Context-specific Factors and Contraceptive Use: A Mixed Method Study among Women, Men and Health Providers in a Rural Ghanaian District

Suitable options for improving women‘s access to effective, safe and context-specific contraceptive methods must be explored to curtail rising unmet needs for contraceptive use in rural Ghana. The study aimed to outline context-specific factors associated with contraceptive use, access on demand and future use intentions among women in one district of Ghana. Using mixed method approach, quantitative data (n=720) was collected among women aged 18-28. Focus group discussions and in-depth interviews were also conducted among women (n=30) aged 18-49 and men (n=10) respectively. IDIs were conducted among 3 midwives. Women who received focused counseling on contraceptive use were twice likely to have ever used (OR=2 95% CI 1.163-3.467) or be current users (OR=2, 95% CI 1.146-4.010) of contraceptives. Male partner support can drive cultural sensitivities towards accepting use of contraception (OR=34.5, CI% 19.01-64.22). Covert use is still preferred by most in the study. Services delivered on good provider-relational grounds and convenient clinic hours encourage contraceptive use among women. Male targeting for improving contraceptive service use must first identify context-specific preferences of the woman, since covert use is highly valued. Ascertaining the prevalence of covert use and how community systems can address this for improved contraceptive uptake is further recommended.  Keywords: context-specific factors, contraceptive use, access on demand, future contraceptive use, rural Ghana Des options appropriées pour améliorer l'accès des femmes à des méthodes contraceptives efficaces, sûres et spécifiques au contexte doivent être explorées pour réduire les besoins non satisfaits de l‘utilisation des contraceptifs au Ghana rural. L'étude visait à décrire les facteurs contextuels associés à l'utilisation de contraceptifs, l'accès sur demande et les intentions d'utilisation future chez les femmes d'un district du Ghana. En utilisant une approche par méthode mixte, des données quantitatives (n = 720) ont été recueillies parmi les femmes âgées de 18 à 28 ans. Des discussions à groupes ciblés et des entretiens approfondis ont également été réalisés auprès des femmes (n = 30) âgées de 18 à 49 ans et les hommes (n = 10) respectivement. Les IDI ont été menées auprès de 3 sages-femmes. Les femmes qui ont reçu des conseils ciblés sur l'utilisation des contraceptifs ont été deux fois plus susceptibles d'avoir déjà utilisé (OR = 2 95% IC 1.163-3.467) ou être des utilisateurs actuels (OR = 2, 95% IC 1.146-4.010) des contraceptifs. Le soutien des partenaires masculins peut stimuler les sensibilités culturelles à l'acceptation de l'utilisation de la contraception (OR = 34,5, IC% 19.01-64.22). L'usage secret est encore préféré par la plupart dans l'étude. Les services fournis sur de bons motifs relationnels avec les fournisseurs et les heures de clinique appropriées encouragent l'utilisation de contraceptifs chez les femmes. Le ciblage masculin pour améliorer l'utilisation des services de contraception doit d'abord identifier les préférences spécifiques au contexte de la femme, car l'utilisation secrète est très appréciée. On recommande en outre de déterminer la prévalence de l'utilisation secrète et comment les systèmes communautaires peuvent répondre à cette question pour une meilleure prise en charge des contraceptifs.Mots-clés: facteurs contextuels, utilisation des contraceptifs, accès sur demande, utilisation des contraceptifs future, Ghana rura

Predictors of Health Care Service Quality among Women Insured Under Ghana’s National Health Insurance Scheme

Background: Insured women in Ghana are more likely to use maternity care services than their uninsured counterparts. To improve service quality among insured women in Ghana, better understanding of the factors that predict quality standards of primary health care services is essential. Objective: To examine predictors of health care service quality among insured women under the National Health Insurance Scheme (NHIS) in Ghana. Methods: Data from the 2014 Ghana Demographic Health Survey was analysed. Cluster analysis was applied to construct a dependent variable; service care quality. Socio-demographic/background characteristics were used as independent variables. Descriptive and inferential analyses were performed followed by multiple regression to predict service quality among the insured population of women aged 15–49 years. SPSS version 21 was used during the clustering while STATA version 14 was used to perform the inferential and regression analyses. Findings: Overall, geographical region of respondents was significant to expressions of insured service quality (χ2=495.4, p ≤ 0.001). Literacy levels were significant at χ2=69.232 and p ≤ 0.001 for service quality. On place of residence, the estimation show urban residency was more positively correlated with indicating quality ratings of health services compared to rural residency (χ2=70.29, p ≤ 0.001). Highest educational level had the highest predictive influence with a coefficient of 0.15. Conclusions:A more supportive health insurance system approach that shifts towards introducing valued-based care models for patients, insurers and health care providers could be supportive in improving quality standards among insured population groups in Ghana

Reproductive-Age Women's Knowledge and Care Seeking for Malaria Prevention and Control in Ghana: Analysis of the 2016 Malaria Indicator Survey.

