Factors associated with reproductive health care utilization among Ghanaian women

Background This study investigates factors determining the timing of antenatal care (ANC) visit and the type of delivery assistant present during delivery among a national representative sample of Ghanaian women. Method Data for the study was drawn from the women questionnaire (N=4,916) of the 2008 Ghana Demographic and Health Survey among 15–49-years-old women. Multivariate logistic regression analysis was used to explore factors determining the type of delivery assistance and timing of ANC visit for live births within five years prior to the survey. Results Majority of Ghanaian women attended ANC visit (96.5%) but many (42.7%) did so late (after the first trimester), while 36.5% had delivery without the assistance of a trained personnel (30.6%) or anyone (5.9%). Age (OR=1.5, CI=1.1-1.9, OR for 25-34-year-olds compared to 15-24-year-olds), religion (OR=1.8, CI=1.2-2.8, OR for Christians versus Traditional believers) wealth index (OR=2.6, CI=1.7-3.8, OR for the richest compared to the poorest) were independently associated with early ANC visit. Likewise, age, place of residence, education and partner’s education were associated with having a delivery assisted by a trained assistant. Also, Christians (OR=1.8, CI=1.1-3.0) and Moslems (OR=1.9, CI=1.1-3.3) were more likely to have trained delivery assistants compared to their counterparts who practised traditional belief. Furthermore, the richer a woman the more likely that she would have delivery assisted by a trained personnel (OR=8.2, CI= 4.2-16.0, OR for the richest in comparison to the poorest). Conclusions Despite the relatively high antenatal care utilisation among Ghanaian women, significant variations exist across the socio-demographic spectrum. Furthermore, a large number of women failed to meet the WHO recommendation to attend antenatal care within the first trimester of pregnancy. These findings have important implications for reducing maternal mortality ratio by three-quarters by the year 2015. Keywords: Antenatal care; Maternal health; Timing of antenatal care visit; Type of delivery assistanceBioMed Central open acces

