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Belief in superstition and witchcraft is central to many African conceptions of illness, disease causation and etiology. While a number of anthropological studies have alluded to a theoretical link between such beliefs and HIV prevention in particular, there is limited empirical assessment of the association. Using data from the 2008 Ghana Demographic and Health Survey and applying random-effects logit models, we investigate whether the belief that AIDS can spread through witchcraft associates with the sexual decision making of never-married men and women. The results show that men who believed AIDS can spread through witchcraft and other supernatural means were less likely to have used condoms at last sexual intercourse, controlling for other socioeconomic and cultural variables. Women with similar beliefs were more likely to have experienced sexual intercourse but less likely to have used condoms at last sex. For women, however, the relationship between such superstitious beliefs and condom use was somewhat attenuated after controlling for ethnicity and region of residence. From a policy perspective, the findings suggest that local beliefs regarding AIDS causation must be considered in designing HIV/AIDS programmes and interventions. [ABSTRACT FROM AUTHOR]

Although studies have examined religious differences in fertility in sub-Saharan Africa, it is argued in this paper that using women-only sample data may be conceptually problematic in patriarchal African societies where the influence of husbands on their wives' reproductive preferences is paramount. The present study contributes to this discourse by examining the relationship between religion and fertility behaviour using matched-couple data from Ghana. Guided by the 'religious values' and 'characteristics' hypotheses, the results indicate significant religious differences in fertility. Compared with Traditionalists, Christians and Muslims have lower fertility, albeit these differences diminish significantly after controlling for socioeconomic variables. The impact of wife's religious denomination on marital fertility is attenuated after controlling for husband's religious affiliation. Also, fertility was found to be higher if couples belong to the same faith compared with those of different faiths. [ABSTRACT FROM AUTHOR]

Empirical research confirms the economic costs of intimate partner violence (IPV) for women. Yet, scholarship on this topic is lacking in Ghana, where IPV against women is commonplace. We used in-depth interviews with 15 female survivors of IPV in the Eastern Region to examine the economic costs of IPV for women. Findings showed that the economic costs were both direct and indirect. Direct costs included out-of-pocket payments for medical and nonmedical services, while indirect costs included diminished work abilities, increased absenteeism from work, and lowered work productivity. Ghanaian policymakers must enforce and strengthen policies to prevent violence against women., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Previous research has established relationships between lineage and intimate partner violence (IPV). The findings suggest matrilineal women experience less IPV than patrilineal women. However, the IPV outcomes of bilateral women are unknown because of the limited operationalization of lineage with ethnicity. In our study, we used self-reported and multidimensional measures of lineage to explore its relationship with IPV, focusing particularly on the mechanisms linking the two. We hypothesized that wielding resources would be negatively associated with IPV. Furthermore, matrilineal women's access to lineage resources would reduce their vulnerability to IPV relative to patrilineal women. To examine these hypotheses, we collected data from 1700 ever-married Ghanaian women residing in three ecological zones (coastal, middle, northern). Path analysis was used to explore resources as mechanisms linking lineage and IPV. Our findings indicated resources were patterned by lineage. Matrilineal women benefitted more from maternal family members than patrilineal women and vice versa. Consistent with the standard resource theory, women's access to resources protected against IPV, and the effects were stronger for matrilineal than patrilineal women. Irrespective of how lineage was measured, matrilineal women experienced lower levels of IPV than patrilineal women. The IPV outcomes for bilateral women were mixed. Part of matrilineal women's reduced IPV risk was explained through access to maternal resources. While patrilineal women experienced higher levels of IPV, this was reversed with resources from paternal kin members. Our findings suggest that as resources are fundamental to reducing IPV, lineage can serve as a conduit for resource exchange and wealth transfer., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Urbanization in Sub-Saharan Africa requires vast quantities of sand to meet infrastructural demands. In Accra, Ghana, sand mining occurs predominantly on farmlands at the city's periphery. We selected three study communities to assess the effects of sand mining on agriculture using interviews with local farmers and soil analyses of mined and unmined fields. The results underscore the profound repercussions of sand mining on farmers, characterized by substantial agricultural land loss, the destruction of food crops, and the absence of compensation payments or land reclamation. The study further reveals a significant decline in soil fertility of mined fields compared to unmined fields as evidenced by reduced levels of carbon (C, by 6.3 g kg -1 ) and macronutrients (nitrogen (N, by 0.6 g kg -1 ), phosphorus (P, 12.7 mg kg -1 ), potassium (K, 77 mg kg -1 ) and magnesium (Mg, 88 mg kg -1 )), and an increase in soil compaction (bulk density by 0.13 g cm -3 and penetration resistance by 0.11 MPa). Soil texture and pH were altered and sodium (Na, by 16 mg kg -1 ) and soil moisture (by 4%) increased. On a communal level, sand mining adversely affected water availability, road infrastructure, and the health of residents. The study fills research gaps on the effects of sand mining on agricultural productivity, soil fertility and livelihoods, emphasizing the urgent need for effective regulation, law enforcement and collaboration as well as compensation and land reclamation mechanisms to limit the adverse impacts of sand mining on ecosystem services. Further, the use of more sustainable building materials should be fostered to reduce the demand for sand in Ghana., (© 2024. The Author(s).)

