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Menstruation among adolescent girls and young women (AGYW) can be marked by several challenges that often result in exclusion from social activities. Information regarding this subject matter is however sparse in Ghana. This study examined the rural-urban differences in prevalence and correlates of exclusion from social activities due to menstruation among AGYW in Ghana. The study used cross-sectional data drawn from the women dataset of 2017/2018 Ghana Multiple Indicator Cluster Survey Six (GMICS 6). Data of adolescents ( n = 2927; age 15-19) and young women ( n = 2194; age 20-24) was analyzed in Stata version 14. About 21.65% of the respondents indicated that they excluded themselves from activities during menstruation with slightly higher rates for rural AGYW (22.2%) compared to their urban counterparts (21.11%). Multivariable Poisson regression models showed that compared with nonattainment of formal education, urban AGYW who attained a primary level education were more likely to exclude themselves from social activities due to menstruation [APR = 2.76, 95% CI:1.11, 6.90]. Also, currently married urban AGYW were less likely to exclude themselves from social activities due to menstruation [APR = 0.63, 95% CI:0.44, 0.91]. AGYW residing in the second-lowest wealth household in rural areas had a higher likelihood of exclusion from social activities due to menstruation [APR = 1.34, 95% CI:1.03, 1.75]. Region of residence was a significant correlate in both rural and urban samples but with an observed rural-urban variation. Given the prevalence of AGYW who exclude themselves from social activities, the government and non-governmental organizations that seek to improve menstrual hygiene and empower young women to participate in social activities regardless of their monthly menstrual flow should take into consideration the urban-rural differentials in the associated factors identified in this study., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

Introduction: Studies in Southeast Asia found that bullying commonly occurred among students, and it has a detrimental impact on their school attendance. However, there is a paucity of literature in Timor-Leste on the association between bullying and truancy. Therefore, this study examined the association between bullying and truancy among Timor-Leste school-going adolescents., Methods: We used the 2015 Timor-Leste Global School-based Student Health Survey (GSHS) dataset to examine our hypothesis in logistic regression models for both full adolescents ( N = 3609) and gender stratified samples. The models further controlled for other sociodemographic variables. Statistical significance was pegged at p ≤ 0.05, and the analyses were performed in Stata version 14., Results: About 28% [95% CI:25.7, 30.8] and 36% [95% CI:33.5, 39.5] of school-going adolescents had experienced bullying and truancy, respectively. In-school adolescents who were bullied were more likely to be truant in school even after controlling for the effects of sex, age, grade in school, food insecurity, current substance use, number of friends, colleague support, and parental involvement. This relationship remained significant in the full and gender stratified models. Additionally, school-going adolescents who were currently using substances were truant. Males who were in a physical fight while females who were physically attacked were more likely to be truant., Conclusion: The study showed that bullying was related to truancy among school-going adolescents in Timor-Leste. Implementation of interventions such as Project START (Stop Truancy and Recommend Treatment) to curtail the incidence of bullying, regulation of current substance use, creating an enabling environment to reduce physical fights, and attacks will significantly reduce the rate of truancy among school-going adolescents in Timor-Leste., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

Background: The literature posits that HIV knowledge is associated with precautious sexual behaviour and practice. We hypothesised and investigated the association between knowledge of HIV transmission and adolescent pregnancy in Ghana, given that the relationship between HIV knowledge and adolescent pregnancy has not been extensively studied., Methods: We did analyses on 5836 cases (weighted as 5121) of 15-24 years old reproductive age women in the female dataset of the 2017 Multiple Cluster Indicator Survey. Adolescent pregnancy was operationalized as reproductive age women between 15-24 years who became pregnant before the age of 18 years. Accurate HIV knowledge was measured by computing the scores of correct responses on six questions exploring women's knowledge about HIV transmission. We accounted for sample design and weight before performing a Chi-square test of independence and Poisson regression., Results: The results indicate that having lower scores on the HIV transmission knowledge scale was correlated with a higher probability of girls becoming pregnant before their 18 th birthday. After controlling for the moderating effect of socio-demographic characteristics of the participants, we found that accurate HIV transmission knowledge loses its statistical significance in determining adolescent pregnancy. The factors that remain significant in the adjusted model were formal education status, household wealth, and region of residence. HIV transmission knowledge was statistically significantly related to adolescent pregnancy in the model after the education level variable was omitted. This observation was due to the significant effect of school education on other variables in the model. This result demonstrates that HIV knowledge has a major impact on adolescent pregnancy, but this effect is predicated by formal education attainment of the adolescent girl., Conclusions: Given the results, adolescent pregnancy issues can be resolved by the government and other development partners by adequately educating adolescents about HIV transmissions. Also, because they have the potential to reduce pregnancy among adolescents in Ghana, we recommend that programs and initiatives should address existing disparities in formal educational attainment and household wealth., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)

