Estimating the stochastic uncertainty in sample-based estimates of infant mortality in Ghana

The Infant Mortality Rate (IMR) is an important population health statistic often used as one of the indicators of the health status of a nation. In many countries lacking adequate vital registration systems, sample methods are used to estimate IMRs. However, evaluations of this approach are rare and the literature contains no assessments of the stochastic uncertainty underlying these estimated IMRs. Stochastic uncertainty reflects the fact that even where the underlying IMR is constant in a small population over time, there is a likelihood of yearly fluctuation in its empirical observations even if it is measured from a complete count of the events of interest. In this study a method is presented that can be used to assess this stochastic uncertainty. We use the country of Ghana as a case study for this purpose. The method, a beta-binomial model, is described, tested for validity, and illustrated using 2014 sample-based estimates of IMR for 13 sample regions in Ghana. As such, the approach we described regarding the revision of sample-based IMR estimates is aimed at taking into account of the stochastic uncertainty while preserving the information concerning the uncertainty due to sampling. In applying the method to Ghana, we find that the sample-based IMR estimates perform well in accounting for stochastic uncertainty and could be applied elsewhere

Increasing access to family planning in Ghana through policy change: Task-sharing to enable auxiliary nurses to provide contraceptive implant services

Ghana has made significant progress toward reducing the maternal mortality ratio but the rate is still unacceptably high. Up to 26 percent of married Ghanaian women have unmet need for family planning and one in four currently married women is using a modern contraceptive method. Satisfying unmet need for family planning could cut the number of maternal deaths by almost a third. One factor contributing to low usage of modern methods is shortage of trained staff, particularly those skilled in providing long-acting reversible and permanent methods. Until recently, implant services were provided primarily by Ghana Health Service (GHS) trained midwives, but lower cadre health workers were restricted from inserting and removing implants. In 2008, the Population Council and partners collaborated with GHS to train 33 Community Health Nurses (CHNs) in insertion and removal of Jadelle to augment services provided by midwives. GHS, in collaboration with the Population Council, convened meetings to discuss experiences with training this group of CHNs, findings of the assessment, WHO task-sharing recommendations, and case study results. As noted in this policy brief, GHS announced in 2013 that reproductive health policy would be changed to allow CHNs to provide implant services

Community-based Health Planning and Services and Women’s Access to Health Care in the Upper West Region of Ghana

The Community-based Health Planning and Services (CHPS) policy was implemented in 1999 to improve access to Primary Health Care (PHC) services in Ghana, particularly in rural and remote areas as part of global efforts to achieve universal health coverage. Despite this initiative, health care access in the Upper West Region (UWR) remains poor with wide gender disparities. Yet, little is known about the impact of CHPS on women’s access to health care services in the UWR of Ghana. This study therefore examines the role of CHPS on women’s access to health care services in the region. Data were obtained from a cross-sectional survey of women (n=805) in seven selected districts using a multi-stage sampling method and analysed using a logistic regression technique. Study findings reveal that women resident in CHPS zones (OR=1.612, p≤ 0.01) were more likely to have access to basic health care services compared to their counterparts in non-CHPS zones. Similarly, women who resided in CHPS zones (OR=2.806, p≤ 0.01) were more likely to report being able to make independent decisions to utilize health facility-based deliveries compared to their non-CHPS resident counterparts. Additionally, women’s geographical location (rural-urban residence and distance to health facility) as well as their socio-economic and demographic status were found to be associated with their access to health care services. These findings suggest that CHPS policy seems to have positive impacts on health care access among women in its operational areas, which are mostly rural. Based on the findings, the study recommends improvement in the number of services and quality of care delivered at CHPS compounds while ensuring community ownership for its sustainability. It is further recommended that the CHPS policy be expanded to cover more rural communities in the region. The current electoral area based zoning system should be re-conceptualized, and a multi-criteria approach used in siting CHPS to ensure optimization of health care services and coverage

Upscaling Community-Arranged Preparedness for Preventing Maternal Mortality in Ghana: A Case Study of Keta and Akatsi Districts of Volta Region

The main objective of the study is to assess maternal health in Ghana using empirical evidence from Akatsi and Keta districts of the Volta Region. Interviews were conducted from a sample size of 6,250 respondents within the reproductive age group of 15-49 years drawn from both districts in 2007. The results show that most of the women had only basic education and were generally petty traders, farmers and fishmongers. Overwhelming majority of the women stated that there was no community-arranged preparedness to aid them in times of emergency obstetric care. A significant proportion of the women (about 30%) relied on relatives/friends/home or traditional birth attendants (TBAs) to deliver their babies, while the road network in both districts was poor. The Government of Ghana should therefore rehabilitate roads or construct new ones that could help the people transport emergency complications to the health facility on time to prevent deaths. These TBAs should be trained to recognize complications and not to manage complications professionally and they should be motivated to make referrals to mainstream health facilities. The Government of Ghana should aim at increasing girls’ participation at all levels of the education system in the country since education is the key to ending poverty

Trends and determinants of contraceptive use among female adolescents in Ghana: Analysis of 2003-2014 Demographic and Health Surveys.

Introduction:Thirty percent (30%) of all deliveries in 2014 were recorded among adolescents in Ghana, whom contraceptive use has been found to be low. Our study, therefore, aimed to retrospectively look at the trends and determinants of contraceptive use (modern and traditional) among female adolescents in Ghana. Materials and methods:We used data from the 2003, 2008 and 2014 Ghana Demographic and Health Surveys. The sample for this study comprised sexually active female adolescents aged 15-19 for each of the rounds thereby resulting in a sample of 426 in 2003, 389 in 2008 and 726 in 2014. We calculated the proportion of adolescents using contraceptives (either traditional or modern) for each of the three surveys. We computed the use of contraceptives among adolescents and the type of contraceptives used with respect to their socio-demographic characteristics. Multinomial Logistic Regression was used to assess the determinants of contraceptive use at 95% confidence interval and Odds Ratios (OR) and p-values were reported. Results:Contraceptive use declined from 22.1% in 2003 to 20.4% in 2014. Adolescents who were married had lower odds [OR = 0.09, 95% CI = 0.03-0.96] of using traditional methods of contraception compared to those who were not married. Those who read newspapers at least once a week were more likely to utilize modern contraceptives [OR=1.84, CI = 1.05-4.78] compared to adolescents who did not read newspapers at all. Similarly, those who watched television at least once a week were more likely to use modern contraceptives than those who did not watch television at all [OR = 2.25, CI = 1.06-4.78]. Conclusion:These findings imply that intensifying educational messages on contraceptive use among adolescents using various newspapers and television stations to convey the messages and emphasizing the importance of using modern contraceptive is worthwhile

Evidence Advisory System Briefing Notes: Ghana

There has been a growing global concern for improving the use of evidence to inform health policy in recent years. Increasingly there is recognition that individual projects or programmes building evidence synthesis skills, may be limited in their effect without a broader consideration of the systems in place which ‘embed’ or ‘institutionalise’ evidence informed policy making practices (Alliance for Health Policy and Systems Research and WHO 2007). The GRIP-Health programme is a five-year project supported by the European Research Council which studies the political nature of health policy to understand how to best improve the use of evidence. This explicitly political lens enables us to focus on the contested nature of health issues as well as the institutions that shape the use of evidence in health policy making. We understand institutions as including both formal structures and rules, as well as informal norms and practices (Lowndes and Roberts 2013). The GRIP-Health programme follows the World Health Organization’s view that Ministries of Health remain the ultimate stewards of a nation’s health, and further play a key role in providing information to guide health decisions (World Health Organization 2000, Alvarez-Rosette, Hawkins et al. 2013). As such, GRIP-Health is particularly concerned with the structures and rules created by government to gather, synthesise, or otherwise provide evidence to inform policy making. This working paper is one of a series of six briefs covering a set of countries in which the GRIP-Health programme is undertaking research. This brief presents an overview of what is termed the ‘Evidence Advisory System’ (EAS) for health policy making within the country of interest, which is taken to encompass the key entry points through which research evidence can make its way into relevant health policy decisions. This can include both formal (government mandated) and informal structures, rules, and norms in place. Individual reports in this series can be useful for those considering how to improve evidence use in specific country settings, while taken together the reports identify the differences that can be seen across contexts, permitting reflection or comparison across countries about how evidence advisory systems are structured – including which responsibilities are given to different types of bodies, and how well evidence advice aligns with decision making authority structures

Introduction of DMPA-SC self-injection in Ghana: A feasibility and acceptability study using Sayana® Press