This study examines the prevalence and risk factors of physical, sexual, psychological, and economic violence during lockdowns associated with COVID-19 among HIV-positive women in Ghana. Data were collected in August 2021 from a cross-section of 538 HIV-positive women aged 18 years and older in the Lower Manya Krobo District in the Eastern region of Ghana. Logit models were used to explore relationships between women's self-reported experiences of physical, sexual, psychological /emotional, and economic violence under lockdown and key socio-economic and demographic characteristics. The findings indicate moderate to high prevalence of intimate partner violence (IPV) under lockdown in our sample: physical violence (30.1%), sexual violence (28.6%), emotional/psychological violence (53.7%), and economic violence (54.2%). IPV was higher on all four measures for educated women, poorer women, employed women, cohabiting and married women, and HIV seroconcordant couples.

Economic abuse is a significant gender-based problem in Ghana and sub-Saharan Africa, but few studies explore the consequences of this type of abuse on women's lives and their coping strategies. This study examined the narratives of 16 Ghanaian women in intimate relationships who experienced economic abuse in the Greater Accra, Ashanti, and Upper East regions of Ghana. Results indicate economic abuse negatively affected female survivors' jobs, businesses, and food security and led to physical violence and adverse health implications. Some women coped by relying on external family networks, religion, and theft from husbands, while others trivialized their experiences., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study used qualitative data from 30 women in three of Ghana's 16 administrative regions to explore motivations and barriers to help-seeking among victims of intimate partner violence. Results of the thematic analysis showed low reporting to formal support networks, such as the Domestic Violence and Victim Support Unit or the police, with higher preference for informal sources, such as family members and friends. Motivations to seek help included fatigue, severity of abuse, abusive partner's negligence in honoring marital obligations, and trust in family members. Barriers to help-seeking included: fear of divorce, stigmatization, lack of trust in formal support channels, sociocultural norms emphasizing gender role expectations, and family privacy., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Sibling relationships are a significant part of family dynamics, and sibling violence may be manifested in these relationships. Sibling violence has rarely been examined in the domestic violence literature on sub-Saharan Africa, so little is known about its prevalence or consequences. This study used a life course perspective to examine the effects of sibling violence on Ghanaian women's intimate partner violence (IPV) victimization and perpetration in adulthood. Data were collected from about 1700 ever-married Ghanaian women aged 18 years and above between May and August 2022. Logit models were used to explore retrospective accounts of women's experience of various types of sibling violence in childhood and their later victimization and/or perpetration of IPV. Results showed sibling violence was prevalent in our sample: 51.2% experienced sibling emotional violence, 39.5% experienced physical violence, and 2.3% experienced sexual violence. Our findings generally supported the life course perspective. Women with experiences of sibling physical, sexual, and emotional violence were significantly more likely to perpetrate physical, sexual, and emotional IPV in adulthood. Similarly, women with experiences of sibling violence were more likely to report IPV victimization in later years. Domestic violence interventions should pay attention to sibling relationships in children's early years., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Child abuse is a significant global health problem. While data on child abuse in Ghana are scant, anecdotal evidence suggests the vast majority of Ghanaian children have experienced some form of physical or sexual abuse. This paper explores links between early childhood abuse and health outcomes using a life course perspective. Nationally representative cross-sectional data were collected from a sample of 2289 ever-married Ghanaian women in 2017. Women provided retrospective accounts of different types of violence in early childhood. Random-effects logit models were used to examine the impact of two dimensions of early childhood abuse (physical and sexual) on the physical, sexual, and psychosocial health outcomes of women in later years. Women who experienced childhood physical abuse, but not often, were significantly more likely to report physical disabilities in later years than women who did not experience it. Women reporting childhood sexual abuse were more likely to be depressed in later years than those who never experienced such abuse. They were also significantly more likely to report sexually transmitted diseases. Our findings provide support for the life course theory by showing abuse experienced in childhood could have a long-term impact. We therefore suggest the need for early interventions to address child abuse., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Intimate partner violence (IPV) is known to have negative health consequences for victims. For women living with HIV/AIDS, whose health may be compromised, exposure to IPV can be devastating. Yet few (if any) studies have explored the health implications of exposure to IPV among HIV-positive women. We begin to fill this gap by examining the effects of various dimensions of IPV (physical, sexual, psychological/emotional, and economic) on the cardiovascular, psychosocial, and sexual reproductive health outcomes of HIV-positive women in Ghana. Data were collected from a cross-section of 538 HIV-positive women aged 18 years and older in the Lower Manya Krobo District in the Eastern Region. We used logit models to explore relationships between IPV and health. The findings indicate high prevalence of IPV in our sample: physical violence (61%), sexual violence (50.9%), emotional/psychological violence (79.6%), and economic violence (66.8%). Generally, participants with experiences of IPV reported cardiovascular health problems, unwanted pregnancies and pregnancy loss, and poor psychosocial health. Our findings suggest the importance of screening for IPV as part of HIV care in Ghana.

While sexual violence against women has gained attention in sub-Saharan Africa, research examining help-seeking remains limited. Scholarship on barriers to help-seeking among sexually abused married or cohabiting women is particularly lacking. We used the barriers model and held 15 in-depth interviews with sexually abused Ghanaian married or cohabiting women to examine help-seeking behaviors. Participants identified multiple barriers to help-seeking, including financial difficulties, lack of social support, and stigma. The results corroborate the barriers model's formulation of the challenges faced by female survivors in reporting violence. They indicate the need to improve laws to promote help-seeking among women with experiences of sexual violence.