Background: Functional difficulties have long-term implications for children's physical, cognitive, emotional, social, and academic growth and development. Although the subject of functional difficulties has received enough scholarly attention in the developed world, few studies have addressed the issue in Ghana. Therefore, the study aimed to regress child, maternal and household and geographical level factors associated with the functional difficulty of children in Ghana., Method: We analysed the 2017/18 multiple indicator cluster survey dataset. The study sample consists of weighted cases of 21,871 children within the ages of 5-17 years. Summary statistics were produced for the study variables. Bivariate analyses were performed to select significant correlates for the multivariate analysis. We accounted for sample design and weight before using Poisson regression techniques to do the bivariate and multivariate analysis., Results: These factors were significantly associated with functional difficulties among 5-17 years old children in Ghana: not covered with health insurance, mothers who have a functional difficulty and those without information on their functional difficulty status, and children who dwelt in richer households compared to the richest households. Compared to the northern region, children from the remaining nine regions in Ghana were more likely to have had a child functional difficulty., Conclusion: Given the results, the government of Ghana and other development partners should promote policies and programs to reduce the consequences of disability or functional difficulties in children by taking into consideration factors like mothers' functional difficulty, access to health insurance, and regional and economic disparities in Ghana., Competing Interests: The authors declare no conflict of interest., (© 2020 The Author(s).)

Objectives: Handwashing with soap and water remains the most effective public health measure to reduce the risk of infectious diseases, which kill over 2.5 million people annually, mostly children in developing countries. The absence of hand hygiene resources in homes put many at risk of these infectious diseases. In the wake of the outbreak of the COVID-19 pandemic, the World Health Organization (WHO) and governments around the world have stressed the importance of regular handwashing to prevent the spread of the virus. This suggests that research on water, sanitation, and hygiene issues deserve continuous scholarly attention. In Ghana, studies on household's access to hand hygiene resources are few and relatively old. Therefore, this study estimated the proportion of Ghanaian households with access to hand hygiene resources and their associated determinants using data from a recent national survey., Methods: The study used the cross-sectional 2014 Ghana Demographic and Health Surveys dataset. We used STATA-14 to perform data analyses on a weighted sample of 11,710.06 households. We used complex samples analysis technique to adjust for sample units, stratification and sample weights for both the descriptive statistics and multivariate robust Poisson regression., Results: The result showed that about one fifth of Ghanaian households had access to hand hygiene resources. Households with heads who attained a Middle/JHS/JSS or Secondary/SSS/SHS/Higher level education, those headed by persons having at least 30-44 years, and non-poorest households, and from the Volta region were more likely to have access to hand hygiene resources. Further, households in urban areas, households that spent between 0-30 min to get to a source of water, and households in Eastern and Brong-Ahafo regions were less likely to have access to hand hygiene resources., Conclusion: This study identified key socioeconomic and demographic correlates of a household's access to hand hygiene resources in Ghana. In the interim, the government and development partners can provide hand hygiene resources to households with limited or no access. For the long term, we recommend that the government should implement measures and policies that facilitate citizens' economic independence and their attainment of higher formal education., (© 2020 Published by Elsevier Ltd.)

