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The extent to which dengue virus has been circulating globally and especially in Africa is largely unknown. Testing available blood samples from previous cross-sectional serological surveys offers a convenient strategy to investigate past dengue infections, as such serosurveys provide the ideal data to reconstruct the age-dependent immunity profile of the population and to estimate the average per-capita annual risk of infection: the force of infection (FOI), which is a fundamental measure of transmission intensity. In this study, we present a novel methodological approach to inform the size and age distribution of blood samples to test when samples are acquired from previous surveys. The method was used to inform SERODEN, a dengue seroprevalence survey which is currently being conducted in Ghana among other countries utilizing samples previously collected for a SARS-CoV-2 serosurvey. The method described in this paper can be employed to determine sample sizes and testing strategies for different diseases and transmission settings. Author summary: The historical circulation of dengue virus is still poorly understood in many parts of the world, and age-stratified seroprevalence surveys can provide the data to quantify population exposure to dengue and its transmission intensity. In this work, we developed a simulation-based method that can be used to identify the sample sizes and age-distribution of the samples needed to obtain informative estimates of dengue force of infection from existing blood samples. We apply this method to data obtained from a SARS-CoV-2 serological survey, previously conducted in three cities in Ghana. The methods and code developed in this paper can be used to design serological surveys for dengue and other pathogens when using existing blood samples with accompanying information on age and location. [ABSTRACT FROM AUTHOR]

The purpose of this paper is twofold: to explore the factors influencing the emergence and growth of informal e-waste activities and to examine workers' motivation for involvement in informal e-waste activities. Semi-structured interviews and observations among actors in the recently established Dagomba-Line e-waste site in Kumasi, Ghana were employed to gather relevant data. Emergence and growth of e-waste activities are largely influenced by spatial, political, socio-cultural and economic factors. The reuse and open disposal of e-waste are the common practices due to the cost of transportation to a final disposal site. Similar to findings at the well-established Agbogbloshie e-waste site, also in Ghana, scavengers are found at the bottom of the e-waste financial ladder. The major motivating factor for engaging in e-waste handling is poverty. Additionally, some respondents mentioned the lucrative nature of the activity, landlessness, and peer influence as a motivation. The results showed that younger workers (below 35 years) were more likely to be engaged in the activity for reasons of peer influence and poverty and major source of livelihood. The paper recommends that policy and planning should reflect ways of delivering and creating stable socio-economic conditions that promote an inclusive and sustainable development. [ABSTRACT FROM AUTHOR]

The paper contributes to unravelling the perceptions of urban commercial drivers regarding their vulnerability to catching the SARS-CoV-2 virus while at work. It further examines how the perception of vulnerability influences personal use of face masks by drivers, as well as on their insistence on appropriate masking behaviour by other persons on-board public transport. Overcrowding and unsanitary conditions in informal public transport in Africa could facilitate the spread of the corona virus. However, the use of face masks, among other enhanced mitigation measures significantly contain and minimize the spread of the virus. Primary data, obtained through surveys at five major public transport terminals in Accra, was analysed and interpreted using the Health Belief Model as an explanatory framework. Results indicate that most drivers have a high vulnerability perception to Covid-19. It further emerged that older drivers, in particular, consistently wore face masks and insisted on other persons in their commercial vehicles to follow suit. Socio-demographic factors, and the need to ensure one's personal safety and those of loved ones were critical determinants of face mask use among surveyed drivers. The study thus recommends that public awareness campaigns should strategically focus attention on the younger generation of drivers (i.e. 18–39 years) who perceived themselves to be immune to the SARS-CoV-2 virus. Also, the collaborative efforts of state and non-state actors, like the transport operator unions, must be further strengthened if the gains made so far against Covid-19 is to be sustained. [ABSTRACT FROM AUTHOR]

Although Akan is one of the most widely spoken indigenous languages in Ghana, very little is known about children's phonological development. This paper investigates the development of consonants in Akan among typically developing children aged 3–5 years. A list of 103 Akan words was compiled, sampling the full range of prosodic structures, sound positions, features and segments, and controlling for word familiarity. A native Akan speaker audio-recorded the 103 single-word productions from each of nine typically developing children aged 3–5 years. The child productions were transcribed and analysed following procedures used in a larger cross-linguistic study. The current study presents results on the acquisition of consonants across the various ages. Preliminary results indicate that most consonants in Akan are mastered by age 4 or 5, similar to reports for other languages, although /w/ and /l/ showed late mastery, contrary to cross-linguistic observations. The rhotic /ɹ/ and consonants with secondary articulation were still developing at age 4 and showing a variety of mismatch patterns across children. The findings provide preliminary information for developmentalists and speech-language pathologists on typical phonological development in Akan and contribute to a growing database on language acquisition in Niger-Congo languages. [ABSTRACT FROM AUTHOR]

Health workers are prone to burnout, which can have an adverse effect on their person and the patients to whom care is offered. The goal of this paper was to assess the levels of burnout experienced by healthcare workers in Accra, Ghana. The study was conducted using the cross-sectional study design. Questionnaires were used to obtain data from 365 respondents who worked in 12 major healthcare facilities. Data obtained were analyzed with SPSS version 23. Majority of the respondents were females (56.7%) as against males (43.3%). The total score for all burnout variables among health worker groups ranged from good (71.50%), alarming (12.60%), acute crisis (6.02%), and burnout (9.90%). Among the health worker groups, nurses had the highest percentage score values for all burnout variables. There was an association between burnout and these sociodemographic characteristics: age (p < 0.001), gender (p = 0.003), educational qualification (p < 0.001), occupation (p < 0.001), years of work experience (p < 0.001), marital status (p < 0.001), and parenthood (having children) (p < 0.001). It is recommended that measures should be put in place in Ghanaian hospitals to assess stress and burnout levels to ensure people who are going through such situations are properly cared and supported. [ABSTRACT FROM AUTHOR]

Globally, young people in sub-Saharan Africa continue to be the population at the greatest risk for sexually transmitted infections (STIs) such as HIV and AIDS, Syphilis, and Gonorrhoea. Research has shown significant relationship between young peoples risky sexual behaviours and their vulnerability to these STIs. The study examined risky sexual behaviours among the youth in Ghana and Kenya in relation to socio-demographic characteristics. The paper uses data from the 2014 Demographic and Health Surveys of Ghana and Kenya. Young people between the ages of 15 to 24 years who were not married or living with a man/woman were included in the study. They comprised 2545 females and 1437 males from Ghana and 3546 females and 4317 males from Kenya. Descriptive analyses and binary logistic regression estimation technique were used to analyse the data. While awareness of AIDS was universal among the youth of both countries, utilisation of condoms on last penetrative sex was low. Risky sexual behaviour among young people was significantly associated with age, level of education, wealth status and religion. Among males and females in Ghana, the odds of sexual risk taking behaviour were higher among those who were employed than those who were unemployed. The reverse of this, however, occurred in Kenya, where males and females who were employed were less likely to engage in risky sexual behaviours than their counterparts who were unemployed. Our findings underscore the need for the relevant stakeholders in the two countries; Ministries of Health, Ghana/KenyaHealth Service, and NGOs concerned with sexual and reproductive health of young people, to intensify education on consistent and proper use of condoms and, position condom use as an acceptable behaviour especially among young people who are sexually active; with multiple partners and who may have STIs. Health literacy, which is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services to make appropriate health decisions, should be given priority. The governments of the two countries, especially Kenya, should promote youth entrepreneurship to reduce unemployment and strengthen job creation as a way of ensuring that young people engage on productive economic activities. With productive economic activities, females for instance may not have to engage in transactional multiple sexual relationships which is risky and, therefore, predisposes them to STIs such as gonorrhoea and HIV. [ABSTRACT FROM AUTHOR]

Quality-certified, nutritious novel groundnut spread has great commercialization possibilities due to evolving urban lifestyles in Africa, but lack of information about likability, sensory attributes, and consumer safety awareness is a severe barrier for small enterprises. This paper examines a novel groundnut spread, made of sorted kernels deemed free of aflatoxin, intended for use on bread in a fashion similar to groundnut paste or groundnut butter, but with modified sensory characteristics. In particular, it seeks to measure the effects of sensory attributes of the novel spread on the intent to pay for safety certification and the role of consumer awareness of aflatoxin. A novel spread was prepared with groundnut paste from sorted kernels (to eliminate the risk of aflatoxin contamination) and cocoa. Adults intercepted at Ghana's International Fair in 2012 volunteered to sample the spread and complete a questionnaire. Results from a tasting panel of untrained participants established that sensory attributes and panellist characteristics are relevant to the intent to pay for quality certification. Spread likability, aroma, education, knowledge about aflatoxin, packaging and being married were identified as major factors increasing the probability of intent to pay for quality certification whereas young age and the presence of children in a household lowered the probability. Results also identified income, education level, and having young children at home as increasing the chances of knowing about aflatoxin. Groundnut paste available in Ghana is often contaminated by aflatoxin as it is in other countries in the region and consumers cannot visually assess paste quality. Under the circumstances, quality certification is necessary. [ABSTRACT FROM AUTHOR]