Background: Despite the fact that the rate of type 1 diabetes (T1D) is increasing worldwide, there exists a dearth of information on the disease in most sub-Saharan African countries. The goal of this study was to determine the enrolment trend of T1D using data compiled over 28 y from a teaching hospital in Kumasi, Ghana., Methods: Information collected included sex, age at diagnosis and date of T1D diagnosis. We identified trends from 1992 to 2018, divided into 3 y intervals., Results: From 1992 to 2018, 1717 individuals with T1D were enrolled in the diabetes clinic at the Komfo Anokye Teaching Hospital. The male:female ratio was 1:1.2. The number of individuals diagnosed with T1D decreased among the 10-19 y age group during the 1992-1994 period, followed by a progressive increase within the same age group during the subsequent period (from 35.4% in 1995-1997 to 63.2% in 2016-2018). There was a decline in the proportion of children 0-9 y of age diagnosed during the study period (from 5.1% in 1992-1994 to 3.6% in 2016-2018)., Conclusions: In our study population, a decreasing trend of T1D enrolments was observed in general while among adolescents an increasing trend was observed., (© The Author(s) 2020. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Hypertension is one of the leading causes of morbidity and mortality among women in sub-Saharan Africa. Although research on the relationship between individual-level socioeconomic status (SES) and hypertension exists, to the best of our knowledge, limited empirical studies examined the effects of neighbourhood-level SES/wealth on the risks of living with hypertension in Ghana. Using data from the 2009 Women's Health Study of Accra (WHSA-II), and applying multilevel logistic regression, this study investigates the effects of both individual and neighbourhood wealth status on hypertension among women in the Greater Accra Region of Ghana. The results show that individual-level SES/wealth is a significant determinant of hypertension among Ghanaian women in Accra. Specifically, wealthy women are more likely to be hypertensive compared to poorer women. However, the effect of neighbourhood SES/wealth was attenuated after adjusting for individual-level SES/wealth. These findings suggest that it is important to develop health promotion programs targeted at a segment of SES group in the prevention, control and management of hypertension among women in the Greater Accra Region of Ghana., (© 2020 John Wiley & Sons Ltd.)

A Caesarean section can be a life-saving intervention in case of pregnancy complications or difficult labour. The prevalence of Caesarean section continues to increase, especially in sub-Saharan Africa, yet the reasons for this remain largely unexplored. This study investigated risk factors contributing to the decision to perform Caesarean sections in Ghana using data from 8645 women aged 15-49 years from the 2017 Ghana Maternal Health Survey. The data were analysed by applying complementary log-log and logit models. The majority of Ghanaian women (about 87%) reported preferring vaginal delivery to Caesarean section. Of those who had undergone a Caesarean section for their most recent birth, about 55% had an elective rather than an emergency section. Women with labour complications (prolonged/obstructed labour) were significantly more likely to have a Caesarean section (OR=4.09, 95% CI=3.10-5.41). Furthermore, women with maternal complications, particularly prolonged/obstructed labour, were less likely to have an elective Caesarean section than those who had no such complications (OR=0.25, 95% CI=0.14-0.46). Compared with poorer women, wealthy women were significantly more likely to have an elective Caesarean section (OR=1.84, 95% CI=1.08-3.14). The findings suggest that beyond maternal complications, women's socioeconomic and demographic characteristics are important risk factors for undergoing a Caesarean section in Ghana.

Objectives: To systematically analyze and summarize the literature on intimate partner violence (IPV) against HIV-positive women in sub-Saharan Africa (SSA) and to identify their risk factors for IPV., Method: A comprehensive review of the literature using the Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) and Meta-Analyses of Observational Studies in Epidemiology (MOOSE) yielded 1,879 articles (PubMed = 1,251, Embase = 491, Web of Science = 132, and identified additional records = 5). Twenty were selected for quantitative and qualitative assessment and synthesis. We employed a random effects model with generic inverse variance method and estimated the odds ratios., Findings: Results indicated a high prevalence of physical, sexual, and emotional violence against women living with HIV/AIDS in SSA. Educational background, alcohol use, marital status, previous experiences with IPV, and employment status were identified as significant risk factors. We also assessed the methodological quality of the articles by examining publication bias and some heterogeneity statistics., Conclusion: There is limited research on IPV against HIV-positive women in SSA. However, the few existing studies agree on the importance of targeting HIV-positive women with specific interventions given their vulnerability to IPV and to address factors exacerbating these risks and vulnerabilities.

Extant research, mostly in western countries, confirms the consequences of sexual violence against women, but academic scholarship on this topic remains scant for Ghana. This study built on existing research by exploring the consequences of sexual violence against married women in the Eastern Region of Ghana. Data were obtained from in-depth interviews purposely conducted with 15 survivors of sexual violence. The thematic analysis showed that sexual violence was accompanied by physical and emotional abuse. Following sexual violence and abuse, these women experienced physical injuries, psychological problems, sexual and reproductive health problems, and suicidal ideations. These health difficulties significantly undermined their economic activities and depleted their income. Sexual violence clearly affects women's empowerment; campaigns against gender-based violence should make sexual violence a top priority in Ghana and elsewhere.

