accra, and to describe food purchases by pupils.MethodsThis was a cross-sectional study of five basic schools (3 public; 2 private) and 644 pupils in the Ga-East Municipality in Ghana. Check-lists were used to document available sources of foods during school hours. Pupils were intercepted after making purchases during breaktime and the type, cost and sources of foods purchased documented. Energy content of foods were read from labels when available or estimated using the Ghana Food Composition database when unlabelled. Frequencies and crosstabs were used to compare food type by source and school type.ResultsFoods were purchased from school canteen, school store, private stores, and 'table-top' vendors. Meals were most frequently purchased (38%) although single purchases were sweetened drinks, savoury snacks and confectioneries. About 53% of retailers located within the schools sold relatively healthier food options. Similar foods with comparable energy content were purchased within and outside of school.ConclusionsBasic schools in urban Ghana provide ready access to energy dense food options, which are purchased by pupils both within and outside of school premises. Timely interventions inclusive of school food policies can encourage healthier diets among pupils

Additional file 1: of Dietary patterns and associated risk factors among school age children in urban Ghana

7-day Food Frequency Questionnaire. (DOCX 21 kb