Socioeconomic Differences in Tobacco Use among Ghanaian and Finnish Adolescents

NUORTEN TUPAKOINNIN SOSIOEKONOMISET EROT GHANASSA JA SUOMESSA Länsimaissa ja erityisesti aikuisilla tupakoinnin ja sosioekonomisen aseman välinen yhteys tunnetaan hyvin. Mitä matalampi sosioekonominen asema, sitä yleisempää on tupakointi. Aikuisilla erot tupakoinnin yleisyydessä eri koulutusryhmien välillä ovat merkittäviä. Nuorten osalta tutkimustieto tupakoinnin sosioekonomisista eroista on ollut vähäistä. Sosioekonomisen aseman ja tupakoinnin välisen yhteyden muuttumisesta pitkällä aikavälillä ei ole tietoa. Saharan etelänpuoleisessa Afrikassa, kuten Ghanassa, nuorten tupakointitutkimusta ei juuri ole tehty. Tupakankulutuksen vähentyessä läntisissä maissa tupakkateollisuus pyrkii etsimään uusia kuluttajia kehitysmaiden nuorisosta. Tästä syystä kehittyvät maat ovat kansanterveydellisestä näkökulmasta tärkeitä. Väitöskirjassa tutkittiin nuorten tupakoinnin sosioekonomisia eroja Ghanassa ja Suomessa sekä verrattiin eroja keskenään. Tutkimus koostui neljästä osatutkimuksesta, joissa käytettiin kahta eri tutkimusaineistoa. Suomalaisena tutkimusaineistona oli valtakunnallinen Nuorten terveystapatutkimus, vuodesta 1977 lähtien joka toinen vuosi toteutettava postikyselytutkimus 12- 18-vuotiaille. Ghanasta kerättiin vastaavanikäisiä nuoria edustava poikkileikkausaineisto koulukyselynä vuonna 2008. Nuorten tupakoinnin ja sosioekonomisen aseman välistä yhteyttä tutkittiin useita eri sosioekonomisia indikaattoreita käyttäen. Tässä työssä kehitettiin materiaalisen hyvinvoinnin mittari, joka sopii kehittyvien maiden nuorten sosioekonomisen taustan tutkimuksiin. Tilastollisina menetelminä käytettiin logistista regressioanalyysia sekä pääkomponenttianalyysiä. Ensimmäisessä osatutkimuksessa (I) selvitettiin ghanalaisnuorten tupakointitottumuksia sekä niihin yhteydessä olevia tekijöitä. Tuloksista ilmeni, että nuorten tupakointi Ghanassa oli selvästi vähäisempää kuin suomalaisnuorten keskuudessa. Toisaalta he altistuivat tupakkamainonnalle useammin sekä tunsivat tupakoinnin haitat ja tupakoinnin lopettamisen vaikeuden selvästi huonommin kuin suomalaiset. Toisessa osatutkimuksessa (II) käytettiin perinteisten sosioekonomista asemaa mittaavien indikaattoreiden ohella uudentyyppistä materiaalisen hyvinvoinnin mittaria. Tärkeä löydös oli, että mittari havaittiin luotettavaksi ja hyvin soveltuvaksi kuvaamaan nuorten sosioekonomista asemaa kehitysmaissa, missä perinteisten sosioekonomista asemaa mittaavien osoittimien käyttö (esim. vanhempien koulutus, tulot, ammatti) voi ajoittain olla vaikeaa. Kolmannessa osatutkimuksessa (III) verrattiin nuorten tupakoinnin sosioekonomisia eroja Ghanassa ja Suomessa. Riippumatta siitä, millä sosioekonomisen aseman mittarilla tupakoinnin ja sosioekonomisen aseman välistä yhteyttä mitattiin, erot olivat selvät ja odotustenmukaiset molemmissa maissa. Samalla havaittiin, ettei ghanalaisnuorten tupakointi näytä seuraavan yhtä selvästi tunnettua tupakkaepidemian kehityskulun mallia kuin mikä on tyypillistä länsimaille. Neljännessä osatutkimuksessa (IV) tarkasteltiin suomalaisnuorten tupakoinnin sosioekonomisten erojen pitkän aikavälin muutoksia (1977 2007) käyttäen useita eri sosioekonomisen aseman indikaattoreita. Tutkimuksen päätulos oli, että sosioekonomiset erot nuorten tupakoinnissa ovat säilyneet koko tutkimusjakson ajan samankaltaisina ja jopa lievästi kasvaneet Suomen aktiivisesta tupakkapolitiikasta huolimatta. Tutkimuksen tulokset korostavat nuorten tupakointitrendien seurannan tärkeyttä: Ghanassa tulisi järjestää tätä mittaava tietojärjestelmä ja Suomessa tupakoinnin sosioekonomisten erojen seurantaa tulisi edelleen jatkaa. Sekä Suomessa että Ghanassa nuorten tupakoinnin sosioekonomisten erojen kaventamiseksi terveyden edistämisohjelmia tulisi kohdentaa siten, että niiden vaikutukset näkyisivät erityisesti alemmissa sosioekonomisissa ryhmissä ja erityisissä riskiryhmissä. Viimeksi mainittuihin kuuluvat etenkin ne nuoret, jotka keskeyttävät koulun tai eivät jatka koulunkäyntiä peruskoulutuksen jälkeen.Socioeconomic Differences in Tobacco Use among Ghanaian and Finnish Adolescents Tobacco use has fallen in most Western countries over the past decades. As a result the tobacco industry is shifting its attention to the developing world. Of particular target are adolescents in these regions. With the already huge public health burden caused by HIV/AIDS, malaria, malnutrition, tuberculosis and the so-called reemerging tropical diseases in developing countries, particularly in sub-Saharan Africa, the public health burden would be severe and the health inequality would widen up if tobacco attributable morbidity and mortality add up to the existing burden. Ghana has a long history of tobacco cultivation and previous tobacco manufacturing. Adolescents in Ghana therefore stand at high risk of the emerging tobacco epidemic. However, like in most countries in the sub-Saharan Africa, information on tobacco use in general and the socioeconomic patterning of the menace is scanty. In Western countries on the other hand, despite the reduction in smoking on population levels, socioeconomic differences still exist in smoking among the adult population in many countries. Among adolescents, however, less is known about these disparities as well as the changes over the years. Finland is a model country in terms of tobacco control. It has a comprehensive tobacco control policy including mass media campaigns, measures providing support for smoking cessation among young people and health education in school curriculum. Consequently, much success has been achieved in reducing smoking particularly among male adults, but not in the socioeconomic differences. Regarding adolescents, the extent to which these