Some evidence suggests that in sub-Saharan Africa, sexual violence is commonplace among married women, yet this problem is underresearched. Using qualitative methods and applying Heise's social-ecological model, this study examined the experiences of 15 Ghanaian women suffering sexual violence in their marriages. Results from the thematic analysis indicate several determinants of sexual violence. Whereas some participants identified macro-level and exosystem factors, including poverty, others pointed to micro-level and ontogenic factors, such as husbands' substance abuse. The results corroborate the core idea of Heise's framework, namely, that structural- and individual-level factors make women vulnerable to violence. The study concludes that Ghanaian legal and policy frameworks must be enforced and strengthened to address the etiology of sexual violence and abuse.

Due to stigma, discrimination and economic insecurity, persons living with HIV/AIDS (PLWHAs) are highly vulnerable to housing instability. For instance, PLWHAs are more likely to either remain stable in inadequate homes or change residence. Yet, few studies explore the contexts of housing stability and change among PLWHAs, especially in sub-Saharan Africa, where the majority reside. This study used qualitative in-depth interviews to explore the narratives of 38 PLWHAs on the contexts of housing stability and the circumstances leading to change in residence. On diagnosis with HIV, the majority of PLWHAs (58%) changed housing locations, mostly from bad to worse conditions. Reasons for change include: eviction due to stigma and discrimination, inability to afford rent, quest to hide HIV status and death of a cohabiting partner. Our findings suggest policy makers should pay attention to the deplorable and poor housing conditions of PLWHAs in Ghana., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: Low birth weight is a public health issue that contributes to perinatal and infant mortality, especially in limited-resource settings, but there is limited understanding of the determinants of low birth weight and the contributions of quality antenatal care to maintaining healthy birth weights for newborns in such settings. This study aims at establishing links between birthweight and quality antenatal care in Ghana., Methods: We used data collected from the recent 2017 Ghana Maternal Health Survey and applied complementary log-log models to investigate relationships between the quality of antenatal care (screening/diagnostic procedures, clinical interventions, type of health provider) and low birth weight in Ghana., Results: The results reveal that compared to women who received low quality clinical interventions, those who received high quality interventions were significantly less likely to have a low birth weight baby. Similarly, women who made the recommended number of antenatal visits (at least eight) were significantly less likely to have a baby with low birth weight than women making fewer visits., Conclusion: Our findings suggest that while the number of antenatal visits is important, the quality of care received during such visits is equally relevant to reducing low birth weight in Ghana.

This article presents qualitative findings on women's knowledge and perceptions of services available to victims of domestic violence in Ghana. In addition, the challenges to access of service and service delivery are explored. Semistructured interviews were conducted with 10 female residents of Sowutuom, a periurban community in Accra, Ghana. An additional three semistructured interviews were also conducted with local service providers in Accra. Results showed that awareness among respondents of available services was low. The majority of women had heard of the Domestic Violence and Victim Support Unit of the Ghana Police Service, though they had limited knowledge of the kind of support provided by this service provider. In addition, most women expressed doubt in the ability of these services to adequately handle cases of intimate partner violence. This study demonstrates that more educational campaigns need to be carried out to raise awareness among Ghanaians on domestic violence and the formal interventions available in the country.

There is a large body of literature on the role of social support systems in the management of chronic conditions in the West, with limited research on the sub-Saharan African and Ghanaian context. In the past, the organization and delivery of formal health services in Ghana were geared towards the treatment of infectious diseases rather than non-communicable diseases (NCDs). We conducted qualitative interviews with a sample of 33 NCD patients purposefully selected from two teaching hospitals in Ghana. The information they provided indicated that the most common types of support received were instrumental and emotional. While a majority of stroke patients experienced activity limitations related to bathing and cooking, they received the emotional support necessary to maintain their psychological well-being. Overall, we found social connections and relationships were an important strategy in the promotion of the physical and mental well-being of these NCD patients.

Few studies have examined the relationships between intimate partner violence (IPV) and the sexual and reproductive health outcomes of women in sub-Saharan countries in general and Ghana specifically. This study began to fill the gap by investigating whether individual- and community-level IPV influenced unwanted pregnancy and pregnancy loss among women in Ghana. Nationally representative cross-sectional data were collected from 2,289 ever-married women, and multilevel modeling was used to estimate individual- and community-level effects. At the individual level, IPV was significantly associated with unwanted pregnancy and pregnancy loss. Women with experience of both physical and sexual violence were more likely to have reported an unwanted pregnancy and a pregnancy loss. However, only those experiencing sexual violence reported unwanted pregnancies. Similarly, community-level IPV was associated with sexual health outcomes. Respondents in communities with higher levels of sexual violence were significantly more likely to have had unwanted pregnancies. The findings corroborate calls for policy makers to consider IPV a reproductive health issue. They also emphasize the need to move beyond individual-level interventions to consider structural and community contexts when addressing the sexual and reproductive health outcomes of women in Ghana.

As part of providing comprehensive HIV/AIDS services, the Ghana National AIDS Control Programme (NACP) and Ministry of Health recommend that Persons Living with HIV/AIDS (PLWHAs) receive psychosocial support and follow-up visits that ensure medical and drug adherence assistance. The successful implementation of these support services requires patients to have stable and quality housing, yet studies that examine associations between housing, psychosocial support, and adherence counseling among PLWHAs in Ghana and sub-Saharan Africa are limited. Data were collected from 605 PLWHAs attending check-up and receiving Anti-Retroviral Therapy (ART) from both Atua Government Hospital and St. Martin's de Porres Hospital, located in the Manya Krobo district. Results show significant relationships between housing and access to psychosocial counseling and support. Specifically, respondents with stable homes and quality housing were significantly more likely to receive psychosocial counseling and support, compared to those without stable and quality housing. It is important for policy makers to consider housing as an important element of psychosocial counseling and care., (© The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Although academically underexplored, economic abuse is common in most societies. Using data collected from 2,289 ever-married Ghanaian women, this study employed regression techniques to examine dimensions of economic abuse (employment sabotage, economic exploitation, and economic deprivation) on the cardiovascular, psychosocial, and overall general health of respondents. Results showed respondents with experiences of economic sabotage had poor psychosocial health. Meanwhile, compared with those with no such experiences, respondents with experiences of economic exploitation not only reported poor psychosocial health but were also more likely to live with cardiovascular diseases. Women with experiences of economic deprivation reported poor psychosocial health, were more likely to live with cardiovascular diseases, and more likely to report poor or good than very good health. Our findings suggest the need to screen for economic abuse as a correlate of poor health among women in Ghana.

Objective: This study examined the relationship between child marriage and intimate partner violence (IPV) in Ghana, looking specifically for possible mechanisms driving the relationship., Method: Nationally representative cross-sectional data were collected from 2289 ever-married Ghanaian women and analysed using random-effects regression techniques., Results: Women who married as children differed significantly from those who did not in their socio-economic characteristics, attitudes to societal gender norms and autonomy. Compared to those who married as adults, women who married as children had lower levels of education, were more likely to endorse patriarchal gender norms and had lower levels of autonomy within the household. Results also showed significant relationships between child marriage and three dimensions of IPV (physical, sexual and emotional). However, for physical and sexual violence, this relationship was completely mediated by differences in the socio-economic characteristics of the women, their attitude to gender norms and their autonomy within the household., Conclusion: Researchers must pay attention to these intermediary factors when theorizing the relationship between child marriage and IPV. Policy makers in Ghana must ensure that young girls receive formal education and have the self-efficacy and skills to reject patriarchal gendered norms that threaten their security and well-being., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Type 2 diabetes affects an increasing number of Ghanaians. The timing of the onset of diabetes is linked to several other co-morbid conditions, yet no study has examined the timing of the onset of type 2 diabetes in Ghana., Methods: To fill this gap in the literature, this study applied logit models to data extracted from the medical records at the Diabetes Clinic of the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Gender-specific models were also estimated., Results: The results show that obesity was a significant predictor of the timing of the first onset of diabetes among both males and females. Women with high school education compared with no formal education, and female employees compared with the unemployed were more likely to experience an early onset of type 2 diabetes., Conclusion: Policymakers must educate Ghanaians about behaviors that will reduce their risk of obesity and diabetes., (© The Author(s) 2018. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Whereas most studies have reported prior history/diagnosis of asthma as an independent risk factor for chronic obstructive pulmonary disease (COPD) development in later life, no systematic review and meta-analysis has been conducted to synthesize these observational studies. The aim of this review is to investigate associations between prior history of asthma and later development of COPD., Methods: We conducted a comprehensive search in PubMed, CINAHL and EMBASE for studies related to prior history of asthma and COPD diagnosis. Articles were screened for relevance by two independent reviewers. Methodological quality was independently assessed and data extracted for qualitative and quantitative review. We explored heterogeneity and performed a publication bias check., Results: From the 1260 articles retrieved, 9 were included in the qualitative review and 7 in the meta-analysis. History of asthma was associated with developing COPD in later life (Inverse Variance Random-effects model, odds ratio: 7.87, 95% confidence interval: 5.40-11.45, p < 0.00001)., Conclusions: Studies with high methodological quality provided sufficient evidence to suggest that individuals with previous history of asthma have an increasing likelihood of developing COPD in later life.

This article examines perceptions of why HIV infection is severe among adolescents in Somanya and less so in Adidome-two seemingly similar communities in Ghana-through analysis of the social control measures employed by these communities to regulate adolescent sexual initiation. Using focus group discussions with parents and caregivers of adolescent children, the study found that parents in Somanya and Adidome used different regulatory mechanisms to influence adolescent sexual initiation. While parents in Somanya relied largely on parental monitoring, parents in Adidome depended more on a combination of neighborhood monitoring and community barriers (informal rules) to control adolescent sexual onset. The study findings showed that contextual factors (socioeconomic and cultural) shaped the social realities of people in these two communities accounting for the differences in HIV prevalence.

Evidence suggests that Ebola virus disease can be transmitted through unprotected sexual intercourse, in particular through contact with the semen of an infected person. Yet few studies examine sexual behaviours in the context of Ebola. Using data collected from 460 women and 340 men within 40 selected communities in the Greater Accra Region of Ghana, this study employed hierarchical linear modelling to examine individual and community-level factors that influence willingness to engage in behaviours that protect against the sexual transmission of Ebola. Results indicate that both individual and community-level factors are significant predictors of respondents' willingness to engage in preventive behaviours. Compared with those with no risks, female respondents with low and medium risk perceptions were significantly more likely to indicate they would use condoms to prevent the sexual transmission of Ebola (AOR = 2.23; p < 0.01). Compared with men who were very concerned, those who were not very concerned (AOR = 0.356; p < 0.01) and not at all concerned (AOR = 0.356; p < 0.05) about Ebola were significantly less likely to protect against the sexual transmission of Ebola. Female respondents in communities with high knowledge about Ebola were significantly more likely to engage in behaviours preventing the sexual transmission of Ebola virus disease (AOR = 1.93; p < 0.05).

The relationship between housing and HIV infection is complex. On one hand, poor housing arrangements may affect the health of persons living with HIV/AIDS (PLWHAs). On the other hand, PLWHAs may be more likely to live in substandard homes because of their health. We used qualitative in-depth individual interviews of 38 PLWHAs attending voluntary counseling services at two government hospitals in the Lower Manya Krobo District (LMKD) in the Eastern region of Ghana to examine their housing and health outcomes. Results show that the majority of PLWHAs lived in homes that lacked basic amenities, were overcrowded, had structural deficiencies, and were noisy and dirty. They suffered from poor housing conditions mainly because of their HIV serostatus, as this affected their ability to finance adequate homes, while HIV-related stigmatization led to eviction from either family homes or rented facilities.

In African societies, kinship ties determine how women are socialized, their access to power and wealth, as well as custody of children, often considered important factors in married women's experience of intimate partner violence (IPV). Yet studies that examine how kinship norms influence IPV are scant. Using in-depth interviews collected from women identifying with both matrilineal and patrilineal descent systems, we explored differences in Ghanaian women's experiences of IPV in both kin groups. Results show that while IPV occurs across matrilineal and patrilineal societies, all women in patrilineal societies narrated continuous pattern of emotional, physical, and sexual assault, and their retaliation to any type of violence almost always culminated in more experience of violent attacks and abandonment. In matrilineal societies, however, more than half of the women recounted frequent experiences of emotional violence, and physical violence occurred as isolated events resulting from common couple disagreements. Sexual violence against matrilineal women occurred as consented but unwanted sexual acts, but patrilineal women narrated experiencing violent emotional and physical attack with aggressive unconsented sexual intercourse. Contextualizing these findings within existing literature on IPV against women suggests that policies aimed at addressing widespread IPV in Ghanaian communities should appreciate the dynamics of kinship norms.

Context: Previous studies have established women's autonomy as an important determinant of several demographic outcomes in Sub-Saharan Africa, yet very few have considered intimate partner violence as one of these outcomes., Methods: Data collected in 2017 from 2,289 women residing in 40 communities in Ghana were used to examine associations between three types of autonomy-economic decision making, family planning decision making and sexual autonomy-and women's experiences with physical, sexual, emotional and economic violence. Multilevel logistic regression was used to identify associations., Results: All three types of autonomy were associated with having experienced intimate partner violence, although in different ways, at the individual level or community level. At the individual level, after adjustment for theoretically relevant variables, family planning decision-making autonomy was negatively associated with all four types of violence (odds ratios, 0.7-0.8), while economic decision-making autonomy was positively associated with emotional and economic violence (1.2 for each). At the community level, living in a community where women had higher levels of sexual autonomy was associated with reduced odds of having experienced physical and economic violence (0.5 and 0.4, respectively)., Conclusions: The findings underscore the relevance of women's empowerment programs as potential mechanisms for reducing intimate partner violence in Ghana. They also point to the need to move beyond individual-level interventions and consider community-level programs that empower women to be autonomous.

Background: Limited studies exist on the effects of knowledge and risk perceptions in Ebola-preventive behaviours in Ghana., Methods: Using data collected from 800 respondents in 40 randomly selected communities in the Greater Accra Region of Ghana, this study employed hierarchical linear modelling to examine the effects of individual- and community-level factors on Ebola-preventive behaviours., Results: The study found individual- and community-level factors are significantly associated with Ebola-preventive behaviours. Respondents with greater knowledge about Ebola were more likely to engage in Ebola-preventive behaviours. In addition, there were significant changes in risk perception from the time the disease had peaked in neighbouring countries to the time data were collected. Most importantly, respondents who perceived themselves to have a high risk of contracting Ebola at the time of the survey were significantly less likely to engage in Ebola-preventive behaviours. Compared with Christians, Muslims were significantly less likely to engage in Ebola-preventive behaviours. Findings from the multilevel analysis indicated significant differences across communities. Communities expressing worry about a potential Ebola outbreak were more likely to engage in Ebola-preventive behaviours., Conclusion: The findings suggest the importance of adopting behaviour change interventions that address Ebola at both the individual and community level, especially in the event of a future outbreak in Ghana.

Previous studies demonstrate the long term effects of childhood violence on future victimization and perpetration of intimate partner violence (IPV). With a few exceptions from Asia, however, this literature is largely limited to North America and Europe. To date, contributions from sub-Saharan Africa remain scant. We began to fill this gap by applying the life course theory to retrospective data collected from 2289 women in Ghana. Specifically, we examined if women's childhood experiences of family violence were associated with their later victimization and/or their perpetration of IPV. We also explored the effect of the timing and continuity of family violence over the life course. Generally, we found that women with childhood experiences of violence were more likely to be victims and perpetrators of IPV than those with no such experiences. However, the effect and significance of the violence was more pronounced if it continued from early childhood (before age 15) to adulthood (after age 15). Violence experienced after age 15 was more significant than violence experienced before age 15, and women who perpetrated IPV were significantly more likely to be victimized themselves. To improve domestic violence interventions in Ghana, it is necessary to pay attention to victims' early childhood experiences., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

As in other parts of sub-Saharan Africa, youth in Kenya report low rates of condom use. Although several studies have explored reasons for the low condom use among Kenyan youth, not many have established linkages between lack of use and normative beliefs and attitudes around condoms. Using the Theory of Planned Behavior (TPB), this article examined whether beliefs and attitudes around condoms influenced intentions and actual condom use. Data for the study were restricted to 1453 sexually active youth during the last school break. Path analysis was used to examine the relationship between the TPB constructs and condom use among Kenyan youth. Results indicated a direct relationship between attitudes and condom use for male respondents and an indirect relationship between these two variables for females. Both males and females who expressed greater intentions to use condoms were significantly more likely to report they used condoms consistently. Also, male and female youth with higher perceived behavioral control were significantly more likely to have used condoms consistently. Males with friends who used condoms were significantly more likely to use condoms consistently. The findings suggest the importance of examining young people's attitudes toward condoms-in particular, those deeply rooted in misconceptions that serve to discourage safer sexual behaviors.

There is evidence that between half and two thirds of Nigerian women have experienced domestic violence, and that this is higher in some ethnic groups than others. Yet, studies that examine the ethnic dimensions of domestic and marital violence are conspicuously missing in the literature. We fill this void using data from the Nigeria Demographic and Health Survey. Results indicate significant ethnic differences with Igbo women more likely to have experienced sexual and emotional violence compared with Yoruba women. Hausa women were however significantly less likely to experience physical and sexual violence but not emotional violence, compared with Yoruba women. Women with domineering husbands were significantly more likely to experience physical, sexual, and emotional violence. Similarly, those who thought wife-beating was justified were more likely to experience all three types of violence. The independent effects of ethnicity on domestic violence suggests that specific interventions may be needed for women belonging to different ethnic groups if the problem of domestic violence is to be dealt with effectively in Nigeria.

Objectives: Type 2 diabetes is a chronic condition that affects nearly over three million Canadians, including immigrants. The timing of the first onset of diabetes has been linked to several other severe diseases. Yet, there is a dearth of empirical studies that examine the timing of the first onset of diabetes among Canadians, in general, and among immigrants and ethnic minority populations within Canada, in particular., Design: Applying event history techniques to the 2013 Canadian Community and Health Survey, we address this research void by examining factors that contribute to the first onset of diabetes among immigrant and visible minority populations in Canada (N = 8905). Given the gendered patterns in the epidemiology of diseases and the differences in risk factors for men and women, gender-specific models were estimated., Results: Results showed that South Asian, Black and Filipino women developed diabetes earlier, compared to women from the UK. Similarly, South Asian, Chinese, Filipino, Black, South East Asian and Arab men developed diabetes earlier than men from the UK. A significant and important finding of this analysis was that the risks of developing diabetes vanished completely for Black and Filipino women, after accounting for lifestyle factors. For South Asian women, however, there was significant attenuation in their risks after accounting for lifestyle factors. The findings were strikingly different for immigrant men. Specifically, their risks of developing diabetes increased after accounting for lifestyle factors., Conclusions: These results suggest the development of gender-specific and lifestyle interventions, targeted at specific immigrant groups with increased risks of developing diabetes earlier in the life course.

Rationale: Although Ebola-related stigmatization continues to undermine efforts to re-integrate survivors, few studies have examined what influences such stigmatizing attitudes., Objective: This paper explores the effects of both individual- and community-level factors on Ebola-related stigma in Ghana., Methods: Data were collected from a cross-section of 800 respondents, nested within 40 communities in the Greater Accra Region of Ghana. Multi-level modelling was employed for analysis., Results: Both individual- and community-level factors were significant determinants of stigma. Respondents who endorsed myths about Ebola were significantly more likely to also endorse Ebola-related stigma. Similarly, those who were worried about a potential outbreak of Ebola in the future, had moderate risk perceptions of contracting Ebola, had primary and secondary education, and were not confident of the quality of health care in the event of an outbreak, were more likely to endorse Ebola-related stigma. Knowledge of Ebola was significant at the community level, but not at the individual level. Communities with more knowledge were less likely to endorse Ebola-related stigma., Conclusions: These findings underscore the need to increase the knowledge base while countering myths that undermine preventive behaviours to fight Ebola-related stigma. It is equally important to adopt multi-level interventions that emphasize community-based strategies., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Like most countries in sub-Saharan Africa, hypertension contributes substantially to morbidity and mortality in Ghana, yet nationally representative studies that examine the odds of becoming hypertensive among Ghanaians are conspicuously missing. We aimed to fill this void in the literature. The data used for analysis came from the first wave of the Study on Global Ageing and Adult Health (SAGE), collected in Ghana from January 2007 to December 2008 by the World Health Organization (WHO). A total of 5573 respondents were sampled for the study. Random-effects C-log-log models were employed in examining socio-economic, lifestyle and psychosocial factors on the odds of becoming hypertensive in Ghana. Separate models were run for male and females. Results indicated there were strong significant associations between socio-economic, lifestyle and psychosocial factors on the likelihood of becoming hypertensive, among Ghanaian men and women. Compared with the poorest, Ghanaians from wealthy households were significantly more likely to be hypertensive. Educated women, as compared with the uneducated, were also more likely to be hypertensive. Ghanaians who engaged in vigorous or intensive activities continuously, for at least 10 minutes, were significantly less likely to be hypertensive, compared to those who did not. Happier men had lower odds of becoming hypertensive, and depressed women had increased odds of reporting they were hypertensive.

