Future husbands: predictors of young males’ exposure to family planning messages in Ghana

Abstract A number of studies have concluded that weak involvement of men in family planning decision-making accounts for the low adoption in countries undergoing fertility transition. Programmes to incorporate men in family planning decision-making have largely focused on married men. However, given the pronatalist nature of such societies, family planning within marriage tends to be low. An alternative is to consider the involvement of unmarried young people. This paper assesses the exposure of young males’ to specific contraceptive messages and their predictors rather than channels. The study uses data from the 2003 round of Ghana Demographic and Health Survey, a nationally representative survey of people in their reproductive ages. Logistic regression was used to examine predictors of exposure to family planning messages. Generally, levels of exposure to messages on contraceptives were high. Messages which positioned family planning messages as beneficial to the individual had high levels of exposure. However, there were marked disparities in exposure to messages based on age, region and rural–urban residence, level of formal education, especially beyond the secondary level. The effect of education beyond the secondary level on exposure appeared more robust than any other socioeconomic variable. Given the multivariate nature of predictors of exposure, appealing and culturally acceptable messages through reliable mediums are likely to increase exposure and attract the attention of young men towards family planning messages.Keywords: exposure; contraceptives; messages; predictors; family planning; young males and GhanaRésumé Un certain nombre d'études ont conclu que la faible implication des hommes dans la planification familiale de prise de décision des comptes pour la faible utilisation dans les pays en transition de la fécondité. Des programmes visant à intégrer les hommes dans la planification familiale de prise de décision ont surtout porté sur les hommes mariés. Toutefois, étant donné la nature de ces sociétés natalistes, la planification familiale au sein du mariage tend à être faible. Une alternative est de considérer l'implication des jeunes célibataires. Cette étude évalue l'exposition des jeunes hommes »aux messages spécifiques de contraception et leurs prédicteurs plutôt que les canaux. L'étude utilise les données du volet 2003 du Ghana et démographiques Enquête sur la santé, une enquête nationale représentative de la population en âge de reproduction. La régression logistique a été utilisée pour examiner les prédicteurs de l'exposition aux messages de planification familiale. Généralement, les niveaux d'exposition aux messages sur les contraceptifs étaient élevés. Les messages dont positionné messages de planification familiale comme bénéfique pour l'individu avaient des niveaux élevés d'exposition. Cependant, il ya eu de fortes disparités dans l'exposition aux messages en fonction de l'âge, région et rurale-urbaine de résidence, niveau d'éducation formelle, en particulier au delà du niveau secondaire. L'effet de l'éducation au-delà du niveau secondaire sur l'exposition apparu plus robuste que toute autre variable socioéconomique. Étant donné la nature multidimensionnelle des facteurs prédictifs de l'exposition, attrayante et des messages culturellement acceptables, grâce médiums fiables sont susceptibles d'accroître l'exposition et attirer l'attention des hommes jeunes vers des messages de planification familiale.Mots clés: exposition, les contraceptifs, les messages, les facteurs prédictifs, la planification familiale, les jeunes hommes et le Ghan

Role-players in abortion decision-making in the Accra Metropolis, Ghana

BACKGROUND: Making the final decision to terminate a pregnancy can be influenced by different circumstances involving various individuals. This paper describes the key players involved in the decision-making process regarding abortions among women who elected to undergo an induced abortion in a cosmopolitan urban setting in Ghana. METHODS: A retrospective cross-sectional mixed method study was conducted between January and December 2011. A total of 401 women with records in abortion logbooks were selected for an interviewer-administered questionnaire and an in-depth interview. Descriptive and multinomial logistic regression analyses were used to assess the quantitative data, and a thematic analysis was applied to the qualitative data. RESULTS: The findings of the study reveal that pregnant individuals, mothers of abortion-seekers, male partners, and “Others” (for example, friends, employers) were instrumental in making a decision to terminate unplanned/unwanted pregnancies. Several key factors influenced the decision-making processes, including aversion from the men responsible for the pregnancy, concerns about abnormalities/deformities in future births due to unprofessionally conducted abortions, and economic considerations. CONCLUSION: A number of individuals, such as friends, mothers, and male partners, influence the decision-making process regarding abortion among the participants of the study. Various targeted messages are needed for the various participants in the decision

Single motherhood in Ghana: analysis of trends and predictors using demographic and health survey data