control measures have reduced inequalities in smoking over the years has not been explored. The aim of this dissertation was to investigate socioeconomic differences in smoking and tawa (traditional smokeless tobacco) use among Ghanaian adolescents and to make a comparison with their Finnish counterparts. In pursuit of this aim, four sub-studies were conducted using data from the Adolescent Health and Lifestyle Survey, a nation wide representative sample of 12 18-year-old Finns conducted from 1977 to 2007 (N = 96,747, response rate 59% 88%) and a survey of a representative sample of Ghanaian adolescents (N=1566, response rate 90%) conducted in three regions in 2008. Multivariate logistic regression analysis and principal component analysis were the main statistical techniques used. In Study I, smoking and tawa use and tobacco promoting and restraining factors among Ghanaian adolescents were investigated. Environmental and familial, as well as individual tobacco promoting and restraining factors and their association with smoking and tawa use among Ghanaian adolescents were explored. First, Study I revealed that tobacco use was lower among Ghanaian adolescents compared to Finnish adolescents. Contrary to the popular acclamation that tawa use is reserved to the elderly, this study provides pacesetter evidence that tawa use is also prevalent among the youth. Secondly, exposure to tobacco advertising was high among Ghanaian adolescents. Also, similar to earlier studies in Western countries, the following increase the probability of tobacco use: misconception that smoking is not difficult to quit, not having been taught the harmful effects of smoking, perception that tobacco products should be sold to minors, attending a school where smoking is allowed on campus, parental smoking and male gender. Despite the high exposure to tobacco advertisement and the lack of knowledge of any national tobacco policy, there seems to be some societal norms or cultural values in Ghana that restrict smoking in schools as well as the accessibility of tobacco products to minors. In Study II, indicators for measuring material affluence status of adolescents in health inequality research in developing countries were explored. Material affluence scale (MAS) was constructed from a summation of underlying structure of numerous material affluence indicators extracted from a principal component analysis. MAS yielded higher response rates compared with the traditional indicators of familial SES (parental occupation and education). It also showed sufficient correlation with the traditional indicators and predicted key health and health behaviour indicators in a similar pattern. In all, Study II revealed that MAS is a reliable alternative for measuring adolescents socioeconomic status (SES) not only in developing countries where information on the traditional indicators (parental education, occupation and income) may be unavailable or difficult to obtain but can also be useful in Western countries, with some modifications. The aim of Study III was to investigate whether socioeconomic differences can also be found among adolescents in a developing country as in Western countries, while Study IV was aimed at investigating the changes in SES differences in smoking among Finnish adolescents over a 30 year period (1977 2007). Multiple indicators were used to assess adolescents SES in both studies. In Study III the SES measures were: familial SES (parental occupation and education, material affluence scale and family structure), an adolescent s individual social position school performance, plans after graduation) and predicted inter-generational social mobility (measured by the differences of familial and individual positions) while in Study IV the adolescents SES was measured by familial SES (parental education and father s occupation) and individual social position (school performance and school career). Studies III and IV revealed that SES differences exist in tobacco use among both Ghanaian and Finnish adolescents whether SES was measured by a familial indicator or an adolescent s individual social position, albeit, the latter was a stronger predictor of tobacco use compared to familial SES. Furthermore, in Ghanaian adolescents, cumulative socioeconomic disadvantage over generations (remaining in lower SES group of origin) increased the probability of adolescent tobacco use. However, tobacco use in Ghana, and probably in sub-Saharan Africa or non-Western countries in general, do not seem to follow the pattern of the smoking epidemic observed in Western countries. In Finland, socioeconomic differences in smoking have persisted over the three decades and even slightly widened despite the well known Finnish comprehensive tobacco control policy measures. On the whole, Studies III and IV conclude that multiple indicators which assess both adolescents familial SES and individual social position, particularly the latter, should be used in health inequality research among adolescents. In all, based on the evidence discussed, this dissertation concludes that, surveillance of tobacco use and exposure to tobacco promotion among adolescents are essential for monitoring smoking trends and evaluating tobacco control efforts, particularly in Ghana. In Ghana, tawa use should be part of any tobacco use surveillance among the youth. The benefit of continuous monitoring of the SES trends in smoking among Finnish adolescents is also emphasised. Among both Ghanaian and Finnish adolescents, health promoting strategies aimed at reducing inequalities in tobacco use or health should be (re)designed to meet the needs of adolescents in lower SES groups, especially those who are likely to discontinue their education after the compulsory phase

