Factors influencing condom use among women in Ghana: an HIV/AIDS perspective

Although in Ghana information on HIV infection and prevention, both in terms of quality and quantity, has increased considerably within the past few years, available literature indicates that behaviour change is yet to correspond with the amount of information and education provided. The objective of this study is to examine factors that influence condom use among women in Ghana in the context of HIV/AIDS prevalence. Data for this study are from the 2003 Ghana Demographic and Health Surveys (GDHS) and the study population (N=5 691) was analysed using logistic regression with the Health Belief Model (HBM) as an explanatory tool. The outcome variable for this study is condom use during last sexual intercourse. The HBM identifies perception of HIV/AIDS risks, awareness of its seriousness, knowledge about prevention, and confidence in condom use as predictors of safe sexual activity. Results show that the proportion of women reporting use of condoms remains tremendously low, in both the rural and urban areas. In the urban areas, only 15% of women reported having sex with condom during their last intercourse, whereas in the rural areas the proportion is even lower (10%). However, multivariate analyses based on the HBM components show that speaking with a partner about how to avoid AIDS (Odds Ratio = 1.63) and perceived benefits of using condoms (Odds Ratio = 1.54) are notable factors that predict condom use. Overall, the study points out that with the exception of perceived severity, the HBM can be applied to understand condom use among the study population. It will be important to emphasise all components of the HBM and empower women with condom negotiation skills.Keywords: Health Belief Model (HBM), HIV/AIDS, condom use, Ghana.Au Ghana, bien que l´information sur la prévention et l´infection VIH est considérablement augmentée au cours des dernières années, aussi bien en qualité qu’en quantité, les publications récentes indiquent que les changements de comportement ne sont pas encore liés à la quantité d’information et à l’éducation dispensée. L’objectif de cette étude est d’examiner les facteurs qui influencent l’utilisation du préservatif chez les femmes au Ghana, dans le cadre de la prévalence du VIH/SIDA. Les données de cette étude provenant de l’enquête sur la démographie et la santé de 2003 et du recensement de la population (N=5 691) ont été analysées en utilisant la méthode de régression logistiques avec le ‘Health Belief’ Modèle (HBM) comme outil d’explication. La finalité de cette étude est de connaître le niveau d’utilisation du préservatif durant les derniers rapports sexuels. La méthode HBM détermine le niveau de perception du risque VIH/SIDA et la conscience de sa gravité, connaissance des mesures de prévention et confiance envers le préservatif comme outil de protection de l’activité sexuelle. Les résultats montrent que la proportion de femmes qui dit utiliser le préservatif demeure extrêmement faible, aussi bien au niveau rural qu’urbain. Dans les zones urbaines, seulement 15% des femmes disent avoir utilisé le préservatif durant le dernier rapport. Aussi, en milieu rural cette proportion est encore plus faible (10%). Quoi qu’il en soit, les multiples analyses basées sur la méthode HBM montrent que parler avec son partenaire sur comment éviter le SIDA (Odds Ratio = 1.63) et des avantages perçus de l’utilisation du préservatif (Odds Ratio = 1.54) sont les facteurs clés qui poussent à l’utilisation du préservatif. En général, l’étude révèle qu’en dehors de sa perception de sévérité, le HBM peut être utilisé pour comprendre l’utilisation du préservatif au sein d’une population. Il est important de souligner tous les aspects de la méthode HBM et en particulier le pouvoir des femmes dans la négociation pour l’utilisation du préservatif

Trends in the prevalence of female genital muti-lation and its effect on delivery outcomes in the kassena-nankana district of northern Ghana