Purpose: This study investigate urban migrant dwellers' gender and age differences in response to the specific phobia of COVID-19 and hesitancy toward vaccines in the slum settlements. Design/methodology/approach: The study anchored on the two-factor model proposed by Mowrer (1939) and used a quantitative design approach with a convenience sampling method for data gathering among 362 urban migrants residing and working in the cities of Ghana. The study used the Mann–Whitney U test and the regression analysis for the analysis. Findings: The result showed that there is a significant difference between males and females in their understanding of economic phobia, thoughts on social phobia and perception level of vaccine hesitancy. Additionally, there is a significant difference between age groups in their level of thoughts of psychological phobia, economic phobia and thoughts of vaccine hesitancy. Finally, the specific of phobias of COVID-19 are significant predictors of vaccine hesitancy. Research limitations/implications: This research is slum-specific, which implies that the outcome cannot be generalized to other geographical settings. Practical implications: The study demonstrates how a pandemic manifests itself to dwellers in slums. The outcome of the study sheds light on how policymakers appreciate the dynamics of the pandemic in a developing country, which may guide future responses to pandemics. Originality/value: The outcome of the study sheds light on how policymakers appreciate the dynamics of the pandemic in a developing country, which may guide future responses to pandemics. [ABSTRACT FROM AUTHOR]

This paper aimed at providing evidence on the variations in HIV prevalence in mining communities in Ghana. Purposive sampling was used for collection of data. Five years records (2011–2015) were reviewed and data on age, sex, date of HIV screening, results and location were extracted from hospital registers and entered electronically for analysis. Findings emerging from this study suggest high HIV prevalence in mining communities in Ghana. This study also identified a decline in routine HIV testing. The study suggests means to tailor public health efforts to improve HIV testing in mining communities. Transactional sexual activities among women and the younger generations may account for the high HIV prevalence according to findings from this study. [ABSTRACT FROM AUTHOR]

Introduction: People with disabilities (PwDs) constitute a large and diverse group within the global population, however, their sexual and reproductive health (SRH) needs are often neglected, particularly in low-and middle-income countries. This may result in adverse outcomes, such as sexually transmitted infections (STIs), unintended pregnancies, and experience of interpersonal violence (IV). This study aimed to assess the factors that influence the sexual lives of PwDs in two districts of Ghana. Methods: A sequential explanatory mixed-methods study design was used to collect data from PwDs. Quantitative data were obtained from 402 respondents using a pretested questionnaire, and qualitative data gathered from 37 participants using in-depth interviews. The quantitative data were analysed using descriptive and inferential statistics, while the qualitative data were analysed using inductive thematic analysis. Results: Most PwDs (91%) reported that they have ever had sex, which was associated with age, disability severity, and household size. The prevalence of poor SRH status, STIs, unintended pregnancy, pregnancy termination, and unsafe abortion were 10.5%, 5.7%, 6.4%, 21.6%, and 36.9% respectively. These outcomes were influenced by education, income, health insurance subscription, and proximity to a health facility. The prevalence of IV was 65%, which was related to disability type and severity. The qualitative data revealed five main themes: curiosity to engage in sexual activities, feelings of despair and insecurity with abled partners, preference for sexual relationships with other PwDs, IV and its perpetrators, and adverse SRH outcomes. Conclusion: The study findings indicate that most adult PwDs have ever had sex and they face various challenges in their sexual lives. They experience multiple forms of abuse and neglect from different perpetrators at different levels of society, which have negative impacts on their well-being. There is a need for comprehensive and inclusive interventions that address the SRH needs of PwDs, as well as the underlying social and structural factors that contribute to their vulnerability. Further research is recommended to explore the perspectives of stakeholders on how to improve the SRH outcomes of PwDs. Plain Language summary: People with disabilities make up 16 percent of the world population, but their sexual and reproductive health (SRH) needs are often unmet, especially in poorer countries, contributing to adverse outcomes. This study assessed factors influencing the sex lives of PwDs in two districts of Ghana. Quantitative data were collected from 402 respondents, while qualitative data were collected from 37 participants. The results showed that age, severity of disability, and household size influence sexual activity. Many respondents also reported adverse SRH issues including STIs and unintended pregnancies. Sixty-five percent reported experiencing violence or abuse, which is related to their disability type and severity. The study also found that PwDs encounter many challenges in their sexual lives, including abuse and neglect. The findings suggest the need to pay attention to the sexual health needs and the social issues that make PwDs vulnerable to various abuses. [ABSTRACT FROM AUTHOR]

Background: Being aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period is often overlooked but remains a significant contributor to unintended pregnancies and may lead to maternal and neonatal comorbidities. Exploring the extent of awareness and associated factors could help tailor more interventions toward reducing the rates of short-interval unplanned pregnancies. Objective: This study explores the extent to which Ghanaian women are aware of the possibility of becoming pregnant shortly after childbirth before the resumption of the menstrual period and its associated factors. Design: A cross-sectional study was conducted using the 2017 Ghana Maternal Health Survey. The women participants were sampled using a two-stage cluster sampling design. Methods: We analyzed the 2017 Ghana Maternal Health Survey data of 8815 women who had given birth and received both antenatal care and postnatal checks after delivery in health facilities (private and public) and responded to questions on being aware of short interpregnancy intervals. A multivariable survey logistic regression was used for the analysis. Results: Of the 8815 women, approximately 62% of women who received both antenatal care and postnatal examinations before discharge reported being aware of short interpregnancy intervals. Postnatal examination before discharge but not antenatal care was associated with a higher awareness of short interpregnancy intervals. Women who received a postnatal examination were more aware of short interpregnancy intervals than their counterparts (adjusted odds ratio = 1.29, 95% confidence interval: 1.03–1.61). Also, awareness of short interpregnancy intervals increased with age, education, knowledge of the fertile period, contraceptive use, and delivery via cesarean section. Conclusion: Over a decade following the initiation of Ghana's free maternal health policy, there remains a significant gap in the awareness of short interpregnancy intervals, even among women who received both antenatal pregnancy care and postnatal examinations before discharge. The unawareness of the short interpregnancy interval observed in approximately 38% of women raises concerns about the effectiveness of counseling or education provided during antenatal care and immediate post-partum care regarding birth spacing, contraceptive use, the timing of resumption of sexual activity, and the extent to which women adhere to such guidance. Plain Language Summary: A study found more women were unaware of pregnancy soon after birth before menses Unplanned pregnancies may lead to worsened health conditions for mothers and newborn infants. One possible way this unplanned pregnancy could happen is through unknowingly becoming pregnant soon after birth before menstruation resumes. However, the more we know about pregnancy soon after birth before menstruation resumes, the better we can introduce measures to reduce it. This study examines how well Ghanaian women are aware of the possibility of becoming pregnant soon after birth before menstruation resumes and factors that may influence the awareness. This study analyzed 2017 data collected from women who received pre-delivery care and post-delivery checks before discharge from a health facility. The study findings revealed that 38% of the 8815 women who received both pre-delivery care and post-delivery checks were unaware of pregnancy soon after birth before menstruation resumed. Factors such as post-delivery checks, contraceptive use, delivery through cesarean section, women aged 30 years and over with secondary education and higher, and having knowledge of the periods more appropriate for a woman to be pregnant were more aware of pregnancy soon after birth before menstruation resumed. We proposed that effective counseling and adherence from women who are not planning to get pregnant soon after birth could help reduce the rate of pregnancy soon after birth before menstruation resumes. These unplanned pregnancies can also be avoided by educating women about birth spacing, contraceptive use, and the timing of resumption of sexual activity. [ABSTRACT FROM AUTHOR]