The authors of this paper are involved in a 5 years respectful maternity care (RMC) project at a tertiary healthcare facility in Kumasi, Ghana that seeks to change the culture of disrespect and abuse in maternity care practice, with a sub-objective of determining its impact on how midwives provide quality maternity care services in this healthcare facility. To achieve this objective, respectful maternity care must be conceptualized and measured. Our literature search revealed that a Ghanaian version tool that measures women's experiences of respectful maternity care is non-existent. Thus, this study aims to construct a scale that measures childbearing women's experiences of respectful maternity care during childbirth and the immediate postpartum period in the study setting. We surveyed 263 postpartum women with a draft scale we have developed. This scale had 42 questions that sought to measure postpartum women's experiences of respectful maternity care in a tertiary health facility in Kumasi. The scale development went through processes of exploratory factor analyses (EFA) and inter-item reliability tests. The EFA was done using SPSS-21. Through series of EFA, we have created a 23 items RMC scale (23i-RMC) with three main factors labelled as follows: Verbal abuse-free, Discriminatory-free and Dignified care (VADDC), Physical and Psychological Abuse-free care (PPAC), and Compassionate Care (CC). The Cronbach's Alpha of the 23i-RMC is 0.945 and those of the individual domains greater than the 0.70 minimum threshold, suggesting that there is greater reliability among the items in the scale and the subscales. This 23i-RMC scale is useful for assessing postpartum women's experiences of RMC in the study setting. We recommend the use and validation of the newly developed respectful maternity care scale in other healthcare facilities in Ghana., (© 2020 The Authors.)

Background: Breast cancer cases are on the rise in Ghana, with older adult women being more at risk of the disease. However, there is a paucity of current studies on factors that predict breast cancer screening among older adult women using nationally representative data. The present study, therefore, addressed this gap by estimating the prevalence of and identifying the factors that predict breast cancer screening among older adult women in Ghana., Methods: We used the cross-sectional survey dataset of the 2014/2015 (wave II) Study on global AGEing and adult health (SAGE). A complex survey design methodology was employed to estimate the prevalence of breast cancer screening and the descriptive statistics of the demographic characteristics of the respondents. We used the firth logistic regression for the bivariate and multivariate analysis., Results: The estimated breast cancer prevalence among older Ghanaian adult women was 4.5%. Older Ghanaian adult women who have screened for cervical cancer [AOR: 13.29; CI: 6.12, 28.84], had attained some primary education [AOR: 3.70; CI: 1.94, 7.07], junior secondary [AOR: 4.02; CI: 1.75, 9.21], senior secondary and higher [AOR: 4.57; CI: 2.15, 9.71], and have ever participated in a club meeting [AOR: 1.85; CI: 1.05, 3.24] were more likely to screen for breast cancer., Conclusion: The significant predictors of breast cancer screening were cervical cancer screening status, formal education, and participation in club meetings. Given that the prevalence of breast cancer screening among the older adult women in Ghana is low, we recommend that policies and programs dedicated to encouraging women to screen for breast cancer should aim at giving women the opportunity to obtain higher formal education, encouraging women to be actively involved in club meetings and to intensify efforts to encourage women to screen for breast cancer., (© 2020 The Authors.)

Sierra Leone is among the countries that recorded high under-five child mortality rate in the world. To design and implement policies that can address this public health challenge, the present study developed a predictive model of factors that explained under-five mortality in Sierra Leone using the 2008 and 2013 Sierra Leone Demographic and Health Survey (SDHS) datasets. LASSO regression technique was used to select the predictors to build the under-five predictive single-level logit and multilevel logit models. Statistical analyses were performed in the R freeware version 3.6.1. About 588 (10.4%) and 1320 (11.1%) children under five were reported dead in 2008 and 2013, respectively. The significant predictors of under-five mortality in Sierra Leone were the total number of children ever born, number of children under five in the household, mother's birth in the last five years, mother's number of living children, and number of household members, household wealth, maternal contraceptive use and intention, number of eligible women in the household, type of toilet facility, sex of the child, and weight of the child at birth. The study identified certain predictors that deserve policy attention and interventions to strengthen the efforts of creating child welfare and survival atmosphere in Sierra Leone., (© 2020 Published by Elsevier Ltd.)