Rational: Female genital mutilation (FGM) is prevalent in northern Ghana, as the practice is seen as a passage rite to women adulthood and thus undertaken just before marriage. Objectives: We determined the changes in trend of FGM in deliveries at the Navrongo War Memo-rial hospital, and compared the outcomes and FGM status.Design: Retrospective extraction and analysis of delivery data at the hospital from 1st January 1996 to 31st December 2003. Results: Of the 5071 deliveries, about 29% (1466/5071) were associated with FGM. The high-est prevalence (95% CI) of 61.5% (50.9, 71.2) was in women aged 40 years and above, and the lowest of 14.4% (11.7, 17.0) was in women below 20 years. The all-age prevalence of FGM showed a significant decline (p-value for linear trend < 0.01) from 35.2% in 1996 to 21.1% in 2003. About 6% (89/1466) of mothers with FGM had stillbirths compared with about 3% (123/3605) of mothers without FGM. Again FGM was associated with 8.2% (120/1466) caesarean section rate compared with 6.7% (241/3605) in mothers without FGM. Mean birth weight and frequency of low birth weights were not significantly associated with FGM status. Conclusion: Although there is a high rate of FGM among mothers in the district and is associated with a higher proportion of stillbirths and caesar-ean sections, practice has shown a significant de-cline in the district in recent years due to the pre-vailing campaigns and intervention studies. There is therefore the need to sustain the ongoing inter-vention efforts

Prevalence and Determinants of Hearing Loss Among Primary School Children in Selected Schools in the Central Region of Ghana

Hearing loss in children often inhibits speech and language development, thus affecting academic performance, social and emotional well-being. Thus a comparative cross-sectional study was conducted in three primary schools in Ghana to assess hearing of the children attending those schools and also compare differences between these schools based on the pupils’ socioeconomic backgrounds. The data was used to determine prevalence of hearing loss in the schools. A comparison was then made between the results obtained among children attending the more affluent school and the less affluent schools. A total of 773 pupils were included in this study even though 839 pupils were screened as some pupils failed to adequately complete the questionnaires. The average age was 10 years with a standard deviation of 2.65. Significant hearing loss was identified in 4 children (0.5%). Abnormal tympanometry was identified in 86 (10.2%). Abnormal otologic findings identified included cerumen impaction in 73 children (36.5%), acute otitis externa in 7, acute otitis media in 6 and foreign bodies in 10. Schools with lower socioeconomic pupils had a higher prevalence of abnormal tympanometry but there was no difference in hearing loss prevalence. In conclusion, unidentified hearing loss in the three basic schools in Ghana was uncommon and prevalence was not impacted by the school’s socioeconomic background. However, a significant portion had abnormal middle ear function or external auditory canal occlusion from cerumen impaction and thus required further management

Performance of the Tariff Method: validation of a simple additive algorithm for analysis of verbal autopsies

<p>Abstract</p> <p>Background</p> <p>Verbal autopsies provide valuable information for studying mortality patterns in populations that lack reliable vital registration data. Methods for transforming verbal autopsy results into meaningful information for health workers and policymakers, however, are often costly or complicated to use. We present a simple additive algorithm, the Tariff Method (termed Tariff), which can be used for assigning individual cause of death and for determining cause-specific mortality fractions (CSMFs) from verbal autopsy data.</p> <p>Methods</p> <p>Tariff calculates a score, or "tariff," for each cause, for each sign/symptom, across a pool of validated verbal autopsy data. The tariffs are summed for a given response pattern in a verbal autopsy, and this sum (score) provides the basis for predicting the cause of death in a dataset. We implemented this algorithm and evaluated the method's predictive ability, both in terms of chance-corrected concordance at the individual cause assignment level and in terms of CSMF accuracy at the population level. The analysis was conducted separately for adult, child, and neonatal verbal autopsies across 500 pairs of train-test validation verbal autopsy data.</p> <p>Results</p> <p>Tariff is capable of outperforming physician-certified verbal autopsy in most cases. In terms of chance-corrected concordance, the method achieves 44.5% in adults, 39% in children, and 23.9% in neonates. CSMF accuracy was 0.745 in adults, 0.709 in children, and 0.679 in neonates.</p> <p>Conclusions</p> <p>Verbal autopsies can be an efficient means of obtaining cause of death data, and Tariff provides an intuitive, reliable method for generating individual cause assignment and CSMFs. The method is transparent and flexible and can be readily implemented by users without training in statistics or computer science.</p

Role of Condom Negotiation on Condom use among Women of Reproductive Age in three Districts in Tanzania.