The rising rate of single-mother families has gained scholarly and policy attention. Understanding the dynamics in the socio-economic and demographic transformations that have led to the relatively high single-mother families in Ghana is important to advance policy and intervention to mitigate adverse effects of single motherhood. The study sought to examine the trends and predictors of single motherhood in Ghana from 1993 to 2014. This paper was based on data from the last five waves of the Ghana Demographic and Health Survey. Descriptive statistics of proportions with Chi-square test and binary logistic regression were used to assess individual and contextual factors associated with single motherhood in Ghana. The proportion of single motherhood increased significantly over the period from 14.1% in 1993 to 19.5% in 2014. Premarital birth emerged as the major pathway to single motherhood. Among individual factors, the likelihood of single motherhood declines as age at first sex [OR = 0.58; 95% CI = 0.48,0.70] and first birth [OR = 0.43; CI = 0.32,0.59] were 25 years and above. Also, Contraceptive users were less likely to be single mothers than non-users. Contextually, women who profess Islam [OR = 0.58; 95% CI = 0.46, 0.74] were less likely to be single mothers than women who had no religious affiliation. We observed that, after accounting some important factors, women with higher economic status—richer [OR = 0.76; 95% CI = 0.59,0.96] and richest [OR = 0.57; 95% CI = 0.31,0.56] were less likely to be single mothers than poorest women. The findings give an impression of single mothers being over-represented among economically poor women. Policies and programmes meant to mitigate adverse effects of single motherhood should also focus on empowering single mothers and their children as a way of alleviating poverty and improve the well-being of children in this family type, as well as enhance Ghana’s capacity to attain the Sustainable Development Goal 1, particularly target 1.2

Health Decision-Making Autonomy and Skilled Birth Attendance in Ghana

Delivering in health facility under the supervision of skilled birth attendant is an important way of mitigating impacts of delivery complications. Empirical evidence suggests that decision-making autonomy is aligned with holistic wellbeing especially in the aspect of maternal and child health. The objective of this paper was to examine the relationship between women's health decisionmaking autonomy and place of delivery in Ghana. We extracted data from the 2014 Ghana Demographic and Health Survey. Descriptive and logistic regression techniques were applied. The results indicated that women with health decision-making autonomy have higher tendency of health facility delivery as compared to those who are not autonomous [OR = 1.27, CI = 1.09-1.48]. However, those who have final say on household large purchases [OR = 0.71, CI = 0.59-0.84] and those having final say on visits [OR = 0.86, CI = 0.73-1.01] were less probable to deliver in health facility than those without such decision-making autonomy. Consistent with existing evidence, wealthier, urban, and highly educated women had higher inclination of health facility delivery. This study has stressed the need for interventions aimed at enhancing health facility delivery to target women without health decision-making autonomy and women with low education and wealth status, as this can play essential role in enhancing health facility delivery

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : a novel analysis from the Global Burden of Disease Study 2015

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Conforming to partnership values: a qualitative case study of public–private mix for TB control in Ghana

Background: Public–private mix (PPM) can supplement public sector initiatives, including public health. As National Tuberculosis Control Programmes around the world embrace PPM, conforming to the four key principles of partnership values of beneficence, non-maleficence, autonomy, and equity as espoused by the World Health Organization can provide a useful framework to guide successful implementation. Design: This is a qualitative case study of PPM in tuberculosis (TB) control, which utilised a purposive sample of 30 key stakeholders involved in TB control in Ghana. Respondents comprised an equal number of respondents from both the public and private sectors. Semi-structured in-depth interviews (IDI) were conducted with respondents. Data emanating from the IDIs were analysed deductively. Results: Although the respondents’ perceptions about beneficence were unanimous, their views about non-maleficence, autonomy, and equity appeared incongruous with the underlying meanings of the PPM values. Underlying the unfavourable perceptions were disruptions in funding, project implementers’ failure to follow-up on promised incentives, and private providers lost interest. This was perceived to have negatively affected the smooth implementation of PPM in the country. Conclusions: Going forward, it is imperative that future partnerships are built around utilitarian principles and also adhere to the dictates of agreements, whether they are ‘soft’ or standard contracts

Individual, household and community level factors associated with keeping tuberculosis status secret in Ghana

Abstract Background In tuberculosis (TB) control, early disclosure is recommended for the purposes of treatment as well as a means of reducing or preventing person-to-person transmission of the bacteria. However, disclosure maybe avoided as a means of escaping stigma, and possible discrimination. This study aimed at providing insights into factors associated with intentions of Ghanaians to keep positive TB diagnosis in their families’ a secret. Methods The paper was based on data from the 2014 Ghana Demographic and Health Survey. Descriptive statistics of proportions with Chi-square test and binary logistic regression were used to identify individual, household and community level factors that predicted the outcome variable (keeping TB secret). Results Women were more inclined (33%) than men (25%) to keep TB in the family a secret. Views about keeping TB secret declined with age for both sexes. For women, higher education had a positive association with whether TB in the family would be kept a secret or not but the same was not observed for men. In a multivariable regression model, the strongest predictor of keeping TB secret was whether the respondent would keep HIV secret, and this was uniform among women (OR = 6.992, p < 0.001) and men (OR = 9.870, p < 0.001). Conclusion Unwillingness towards disclosing TB status in Ghana is associated with varied socioeconomic and demographic characteristics, which may be driven by fears of stigma and discrimination. Addressing TB-related stigma and discrimination can enhance positive attitudes towards TB disclosure. For an infectious disease such as TB, openness towards status disclosure is important for public health

