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Background: Women's intentions to use any contraceptive method are critical for better understanding their future needs and making them more likely to act on that intention. This study assessed the factors associated with the intention to use modern contraceptives among women of reproductive age in Benin., Methods: This was a cross-sectional study that used the 2017-2018 Benin Demographic and Health Survey (BDHS). The study analyzed a weighted sample of 13, 582 women of reproductive age who were non-users of contraceptives. The intention to use contraceptives was the outcome variable. Multivariate logistic regression analysis was conducted to determine the factors associated with the intention to use contraceptives among women of reproductive age. The results were estimated using an adjusted odds ratios (aOR) with a 95% confidence interval (CI) and statistical significance set at p < 0.05.  RESULTS: Approximately 35.0% of the women had the intention to use modern contraception. We found that women aged between 30 and 34 (aOR = 0.70, 95%CI: 0.57, 0.86), 35-39 (aOR = 0.52, 95%CI: 0.42, 0.66), 40-44(aOR = 0.30, 95%CI: 0.22, 0.39) and 45-49 (aOR = 0.10, 95%CI: 0.07, 0.14), Muslim women (aOR = 0.68, 95%CI: 0.53, 0.85) and those who perceived the distance to a health facility not to be a big problem (aOR = 0.75, 95%CI: 0.67, 0.84) were less likely to have the intention to use modern contraceptives compared with their counterparts. On the other hand, women who attained primary (aOR = 1.21, 95%CI: 1.07, 1.36), secondary (aOR = 1.39, 95%CI: 1.21, 1.59), and higher education (aOR = 1.60, 95%CI: 1.13, 2.26), women who were employed (aOR = 1.39, 95%CI: 1.23, 1.57), women with no religion (aOR = 1.32, 95%CI: 1.04, 1.69), women whose partners were working (aOR = 1.69, 95%CI: 1.16, 2.44), women who heard about family planning in the media (aOR = 1.51, 95%CI: 1.16, 2.44), and women in the poorer (aOR = 1.31, 95%CI: 1.10, 1.54), middle (aOR = 1.42, 95%CI: 1.20, 1.67]), richer (aOR = 1.23, 95%CI: 1.03, 1.47), and richest households (aOR = 1.42, 95%CI: 1.15, 1.75) were more likely to have the intention to use contraceptives than their counterparts., Conclusion: The study provides valuable insights into the intention to use contraceptives among women of reproductive age in Benin. The findings indicate that the proportion of women who have intention to use contraceptives remains low. The findings of this study could inform the development of targeted interventions and policies to increase access to and uptake of contraceptives in Benin, with the ultimate aim of improving the reproductive health and well-being of women and their families., (© 2024. The Author(s).)

Neonatal mortality accounts for nearly half of under-5 mortality in Ghana. The aim of this study was to identify the predictors of neonatal mortality in the Eastern Regional Hospital, Ghana. This was a retrospective cohort study conducted using secondary data from electronic medical records from the Eastern Regional Hospital between 1st January 2022 and 31st December 2022. The Kaplan-Meier estimator and adjusted Cox regression model were used to estimate survival probability and to assess the predictors of neonatal mortality. Data on 1684 neonates were analyzed and we found that 11.82% deaths occurred with a neonatal mortality rate (NMR) of 13.98 (95% CI: 12.05, 15.91) per 1000 person-days. Most neonatal deaths occurred within the first 24hrs of life (9.9%). The predictors of neonatal mortality were found to be low birthweight [Adjusted hazard rate (aHR): 1.63, 95% CI: 1.04, 2.54], hypothermia (aHR: 1.82, 95% CI: 1.16, 2.85), hyperthermia (aHR: 1.85, 95% CI: 1.01, 3.39), birth asphyxia (aHR: 3.69, 95% CI: 1.68, 8.11), and multiparty (aHR: 1.66, 95% CI: 1.02, 2.70). However, neonates aged 8-28 days (aHR: 0.41, 95% CI: 0.21, 0.81), born in the Eastern Regional Hospital (aHR: 0.39, 95% CI: 0.28, 0.55), walk-in neonates (aHR: 0.54, 95% CI: 0.32, 0.90), and neonates whose mothers had 8 or more antenatal contacts (aHR: 0.54, 95% CI: 0.32, 0.92) had lower neonatal mortality. There was high NMR in the Eastern Regional Hospital in Ghana. Averting complications such as low birthweight, hypothermia, hyperthermia, birth asphyxia, including the provision of obstetric and early neonatal care within the first 24 hours of life is critical to reducing neonatal mortality. Adherence to the World Health Organization's recommendation of 8 or more antenatal contacts among pregnant women is also essential in reducing neonatal mortality., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Apanga et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