Background. Although inappropriate gestational weight gain is considered closely related to adverse maternal and birth outcomes globally, little evidence was found in low- and middle-income countries. Study Objectives. This study is aimed at identifying the determinants of gestational weight gain and examine the association between gestational weight gain and maternal and birth outcomes in the Northern Region of Ghana. Study Methods. The study used a facility-based cross-sectional study design involving 611 antenatal and delivery records in Tatale district, Tamale west, and Gushegu municipal hospitals. A two-stage sampling method involving cluster and simple random sampling was employed. Descriptive statistical analysis and measures of central tendency were used to describe the sample. The multinomial logistic regression model was used to determine the determinants of gestational weight gain and its association with maternal and birth outcomes. Results. Among the 611 women included in the study, 516 (84.45%) had inadequate gestational weight gain, and 19 (3.11%) had excessive gestational weight gain. The gestational weight gain ranged from 2 kg to 25 kg with a mean of 7.26 ± 3.70 kg. The risk factor for inadequate gestational weight gain was low prepregnancy BMI (adjusted odds ratio AOR = 1.33 , 95% CI = 1.18 − 2.57 , P = 0.002). Pregnant women who had inadequate gestational weight gain were significantly less likely to deliver through caesarean section (AOR = 0.27 , 95% CI = 0.12 − 0.61 , P = 0.002), and those who had excessive weight gain were more likely to undergo caesarean section (AOR = 19.81 , 95% CI = 5.38 − 72.91 , P = 0.001). The odds of premature delivery (birth < 37 weeks) among pregnant women with inadequate weight gain were 2.88 (95% CI = 1.27 − 6.50 , P = 0.011). Furthermore, subjects who had excessive weight gain were 43.80 times more likely to give birth to babies with macrosomia (95% CI = 7.07 − 271.23 , P = 0.001). Conclusion. Inappropriate gestational weight gain is prevalent in Ghana, which is associated with caesarean section, preterm delivery, delivery complications, and macrosomia. Urgent policy interventions are needed to improve on the frequent monitoring and management of gestational weight gain of pregnant women till term. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Ghana faces an increasing burden of non-communicable disease with rates of hypertension estimated as high as 36% in adults. Despite these high rates, hypertension control remains very poor in Ghana (4%). The current project aims to implement and evaluate a community-based programme to raise awareness, and to improve treatment and control of hypertension in the Eastern Region of Ghana. In this paper, we present the findings of the baseline cross-sectional survey focusing on hypertension prevalence, awareness, treatment, and control.Methods: To evaluate the ComHIP project, a quasi-experimental design consisted of a before and after evaluations are being implemented in the intervention and comparison districts. A cohort study component is being implemented in the intervention district to assess hypertension control. Background anthropometric and clinical data collected as part of the baseline survey were analyzed in STATA Version 11. We examined the characteristics of individuals, associated with the baseline study outcomes using logistic regression models.Results: We interviewed 2400 respondents (1200 each from the comparison and intervention districts), although final sample sizes after data cleaning were 1170 participants in the comparison district and 1167 in the intervention district. With the exception of ethnicity, the control and intervention districts compare favorably. Overall 32.4% of the study respondents were hypertensive (31.4% in the control site; and 33.4% in the intervention site); 46.2% of hypertensive individuals were aware of a previous diagnosis of hypertension (44.7% in the control site, and 47.7% in the intervention site), and only around 9% of these were being treated in either arm. Hypertension control was 1.3% overall (0.5% in the comparison site, and 2.1% in the intervention site). Age was a predictor of having hypertension, and so was increasing body mass index (BMI), waist, and hip circumferences. After adjusting for age, the risk factors with the greatest association with hypertension were being overweight (aOR = 2.30; 95% CI 1.53-3.46) or obese (aOR = 3.61; 95% CI 2.37-5.51). Older individuals were more likely to be aware of their hypertension status than younger people. After adjusting for age people with a family history of hypertension or CVD, or having an unhealthy waist hip ratio, were more likely to be aware of their hypertension status.Conclusions: The high burden of hypertension among the studied population, coupled with high awareness, yet very low level of hypertension treatment and control requires in-depth investigation of the bottlenecks to treatment and control. The low hypertension treatment and control rates despite current and previous general educational programs particularly in the intervention district, may suggest that such programs are not necessarily impactful on the health of the population. [ABSTRACT FROM AUTHOR]

Background: Children's initiation of early sex has several negative implications on their sexual and reproductive health, growth and development. In Ghana, few studies on early sexual debut have focused on adolescents. Therefore, this study examined the prevalence, causes, correlates and effects of early sexual debut among children aged 8 to 17 in Ghana using secondary data from the Department of Children of the Ministry of Gender, Children, and Social Protection. Methods: A convergent parallel mixed-method approach guided the study. Descriptive statistics and multivariable binary logistic regression were used to analyse the quantitative data, while thematic analysis was used to analyse the qualitative data. Results: The study found that the prevalence of early sexual debut among children was 13.2%, which is more predominant among female children. The main causes of early sexual debut include engaging in sex after watching pornography, self-desire to have sex, and being influenced by alcohol consumption. Also, age, sex, education, marital status, religion, ecological zone, living arrangements, and access to the Internet were significant correlates of early sexual debut. Early sexual debut increases children's risk of unwanted pregnancy, which leads to the termination of children's education or induced abortion. Also, early sexual debut had adverse impacts on the wellbeing of pregnant children and increased children's risk of multiple lifetime sexual partners. Conclusions: This study demonstrated that socio-demographic characteristics of children (e.g., age, sex, education, and marital status) were significant correlates of early sexual debut. Policymakers need to design appropriate interventions, considering the socio-demographic characteristics of children, to curb its occurrence in Ghana. [ABSTRACT FROM AUTHOR]

Background: Ghana is currently undergoing a profound demographic transition, with large increases in the number of older adults in the population. Older adults require greater levels of healthcare as illness and disability increase with age. Ghana therefore provides an important and timely case study of policy implementation aimed at improving equal access to healthcare in the context of population ageing. This paper examines the determinants of National Health Insurance (NHIS) enrolment in Ghana, using two different surveys and distinguishing between younger and older adults. Two surveys are used in order to investigate consistency in insurance enrolment. The comparison between age groups is aimed at understanding whether determinants differ for older adults. Previous studies have mainly focused on the enrolment of young and middle aged adults; thus by widening the focus to include older adults and taking into account differences in their demographic and socio-economic characteristics this paper provides a unique contribution to the literature. Methods: Using data from the 2007-2008 Study on Global Ageing and Adult Health (SAGE) and the 2012-2013 Ghanaian Living Standards Survey (GLSS) the determinants of NHIS enrolment among younger adults (aged 18-49) and older adults (aged 50 and over) are compared. Logistic regression explores the socio-economic and demographic determinants of NHIS enrolment and multinomial logistic regression investigates the correlates of insurance drop out. Results: Similar results for people aged 18-49 and people aged 50 plus were revealed, with older adults having a slightly lower probability of dropping out of insurance coverage compared to younger adults. Both surveys confirm that education and wealth increase the likelihood of NHIS affiliation. Further, residential differences in insurance coverage are found, with greater NHIS coverage in urban areas. The findings give assurance that both datasets (SAGE and GLSS) are suitable for research on insurance affiliation in Ghana. Conclusion: The paper indicates that although the gap in coverage among rich and poor and urban and rural residents appears to have decreased, these factors still determine NHIS coverage of younger and older adults. The same holds for education. Increasing efforts are needed to ensure equal access to healthcare. [ABSTRACT FROM AUTHOR]

Menstruation-related school absenteeism significantly affects girls' academic progress and general wellbeing. This study aimed to assess menstruation-related school absenteeism in an urban population in the Northern Region of Ghana. A school-based cross-sectional study was conducted to determine the prevalence of school absenteeism among girls using a structured questionnaire, which was pretested. The data were analyzed using Stata 16. Descriptive and inferential statistics, including cross-tabulation, the chi-square test, and binary logistic regression, were performed. The majority (59%) was between the ages of 15 and 19 years. Approximately one fifth of all respondents missed school during menstruation. Reasons assigned to missing school were menstrual pains (57%), stained clothes (43%), heavy bleeding (40%), and self-stigmatization (2%). The majority (95%) of respondents used some form of materials to absorb menstrual blood. About 88% of respondents used sanitary pads, 11% used cloth, and 1% used tissues to absorb their menstrual blood. The multivariable analysis showed that school girls < 15 years old (AOR: 3.69, 95% CI: 2.02–6.73), first year of Junior High School (AOR: 4.68, 95% CI: 2.14–10.22), and public school (AOR: 3.57, 95% CI: 1.83–6.94) were associated with increased odds of menstruation-related school absenteeism. Menstruation-related school absenteeism is considered high and could affect girls' educational attainment. School absenteeism due to menstruation, particularly in public schools, warrants attention by the Ghana Education Service. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. In recent times, cervical dysbiosis which mostly causes and aggravates infections is highlighted for its role in immune modulation in cervical dysplasia, which promotes the shifting of Th1 phenotype immunity to Th2 phenotype immunity. This study therefore estimated and compared the levels of circulatory IL-4, IL-6, IL-10, TNF-α, and IFN-γ cytokines among adult women identified to have different grades of cervical intraepithelial neoplasia (CIN) and with cervicovaginal infection. Methods. A total of 157 participants were recruited from the Akyemansa District of Ghana, and cervical swabs and blood samples were taken. The Pap smear test, microbiological culture, and ELISA were employed for cytology analysis, bacteria isolation, and identification and estimation of IL-4, IL-6, IL-10, TNF-α, and IFN-γ cytokines, respectively. Results. Overall, 14/157 (8.9%) had CIN with 7.6% having CIN 1 and 1.3% having CIN 2. The main predictor for CIN was age above 46 years (OR 11.16, 95% CI: 2.4-51.8). Bacterial vaginosis (p = 0.003) and Candida infection (p = 0.012) were significantly higher in CIN. Again, Staphylococcus aureus (60% vs. 17.6%, p = 0.005), Citrobacter sp. (40.0% vs. 13.2%, p = 0.017), and Morganella morganii (40.0% vs. 4.4%, p = 0.002) isolates were significantly higher in CIN-positive participants. IL-10 and TNF-α concentrations were elevated in participants with CIN 1+ (TNF-α NIL vs. CIN 1+ only, p < 0.05) while IL-6 was decreased among participants with CIN 1+. In the presence of vaginal infection, TNF-α decreased among CIN 1+ participants while IL-10 remained elevated. Conclusion. The findings of this study suggest that cervical dysbiosis causes immune suppression, which creates a suitable microenvironment for the development of CIN. [ABSTRACT FROM AUTHOR]