Social determinants of adolescent smoking over three generations

Aim: We studied how multigenerational socioeconomic circumstances influence adolescents’ smoking. Previous studies have shown that low academic achievement as well as parents’ low socioeconomic circumstances are associated with adolescents’ smoking, but there are few studies on grandparents’ influence on their grandchildren’s smoking. For the chain of three generations, we hypothesised that high socioeconomic circumstances of both parents and grandparents decrease the probability of smoking and adolescents’ own education and circumstances contribute to this association. We further investigated the role of intergenerational social mobility. Method: Survey data from 1979 to 1997 on 12- to 18-year-old Finns (n=54,487) were linked with 1970–2009 registry-based data of their grandparents, parents and themselves. Socioeconomic circumstances among parents and grandparents were measured by socioeconomic status, education and material resources and among adolescents by academic achievement, educational orientation, family structure and parental smoking. Logistic regression analysis was used to study the associations. Results: Associations of adolescent smoking with grandparental socioeconomic circumstances were weak and mediated through parental circumstances. Parental smoking and divorce and living in a non-intact family increased smoking. Adolescents’ low academic achievement and orientation to low education level were the most important predictors of smoking. Upward intergenerational social mobility between fathers and children decreased the risk of smoking, whereas downward mobility increased it. Conclusions: The influence of grandparents’ low socioeconomic circumstances on grandchildren’s smoking is mediated through parents’ socioeconomic circumstances. Low academic achievement in adolescence is a strong predictor of smoking and adolescents orient towards the group of their future education level, not that of their parents.</p

Socio-demographic trends in overweight and obesity among parous and nulliparous women in Ghana

Background Overweight and obesity are among the leading threats to global health because of their association with increased risk of morbidity and mortality. Much of the research on overweight and obesity among women largely generalize without due cognisance to differences in their reproductive history. This study explored differences in trends in overweight/obesity, and associated factors between parous and nulliparous women in Ghana. Methods Anthropometric measurements from three nationally representative Ghana Demographic and Health Surveys (2003, 2008 and 2014) were analysed using descriptive statistics and multivariate binary logistic regression. Results Over all, overweight/obesity increased between 2003 and 2014, with disproportionately higher rates among parous women (from about 30 % in 2003 to about 48 % in 2014) than nulliparous women (from about 15 % in 2003 to about 24 % in 2014). Age, wealth quintile and marital status were associated with overweight/obesity similarly in both women groups. However, there were variations in the association between parous and nulliparious women by educational level, type of locality, occupation and ethnicity. Conclusion The trend of overweight/obesity in Ghana warrants urgent national level public health attention to help curb the situation. Such interventions should be tailored bearing in mind the peculiar differences in associated factors between parous and nulliparous women.BioMed Central open acces

Factors influencing dropout rate of intermittent preventive treatment of malaria during pregnancy