ABSTRACT: BACKGROUND: HIV/AIDS remains being a disease of great public health concern worldwide. In regions such as sub-Saharan Africa (SSA) where women are disproportionately infected with HIV, women are reportedly less likely capable of negotiating condom use. However, while knowledge of condom use for HIV prevention is extensive among men and women in many countries including Tanzania, evidence is limited about the role of condom negotiation on condom use among women in rural Tanzania. METHODS: Data originate from a cross-sectional survey of random households conducted in 2011 in Rufiji, Kilombero and Ulanga districts in Tanzania. The survey assessed health-seeking behaviour among women and children using a structured interviewer-administered questionnaire. A total of 2,614 women who were sexually experienced and aged 15--49 years were extracted from the main database for the current analysis. Linkage between condom negotiation and condom use at the last sexual intercourse was assessed using multivariate logistic regression. RESULTS: Prevalence of condom use at the last sexual intercourse was 22.2% overall, ranging from12.2% among married women to 54.9% among unmarried (single) women. Majority of the women (73.4%) reported being confident to negotiate condom use, and these women were significantly more likely than those who were not confident to have used a condom at the last sexual intercourse (OR = 3.13, 95% CI 2.22-4.41). This effect was controlled for marital status, age, education, religion, number of sexual partners, household wealth and knowledge of HIV prevention by condom use. CONCLUSION: Confidence to negotiate condom use is a significant predictor of actual condom use among women in rural Tanzania. Women especially unmarried ones or those in multiple partnerships should be empowered with condom negotiation skills to enhance their sexual and reproductive health outcomes

Implementation of World Health Organization Integrated Management of Childhood Illnesses (IMCI) Guidelines for the Assessment of Pneumonia in the Under 5s in Rural Malawi

The Cooking and Pneumonia Study (CAPS) is a pragmatic cluster-level randomized controlled trial of the effect of an advanced cookstove intervention on pneumonia in children under the age of 5 years (under 5s) in Malawi (www.capstudy.org). The primary outcome of the trial is the incidence of pneumonia during a two-year follow-up period, as diagnosed by healthcare providers who are using the World Health Organization (WHO) integrated management of childhood illnesses (IMCI) pneumonia assessment protocol and who are blinded to the trial arms. We evaluated the quality of pneumonia assessment in under 5s in this setting via a cross-sectional study of provider-patient encounters at nine outpatient clinics located within the catchment area of 150 village-level clusters enrolled in the trial across the two study locations of Chikhwawa and Karonga, Malawi, between May and June 2015 using the IMCI guidelines as a benchmark. Data were collected using a key equipment checklist, an IMCI pneumonia knowledge test, and a clinical evaluation checklist. The median number of key equipment items available was 6 (range 4 to 7) out of a possible 7. The median score on the IMCI pneumonia knowledge test among 23 clinicians was 75% (range 60% to 89%). Among a total of 176 consultations performed by 15 clinicians, a median of 9 (range 3 to 13) out of 13 clinical evaluation tasks were performed. Overall, the clinicians were adequately equipped for the assessment of sick children, had good knowledge of the IMCI guidelines, and conducted largely thorough clinical evaluations. We recommend the simple pragmatic approach to quality assurance described herein for similar studies conducted in challenging research settings

Human resource allocation management in multiple projects using sociometric techniques

This article describes a new application of key psychological concepts in the area of Sociometry for the selection of workers within organizations in which projects are developed. The project manager can use a new procedure to determine which individuals should be chosen from a given pool of resources and how to combine them into one or several simultaneous groups/projects in order to assure the highest possible overall work efficiency from the standpoint of social interaction. The optimization process was carried out by means of matrix calculations performed using a computer or even manually, and based on a number of new ratios generated ad-hoc and composed on the basis of indices frequently used in Sociometry