While the practice of polygyny is common in Ghana, little is known about its impact on the use of reproductive health services. The aim of this study was to assess the relationship between polygynous marriage and the utilisation of skilled antenatal care (ANC), assisted skilled birth, and modern contraceptive services among married women in Ghana. Secondary data from the 2017 Ghana Maternal Health Survey were used for this study. The study included a weighted sample of 9,098 married women aged 15-49 years. We used multivariable logistic regression models to assess the association between polygyny and each outcome variables. Sensitivity analysis was conducted to assess the dose-response relationship between polygyny and each outcome variable. The prevalence of eight or more ANC contacts, assisted skilled births, and use of modern contraception were 47.0%, 81.4%, and 25.4%, respectively. The prevalence of women in polygynous marriages was 15.3%. Compared to monogynous marriage, polygynous marriage was associated with 19% lower odds of having eight plus ANC contacts (adjusted odds ratio [aOR] 0.81, 95% CI: 0.69, 0.96), 25% lower odds of having assisted skilled birth (aOR 0.75, 95% CI: 0.63, 0.89), and 19% lower odds of modern contraceptive utilisation (aOR 0.81, 95% CI: 0.66, 0.99). Interventions on reproductive health may need to prioritise women in polygynous marriages in order to improve the utilisation of skilled ANC, assisted skilled birth, and modern contraceptive services.

Background: Globally, health insurance has been identified as a key component of healthcare financing. The implementation of health insurance policies in low and middle-income countries has led to a significant increase in access to healthcare services in these countries. This study assessed health insurance coverage and its associated factors among women of reproductive age living in rural Ghana., Methods: This study used a nationally representative data from the 2017/2018 Ghana Multiple Indicator Cluster Survey (GMICS) and included 7340 rural women aged 15-49 years. Bivariate and multivariable logistic regression models were developed to assess the association between the explanatory and the outcome variable. Statistical significance was considered at p = 0.05., Results: The overall prevalence of health insurance coverage among rural women in Ghana was 51.9%. Women with secondary (aOR = 1.72, 95% CI: 1.38-2.14) and higher education (aOR = 4.57, 95% CI: 2.66-7.84) were more likely to have health insurance coverage than those who had no formal education. Women who frequently listened to radio (aOR = 1.146, 95% CI: 1.01-1.30) were more likely to have health insurance coverage than those who did not. Women who had a child (aOR = 1.81, 95% CI: 1.50-2.17), two children (aOR = 1.59, 95% CI: 1.27-1.98), three children (aOR = 1.41, 95% CI: 1.10-1.80), and five children (aOR = 1.36, 95% CI: 1.03-1.79) were more likely to have health insurance coverage than those who had not given birth. Women who were pregnant (aOR = 3.52, 95% CI: 2.83-4.38) at the time of the survey, and women within the richest households (aOR = 3.89, 95% CI: 2.97-5.10) were more likely to have health insurance coverage compared to their other counterparts. Women in the Volta region (aOR = 1.36, 95% CI: 1.02-1.81), Brong Ahafo region (aOR = 2.82, 95% CI: 2.20-3.60), Northern region (aOR = 1.32, 95% CI: 1.02-1.70), Upper East region (aOR = 2.13, 95% CI: 1.63-2.80) and Upper West region (aOR = 1.56, 95% CI: 1.20-2.03) were more likely to have health insurance coverage than those in the Western region., Conclusion: Although more than half of women were covered by health insurance, a significant percentage of them were uninsured, highlighting the need for prompt policy actions to improve coverage levels for insurance. It was found that educational level, listening to radio, parity, pregnancy status, wealth quintile, and region of residence were factors associated with health insurance coverage. We recommend better targeting and prioritization of vulnerability in rural areas and initiate policies that improve literacy and community participation for insurance programs. Further studies to establish health policy measures and context specific barriers using experimental designs for health insurance enrolments are required., (© 2023. The Author(s).)