Perspectives of Stakeholders on the Sustainability of Tuberculosis Control Programme in Ghana

Objectives. To solicit the views of some key stakeholders involved in TB control in Ghana on the sustainability of the current programme and corresponding interventions and to further discuss these views in the context of improving and/or ensuring the sustainability of existing interventions and structures. Methods. The study employed an interpretivist (qualitative) approach in order to obtain the &quot;lived&quot; experiences of personnel who are involved in TB control, either directly or indirectly. Purposive sampling was applied to select 19 respondents who provided data for the study through in-depth interviews (IDIs). The IDI data was analysed inductively in a progressive manner. Thus, respective codes were allowed to emerge from the data as opposed to deductive coding where themes are precoded. Results. The findings reveal two main strands of views about the sustainability of the current TB control programmes: optimism and pessimism. The optimists revealed that the integration of TB into the generalised health system, integration of TB and HIV control services, the use of internally generated funds of health facilities, and a general improvement in socioeconomic conditions of the general population could provide positive pathways to sustainability. The pessimists on the other hand noted that the existing programme was not likely to be sustainable so long as much of the operational funds were derived from external sources. Largely, the views of the pessimists were influenced by their past experiences in TB control. Conclusions. This paper has shown both opportunities and threats to sustainability of TB control in Ghana. The opportunities and threats could be managed positively depending on how policy actors respond to the issues raised

Age differences and protected first heterosexual intercourse in Ghana

Age differences between partners, where females are relatively younger than their male partners, can negatively affect power dynamics and subsequent negotiations for safe sex practices with implications on unplanned pregnancies and STIs transmission. This paper examines the effects of age differentials on condom use at first sex. Using a weighted sample of 925 women drawn from the fifth round of Ghana Demographic and Health Survey and applying complementary log-log model, the probability of first sex being protected vis-à-vis partner age differences are estimated. The results suggest that females’ being ten or more years younger than their male partners at first sex was a significant indicator of non-protection while at age intervals 1-4 and 5-9 years, the probability of protected sex inflates significantly. The results demonstrate that large age disparities between partners pose a significant barrier to protection during first sex and strategies have to be developed to altering wrong perceptions associated with intergenerational sex, particularly, in settings such as Africa where gerontocratic tendencies pervade not only social relationships but sexual as well.Les différences d&apos;âge entre les partenaires, chez qui les femmes sont relativement plus jeunes que leurs partenaires masculins, peuvent affecter de manière négative la dynamique du pouvoir et des négociations ultérieures sur les pratiques sexuelles sans risque avec les implications sur les grossesses non planifiées et de la transmission des IST. Cette étude examine les effets des écarts d&apos;âge sur l&apos;utilisation du préservatif au premier rapport sexuel. A l’aide d&apos;un échantillon pondéré de 925 femmes tirées de la cinquième phase de l&apos;Enquête Démographique et de Santé du Ghana et de l&apos;application du modèle log-log complémentaire, la possibilité de protéger le premier rapport sexuel vis-à-vis des différences d&apos;âge entre des partenaires a été estimée. Les résultats suggèrent que le fait que les femmes sont au moins dix ans plus jeunes que leurs partenaires masculins lors du premier rapport sexuel, était un indice significatif de non-protection tout en intervalles d&apos;âge de 1-4 et de 5-9 ans ; la possibilité de rapports sexuels protégés est gonflée de façon significative. Les résultats montrent que les disparités d&apos;âge entre les partenaires constituent un obstacle important à la protection lors de leur premier rapport sexuel et les stratégies doivent être élaborées pour modifier les perceptions erronées qui sont liées au sexe intergénérationnel, en particulier, dans des milieux comme l&apos;Afrique où les tendances gérontocratiques envahissent non seulement des rapports sociaux, mais sexuels auss

Local realities or international imposition? Intersecting sexuality education needs of Ghanaian adolescents with international norms

The content of comprehensive sexuality education (CSE) programmes is contested in many parts of the world, yet we know less about what primary beneficiaries (learners) consider as (in) appropriate school curriculum. I examined this phenomenon in Ghana. Data generated from focus group discussions suggests that, overall, participants used positive phrases to describe the need for sexuality education. The prevalent and recurrent needs of adolescents centred around personal reproductive health hygiene, pregnancy prevention, healthy relationships, reproductive infections and control, reproductive physiology and maturation, gender differences and sexual orientations, and sexual pleasure and pain. However, these needs varied in some ways between males and females and between early adolescents and older adolescents. The study shows that what adolescents seek to learn fall within international norms/standards on CSE. However, some of these concepts were not covered in the guidelines proposed for Ghana. The prevalent view among many opponents that CSE is not driven by local need may not be consistent with adolescents’ own aspirations and realities. The voices of children and adolescents should constitute part of the discussions on the form and content of sexuality education