This paper uses a survival analysis technique to examine socio-economic and demographic factors that influence under-five mortality for rural and urban Ghana. The paper employs the Breslow Method for Ties for survival probability and uses data for the 2014 Ghana Demographic and Health Survey (GDHS). Data on some 5884 children was also generated through the interview of 4086 women aged 15–49. They indicated the birth histories of the children under five years. The study finds the most significant socio-economic determinants of a child survival in Ghana to be maternal age, mother's education, household wealth index quintile, place of delivery and birth order. The influence of these determinants on child survival differ from urban to rural. The survival probabilities of these explanatory variables are different in the rural area from the urban area. Therefore, it is imperative to scale up efforts in the rural area to ensure children live up to age five. • The determining factors of under-five mortality are maternal age, mother's education and wealth. • Other factors of child survival are place of delivery and birth order. • The child survival probabilities are different from rural to urban Ghana. • Immunization, Breastfeeding, Gender, and Birth weight were not statistically significant. • The study is limited by the lack of information about unwanted children. [ABSTRACT FROM AUTHOR]

Background: The birth of a child is a vital event that needs to be registered but this is not always the case as an estimated 40 million births go unregistered annually. Birth registration safeguards the basic rights of children and gives them an identity, citizenship/nationality and legal protection against violence, abuse and human rights violations. It is therefore necessary that all births are registered and even more critical that the registration of a birth is followed by the issuance of a birth certificate. But sadly, birth registration in many African countries continues to remain below acceptable international standards and not all registered births are certified. This paper examined birth registration and certification in Ghana. Differentials in the characteristics of children and mothers of children whose births are registered and certified, children whose births are registered but not certified and children whose births are not registered were examined. Methods: This paper analysed data from the 2014 Ghana Demographic and Health Survey drawing on variables from the household and children's data files. Descriptive analytical tools (frequencies, percentage and cross tabulations) and multinomial logistic regression analysis were used to examine differentials in birth registration status among an analytical sample of 3880 (weighted) children aged 0–4 years. Results: The birth of about every 1 in 4 (28.89%) children in Ghana have never been registered. Birth registration and certification was lowest among children born to young mothers (15–19 years), children whose mothers have no formal education, mothers who reside in rural areas and mothers in the poorest wealth quintile. Additionally, home births and births that were not assisted by a medical professional were observed to have the lowest proportion of registered and certified births. Furthermore, the birth of children who are less than a year old was significantly more likely not to be registered or issued with a birth certificate. Conclusion: Efforts aimed at improving birth registration and certification in Ghana need to target groups of children and mothers with low levels of registration and certification particularly children who are born at home, children born to young mothers and children whose mothers are poor and or reside in rural areas. [ABSTRACT FROM AUTHOR]

Ghana's older population is projected to increase in coming decades and as a result will see increasing care needs. Understanding the functional difficulties older adults experience, and the associated factors, will help identify relevant intervention to assist older adults in meeting their care needs. This study aimed to analyse the prevalence of functional difficulties among older adults in Ghana, and examine how the World Health Organization International Classification of Functioning, Disability and Health (WHO-ICF) conceptual framework can relate to toileting difficulty to understand the factors that increase older adults' care needs. Data were for 5,096 adults aged ⩾50 years from the WHO Study on global AGEing and adult health (SAGE) Ghana Wave 1. Difficulties were assessed using self-reported difficulty on 22 functional items, including toileting. Multivariate logistic regression tested associations between toileting and other factors as related to the WHO-ICF conceptual framework. Older adults reported climbing one flight of stairs without resting as a common functional difficulty. Difficulty eating was the item least identified. Toileting difficulty was ranked second among five total activities of daily living difficulties. Age, marital status, self-reported health, memory, bodily pain, short- and far-distance vision, obesity, stroke, chronic lung disease, trust at individual and neighbourhood level, toilet facility type, socialising with co-workers, and public and religious meeting attendance were statistically significantly associated with toileting difficulty in the final parsimonious model. Post-hoc analysis testing interaction revealed that interaction existed between female sex and never married marital status (p = 0.04), and obesity and widowed marital status (p = 0.01), with toileting as the outcome. A significant level of functional difficulty existed among Ghanaian older adults in this sample. Toileting difficulty was associated with factors across different components in the WHO-ICF, emphasising functional, social and environmental factors related to this fundamental human activity. [ABSTRACT FROM AUTHOR]

Child maltreatment is considered a major public health concern among children because they can cause significant physical and psychological problems. Child maltreatment is widespread but often underestimated. Surprisingly, there is hardly any data on child maltreatment and any associated sociodemographic factors children affected by HIV/AIDS in low-income countries. This study employed cross-sectional, quantitative survey that involved 291 children aged 10–17 years and their caregivers in the Lower Manya Krobo District, Ghana and examined their exposure to and experience of child maltreatment. The results show that at least one form of maltreatment was reported by approximately 90% of the children, and it was significantly higher among orphans and vulnerable children (OVC) as compared with comparison children. Older age, frequent changes in residence, non-schooling and living with many siblings are associated with child maltreatment. The results demonstrate that maltreatment among children affected by HIV/AIDS are not rare, and that the dysfunction family conditions that they find themselves bear systemic risks for maltreatment. It is important that culturally appropriate and evidence-based interventions are implemented to address the maltreatment. [ABSTRACT FROM AUTHOR]

Although sub-Saharan Africa has the world's highest rates of early pregnancy, there is little awareness of pregnancy and parenting among young people in out-of-home care in this region. Therefore, this study looked into the experiences of pregnancy and parenting among young women who had been in residential care in Ghana and Uganda. We gathered data from ten parenting care leavers in both countries using semi-structured interviews and then analyzed the data from the interviews thematically. The study's findings revealed that the young mothers had minimal sexual and reproductive health education, as well as a lack of sufficient monitoring, which predisposed them to early pregnancy. The young mothers indicated that emotional stress, financial and employment obstacles, as well as stigma, were some challenges they had experienced. They used personal motivation and spirituality as coping mechanisms to deal with their challenges. Training caregivers to deliver sexual and reproductive health information, having practitioners who will offer supervision during the semi-independent phase of leaving care, and providing separate housing for young mothers are some implications for practice emerging from the study. Policy implications include the need for social inclusion programs to support the academic, vocational, and parenting skills of young mothers who leave care. [ABSTRACT FROM AUTHOR]

The assessment of psychomotor development in young children from low‐ and middle‐income countries is impeded due to the lack of tools specifically designed for these resource‐constrained contexts. This cross‐sectional study aimed at analysing the measurement properties of the Kilifi Developmental Inventory (KDI) in two‐year‐old children. We administered the KDI to 289 children from Côte d'Ivoire and 230 children from Ghana. The postulated internal structure with two first‐order latent variables (locomotor performance and eye‐hand coordination) that loaded on a second‐order latent variable (psychomotor functioning) was supported. The reliability of most factors and scales was sufficient. Interrater reliability of most items was acceptable. Correlations were weak between the scale scores and age and gender, respectively. The findings are limited by the restricted age range of the sample. Overall, the KDI showed promising measurement properties for the assessment of psychomotor performance in children from sub‐Saharan countries. [ABSTRACT FROM AUTHOR]

Utilization of antiretroviral therapies (ART) prolongs life and heightens ability to engage in productive activities among people living with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS). This study implemented a 6-week long Social Care Intervention (SCI) Program in Ghana and identified protective factors associated with Quality of Life (QoL) among people living with HIV/AIDS (PLWHA). We discovered that SCI model in the form of social support associated positively with differences in the QoL among PLWHA. Logistic regression revealed that social support, especially affectionate support, was positively associated with a higher level of QoL. People who were older and healthier tended to have higher levels of QoL compared with their counterparts who were younger and sicker. These findings suggest that building social support system can serve as an empowerment approach to promote quality of life among PLWHA in low- and middle-income countries (LMICs) where resources are limited. [ABSTRACT FROM AUTHOR]

Numerous studies have shown that men's attitudes towards intimate partner violence (IPV) remain a strong predictor of its actual perpetration. Very few trend studies available have also reported that IPV-acceptance is gradually declining globally. However, almost none of these trend studies have included men in their samples, nor have investigated factors associated with changes in men's attitudes towards IPV. To supplement this sparse knowledge, the current study employed three waves of the Ghana Demographic and Health Survey (GDHS): 2003 (n =4,901), 2008 (n = 4,481), and 2014 (n = 4,333) data, and reports trends and patterns in men's attitudes towards wife-beating at national, regional, and rural-urban residences of Ghana. Multivariable logistic regression models were fitted to further examine the key socioeconomic and cultural factors significantly associated with men's acceptance of IPV at 95% confidence interval. The results show that men's acceptance of wife-beating declined largely at the national level by 60.8% between 2003 and 2014: from 31.7% in 2003 to 12.4% in 2014. However, when disaggregated by region, data revealed a slight increase in men's IPV-acceptance in two regions between 2008 and 2014—the Western and Upper East regions, by 2.1% and 3.8%, respectively. Having less than secondary education, being in a polygynous union, and residence in certain regions, was significantly associated with justification of wife-beating. Whereas having access to media was not consistently significant in influencing men's attitudes against wife-beating, especially in the rural areas. The decreasing significance of education, household wealth, and religion in the 2014 wave (especially in urban areas) seem to suggest that recent decline in men's acceptance of wife-beating may not have been driven by a single isolated factor, but by complex interactions of several exogenous factors including those not captured in the current data. Study implications and need for further studies are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Assess factors associated with the quality of mental health services. Design and Methods: Cross‐sectional design, quantitative data, and 510 consumers from three psychiatric facilities. Results: The average age of consumers was 34 years and 51.57% males. Consumers reported mixed satisfaction with the quality of mental health services (mean = 3.2; SD = 0.56) but were dissatisfied with the range of interventions (mean = 1.57; SD = 0.77). Predisposing (age, education, and primary occupation), enabling (insurance status), and need factors (mental health status) were significantly associated with quality indicators (range of interventions, efficacy, and overall satisfaction). These factors were significantly associated with consumers' functionality (cognition, mobility, self‐care, getting along, life activities, and participation). Practice Implications: Policymakers and clinicians are encouraged to incorporate the predisposing, enabling, and need factors into mental health planning, monitoring, and advocacy to improve service outcomes. [ABSTRACT FROM AUTHOR]

Background: Ghana introduced capitation payment method in 2012 but was faced with resistance for its perceived poor quality of care. This paper assesses National Health Insurance Scheme subscribers and care providers’ perception of quality of care under the capitation payment method. Methods: This is a cross-sectional survey of subscribers and care providers perception of quality of care in three administrative regions of Ghana using a 5-point Likert scale for the assessment based on a set of quality of care measures. We performed descriptive analysis to determine average perception of quality of care scores for each of the measures used. Bivariate and multivariate analyses were also performed to examine relationships between respondent’s characteristics and their perception of quality of care. Results: In general, subscribers expressed positive perception about the quality of care though subscribers in Ashanti were less positive compared to those in the Central region. A chi-square analysis, however, showed significant differences in subscribers’ perception of quality of care by occupation (p = 0.002), region (p = 0.007) length of NHIS membership (p = 0.006), and age (p = 0.014). Multivariate logistic regression analysis also showed that different factors, other than region of residence, were significantly associated with perceived good quality of care. Analysis of health care providers’ responses also showed significant differences in their perception of quality of care by region (p = 0.001). Multivariate logistic model showed that health care providers in the Volta region (OR = 0.14, 95% CI: 0.03–0.58) were significantly less likely to perceive quality of care as good compared to those in the Ashanti region. Conclusion: Subscribers and care providers across the three regions have relatively good perception of the quality of health care in general though subscribers in Ashanti were less positive than those in the Central region. It is, therefore, plausible that capitation payment may have influenced the relatively low perception of quality of care in the Ashanti region. [ABSTRACT FROM AUTHOR]

Background: Child marriage is a human rights violation disproportionately affecting girls in lower- and middle-income countries and has serious public health implications. In Ghana, one in five girls marry before their 18th birthday and one in 20 girls is married before her 15th birthday. This paper uses a unique dataset from Northern Ghana to examine the association between child marriage and adverse outcomes for women among a uniquely vulnerable population.Methods: Baseline data from on ongoing impact evaluation of a government-run cash transfer programme was used. The sample consisted of 1349 ever-married women aged 20-29 years from 2497 households in the Northern and Upper East regions of Ghana. We estimated a series of ordinary least squares (OLS) and logistic regression models to examine associations of child marriage with health, fertility, contraception, child mortality, social support, stress and agency outcomes among women, controlling for individual characteristics and household-level factors.Results: Child marriage in this sample was associated with increased odds of poorer health, as measured by difficulties in daily activities (OR = 2.08; CI 1.28-3.38 among women 20-24 years and OR = 1.58; CI 1.19-2.12 among women 20-29 years), increased odds of child mortality among first-born children (OR = 2.03; CI 1.09-3.77 among women 20-24 years) and lower odds of believing that one's life is determined by their own actions (OR = 0.42; CI 0.25-0.72 among women 20-24 years and OR = 0.54; CI 0.39-0.75 among women 20-29 years). Conversely, child marriage was associated with lower levels of reported stress (regression coefficient = - 1.18; CI -1.84--0.51 among women 20-29 years).Conclusions: Child marriage is common in Northern Ghana and is associated with poor health, increased child mortality, and low agency among women in this sample of extremely poor households. While not much is known about effective measures to combat child marriage in the context of Ghana, programmes that address key drivers of early marriage such as economic insecurity and school enrolment at the secondary level, should be examined with respect to their effectiveness at reducing early marriage.Trial Registration: Registered in the Registry for International Development Impact Evaluations (RIDIE) on 01 July 2015, with number RIDIE-STUDY-ID- 55942496d53af . [ABSTRACT FROM AUTHOR]

The use of mobile phone and factors influencing usage have least been explored in spite of its relevance in mHealth adoption. We conducted a descriptive exploratory study to evaluate the use of mobile phone alarm application, text messaging and voice call among HIV positive clients. We randomly selected 362 respondents who were 18–65 years and receive care from two health facilities in Accra, Ghana. Questionnaires were administered and data analysed to describe and predict mobile phone use. SPSS version 20 was used to process data for analysis. Findings revealed respondent (n = 338, 93%) did not share their mobile phones. Voice call was predominantly used (n = 227, 63%) while text messaging and mobile alarm functions were sparingly used. Majority (n = 285, 78.9%) did not use the mobile phone application to support adherence. Age and employment predicted the use of mobile phone alarm (OR ± 1.56, p < 0.05), test messaging (OR ± 1.48, p < 0.05) and voice calls (OR ± 1.25, p < 0.05). We observed that younger age and employment influence the use of mobile phones. Voice calls are more acceptable because it is simple and easy to use. Knowledge and persuasion are fundamental to mobile phone literacy skills development and should be integrated in mHealth interventions. [ABSTRACT FROM AUTHOR]

Psychosocial stressors have significant health and socio-economic impacts on individuals. We examined the prevalence and correlates of psychosocial stressors among non-migrant and migrant Ghanaians as there is limited research in these populations. The study was cross-sectional and quantitative in design. A majority of the study participants had experienced stress, discrimination and negative life events. Increased age, female sex, strong social support and high sense of mastery were associated with lower odds of experiencing psychosocial stressors in both populations. Interventions should be multi-level in design, focusing on the correlates which significantly influence the experience of psychosocial stressors [ABSTRACT FROM AUTHOR]

Background: Though extensive studies have been conducted on assessing the predictors of cognitive functioning among older adults in small community-based samples, very few studies have focused on understanding the impact of socioeconomic status (SES), demographic characteristics and other risk factors such as lifestyle and chronic diseases on the cognitive functioning among adults of all ages in a nationally representative population-based sample across low- and middle-income countries. This study, therefore, seeks to evaluate the impact of SES, demographic characteristics and risk factors on the cognitive functioning of adults across all ages in five selected developing countries. Methods: Data from 12,430 observations obtained from the WHO Study on Global AGEing and Adult Health (SAGE) Wave 1; consisting of 2,486 observations each for China, Ghana, India, the Russian Federation, and South Africa, were used for the study. A meta-regression and a five-step hierarchical linear regression were used to analyze the data, with cognitive functioning as the dependent variable. Independent variables used in this study include SES; assessed by household income and education, demographic characteristics, other risk factors such as lifestyle, self-reported memory difficulty and chronic diseases. Results: This study found that SES and lifestyle significantly predicted cognitive functioning in all the five selected countries as obtained by the pooled results of the meta-regression analysis. The hierarchical linear regression results also revealed that demographic characteristics such as age, type of residency, and self-reported memory difficulty significantly impact cognitive functioning in China, Ghana, Russia, and South Africa. Conclusion: The findings in this study provide new insights for policymakers, caregivers, parents, and individuals, especially those in developing countries, to implement policies and actions targeted at improving SES and eliminating risk factors associated with cognitive decline, as these measures could help improve the cognitive functioning among their populations. [ABSTRACT FROM AUTHOR]

Background: Significant inequalities still exist between low- and high-income countries regarding access to optimum emergency obstetric care including life-saving emergency caesarean section. These relationships are considerably stronger between population-based caesarean section rates and socio-economic characteristics with poorest households experiencing significant unmet needs persistently. Objective: To explore the characteristics of women receiving emergency C-section using a new, validated definition in Ghana and the Dominican Republic. Materials and Methods: This was a cross-sectional study conducted in Ghana and the Dominican Republic. Multivariable logistic regression analysis was used to determine women's characteristics associated with emergency C-section. Results: This analysis included 2166 women who had recently delivered via C-section comprising 653 and 1513 participants from Accra and Santo Domingo, DR, respectively. Multivariable analyses showed that women, both in Ghana and the DR, were more likely to have an emergency C-section if they did not have a previous C-Section (adjusted Odds Ratio (aOR): 2.45, 95% CI [1.57–3.81]; and aOR: 15.5, 95% CI [10.5–22.90], respectively) and if they were having their first childbirth, compared to women with previous childbirth (aOR: 1.77, 95%CI [1.13–2.79]; and aOR: 1.46, 95%CI [1.04–2.04], respectively). Also, preterm birth was associated with significantly decreased likelihood of emergency C-section compared with childbirth occurring at term in both Ghana and the DR (aOR: 0.31, 95%CI [0.20–0.48]; and aOR: 0.43, 95%CI [0.32–0.58], respectively). Among the Ghanaian participants, having an emergency C-section was positively associated with being referred and negatively associated with being older than 35 years of age. Characteristics such as education, religion, marital status, and residence did not differ between women's emergency versus non-emergency C-section status. Conclusion: Emergency C-section was found to be significantly higher in women with no prior C-section or those having their first births but lower in those with preterm birth in both Ghana and the DR. Data from additional countries are needed to confirm the relationship between emergency C-section status and socio-economic and obstetric characteristics, given that the types of interventions required to assure equitable access to potentially life-saving C-section will be determined by how and when access to care is being denied or not available. [ABSTRACT FROM AUTHOR]

Social work profession can be useful in addressing the transportation needs of older adults. However, there is a paucity of knowledge concerning this need in Ghana. The purpose of the study was to investigate the factors relating to transportation difficulty among older adults in Ghana, employing the World Health Organisation (WHO) Healthy Ageing framework. The implications of the findings on social work practice with older adults in Ghana are herein discussed. Data for 5,107 adults aged fifty years or more came from the WHO Study on global AGEing and adult health Ghana Wave 1. Transportation difficulty was assessed using the self-reported question. In the last thirty days, how much difficulty did you have with getting to where you want to go using private or public transport if needed?" Logistic regression tested associations between transportation difficulty and other independent variables. About 31 per cent of the participants, mostly women (54.7 per cent), experienced transportation difficulty. Associated factors included (not exhaustive) advanced age, lower household income, chronic diseases and lack of trust for others. A high prevalence of transportation difficulty exists among older adults in Ghana and is holistically related. Social work's intervention to address the transportation needs of older adults in Ghana should be holistic; incorporating the significant factors identified affecting older adults' well-being. [ABSTRACT FROM AUTHOR]

The employment landscape has changed significantly over the past few years in emerging economies including Ghana where many people are rapidly transitioning from livelihood activities that originally involved physical exertion to work environments where performance of duties are mostly non-physical. Working under non-active conditions could, however, exacerbate the risk of developing chronic diseases that are increasingly becoming problematic in many developing countries. Drawing on a cross-sectional nationally representative sample data of 4425 adult Ghanaian workers collected by the WHO Study on Global Ageing and Adult Health in developing countries, we examined the relationship between occupational physical activity and hypertensive status. We employed the complementary log–log analysis technique to build nested models with results presented in odds ratios. After controlling for several relevant variables, the results show that performing sedentary related work (AOR = 1.23, CI = 1.06–1.42) is significantly associated with a higher likelihood of being hypertensive compared with those whose work involved moderate physical activity. Other factors that were significantly associated with being hypertensive included tobacco use (AOR = 1.33, CI = 1.05–1.70), living in an urban environment (AOR = 1.15, CI = 1.01–1.32), and being a female (AOR = 1.18, CI = 1.01–1.37) and being an older person. Policies on reducing the risk of developing chronic conditions especially hypertension need to recognize the contributions of the work environment in emerging developing economies. [ABSTRACT FROM AUTHOR]

Very few studies examine sexual violence perpetrated on adolescents in Ghana or in sub-Saharan Africa more generally. Using data collected in 2015 as part of a multi-country initiative, we employed multinomial logit models to examine violence experienced by Ghanaian adolescents at sexual debut. Results of our gender-specific models showed violence at sexual debut is gendered. While adolescent girls reported higher levels of forced sex (rape) at sexual debut, boys reported higher levels of coercion. Compared to those who had sex at relatively older ages, girls who had sex at younger ages were significantly more likely to say they were raped, were coerced or that sex 'just happened' than to report sex was wanted. Both male and female adolescents were significantly more likely to report sex was forced than wanted if the sexual partner was older. Female respondents who lived with family members other than their parents were significantly more likely to report forced sex (rape). We recommend government and interested stakeholders to promote social norms that discourage violence against adolescents. School-based programs, such as Ghana's comprehensive sexuality education, must focus on equipping adolescents with the confidence and skills required to handle cultural pressures and the power differences that characterize sexual relationships. [ABSTRACT FROM AUTHOR]

Early sexual initiation is linked to an increased risk of HIV/AIDS and other STIs among teenagers, as well as having multiple partners, not using contraception, unintended pregnancy, and illegal abortions. Aim. To identify the correlates and psychological effects of early sexual debut among not-in-union women in Ghana. A descriptive cross-sectional survey was used for this study using data from Ghana Multiple Indicator Cluster Survey (MICS) for the year 2017/2018. SPSS software was used for data analysis, bivariate analysis for association was done using chi-square, and the prediction was done using a binary logistic regression model. The national prevalence of nonmarital early sexual initiation this current study recorded was 56.9%. Predictors variables were age, 15-24/≥35 years (AOR = 1.51 , 1.28-1.78), ever educated (AOR = 0.50 , 0.43-0.60), urban address (AOR = 0.85 , 0.74-0.98), married/single (AOR = 1.23 , 1.07-1.42), cohabitation/single (AOR = 1.43 , 1.19-1.72), Greater Accra Region/Upper West Region (AOR = 0.67 , 0.49-0.92), and health insurance (AOR = 0.89 , 0.79-0.998). As the wealth indices of the woman decrease from the richest to poorest, the likelihood of early sexual debut inversely increases: fourth/richest (AOR = 1.23 , 1.04-1.45), middle/richest (AOR = 1.31 , 1.09-1.58), second/richest (AOR = 1.38 , 1.11-1.72), and poorest/richest (AOR = 1.44 , 1.12-1.86); use of the internet (AOR = 0.58 , 0.50-068); substance use and alcohol ever use (AOR = 1.32 , 1.17-1.49); cigarette ever use (AOR = 2.58 , 1.44-4.64); contraceptive use (AOR = 1.31 , 1.16-1.49); and ever heard of HIV (AOR = 59 , 0.42-0.82). In conclusion, the prevalence of early sexual debut is still high in Ghana, especially among the northern regions. Several factors predicted early sex debut, and low life satisfaction and happiness were related to early sexual debut. [ABSTRACT FROM AUTHOR]

Background: Unlike some neighboring countries like Nigeria, few studies on actual causes, impact and the prevention of road traffic collisions have been carried out in Ghana. There is the need for further research and this study sought to link injuries that caused the death of drivers involved in vehicular collisions to the latent possible contributing diseases and medical conditions in these drivers and how these conditions predispose them to the collisions. Methods: This is a retrospective study that used the forensic autopsy records of driver fatalities and various injuries and medical conditions of drivers involved in road traffic collisions. Information on all drivers was retrieved from archives at the Komfo Anokye Teaching Hospital' Pathology Unit. Demographics and cause of death were used in selecting the cases, including all driver-related road traffic collisions from 2009 to 2014. Results: A total of 1842 road traffic collisions were recorded with 127 of them being driver related. There were 31 cases (24.4%) in 2014; the highest cases recorded for this study, with the least recorded in 2009 with only 12 cases (9.4%). There were 121 (95.3%) male drivers and 6 female drivers (4.7%). Most of the male drivers were between the ages of 30 and 39 with 39 cases, while that of females was between 40 and 49 years with 6 cases. There was no significant statistical correlation between age and sex (P =.124). No statistical correlation also existed between sex and year (P =.331). Pathologies of all body systems were established. Cardiovascular diseases were the most prevalent systemic medical condition seen in the drivers with 44.1%. Conclusion: The study established that the drivers had various latent medical conditions and all these could lead to possible incapacitation, affecting driver judgment, leading to collisions on the road. The National Road Safety Commission (NRSC) should request medical screening before issuing driver licenses. [ABSTRACT FROM AUTHOR]

Background: Young Ghanaian women experience high rates of unmet need for contraception and unintended pregnancy, and face unique barriers to accessing sexual and reproductive health services. This study provides a comprehensive national analysis of young women's contraceptive and abortion practices and needs. Methods: In 2018, we conducted a nationally representative survey of women aged 15–49, including 1039 women aged 15–24. We used descriptive statistics, multivariable logistic and multinomial regression to compare young versus older (25–49 year-old) women's preferred contraceptive attributes, reasons for discontinuing contraception, quality of counseling, use of Primolut N-tablet, method choice correlates, and friends' and partners' influence. We also examined youth's self-reported abortion incidence, abortion methods, post-abortion care, and barriers to safe abortion. Results: Among Ghanaian 15–24 year-olds who had ever had sex, one-third (32%) were using contraception. Compared to older women, they had higher desires to avoid pregnancy, lower ever use of contraception, more intermittent sexual activity, and were more likely to report pregnancies as unintended and to have recently ended a pregnancy. Young contraceptors most commonly used condoms (22%), injectables (21%), withdrawal (20%) or implants (20%); and were more likely than older women to use condoms, withdrawal, emergency contraception, and N-tablet. They valued methods for effectiveness (70%), no risk of harming health (31%) nor future fertility (26%), ease of use (20%), and no effect on menstruation (19%). Infrequent sex accounted for over half of youth contraceptive discontinuation. Relative to older women, young women's social networks were more influential on contraceptive use. The annual self-reported abortion rate among young women was 30 per thousand. Over half of young women used abortion methods obtained from non-formal providers. Among the third of young women who experienced abortion complications, 40% did not access treatment. Conclusions: Young people's intermittent sexual activity, desire for methods that do not harm their health, access barriers and provider bias, likely contribute to their greater use of coital-dependent methods. Providers should be equipped to provide confidential, non-discriminatory counseling addressing concerns about infertility, side effects and alternative methods. Use of social networks can be leveraged to educate around issues like safe abortion and correct use of N-tablet. Plain English summary: Young Ghanaian women can experience difficulties accessing sexual and reproductive health services, and many are not using contraception despite wanting to avoid pregnancy. To better understand their needs, we describe their preferences and behaviors around contraception and abortion. We surveyed a nationally representative sample of women aged 15–49, and compared young (15–24) versus older (25–49) women's contraceptive preferences, reasons for stopping contraception, quality of counseling, friends' and partners' influence on contraceptive use, and use of abortion. One-third of 15–24 year-olds who ever had sex were using contraception. Compared to older women, young women's pregnancies were more likely to be unintended and to end in abortion. Young women most commonly used condoms, injectables, withdrawal or implants; and were more likely than older women to use condoms, withdrawal, emergency contraception, and Primolut N-tablet. They preferred methods that were effective, did not harm their health or future fertility, were easy to use, and did not disrupt their menstrual cycle. Over half of young women who stopped contraception did so because they were not having sex regularly. Friends had more influence on contraceptive use among young women than older women. Each year on average, there were 30 abortions per 1000 young women. Over half of young women who had abortions used methods from non-formal providers, and 40% of those who had complications did not get treated. Providers should be equipped to provide confidential, non-discriminatory counseling about contraceptive side effects and options. Social networks can be used to educate women about safe abortion. [ABSTRACT FROM AUTHOR]

Students continue to face significant mental health challenges that vary in severity and type. It is, therefore, imperative that researchers and clinicians pay more attention to efforts aimed at improving the mental well-being of students. This study examined the differences between Ghanaian students of the various educational levels on some mental health variables and the psychosocial factors of suicidal ideation. Three hundred and fifty-seven (357) participants consisting of junior (92 students) and senior (99 students) high school students, undergraduates (86 students) and postgraduates (80 students) were involved in this cross-sectional study. The study revealed that high school students had higher academic stress, depression and suicidal ideation and they used more coping strategies compared to university students. Depression, age, and educational levels were the factors that facilitated suicidal ideation, with spiritual and ritual centred coping strategy and religion (Islam) serving as a buffer for suicidal ideation among students. These factors varied with different educational levels. High school students experienced significant mental health problems compared to university students—this has direct implications on their academic and psychosocial development. The study recommends that mental health facilities be provided and managed by professionals, especially in high schools. [ABSTRACT FROM AUTHOR]

In Ghana, some divorce cases are conducted through the courts, and the reasons for such cases are important to gauge the factors that account for the dissolution of marriages in Ghana. This study was conducted to explore in-depth, the factors that lead to divorce using court suits in Ghana. Data were obtained from 30 lawsuits consisting of 11 men and 19 women with an age range of 29–71 years. Reasons for marital dissolution were assembled from a 10-year period (2007–2017) cases of divorce from the Greater Accra Region of Ghana. Conventional content analysis identified six main factors as possible reasons for divorce: infidelity, abuse, financial support, intimacy, financial problems, third-party intrusion and gender-role ideology. Men were likely to seek for divorce at an older age compared to women. Women attributed reasons for divorce to lack of respect from the husband and gender-role ideology. Our findings underscore the need for pre-marital counseling psychologists to help would-be couples address pertinent issues which could lead to distress and ultimately divorce in their marriages. [ABSTRACT FROM AUTHOR]

A study on the Standardized Assessment of Depressive Disorders (SADD) in collaboration with WHO Headquarters, Geneva, is reported in this paper. The instruments used for the study were screening forms and the SADD schedule, both of which were supplied by WHO. Fifty depressed patients were selected from the outpatients and inpatients of the Accra psychiatric hospital by experienced specialist psychiatrists using the screening forms. The two investigators then carried out a clinical assessment on each selected patient using the SADD schedule. The data collected were subjected to computer analysis. Findings were similar to those from previous WHO/SADD studies in different cultures. Specifically, the investigators found a "core" of depressive symptomatology among African patients in Ghana. An interesting finding was the change in the presentation of depression in African patients over the past 30 years. Broad diagnostic groupings like endogenous depression and psychogenic depression could easily be applied to the study patients. There is a great need for more SADD studies in Africa. [ABSTRACT FROM AUTHOR]

Background The burden of cardiovascular risk is distributed unequally between ethnic groups. It is uncertain to what extent this is attributable to ethnic differences in general and abdominal obesity. Therefore, we studied the contribution of general and abdominal obesity to metabolic cardiovascular risk among different ethnic groups. Methods We used data of 21 411 participants of Dutch, South-Asian Surinamese, African-Surinamese, Ghanaian, Turkish or Moroccan origin in Healthy Life in an Urban Setting (Amsterdam, the Netherlands). Obesity was defined using body-mass-index (general) or waist-to-height-ratio (abdominal). High metabolic risk was defined as having at least two of the following: triglycerides ≥1.7 mmol/l, fasting glucose ≥5.6 mmol/l, blood pressure ≥130 mmHg systolic and/or ≥85 mmHg diastolic and high-density lipoprotein cholesterol <1.03 mmol/l (men) or <1.29 mmol/l (women). Results Among ethnic minority men, age-adjusted prevalence rates of high metabolic risk ranged from 32 to 59% vs. 33% among Dutch men. Contributions of general obesity to high metabolic risk ranged from 7.1 to 17.8%, vs. 10.1% among Dutch men, whereas contributions of abdominal obesity ranged from 52.1 to 92.3%, vs. 53.9% among Dutch men. Among ethnic minority women, age-adjusted prevalence rates of high metabolic risk ranged from 24 to 35% vs. 12% among Dutch women. Contributions of general obesity ranged from 14.6 to 41.8%, vs. 20% among Dutch women, whereas contributions of abdominal obesity ranged from 68.0 to 92.8%, vs. 72.1% among Dutch women. Conclusions Obesity, especially abdominal obesity, contributes significantly to the prevalence of high metabolic cardiovascular risk. Results suggest that this contribution varies substantially between ethnic groups, which helps explain ethnic differences in cardiovascular risk. [ABSTRACT FROM AUTHOR]

Aim: This study aims to determine risk factors associated with the injury severity of motorcycle users in Ghana. Subject and methods: Data on all reported crashes involving motorcycle users in Ghana were analyzed. The data were extracted from the National Road Traffic Accident Database at the Building and Road Research Institute (BRRI) of the Council for Scientific and Industrial Research (CSIR). Generalized ordered logit models were specified separately for riders and pillion passengers to determine the relationship between injury severity, as an ordered categorical outcome, and a set of possible explanatory variables. Results: The results from the model showed that the injury severity of both riders and pillion passengers was significantly influenced by the day of the week when the crash occurred, weather conditions, road geometry, location type, and traffic control. In addition, the injury severity of riders was also influenced by their age, presence of passenger, and light conditions, whilst the injury severity of pillion passengers was influenced by the time of the crash. Conclusion: The findings from this study provide useful information to improve the understanding of risk factors associated with motorcycle user injury severity. Such data are also important to support the development of appropriate countermeasures to help prevent motorcycle crashes. [ABSTRACT FROM AUTHOR]

The human endogenous retroviruses HERV-K HML-2 have been considered a possible cause of human breast cancer (BrC). A HERV-K HML-2 fully intact provirus Xq21.33 was recently identified in some West African people. We used PCR technology to search for the Xq21.33 provirus in DNA from Nigerian women with BrC and controls. to see if Xq21.33 plays any role in predisposing to BrC. This provirus was detected in 27 of 216 (12.5%) women with BrC and in 22 of 219 (10.0%) controls. These results were not statistically significant. The prevalence of provirus in premenopausal control women 44 years or younger [18/157 (11.46%)} vs women with BrC [12/117 (10.26%)] showed no statistical difference. The prevalence of virus in postmenopausal control women > 45 yrs. was 7.4% (4/54) vs 15.31% (15/98) in postmenopausal women with BrC. These changes were not statistically significant at <.05, but the actual p value of <.0.079, suggests that Xq21.33 might play some role in predisposing to BrC in postmenopausal women. Provirus was present in Ghanaian women (6/87), in 1/6 Pygmy populations and in African American men (4/45) and women (6/68), but not in any Caucasian women (0/109). Two BrC cell lines (HCC 70 and DT22) from African American women had Xq21.33. Env regions of the virus which differed by 2–3 SNPs did not alter the protein sequence of the virus. SNP at 5730 and 8529 were seen in all persons with provirus, while 54% had an additional SNP at 7596.Two Nigerian women and 2 Ghanaian women had additional unusual SNPs. Homozygosity was seen in (5/27) BrC and (2/22) control women. The genetic variation and homozygosity patterns suggested that there was gene conversion of this X chromosome associated virus. The suggestive finding in this preliminary data of possible increased prevalence of Xq21.33 provirus in post-menopausal Nigerian women with BrC should be clarified by a more statistically powered study sample to see if postmenopausal African and/or African American women carriers of Xq21.33 might show increased risk of BrC. The implication of finding such a link would be the development of antiretroviral drugs that might aid in preventing BrC in Xq21.33+ women. [ABSTRACT FROM AUTHOR]

The uptake of HIV testing has always been found to be lower among men compared with women in many developing countries. The aim of this study was to ascertain the level and determinants of HIV testing uptake among men aged 15 to 59 in Ghana. This article was based on data from the 2003, 2008 and 2014 Ghana Demographic and Health Surveys. A bivariate statistical method was used to calculate the levels of uptake while three logit models were fitted to estimate the determinants of HIV uptake among the respondents. The total levels of the uptake of HIV testing among the respondents were 9.1%, 14.7% and 22.7% for 2003, 2008 and 2014, respectively; 15% overall. These were significantly determined by age, educational attainment, religious affiliation, wealth and work status, region of residence and media exposure. HIV testing uptake is very low among men in Ghana, albeit it has seen consistent improvements over the past years. Specially tailored HIV education and prevention programmes should be targeted at men in areas of low uptake, based on their different characteristics, in order to increase uptake. [ABSTRACT FROM AUTHOR]

Purpose. To determine normative values of retinal nerve fibre layer thickness (RNFL) and optic nerve head (ONH) parameters and their association with routine clinical tests such as refractive error (RE), stereoacuity (SA), and contrast sensitivity (CS) in an African population. Methods. In a cross-sectional observational study, 100 normal subjects aged 20 to 78 years were evaluated using the Cirrus HD-OCT 5000 and matched with 200 glaucoma patients. Results. Average (±SD) RNFL thickness for normal subjects was found to be 102.37 ± 7.45 (range, 82–119 microns) compared with 90.74 ± 14.50 found for glaucoma subjects. Females had higher average RNFL values (104.84 ± 6.90) compared with males (99.80 ± 7.18). Significant associations were calculated between quadrant RNFL thickness and SA, SE, and CS (all p < 0.05). The mean cup to disc ratio (CDR) was 0.49 ± 0.12, and mean optic disc area (DA) was 2.08 mm2 ± 0.40. Smaller DA was recorded for participants aged 60+ years (1.86 ± 0.25), followed by 40–59 age group (2.01 ± 0.41) and then 20–39 age group (2.19 ± 0.41). Significant associations were calculated between SA and ONH parameters, except rim area (all p < 0.01), and RE was significantly associated with DA and average CDR (all p < 0.05). Conclusion. RNFL thickness in healthy black Ghanaian population was significantly higher than that reported in other races. The values and associations reported in this study can inform clinical decision on the normal variation in RNFL and optic disc parameters. [ABSTRACT FROM AUTHOR]

Background: There is a dearth of publications on the prevalence of venous thromboembolism in Ghana. Knowledge of the prevalence of venous thromboembolism, which is often undetected clinically, will help save lives as appropriate interventions can be made as well as provide a general clue to clinicians on detecting venous thromboembolism and pulmonary embolism. Methods: The study employs a retrospective design with data extracted from the Autopsy Daybook of the Pathology unit, Komfo Anokye Teaching Hospital, 2009 to 2016. Data on patients' demographics were retrieved to establish diagnoses and age and gender distribution. Analysis was made of pulmonary embolism and deep vein thrombosis as a cause of death recorded on death certificates using the criteria of the International Classification of Diseases, version 10. Results: A total of 150 cases of deep vein thrombosis and/or pulmonary embolism were available for the study period and the results showed an average age of 45.3 years with a standard deviation of 19.96. The ages ranged between 3 years and 96 years with the age group 31 to 40 years being the modal age group. Males recorded the highest number of cases with 92 (59.35%) compared to females with 63 (40.65%). Respiratory disorders, of which pneumonia is the most prevalent, are the leading clinical condition that is often misdiagnosed in place of pulmonary thromboembolism. Conclusion: VTE is a major health problem especially among the elderly, but unfortunately the clinical diagnosis is usually missed by clinicians hence the need to maintain a high suspicion index. [ABSTRACT FROM AUTHOR]

Background The burden of multimorbidity is likely higher in ethnic minority populations, as most individual diseases are more prevalent in minority groups. However, information is scarce. We examined ethnic inequalities in multimorbidity, and investigated to what extent they reflect differences in socioeconomic status (SES). Methods We included Healthy Life in an Urban Setting study participants of Dutch (N = 4582), South-Asian Surinamese (N = 3258), African Surinamese (N = 4267), Ghanaian (N = 2282), Turkish (N = 3879) and Moroccan (N = 4094) origin (aged 18–70 years). Educational level, employment status, income situation and multimorbidity were defined based on questionnaires. We described the prevalence and examined age-adjusted ethnic inequalities in multimorbidity with logistic regression analyses. To assess the contribution of SES, we added SES indicators to the age-adjusted model. Results The prevalence of multimorbidity ranged from 27.1 to 53.4% in men and from 38.5 to 69.6% in women. The prevalence of multimorbidity in most ethnic minority groups was comparable to the prevalence among Dutch participants who were 1–3 decades older. After adjustment for SES, the odds of multimorbidity remained significantly higher in ethnic minority groups. For instance, age-adjusted OR for multimorbidity for the Turkish compared to the Dutch changed from 4.43 (3.84–5.13) to 2.34 (1.99–2.75) in men and from 5.35 (4.69–6.10) to 2.94 (2.54–3.41) in women after simultaneous adjustment for all SES indicators. Conclusions We found a significantly higher prevalence of multimorbidity in ethnic minority men and women compared to Dutch, and results pointed to an earlier onset of multimorbidity in ethnic minority groups. These inequalities in multimorbidity were not fully accounted for by differences in SES. [ABSTRACT FROM AUTHOR]