Background: The free maternal healthcare policy was introduced in Ghana in 2008 under the national health insurance scheme as a social intervention to improve access to maternal health services. This study investigated the prevalence of out of pocket (OOP) payment among pregnant women with valid national health insurance who sought skilled delivery services at public sector health facilities in Ghana. The study also assessed the health system factors associated with OOP payment., Methods: We used data from the Ghana Maternal Health Survey (GMHS), which was conducted in 2017. The study comprised 7681 women who delivered at a public sector health facility and had valid national health insurance at the time of delivery. We used multivariable logistic regression analysis to assess factors associated with OOP payment, whiles accounting for clustering, stratification, and sampling weights., Results: The prevalence of OOP payment for skilled delivery services was 19.0%. After adjustment at multivariable level, hospital delivery services (adjusted Odds Ratio [aOR] = 1.23, 95% Confidence Interval [CI] = 1.00, 1.52), caesarean section (aOR = 1.73, 95% CI = 1.36, 2.20), and receiving intravenous infusion during delivery (aOR = 1.31, 95% CI = 1.08, 1.60) were associated with higher odds of OOP payment. Women who were discharged home 2 to 7 days after delivery had 19% lower odds of OOP payment compared to those who were discharged within 24 hours after delivery., Conclusion: This study provides evidence of high prevalence of OOP payment among women who had skilled delivery services in public sector health facilities although such women had valid national health insurance. Government may need to institute measures to reduce OOP payment in public sector facilities especially at the hospitals and for women undergoing caesarean sections., (© 2023. The Author(s).)

Background: Early antenatal care (ANC) is essential for improving maternal and child health outcomes. The primary aims of this study were to 1) estimate the association between partners' education attainment and early ANC, and 2) determine whether partners' level of education modified the relationship between mothers' education, mothers' age, planned pregnancy, employment status and early ANC., Methods: Data were obtained from a cross-sectional study conducted from April to May 2021 among 519 mothers with a live birth in the past year in the Nabdam district in the Upper East Region in northern Ghana. Generalized estimating equations were used to assess whether partners' level of education modified the relationship between mothers' education, mothers' age, planned pregnancy, employment status and early ANC. Effect modification was assessed on the additive and multiplicative scales using adjusted prevalence ratios (aPR) and corresponding 95% confidence intervals., Results: Mothers whose partners had secondary or higher education had a 26% higher prevalence of early ANC compared to mothers whose partners had less than a secondary level of education (aPR: 1.26, 95% CI: 1.05,1.51). There was evidence of effect modification by partners' education on the relationship between planned pregnancy and early ANC on both the additive (Relative excess risk due to interaction [RERI]: 0.61, 95% CI: 0.07,0.99), and multiplicative (ratio of PRs: 1.64, 95% CI: 1.01,2.70) scales. Among mothers whose partners had less than secondary education, mothers who had teenage pregnancy (i.e., aged 18-19 years old during pregnancy) were less likely to have early ANC compared to those who did not have teenage pregnancy (aPR: 0.71, 95% CI: 0.53,0.97). Among mothers whose partners had a secondary or higher education, early ANC was more prevalent among employed mothers compared to those who were unemployed (aPR: 1.27, 95% CI: 1.02,1.57)., Conclusions: Our findings suggest that whilst mothers whose partners had a secondary or higher education were more likely to initiate early ANC, supporting such women to plan their pregnancies can further increase the coverage of early ANC., (© 2022. The Author(s).)