Sustainable development of a GCP-compliant clinical trials platform in Africa: the Malaria Clinical Trials Alliance perspective

BACKGROUND: The Malaria Clinical Trials Alliance (MCTA), a programme of INDEPTH network of demographic surveillance centres, was launched in 2006 with two broad objectives: to facilitate the timely development of a network of centres in Africa with the capacity to conduct clinical trials of malaria vaccines and drugs under conditions of good clinical practice (GCP); and to support, strengthen and mentor the centres in the network to facilitate their progression towards self-sustaining clinical research centres. CASE DESCRIPTION: Sixteen research centres in 10 African malaria-endemic countries were selected that were already working with the Malaria Vaccine Initiative (MVI) or the Medicines for Malaria Venture (MMV). All centres were visited to assess their requirements for research capacity development through infrastructure strengthening and training. Support provided by MCTA included: laboratory and facility refurbishment; workshops on GCP, malaria diagnosis, strategic management and media training; and training to support staff to undertake accreditation examinations of the Association of Clinical Research Professionals (ACRP). Short attachments to other network centres were also supported to facilitate sharing practices within the Alliance. MCTA also played a key role in the creation of the African Media & Malaria Research Network (AMMREN), which aims to promote interaction between researchers and the media for appropriate publicity and media reporting of research and developments on malaria, including drug and vaccine trials. CONCLUSION: In three years, MCTA strengthened 13 centres to perform GCP-compliant drug and vaccine trials, including 11 centres that form the backbone of a large phase III malaria vaccine trial. MCTA activities have demonstrated that centres can be brought up to GCP compliance on this time scale, but the costs are substantial and there is a need for further support of other centres to meet the growing demand for clinical trial capacity. The MCTA experience also indicates that capacity development in clinical trials is best carried out in the context of preparation for specific trials. In this regard MCTA centres involved in the phase III malaria vaccine trial were, on average, more successful at consolidating the training and infrastructure support than those centres focussing only on drug trials

Accuracy of Rapid Tests for Malaria and Treatment Outcomes for Malaria and Non-Malaria Cases among Under-Five Children in Rural Ghana

BACKGROUND: WHO now recommends test-based management of malaria across all transmission settings. The accuracy of rapid diagnostic test (RDT) and the outcome of treatment based on the result of tests will influence acceptability of and adherence to the new guidelines. METHOD: We conducted a study at the Kintampo hospital in rural Ghana to evaluate the performance of CareStart, a HRP-2 based RDT, using microscopy as reference. We applied IMCI treatment guidelines, restricted ACT to RDT-positive children and followed-up both RDT-positive (malaria) and RDT-negative (non-malaria) cases over 28 days. RESULTS: 436 children were enrolled in the RDT evaluation and 391 (children with haemoglobin >8.0 gm/dl) were followed-up to assess treatment outcomes. Mean age was 25.4 months (s.d. 14.6). Sensitivity and specificity of the RDT were 100.0% and 73.0% respectively. Over the follow-up period, 32 (18.5%) RDT-negative children converted to positive, with 7 (4.0%) of them presenting with fever. More children in the non-malaria group made unscheduled visits than children in the malaria group (13.3% versus 7.7%) On all scheduled follow-up visits, proportion of children having a temperature higher than that recorded on day 0 was higher in the non-malaria group compared to the malaria group. Reports of unfavourable treatment outcomes by caregivers were higher among the non-malaria group than the malaria group. CONCLUSIONS: The RDT had good sensitivity and specificity. However a minority of children who will not receive ACT based on RDT results may develop clinical malaria within a short period in high transmission settings. This could undermine caregivers' and health workers' confidence in the new guidelines. Improving the quality of management of non-malarial febrile illnesses should be a priority in the era of test-based management of malaria. TRIAL REGISTRATION: ClinicalTrials.gov NCT00832754