BACKGROUND: The burden of malaria in terms of morbidity and mortality is huge is Sub-Saharan Africa, particularly among pregnant women. Among the measures to curb down this burden include intermittent preventive treatment (IPT) and effective case management. These strategies were adopted by Ghana and implemented since 2003; however, there is still high dropout rate in IPT coverage. This study sought to investigate factors contributing to high dropout rate between IPT1 and IPT3 in the Tamale Metropolis, one of the health facilities with the highest IPT dropout rates in Ghana. METHODS: Survey, in-depth interviews and short ethnographic techniques were conducted among pregnant women, antenatal care (ANC) health workers and heads of health facilities to investigate factors which account for dropout rate of intermittent treatment of malaria. RESULTS: Shortage of sulphadoxine pyrimethamine (SP), inadequate supply of portable water for administration of SP, unavailability of IPT during outreach services, lack of knowledge by ANC staff about the dropout rate in their area of jurisdiction and poor attitude of some health workers were identified as barriers to achieving high IPT3 coverage. CONCLUSIONS: Late ANC visit, provider and logistical barriers account for the women's missed opportunities to prevent malaria in pregnancy through IPT. Addressing the above barriers will contribute to saving lives and ensuring progress towards the goal of combating malaria as well as reducing maternal, neonatal and child mortalities.BioMed Central open acces

Health and socioeconomic circumstances over three generations as predictors of youth unemployment trajectories

BackgroundYouth unemployment is a critical life event, which may trigger other labour market-related disadvantages and detrimental health implications. To better understand the processes causing unemployment, we study how socioeconomic circumstances of successive generations and familial and health factors in adolescence predict youth unemployment trajectories between ages 16 and 28 in Finland from 2000 to 2009.MethodsWe used survey data from 1979 to 1997 on 12- to 18-year-old Finns (n = 43 238) linked with 1970–2009 registry-based data of their grandparents, parents and themselves. Growth mixture modelling and multivariate logistic regression analyses were used.ResultsThree latent youth unemployment trajectories emerged; low (46%), decreasing (38%) and high (16%) risk groups. Of adolescent factors, low school achievement was the most important predictor of youth unemployment followed by smoking, stress symptoms and poor self-rated health. Grandparents’ education predicted their grandchildren’s unemployment but the effects of other grandparental socioeconomic circumstances mediated through parents’ socioeconomic status (SES). Parents’ low SES and education, and long-term unemployment increased the risk of the child’s unemployment. Youth unemployment was related to low education at the age of 29.ConclusionGrandparents’ education, family socioeconomic circumstances and adolescents’ health and school achievement predict the developmental trajectory of youth unemployment. Youth unemployment is also related to low education in early adulthood. Our findings suggest that the health selection of unemployment works already in adolescence.</p

Prostate Cancer Knowledge, Perceptions and Screening Behaviour among Male University Students in Ghana

Inadequate literature exists on knowledge and perception of prostate cancer and screening behaviour particularly among male tertiary students in Ghana. This paper sought to examine prostate cancer knowledge, perceptions and screening behaviour among male students in the University of Cape Coast and Ghana Institute of Management and Public Administration in Ghana. Using a cross-sectional survey design for the study, systematic and stratified random sampling techniques were used to select 438 participants for the study. Questionnaire was used to collect data from participants. The study revealed that the participants lacked knowledge on key risk factors and symptoms of prostate cancer. However, the majority of the participants had a quite correct perception of prostate cancer. Also, the participants had a poor screening behaviour for prostate cancer. The University Health Services should promote regular and effective prostate cancer sensitisation programmes for students particularly the males

Timing of puberty and reserve capacity in adolescence as pathways to educational level in adulthood – a longitudinal study

Background. Family socioeconomic status (SES) is related to a child´s educational success. Intermediate pathways for this relationship, such as through pubertal timing and reserve capacity, occur in adolescence.Aim. To study whether family SES affects a child’s adult education through a psychosocial and behavioural pathway (reserve capacity) and/or a biological pathway (pubertal timing) or only through school achievement in adolescence.Subjects and methods. Finnish adolescents sampled in five cross-sectional surveys from 1985-1995 (N = 37,876) were followed through the Registry of Completed Education and Degrees until 2009, when they were 29-43 years old. Family SES data also came from this registry. Structural equation modelling adjusted for ages at baseline and follow-up was used.Results. Low family SES increased the probability of low adult education, delayed pubertal timing (in boys), weak reserve capacity and low school achievement. Reserve capacity and school achievement directly affected adult education and mediated the relationship of family SES with the outcome. Delayed pubertal timing predicted low adult education except when school achievement was added to the model.Conclusions. Our results show that family SES affects the child’s adult education level through psychosocial and biobehavioural pathways, but the biological pathway is mediated by school achievement.</p