Factors Associated with Haemoglobin Prevalence among Ghanaian Children Aged 6 – 59 months.

This study was undertaken to assess the prevalence of anaemia and to investigate various factors associated with haemoglobin (Hb) prevalence in children aged 6–59 months in Ghana. The data set used was based on a longitudinal study from the fourth round Multiple Indicator Cluster Survey (MICS). This was a national survey conducted by Ghana Statistical Service (GSS) to monitor the progress of women and children. A sample of 7,626 children under-five years across the country between 2009 and 2011 were selected for the survey. Multiple logistic regression and bootstrap technique for parameter estimates were used to determine the relationship of biological, socio-economic, nutritional and other factors associated with Hb concentration. The prevalence of anaemia among children between 6 – 59 months in Ghana found in this study was 64.7% which is quite high even though lower than the 2008 GDHS rate of 78%. This is so because it is still higher than the WHO cut-off point of 40% making it a serious public health concern. The highest rate of 36.2% occurs within the 6 – 23 months. The factors observed to be highly significantly associated with anaemia among these children included malaria prevalence (p-value=0.000), age of the child (p-value=0.000), household economic status (0.000), region of residence (p-value=0.000), mothers educational level (p-value=0.000) and sex of the child (p-value=0.000). All other factors considered such as area of residence and ethnicity were not significant (p-values > 0.05). In a nutshell, children who are born to more advantaged women who have high educational levels, economically sound, live in areas that are not infested with malaria, live in the southern part of Ghana and are females have low probability of becoming anaemic than their counterparts who are disadvantaged and live in malaria prone environment. Keywords: Haemoglobin, Prevalence rate, Anaemia, Malaria, Socio-Economi

The Effect of Household Characteristics on Child Mortality in Ghana

The objective of this study was to establish the relationship between household characteristics and mortality among children under the ages of five in Ghana. Ghana’s under-five mortality rate stands at 82 deaths per 1000 live births and infant mortality rate of about 53 deaths per 1000 which is far above the world’s average in 2006 of 52 deaths per 1000 live births (GSS, MICS 2011). Again, according to (IGME 2012 report) in the 2011 under-five mortality league, Ghana is ranked 34 among 195 countries with child mortality rate of 78 per 1000. (Number 1 being the highest and 195 being the lowest in terms of child mortality). In order to address this problem, the authors used survey data on 4169 women respondents drawn from the 10 administrative regions of Ghana. Brass-type indirect techniques for mortality estimation were employed to establish the mortality rates. In addition, logistic regression analysis examined factors related with child mortality. Of the 1411 women who gave birth during the survey period about (295) 20.9% had given birth who later died. Findings show wide mortality differentials by Mothers’ age, mothers’ educational levels, place of residence, and household size. Breastfeeding, children ever born, material used for floor of the dwellings and region of residence were the four major variables highly associated with child mortality. The study concludes that household structure, source of drinking water and toilet facilities used were not related to child mortality. There is need for adult literacy, secondary and above education for women and sensitization about the effects of large households, exclusive breastfeeding and children ever born. Such studies provide insight into understanding the relationship between various household characteristics and child health outcomes. Keywords: Household, Characteristics, Child, Mortality, Ghan

Low Birth Weight and Associated Maternal Factors in Ghana

This study examines the prevalence of low birth weight (LBW) among infants and its association with maternal factors in Ghana. The study used a data set based on alongitudinal study from the fourth round Multiple Indicators Cluster Survey (MICS). This was a national  survey conducted by Ghana Statistical Service (GSS) in 2011 to monitor the progress of women and children. A sample of 10,963 women within the reproductive age (15 - 49 years) across the country between 2009 and 2011 were selected for the survey. In this study, a multiple logistic regression was used to determine the relationship of maternal factors and low birth weight. The estimated LBW prevalence was 9.2% which is higher than other part of the world. Few children are weighed at birth as less than 50% of babies born in Ghana are weighed at birth.This means that the prevalence rate could be higher than the current estimate. This stands to reason that the rate still indicates a public health problem (ACC/SCN, 2000). The factors observed to be  highly significantly associated with LBW included Antenatal Care (p-value =0.0010), Educational level (p-value =0.0011), Location (p-value =0.0011) and Economic status (p-value=<0.0001) as well as Central region (p-value= 0.0003). There is also risk for maternal age less than 24 and above 35 years (p-value=1.3409E-19 and 3.8257E-21 respectively), mothers who had given birth to more than four children (p-value=1.4519E-33) and women in Northen region (p-value= 0.0535 ). All other variables considered such as malaria in pregnancy, ethnicity, and marital status were not very significant (p-values > 0.05). In a nutshell, economic status, educational level, antenatal care and location are highly significantly risk factors associated with LBW in Ghana. Early/late maternal age and parity of more than four also showed some level of significance with LBW. Malaria in pregnancy, ethnicity, and marital status among others were however not significant. Keywords: Low birth weight, maternal factors, prevalence rate, risk factor