Objective: Although emerging in Western industrialized societies, limited research exists on the links between housing and health outcomes for persons living with HIV/AIDS (PLWHAs) in sub-Saharan Africa (SSA)., Methods: Using survey data collected from 605 PLWHAs in the Lower Manya Krobo district of Ghana, this paper examined the effects of housing structure, arrangements, accessibility and conditions on the physical and psychological/emotional health of respondents., Results: Results indicate that housing variables have independent effects on health outcomes, controlling for socio-economic and demographic variables. Respondents living in poor housing structures and deplorable housing conditions had poorer physical and psychological health scores., Conclusion: The findings suggest that it is relevant to think about houses occupied by PLWHAs as important sources of health inequality.

Intimate partner violence has implications for women's health globally. Patrilineal women have been shown to have increased risk of experiencing intimate partner violence, yet, the health consequences of intimate partner violence in patrilineal women have not been thoroughly explored or documented. This study used qualitative in-depth interviews to explore the health effects of intimate partner violence among 15 ever-partnered Ghanaian patrilineal women. Participants attributed violence to several factors including gendered domestic relations, cultural and marital rites and alcohol use, among other factors. Abused women reported health problems such as feelings of worthlessness, sleeplessness, suicidal ideation, eye injuries, bodily weakness, hypertension, genital sores and the premature termination of pregnancy. Policy makers should pay particular attention to intimate partner violence-related health consequences in designing health interventions for abused women.

The importance of perceived vulnerability to risk-reducing behaviors, including HIV testing, is fairly established, especially among youth in sub-Saharan Africa. Yet, the majority of studies that examined this important relationship used cross-sectional data that inherently assume that perceived vulnerability does not change. While these studies have been useful, the assumption of perceived vulnerability as time invariant is a major flaw and has largely limited the practical usefulness of this variable in AIDS prevention and programing. Using longitudinal data and applying random-effects logit models, this study makes a major contribution to scholarship by examining if changes in perceived vulnerability associate with a change to test for HIV among 857 young people in Cape Town, South Africa. Results show that female youth who changed their risk perceptions were more likely to also change to test for HIV, but the effects were completely attenuated after controlling for theoretically relevant variables. No significant relationships were observed for males. Also, females who were virgins at wave 2 but had sex between waves were significantly more likely to have changed to test for HIV. Of most importance was that sexual behavior eliminated the effects of change in risk perceptions suggesting that a change in perception may have occurred as a result of changes in sexual behavior. AIDS prevention programs must pay particular attention to helping youth become aware of their vulnerability to HIV risks, especially as these have implications for risk-reducing behaviors, especially for females who are burdened., (© The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

-Although largely controlled by government, Ghana's health delivery system has witnessed dramatic growth in private sector participation. This growth is important for consumers of health care because it provides a wide range of choices, while informing health providers, through consumer feedback, of the quality indicators relevant for improving their services. For consumers of health care, measuring and monitoring quality based on health provider characteristics is crucial to making appropriate choices, especially because these have implications for morbidity, mortality, and longevity. There is limited research in sub-Saharan Africa, and Ghana in particular, that examines how health provider characteristics associate with choice of health facility. Using recently collected data from the Ghana Demographic and Health Survey and employing random intercept models, we fill this research void. Results showed that Ghanaian men and women who were satisfied with wait time at the health facility were significantly more likely to have visited private health facilities compared to public health facilities. Similarly, Ghanaian women who appeared satisfied with conditions at the health facility and accessibility of the health facility were significantly more likely to have visited private hospitals compared to public hospitals. This study provides important evidence to policy makers and major stakeholders in the public health sector of the need for quality adjustments and the relevance of improving health care delivery in the public health facilities.

The theory of social gradient in health posits that individuals with lower socioeconomic status (SES) have poorer health outcomes, compared with those in higher socioeconomic brackets. Applied to noncommunicable diseases (NCDs), this theory has largely been corroborated by studies from the West. However, evidence from sub-Saharan Africa are mixed, with those from Ghana conspicuously missing in the literature. Using data from the Study on Global Ageing and Adult Health, and applying random-effects C log-log models, this study examined the relationship between SES and the risks of living with NCDs in Ghana. Results confirmed a negative social gradient, as Ghanaians with higher SES were more likely to live with NCDs compared with those with low SES. The addition of lifestyle factors attenuated the risks of living with NCDs among Ghanaian men and women with higher SES. This study underscores the need for policies targeted at specific socioeconomic and demographic groups, such as the emerging middle and upper class Ghanaians. It is similarly important for interventions to move beyond biomedical solutions that put more emphasis on epidemiological risk factors to strategies that embrace psychosocial factors as important correlates of cardiovascular health., (© 2015 Society for Public Health Education.)

Background: The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country., Methods: Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures., Results: In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries., Conclusions: Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)