This research report describes results from an implementation science study that explored the feasibility and acceptability of administering depot medroxyprogesterone acetate-subcutaneous (DMPA-SC) among health-care providers and family planning (FP) clients in Ghana. DMPA-SC is an injectable contraceptive method that can be self-administered. The study, conducted by the Population Council through the USAID-funded Evidence Project in collaboration with the Ghana Health Service, was implemented in rural, peri-urban, and urban areas of the Ashanti and Volta regions. A total of 150 health-care providers were trained to administer DMPA-SC and to train clients on self-injection. Clients assessed as being competent self-injected under the provider’s supervision and could take two DMPA-SC doses home for future self-injections. Results indicate that DMPA-SC self-injection is feasible and acceptable to both providers and FP clients. The report also examines the socio-demographic profile of providers and clients, method continuation, and feasibility and acceptability of home self-injection. Results have informed the national scale-up of DMPA-SC in public and private facilities, which began in April 2019

Comparing the effectiveness and costs of alternative strategies for improving access to information and services for the IUD in Ghana

The Ghana Health Service (GHS) was prompted to explore ways of increasing interest in the IUD through increasing awareness of this and other long-acting and permanent methods via interpersonal channels and by intensifying campaigns to dispel rumors about the method. The Health Research Unit of the GHS, EngenderHealth’s Quality Health Partners project, and the Population Council’s Frontiers in Reproductive Health (FRONTIERS) project collaborated with the GHS to test innovative approaches to increase awareness of the IUD and to improve access to the method. The study examined the general and method-specific knowledge of long-acting family planning methods among clients and providers, as well as the level of contraceptive use by method in the intervention and comparison communities. In general, community health officers (CHOs) exhibited adequate knowledge of and a positive attitude toward the IUD. The report concludes that increases in the numbers of new IUD and implant users recorded by CHOs who undertook insertions at the community level, together with the much lower cost for this model, suggest that training CHOs to educate communities about long-acting methods and enabling them to provide them at the community level should be considered

Postnatal care utilisation among women in rural Ghana: analysis of 2014 Ghana demographic and health survey

Background Maternal mortality is high in Ghana, averaging 310 maternal deaths per 100,000 live births in 2017. This is partly due to inadequate postnatal care especially among rural communities. Ghana can avert the high maternal deaths if women meet the World Health Organisation’s recommended early postnatal care check-up. Despite the association between geographical location and postnatal care utilisation, no study has been done on determinants of postnatal care among rural residents in Ghana. Therefore, this study determined the prevalence and correlates of postnatal care utilization among women in rural Ghana. Methods The study utilised women’s file of the 2014 Ghana Demographic and Health Survey (GDHS). Following descriptive computation of the prevalence, binary logistic regression was fitted to assess correlates of postnatal care at 95% confidence interval. The results were presented in adjusted odds ratio (AOR). Any AOR less than 1 was interpreted as reduced likelihood of PNC attendance whilst AOR above 1 depicted otherwise. All analyses were done using Stata version 14.0. Results The study revealed that 74% of the rural women had postnatal care. At the inferential level, women residing in Savanna zone had higher odds of postnatal care compared to those in the Coastal zone [AOR = 1.80, CI = 1.023–3.159], just as among the Guan women as compared to the Akan [AOR = 7.15, CI = 1.602–31.935]. Women who were working were more probable to utilise postnatal care compared to those not working [AOR = 1.45, CI = 1.015–2.060]. Those who considered distance as unproblematic were more likely to utilise postnatal care compared to those who considered distance as problematic [AOR = 1.63, CI = 1.239–2.145]. Conclusions The study showed that ethnicity, ecological zone, occupation and distance to health facility predict postnatal care utilisation among rural residents of Ghana. The study points to the need for government to increase maternal healthcare facilities in rural settings in order to reduce the distance covered by women in seeking postnatal care

Gender Needs Assessment for Kumasi, Ghana

In September 2000, Ghana was one of 189 signatories to adopt the United Nations Millennium Declaration on the Millennium Development Goals (MDGs). This gender needs assessment focuses on the Millennium Development Goal of gender equality and women‟s empowerment (MDG 3), and whether Kumasi, Ghana‟s second largest city, can achieve both objectives by 2015. MDG 3 specifically seeks to eliminate gender inequality at all levels of education by 2015, but gender equality and women‟s empowerment entail much more. They require equality of economic opportunity, equitable representation in political bodies, access to reproductive rights and freedom from gender-based violence