Female Genital Mutilation/Cutting among Ghanaian Women: The Determinants

This study examines female genital mutilation/cutting (FGM) among Ghanaian women and the determining factors associated with the practice. We used a data set based on a longitudinal study from the fourth round Multiple Indicators Cluster Survey (MICS). This was a national survey conducted by Ghana Statistical Service (GSS) in 2011 to monitor progress of women and children. A sample of 10,963 women within the reproductive age (15 – 49) years across the country between 2009 and 2011 were selected for the survey. A multiple logistic regression and bootstrap techniques were used to determine the relationship of socio-demographic factors and female circumcision. The estimated women who had undergone female circumcision was about 15.9% out of the 7666 women who responded to the question on female circumcision. This means that about 2 out of 10 women between 15 – 49 years have undergone circumcision. Female circumcision is very predominant among women in the Upper West region, Moslems and the Mole/Dagbanis. The factors observed to be highly significantly associated with female circumcision among Ghanaian women included marital status (p-value = 0.000), woman’s age (p-value = 0.000), region of residence (p-value = 0.000), educational level (p-value = 0.001), religion (p-value = 0.002) and ethnicity (p-value = 0.002). The results show that prevalence of FGM among more advantaged women is lower than less advantaged women. The findings further reveal that women from the northern part of Ghana are more prone to FGM than women who live elsewhere. Keywords: Female Genital Mutilation/Cutting, Reproductive age, Prevalence, Endemi

The Desire for last Birth among Ghanaian women: The Determinants

This study examines the desire for last birth among Ghanaian women and the determining factors associated with such desire. The study used a data set based on a longitudinal study from the fourth round Multiple Indicators Cluster Survey (MICS). This was a national survey conducted by Ghana Statistical Service (GSS) in 2011 to monitor progress of women and children. A sample of 10,963 women within the reproductive age (15 – 49) years across the country between 2009 and 2011 were selected for the survey. In this study, a multiple logistic regression and bootstrap techniques were used to determine the relationship of maternal factors and desire for more children. The estimated women who expressed no desire for the last birth was about 33.7% out of the 2873 women who gave birth within the survey period. This means that more than 3 in 10 women get pregnant when they are not prepared. The factors observed to be highly significantly associated with desire for more children among Ghanaian women included marital status (p-value = 0.000), parity (p-value = 0.000), mothers’ age (p-value = 0.000) and region of residence (p-value = 0.000). The results show that childbearing among more advantaged women are better planned than less advantaged women. The findings further reveal that about 30.7% of married women have an unmet need for family planning (unmet need for family planning defined as the percentage of married women who want to space their next birth or stop childbearing entirely but are not using contraception). Keywords: Desire for last birth, unmet need, maternal factors, determinant

An innovation platform for institutional change in Ghana's cocoa sector

Cocoa is a major source of employment, smallholder farmers' incomes, and export revenue in Ghana. However, by 2010 institutional constraints throughout the value chain were failing to sustain bean quality and cocoa production. A national-level innovation platform, comprising key public and private actors in the cocoa sector, was established in 2010 to analyse and act to address this concern. The members' initial inquiries revealed that: farmers indirectly were paying for the national mass spraying and Hi-Tech input programmes, both provided free at the point of delivery. As the largest components in the cost structure, these programmes to a large extent accounted for the low price paid to farmers for their beans; a volatile exchange rate regime meant that often the prevailing rate was not equal to its equilibrium level; policies that heavily taxed cocoa were destroying farmers' expectation of long-term profitability. This paper draws on data recorded from the beginning 2009 to end 2013 by means of theory-guided process tracing (TGPT), to show how the platform contributed to increased prices for farmers, to subsequent reform of the input supply arrangements, and to changes to the mass spraying programme. The key causal mechanisms identified are policy learning and progressive amendment of existing institutions. The paper concludes by drawing lessons for the role of an innovation platform

An innovation platform for institutional change in Ghana's cocoa sector

Cocoa is a major source of employment, smallholder farmers' incomes, and export revenue in Ghana. However, by 2010 institutional constraints throughout the value chain were failing to sustain bean quality and cocoa production. A national-level innovation platform, comprising key public and private actors in the cocoa sector, was established in 2010 to analyse and act to address this concern. The members' initial inquiries revealed that: farmers indirectly were paying for the national mass spraying and Hi-Tech input programmes, both provided free at the point of delivery. As the largest components in the cost structure, these programmes to a large extent accounted for the low price paid to farmers for their beans; a volatile exchange rate regime meant that often the prevailing rate was not equal to its equilibrium level; policies that heavily taxed cocoa were destroying farmers' expectation of long-term profitability. This paper draws on data recorded from the beginning 2009 to end 2013 by means of theory-guided process tracing (TGPT), to show how the platform contributed to increased prices for farmers, to subsequent reform of the input supply arrangements, and to changes to the mass spraying programme. The key causal mechanisms identified are policy learning and progressive amendment of existing institutions. The paper concludes by drawing lessons for the role of an innovation platform

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways