Child loss and fertility behaviour in Ghana

Evidence shows a strong relationship between child mortality and fertility at the aggregate level but the relationship at the individual level is less clear. Data from the 1993 Ghana DHS are used to examine the impact of infant death on a woman's subsequent fertility behaviour. Birth interval analysis, parity progression ratios, and multilevel discrete-time hazard models are used. Child replacement after infant death is found to be taking place in Ghana. On average, birth intervals are shortened by about 15 months if a child dies in the neonatal stage, and by about 11 months for postneonatal death. Progression to the next parity is higher if an infant dies than if it survives; the probability of progression is about 32% higher if a male child dies than if a female dies. A sustained decline in child mortality in Ghana is likely to result in further reduction in fertility

Immunization status and child survival in rural Ghana

For three decades, the Expanded Programme on Immunization (EPI) has been promoted as one of the key child health interventions in developing countries. Vaccines for six childhood diseases (diphtheria, measles, pertussis, poliomyelitis, tetanus, and tuberculosis) have been shown to be efficacious in preventing disease-specific morbidity and mortality, yet not all commentators are convinced that the EPI reduces all-cause child mortality. Numerous studies have found that measles vaccination programs substantially reduce all-cause child mortality, but recent findings from Guinea-Bissau suggest that diphtheria, pertussis, and tetanus (DPT) vaccine may increase all-cause child mortality. The present study uses five years of data from the Navrongo Demographic Surveillance System, a longitudinal population registration system in northern Ghana, to examine all-cause mortality among vaccinated and unvaccinated children under 5 years of age. The data indicate that coverage by one Bacillus Calmette-Guerin (BCG) shot, three sets of polio drops, and three DPT shots reduces mortality between ages 4 and 8 months by nearly 90 percent. Complete coverage by all EPI antigens reduces mortality between ages 9 and 59 months by 70 percent. BCG, polio, and DPT vaccines without measles vaccination reduce mortality by 40 percent. The independent reduction in mortality associated with measles vaccination is 50 percent. Our data add to a growing body of evidence that suggests that measles vaccination programs reduce all-cause mortality substantially beyond the proportion of deaths caused by measles. These results indicate a need for further research in developing countries on the all-cause mortality impact of these vaccines, in particular DPT vaccine

Contemporary female migration in Ghana: analyses of the 2000 and 2010 censuses

BACKGROUND Knowledge of female migration patterns is scant despite increased recognition and reporting of the feminization of migration. Recent data on female internal migration in Ghana challenge historical assumptions that underestimated female migration. OBJECTIVE This study presents the first detailed comparative analyses of female migration using microdata from Ghana’s censuses (2000-2010) and exploits these national data to understand gendered dimensions of migration in Ghana. METHODS Secondary analyses use direct and indirect methods to describe the scale, type, and demographic structure of contemporary female migration; assess the distribution of female migrants across age and geography; and estimate net internal female migration. RESULTS Approximately 40-50% of internal migrants captured by the census are excluded from other national migration data sources. Excluding international migrants, census microdata identify 31.1% of females and 30.4% of males as internal migrants in 2000. By 2010, the proportion of internal migrants had risen to 37.4% of females and 35.7% of males. Working-age migration is particularly pronounced in 2010, reinforcing economic opportunity as a likely driver of migration for both sexes. Female migrants are significantly more likely than female non-migrants to reside in urban areas and work for pay, profit, or family gain. CONTRIBUTION Our analyses expand the evidence base on contemporary female migration and refute the out-dated stereotype that girls and women do not participate in migration. Productive female labour losses may negatively impact development efforts and local economies in Ghana’s rural regions, requiring interventions to reduce poverty and develop greater economic opportunities for rural girls and women

Costs of reproductive health services provided by four Christian Health Association of Ghana (CHAG) hospitals

The Christian Health Association of Ghana (CHAG) is a large faith-based NGO which currently serves an estimated 35 percent of the Ghanaian population, mainly in remote rural areas. This study built capacity within the CHAG secretariat to calculate the economic cost and cost recovery levels of selected reproductive health services in four CHAG-affiliated hospitals. Techniques learned in the study are applicable to most costing problems, not just to reproductive health. Information obtained in the study forms the basis for negotiating reimbursement under the Ghana National Health Insurance Scheme, and for setting cost recovery and containment policies. CHAG senior managers plan to train other association hospitals in the technique

Acceptability and feasibility of introducing the WHO focused antenatal care package in Ghana

The main objective of this study, undertaken by Noguchi Memorial Institute for Medical Research in collaboration with the Ghana Health Service and FRONTIERS, with USAID funding, was to examine the extent to which adaptation of the WHO focused antenatal care (ANC) package influenced quality of care received by pregnant women and its acceptability to both providers and clients. The results indicate that national-level support for focused ANC is high. The package appears to have been well accepted by both clients and providers because of its comprehensiveness and the individualized care. The process of stimulating changes in focused ANC service delivery will need further consultation of key stakeholders (e.g., pre-service training institutions and professional bodies) to ensure its institutionalization. Community-level education is also required to create awareness about the timing of ANC visits, individual birth planning, advice on danger signs and self-care in pregnancy, complication preparedness, and the need to involve other family members in birth planning

Acceptability and promotion strategies for LNG-IUS in Ghana: A public health assessment

In response to concerns about the side effects of the IUD, the commonly known reversible, long-term method in Ghana, and to curb the shift from long-term to short-term methods, the Ghana Health Service decided to expand women’s contraceptive method choices by introducing the Levonorgestrel-releasing Intrauterine System (LNG-IUS), a hormonal IUD, into the contraceptive method mix. The LNG-IUS is a uterine contraceptive that provides effective long-term protection up to five years. Even though the product has been certified as safe and effective, it was necessary to ensure that it satisfies client’s needs and meets provider expectations. The Population Council, in collaboration with the Reproductive and Child Health Unit of the Family Health Division of the Ghana Health Service and EngenderHealth, implemented an intervention to evaluate the acceptability of the LNG-IUS among family planning clients and to explore effective ways of scaling it up throughout the country. As noted in this report, the study also explored promotion and sustainability strategies to enhance the integration of the product into the family planning method mix

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

Priority setting for reproductive health at the district level in the context of health sector reforms in Ghana

This report outlines results of an in-depth assessment carried out in Ghana in order to provide a better understanding of key factors affecting reproductive health (RH) prioritization at the district level; and to make recommendations for policy dialogue, advocacy, resource allocation, and RH program implementation. In particular, the study examined whether or not districts are connecting to the central process of priority setting and reasons for not doing so. The report includes recommendations for bridging the policy implementation gap, including: ensuring that RH advocates participate in national policy dialogue; investing in systems development for procurement and delivery of drugs and supplies to the health institutions; recognizing that other implementers, in particular NGOs, have a comparative advantage in the delivery of certain components and mobilizing them to deliver these packages to ensure availability of these services at the district level; and mobilizing District Assemblies to support RH activities

A year of genomic surveillance reveals how the SARS-CoV-2 pandemic unfolded in Africa

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