Background: Evidence of the association between early antenatal care (ANC) and receiving at least three doses of sulphadoxine-pyrimethamine (IPTp3+) during pregnancy is limited. It's also unclear whether the association between early ANC and IPTp3+ is modified by planned pregnancy status., Objectives: Our primary aim was to assess the relationship between early ANC and IPTp3+ and to assess whether this relationship is modified by a woman's planned pregnancy status. We also estimated IPTp3+ coverage across Sub-Saharan African countries., Methods: Data on 77 183 mothers with a live birth in the past two years were analyzed using multiple indicator cluster surveys (MICSs) from 17 Sub-Saharan African countries conducted between 2013 and 2019. We used modified Poisson regression with a robust variance to assess the association between early ANC and IPTp3+, while adjusting for country, clustering, stratification and sample weights. Effect modification by planned pregnancy status was assessed on the additive and multiplicative scales. We used meta-analytic techniques to pool prevalent estimates of IPTp3+ across all countries., Findings: IPTp3+ overall coverage was 22.1% (95% CI: 17.0%, 27.1%), and ranged from 2.9% (95% CI: 1.3%, 4.4%) in São Tomé and Príncipe to 51.7% (95% CI: 49.2%, 54.1%) in Ghana. IPTp3+ coverage was 30% higher among mothers who had early ANC compared to those who did not have early ANC [adjusted prevalence ratio (aPR): 1.30, 95% CI: 1.23,1.36]. There was evidence of effect modification on the additive [relative excess risk due to interaction (RERI): 0.08, 95% CI: 0.0002, 0.15] and multiplicative (aPR: 1.10, 95% CI: 1.01, 1.20) scales., Conclusions: IPTp3+ coverage was low across many of the countries in Sub-Saharan Africa. Women who had early ANC were more likely to receive IPTp3+. Women whose pregnancies were unplanned were less likely to receive IPTp3+, but our effect modification analysis showed that early ANC among such women can increase IPTp3+ coverage., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2022 The Author(s).)

Background: Although menstruation is a normal physiological process that begins in girls during adolescence, it has the potential to negatively impact on the self-esteem and education of girls particularly those from low- and middle-income countries. We investigated the prevalence and factors associated with menstruation-related school absenteeism among adolescent girls in the Talensi district of rural northern Ghana., Methods: We conducted a cross-sectional survey among 705 adolescent girls aged 12-19 years who had attained menarche. The sample size was estimated using Epi Info version 6 at 95% confidence interval and a 5% margin of error. A two-stage sampling technique was employed to recruit participants. We conducted univariate and multivariate logistic regression models to determine factors associated with menstruation-related school absenteeism which was defined as "being absent from school due to menstruation-related issues during the last menstruation.", Results: The prevalence of menstruation-related school absenteeism was 27.5%. School absenteeism ranged from one to seven days during the menstrual period. Older adolescent girls, (aOR = 2.38, 95% CI 1.29-4.40), use of cloth as a sanitary material at the last menstruation, (aOR = 3.21, 95% CI 2.22-4.63), and cultural restriction, (aOR = 2.54, 95% CI 1.76-3.67) were associated with higher odds of menstruation-related school absenteeism. Meanwhile, girls from moderate income parent(s), [aOR = 0.57 95% CI 0.34-0.94] had lower odds of menstruation-related school absenteeism. Mother's education and privacy in school were only significant at the univariate level., Conclusions: The prevalence of menstruation-related school absenteeism highlights the need for interventions aimed at improving the availability of sanitary pads for girls, eliminating cultural restrictions associated with menstruation, and also improving parent(s) income level., (© 2021. The Author(s).)

Background: Early essential newborn care is one of the important interventions developed by the World Health Organization to reduce morbidities and mortalities in neonates. This study investigated the role of the public and private sector health facilities on factors associated with early essential newborn care practices following institutional delivery in Ghana., Methods: We used data from the 2017/2018 multiple indicator cluster survey for our analysis. A total of 2749 mothers aged 15-49 years were included in the study. Logistic regression analysis was used to assess the factors associated with early essential newborn care in both public and private health sectors., Results: The prevalence of good early essential newborn care in the public sector health facilities was 26.4 % (95 % CI: 23.55, 29.30) whiles that of the private sector health facilities was 19.9 % (95 % CI: 13.55, 26.30). Mothers who had a Caesarean section in the public sector health facilities had 67 % lower odds of early essential newborn care compared to mothers who had a vaginal delivery [adjusted prevalence odds ratios (aPOR) = 0.33, 95 % CI: 0.20, 0.53]. Mothers without a health insurance in the public sector health facilities had 26 % lower odds of early essential newborn care compared to mothers with a health insurance (aPOR = 0.74, 95 % CI: 0.56, 0.97). However, these associations were not observed in the private sector health facilities., Conclusions: The findings suggest that the prevalence of good early essential newborn care in the public sector health facilities was higher than that reported in the private sector health facilities. Child health programs on early essential newborn care needs to be prioritized in the private healthcare sector. The Government of Ghana may also need to increase the coverage of the national health insurance scheme for women in reproductive age.

Background: COVID-19 is a novel respiratory disease associated with severe morbidity and high mortality in the elderly population and people with comorbidities. Studies have suggested that pregnant women are more susceptible to COVID-19 compared to non-pregnant women. However, it's unclear whether pregnant women in Ghana are knowledgeable about COVID-19 and practice preventive measures against it. This study sought to assess the knowledge and preventive practices towards COVID-19 among pregnant women seeking antenatal services in Northern Ghana., Methods: A cross-sectional study was conducted using a structured questionnaire in the Nabdam district in Ghana. A total of 527 pregnant women were randomly sampled from health facilities offering antenatal care services in the district. Multivariable logistic regression analysis was used to assess the association between the predictors and outcome variables., Results: The prevalence of adequate knowledge and good COVID-19 preventive practices were 85.6%, (95% CI: 82.57, 88.59) and 46.6%, (95% CI: 42.41, 50.95) respectively. Having at least a primary education, residing in an urban area, and receiving COVID-19 education at a health facility were positively associated with adequate knowledge on COVID-19. Factors positively associated with good COVID-19 preventive practices were older age, having at least a primary education, pregnant women with a chronic disease, and living in an urban area. Multiparity was negatively associated with good COVID-19 preventive practices., Conclusion: Although majority of women had adequate knowledge of COVID-19, less than half of them were engaged in good COVID-19 preventive practices. Education of pregnant women on COVID-19 preventive practices should be intensified at health facilities while improving upon the water, sanitation and hygiene need particularly in rural communities., Competing Interests: The authors have declared that no competing interests exist.

Objective: To assess adherence to COVID-19 preventive measures and its associated factors among pregnant women in Ghana., Methods: This was a cross-sectional study conducted in the Nabdam district, Ghana. Data were collected from 527 pregnant women randomly selected from antenatal care clinics from 16 healthcare facilities. Descriptive statistics were used to assess the prevalence of adherence to COVID-19 preventive measures. Multivariable logistic regression was used to estimate the factors associated with COVID-19 preventive measures, whilst adjusting for potential confounders., Results: The prevalence of wearing a face mask 18.0% (95% CI: 14.73%, 21.32%); of handwashing/hand sanitising 31.7% (95% CI: 27.70%, 35.67%), and of social distancing, 22.0% (95% CI: 18.46%, 25.56%). Multivariable logistic regression analysis revealed that knowledge of COVID-19 symptoms [Adjusted odds ratios (aOR): 2.86, 95% CI: 1.03, 7.89] and knowledge of COVID-19 transmission via contaminated surfaces/objects (aOR: 4.60, 95% CI: 1.23, 17.18) were associated with wearing a face mask. Pregnant women who knew that avoiding the touching of eyes, nose and mouth can prevent COVID-19 (aOR: 2.71, 95% CI: 1.01, 7.28), and knowledge of the virus being transmitted via contaminated objects/surfaces (aOR: 4.08, 95% CI: 1.42, 11.76), were associated with handwashing/hand sanitising. Knowledge of COVID-19 transmission via contaminated surfaces/objects (aOR: 15.27, 95% CI: 1.87, 124.43) was also associated with social distancing., Conclusion: The findings of our study suggest that knowledge of COVID-19 symptoms, transmission and preventive measures may play an important role in the practice of preventive measures against COVID-19 among pregnant women., (© 2021 John Wiley & Sons Ltd.)

Background: Timely initiation of breastfeeding is putting the newborn baby to the breast within 1 h of birth. Its practice can prevent neonatal and under-5 mortality. This study aims to assess the prevalence and factors associated with timely initiation of breastfeeding among mothers in Ghana., Methods: We used data from the 2017-2018 Ghana multiple indicator cluster survey and our analysis was restricted to 3466 mothers who had a live birth within 2 years. Multivariable logistic regression was used to estimate the factors associated with timely initiation of breastfeeding whilst adjusting for potential confounders, and accounted for clustering, stratification, and sample weights., Results: The prevalence of timely initiation of breastfeeding was 52.3% (95% CI 49.7%, 54.9%). Mothers who were assisted by a skilled attendant at birth had 65% higher odds of timely initiation of breastfeeding compared to mothers who were not assisted by a skilled attendant (adjusted prevalence odds ratio [aPOR] 1.65; 95% CI 1.28, 2.13). Mothers who delivered by Caesarean section had 74% lower odds of timely initiation of breastfeeding compared to mothers who had vaginal delivery (aPOR 0.26; 95% CI 0.18, 0.36). Mothers who had planned their pregnancy had 31% higher odds of timely initiation of breastfeeding compared to mothers who had an unplanned pregnancy (aPOR 1.31; 95% CI 1.05, 1.63). There were also 74% and 51% higher odds of timely initiation of breastfeeding among mothers who perceived their baby was large (aPOR 1.74; 95% CI 1.34, 2.26), and of average size (aPOR 1.51, 95% CI 1.16, 1.97) at birth respectively, compared to mothers who perceived their baby was small., Conclusions: Interventions to increase timely initiation of breastfeeding should provide breastfeeding support to mothers who have had a Caesarean section, small sized babies and unplanned pregnancies, and to promote birthing by skilled birth attendants.

Background: Diarrhoea and acute respiratory infection (ARI) are major causes of morbidity and mortality in children under-5 years old in Ghana. The aim of the study was to assess factors associated with diarrhoea and ARI in children under-5 years old., Methods: We analysed nationally representative data from the 2017-2018 Ghana Multiple Indicator Cluster Survey (MICS) on 8879 children under-5 years old. Multivariable logistic regression was used to assess the factors associated with diarrhoea and ARI. We applied sample weights, stratification and clustering to account for the sampling design of the MICS., Results: The prevalence of diarrhoea was 17.0% (95% CI: 15.70, 18.24%). Children aged 6-11 months [Adjusted prevalence odds ratio (aPOR): 2.06, 95% CI: 1.45, 2.92], and 12-23 months (aPOR: 2.37, 95% CI: 1.67, 3.35), had higher prevalence of diarrhoea compared to children aged 0-5 months. Children whose mothers had a college or higher education (aPOR: 0.41, 95% CI: 0.22, 0.78), and a secondary education (aPOR: 0.66, 95% CI: 0.51, 0.86), had 59% and 34% lower odds of diarrhoea respectively, compared to children whose mothers had no formal education. Children from the richest households (aPOR: 0.58, 95% CI: 0.39, 0.86), had 42% lower odds of diarrhoea compared to children from the poorest households. Children resident in rural areas had 22% lower odds of diarrhoea compared to their peers in urban areas (aPOR: 0.78, 95% CI: 0.63, 0.98). The prevalence of ARI was 33.3% (95% CI: 31.72, 34.82%). Children aged 6-11 months (aPOR: 1.43, 95% CI: 1.06, 1.93), and 12-23 months (aPOR: 1.41, 95% CI: 1.10, 1.82), had higher prevalence of ARI compared to children aged 0-5 months., Conclusions: This study suggests that the prevalence of diarrhoea and ARI among children aged 6-11 and 12-23 months was higher compared to children aged 0-5 months. Children under-5 years old whose mothers had a secondary or higher education had a lower prevalence of diarrhoea compared to children whose mothers had no formal education.

Background: The World Health Organization in 2016 recommended eight or more antenatal care (ANC) contacts for a positive pregnancy experience, however, it is unclear what impact the time spent during the first ANC contact and home visits can have on eight or more ANC contacts., Objectives: Our study investigated the relationship between time spent during the first ANC contact and eight or more ANC contacts, and between home visits and eight or more ANC contacts. We also assessed the prevalence of eight or more ANC contacts., Methods: A cross-sectional study was conducted among 519 mothers with children 12 months old and below attending child welfare clinics in the Nabdam district in the Upper East Region, Ghana. Multivariable logistic regression analysis was used to assess the relationship between time spent during the first ANC contact, home visits, and eight or more ANC contacts, while controlling for potential confounders., Results: The proportion of mothers who attained eight or more ANC contacts during pregnancy was 31.2%. Spending 20 minutes or more during the first ANC contact was associated with 2.07 times the odds of having eight or more ANC contacts compared to spending less than 20 minutes [adjusted odds ratio (aOR): 2.07, 95% CI: 1.18,3.63]. Mothers who received at least a home visit from skilled health professionals during pregnancy were 2.44 times more likely to have eight or more ANC contacts compared to mothers who were not visited (aOR: 2.44, 95% CI: 1.51,3.94)., Conclusion: Spending at least 20 minutes during the first ANC contact and home visits were positively associated with eight or more ANC contacts. We recommend that skilled health professionals should spend at least 20 minutes during the first ANC contact as well as encourage home visits in order to increase the coverage of eight or more ANC contacts.

Objectives: The relationship between receiving early antenatal care (ANC) and 8 or more antenatal contacts (ANC8+) has not been well characterised across low-and middle-income countries (LMICs). It is also unclear whether the association between early ANC and ANC8+ is modified by a woman's place of residence. Our primary aim was to assess the relationship between early ANC and ANC8+ and to investigate whether this relationship was modified by place of residence. We also estimated the coverage of ANC8+ across LMICs., Methods: We analysed data on 207,388 mothers with a recent live birth using multiple indicator cluster surveys conducted between 2017 and 2020 in 30 LMICS. Modified Poisson regression with robust variance was used to evaluate the relationship between early ANC and ANC8+, whilst adjusting for country, clustering, stratification, and sampling weights. Effect modification by place of residence was assessed on additive and multiplicative scales. A meta-analysis was conducted to pool prevalence estimates of ANC8+ across all countries., Results: The overall prevalence of ANC8+ was 35.6%, ranging from 1.7% in Madagascar to 99.4% in Belarus. Early ANC was positively associated with ANC8+ (adjusted prevalence ratio [aPR], 2.61; 95% confidence interval [CI], 1.82 to 3.74). There was evidence of positive effect modification on additive (relative excess risk due to interaction, 0.39; 95% CI, 0.35 to 0.44) and multiplicative (aPR, 1.78; 95% CI, 1.08 to 2.95) scales., Conclusions: Many LMICs may not have adopted the 2016 World Health Organization guidelines on ANC8+. Receiving early ANC was associated with a higher likelihood of ANC8+, particularly for women in rural areas.

Background: Timely initiation of breastfeeding is putting the newborn to the breast within 1 h of birth. Its practice can prevent neonatal and under-5 mortality. This study aims to assess the prevalence and factors associated with timely initiation of breastfeeding among mothers in Ghana., Methods: We used data from the 2017-2018 Ghana multiple indicator cluster survey and our analysis was restricted to 15,305 mothers who had a live birth within 2 years. Multivariable logistic regression was used to estimate the factors associated with timely initiation of breastfeeding whilst adjusting for potential confounders, and accounted for clustering, stratification, and sample weights., Results: The prevalence of timely initiation of breastfeeding was 51.3% (95% CI 48.1, 54.6%). Mothers who received antenatal care were twice as likely to timely initiate breastfeeding compared to mothers who did not receive antenatal care (Adjusted prevalence odds ratios [aPOR] 2.01, 95% CI 1.03, 3.95). Mothers who were assisted by a skilled attendant at birth had 90% higher odds of timely initiation of breastfeeding compared to mothers who were not assisted by a skilled attendant (aPOR 1.90, 95% CI 1.41, 2.55). Mothers who delivered by caesarean section had 76% lower odds of timely initiation of breastfeeding compared to mothers who had a vaginal delivery (aPOR 0.24, 95, 95% CI 0.16, 0.36). Mothers who had planned their pregnancy had 45% higher odds of timely initiation of breastfeeding compared to mothers who had an unplanned pregnancy (aPOR 1.45, 95% CI 1.09, 1.92). There were also 84% and 55% higher odds of timely initiation of breastfeeding among mothers who perceived their baby was large (aPOR 1.84, 95% CI 1.32, 2.58), and of average size (aPOR 1.55, 95% CI 1.11, 2.17) at birth respectively, compared to mothers who perceived their baby was small., Conclusions: Interventions to increase timely initiation of breastfeeding should provide breastfeeding support to mothers who have had a caesarean section or small sized babies, prevent unplanned pregnancies, and promote antenatal care attendance among pregnant women.

Introduction: the issue of menstrual hygiene is inadequately acknowledged and efforts to address the gaps has been unsatisfactory. Hygienic menstrual practice such as the use of sanitary pads is crucial during menstruation. Lack of sanitation facilities, especially for school girls, makes them vulnerable to emotional and physical challenges during their menstrual days. This study sought to investigate menstrual hygiene management among adolescent girls in junior high schools in rural northern Ghana. Methods: a school-based cross-sectional study design was used. Multistage sampling technique was employed to select 730 school girls who had attained their menarche. Menstrual hygiene management was rated using the Selvi and Ramachandran scale. Bivariate analysis was conducted to compare good and poor menstrual hygiene management. The data were analyzed using STATA version 13.1., Results: the prevalence of good menstrual hygiene was 61.4%. Mothers' education and parents' socio-economic status were significantly associated with menstrual hygiene management. Inadequate sanitation facilities was a major challenge to menstrual hygiene management at schools. The use of sanitary pads was significantly associated with school attendance (p-value < 0.0001)., Conclusion: the level of menstrual hygiene among in-school adolescent girls in northern Ghana is described as average. Although most of the schools had toilet facilities, they lacked clean water, soap, privacy and dustbins which are necessary for menstrual hygiene management. Interventions should target improving water, sanitation and hygiene facilities in schools as well as supply of pads to girls in rural school., Competing Interests: The authors declare no competing interests., (Copyright: Maxwell Tii Kumbeni et al.)

Objective: To assess the prevalence and factors associated with modern contraceptive (CP) use among women of the reproductive age., Design: Cross-sectional study., Setting: We used data from the Multiple Indicator Cluster Surveys (MICSs) from 20 African countries collected between 2013 and 2018., Participants: Data on 1 177 459 women aged 15-49 years old., Methods: Multivariable logistic regression was used to identify factors associated with modern CP use, while controlling simultaneously for independent variables, and accounting for clustering, stratification and sample weights from the complex sampling design. We used random effects meta-analysis to pool adjusted estimates across the 20 countries., Results: The overall prevalence of modern CP use was 26% and ranged from 6% in Guinea to 62% in Zimbabwe. Overall, injectable (32%) was the most preferred method of CP, followed by oral pill (27%) and implants (16%). Women were more likely to use a modern CP if they: had a primary (adjusted prevalence odds ratios (aPORs): 1.68, 95% CI: 1.47 to 1.91)) or secondary/higher education (aPOR: 2.16, 95% CI: 1.80 to 2.59) compared with women with no formal education; had no delivery in the last 2 years (aPOR: 3.89, 95% CI: 2.76 to 5.47) compared with women who delivered in the last 2 years; were aged 25-34 years (aPOR: 1.33, 95% CI: 1.20 to 1.47) compared with women aged 15-24 years; were of middle-income status (aPOR: 1.25, 95% CI: 1.11 to 1.39) or rich (aPOR: 1.53, 95% CI: 1.27 to 1.84) compared with poor women and had two or more antenatal care visits compared with women without a visit. Perceived domestic violence was not associated with modern CP use (aPOR: 0.98, 95% CI: 0.92 to 1.05)., Conclusion: Our findings are relevant in a global context, particularly in the African region, and improve our understanding on relevant factors essential to increasing modern CP use., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)