INTRODUCTION: Malaria is a major cause of morbidity and mortality worldwide, requiring individual and environmental level controls to prevent its adverse morbidity effects. This study examined reproductive-aged women's knowledge and care-seeking practices for malaria prevention and control in Ghana. METHODS: The 2016 Ghana Malaria Indicator Survey data for reproductive-age women was analysed (n=5,150). Multilevel mixed-effects logistic regression model was used to determine factors associated with reproductive-aged women's knowledge and care-seeking practices for malaria. RESULTS: 62.3%, 81.3%, and 64.6% knowledge levels on causes, signs/symptoms, and prevention of malaria were found, respectively, among respondents. Age, wealth and educational status, religion, region, and place of residence (rural) were found to significantly influence respondents' knowledge of causes, signs/symptoms, and care-seeking practices for malaria. A 15% differential among Insecticide Treated Nets (ITNs) awareness and use was found. Increasing age (≥35 years) was associated with increasing knowledge of malaria. Regional variations were observed to significantly influence knowledge of malaria treatment. CONCLUSION: Though ownership of ITNs and knowledge of malaria prevention were high, it did not necessarily translate into use of ITNs. Thus, there is a need to intensify education on the importance and the role of ITNs use in the prevention of malaria

Informal payments and willingness to pay informally for health care among older adults:equity perspectives for geriatric care in Ghana

BackgroundOut-of-Pocket (OOP) payment is one mechanism for funding health care in low- and middle-income countries (LMICs). The wider implications mean OOP payments have the potential to increase, with catastrophic effects for a vulnerable population group such as older adults. This study aimed to determine the prevalence of informal patient payments (IPPs) and willingness and ability to pay informally, and its associated factors among older adults in Ghana.MethodsWe conducted a community-based cross-sectional study to collect data among 462 older adults (60+ years) across three municipal areas in the Volta Region of Ghana. Data were collected using an interviewer-administered semi-structured questionnaire. Binary logistic regression was performed to identify factors associated with IPP. The significance level was set at P < 0.05.ResultsThe prevalence of IPP was 21.2%. About 64.5% of respondents were willing to make IPP if they had good financial standing. Factors significantly associated with IPP were age (75 years and above) (odds ratios [OR], 1.76; 95% confidence interval [CI], 1.37–2.26), being uninsured (OR, 1.68; 95% CI, 1.48–1.91), having a urinary health problem (OR, 2.49; 95% CI, 1.56–3.97), and having a stronger preference for private healthcare facilities (OR, 1.35; 95% CI, 1.26–1.44). Not having a chronic condition (OR, 0.59; 95% CI, 0.41–0.83) and unwillingness to make IPP (OR, 0.48; 95% CI, 0.26–0.87) were associated with lower odds of IPP.ConclusionThe existence IPP reflects important inequity gaps within the formal healthcare system and requires urgent sustainable policy actions to protect economically vulnerable older adults from financial catastrophe. We recommend measures of informal payments and “perceived corruption” in the health system be included in the Ghana Living Standard Surveys and Demographic Health Surveys to inform future policy decisions in this area

Impact of a bottom-up community engagement intervention on maternal and child health services utilization in Ghana: a cluster randomised trial.

BACKGROUND: Ghana is among African countries not likely to achieve the Sustainable Development Goal (SDG) three (3) target of reducing maternal mortality to 70 per 100,000 live births by the year 2030 if maternal and child health services utilization are not improved. Community engagement in health is therefore advocated to help address this challenge. This study evaluated the impact of a community engagement intervention on maternal and child health services utilization in Ghana. METHODS: This study was a cluster randomised trial among primary healthcare facilities (n = 64) in the Greater Accra and Western regions in Ghana. Multivariate multiple regression analysis and paired-ttest were used to determine impact of the community engagement intervention on maternal and child health indicators at baseline and follow-up. RESULTS: Intervention health facilities recorded significant improvements over control facilities in terms of average spontaneous vaginal deliveries per month per health facility (baseline mean = 15, follow-up mean = 30, p = 0.0013); child immunizations (baseline mean = 270, follow-up mean = 455, p = 0.0642) and female condoms distribution (baseline mean = 0, follow-up mean = 2, p = 0.0628). Other improved indicators in intervention facilities were average number of Human Immunodeficiency Virus (HIV) tests for non-pregnant women (baseline mean = 55, follow-up 104, p = 0.0213); HIV tests for pregnant women (baseline mean = 40, follow-up mean = 119, p = 0.0067) and malaria tests (baseline mean = 43, follow-up mean = 380, p = 0.0174). Control facilities however performed better than intervention facilities in terms of general laboratory tests, voluntary counselling and testing, treatment of sexually transmitted infections, male child circumcisions and other minor surgical procedures. CONCLUSION: Community engagement in health has the potential of improving utilization of maternal and child health services. There is the need for multi-stakeholder dialogues on complementing existing quality improvement interventions with community engagement strategies

Leveraging breast cancer screening to promote timely detection, diagnosis and treatment among women in sub-Saharan Africa: a scoping review protocol

Introduction Female breast cancer is now the most often diagnosed cancer in the world. Breast cancer screening aims to reduce mortalities related to cancer, and morbidity associated with advanced stages of the disease, through timely detection in asymptomatic women. This study aims to conduct a comprehensive assessment and evaluation of the evidence on the factors that influence the provision and uptake of breast cancer screening among women in sub-Saharan Africa (SSA). Methods and analysis PubMed, Web of Science, EMBASE and the Cumulative Index to Nursing and Allied Health Literature including Google Scholar will be searched to identify published studies on barriers and facilitators to breast cancer screening from January 2010 to 2021. Two reviewers will independently assess the quality of all the included studies using the Mixed Methods Appraisal Tool version 2018. We envisage that this review will adduce evidence on common barriers and facilitators to breast cancer screening in SSA. Identifying these barriers and facilitators will help guide the initialisation of effective interventions that will improve breast cancer screening uptake among women in SSA. This review will also guide future research in developing, implementing and evaluating appropriate interventions tailored toward increasing breast cancer screening uptake. Ethics and dissemination Ethics approval for this protocol is not required since it does not involve collecting data from human participants. The outcomes of this study will be published in a peer-reviewed journal.info:eu-repo/semantics/publishedVersio

Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000-2018

Background Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15–59 years across SSA. Methods We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. Results We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. Conclusions As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.publishedVersio