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Background: Ghana was one of the few countries commended to have halved extreme poverty after the MDG era yet the under-five mortality rate (U5MR) was dire. Ghana's U5MR is still above the national and global SDG target. As a result, the government has over the years implemented other complementary social and policy interventions to improve the socioeconomic status of households to ensure better child health outcomes. Yet key gaps exist and threaten child health outcome sustainability, and child health-related SDG targets. In this regard, we hypothesize that household wealth should therefore not influence under-five child deaths significantly. Methods: The paper first reports the under-five mortality trend over the past 30 years in Ghana. It uniquely analyses the levels and trends in wealth as measured by the Gross National Income per capita at purchasing power parity (ln GNI/p, ppp) as a proxy of the mean Comparative Wealth Index (CWI) against under-five child deaths in Ghana. Using data from the 2014 Ghana Demographic and Health Survey and employing the logistic regression estimation technique, the paper further estimates the effect of household wealth and other key covariates on under-five child deaths. Implemented government poverty-alleviating policies and intervention programs to reduce childhood mortality in Ghana were reviewed to identify risk gaps to child deaths. Results: The 30 year trend analysis from 1990 to 2020 shows that the under-five mortality rate in Ghana is still high, falling short of the rate of decline that is expected toward achieving the 2030 SDG target for U5MR of 25 deaths per 1000 live births. Our empirical estimations show that household wealth still has a negative and significant relationship with under-five child deaths despite the government's existing poverty-alleviating and pro-poor health policies. In addition, the results show that regional differences, maternal age, the number of children alive, and attendance to postnatal healthcare services are crucial for child survival. Conclusion: The results imply that the government should consolidate universal programmes with intensified targeted interventions toward improving household wealth, especially in the Northern Savannah regions. A new and dynamic child health policy is imminent to reflect strategies towards achieving the SDG target on U5MR. Additionally, intensive education on active maternal participation in postnatal care should be given critical consideration to improve child survival. [ABSTRACT FROM AUTHOR]

Background: A robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews of the National Health Insurance Scheme (NHIS) in Ghana.Methods: The study was a cross-sectional comparative assessment of paper- and electronic-based claims reviews of the NHIS. Medical claims of subscribers for the year, 2014 were requested from the claims directorate and analysed. Proportions of claims adjusted by the paper- and electronic-based claims reviews were determined for each type of healthcare facility. Bivariate analyses were also conducted to test for differences in claims adjustments between healthcare facility types, and between the two claims reviews.Results: The electronic-based review made overall adjustment of 17.0% from GHS10.09 million (USD2.64 m) claims cost whilst the paper-based review adjusted 4.9% from a total of GHS57.50 million (USD15.09 m) claims cost received, and the difference was significant (p < 0.001). However, there were no significant differences in claims cost adjustment rate between healthcare facility types by the electronic-based (p = 0.0656) and by the paper-based reviews (p = 0.6484).Conclusions: The electronic-based review adjusted significantly higher claims cost than the paper-based claims review. Scaling up the electronic-based review to cover claims from all accredited care providers could reduce spurious claims cost to the scheme and ensure long term financial sustainability. [ABSTRACT FROM AUTHOR]

Background: Poor communication on sexual issues between adolescents and their parents results in high rates of negative sexual practices such as teenage pregnancy. Contributing factors to this poor communication on sexual issues between adolescents and their parents in a high teenage pregnancy setting have not been adequately explored. We sought to fill this gap by examining the factors that predict communication on sexual issues between adolescents and their parents in the Adaklu district of the Volta region of Ghana. Methods: A baseline cross-sectional household survey of 221 adolescents aged 10–19 years in 30 randomly selected communities was used. A well-structured questionnaire was developed. A multinomial logistic regression analysis was used to examine factors that significantly influenced communication between adolescents and their parents regarding sex. Results: Only 11.3% of adolescents had discussions on sexual issues with both parents while 27.6% of communicated sexual issues with only one parent in Adaklu district. Adolescent males (AOR = 0.21, CI = 0.06–0.75), those aged 10–14 years (AOR = 0.41, CI = 0.04–0.57), non-members of adolescent health clubs (AOR = 0.46, CI = 0.21–1.00), and those living with only a father (AOR = 0.19, CI = 0.06–0.61) had lower odds of communicating with their parents on sexual issues. Conclusions: Adolescent-parental communication on sexual issues in Adaklu district is very low. This situation requires more empowerment of adolescents to enable them to discuss sexual issues with their parents through increased engagement with adolescent health club activities and capacity building capacity of parents with the right information on sexual and reproductive health by health staff within the district. Additionally, parents need to be equipped with communication skills to enable them to communicate effectively with their children. Plain language summary: Parent-adolescent and older sibling adolescent communication on issues about sex is considered an important aspect of adolescent development and well-being, as it ensures informed decision making and good behavior and a protective factor for adolescent sexual health. However, poor communication on sexual issues between adolescents and their parents results in high rates of negative sexual practices such as teenage pregnancy. Contributing factors to this poor communication on sexual issues between adolescents and their parents in a high teenage pregnancy setting have not been adequately explored. This paper, therefore, examines the factors that predict communication on sexual issues between adolescents and their parents in the Adaklu district of the Volta region of Ghana. It highlights individual, household, societal and sexual-related factors that predict communication on sexual issues between adolescents and their parents in an area with a high rate of teenage pregnancy among adolescent girls. The data on adolescent sexual and reproductive health in Adaklu district show poor communication on sexual issues between adolescents (aged 10–19 years) and their parents. Improving communication on sexual issues between adolescents and their parents in rural settings requires capacity building of parents (especially mothers) with the right information and communication skills for discussing sexual and reproductive health issues with their children. [ABSTRACT FROM AUTHOR]

Background: Termination of pregnancy (TOP) is a common cause of maternal morbidity and mortality in low- and middle-income countries. Population-based surveys are the major data source for TOP data in LMICs but are known to have shortcomings that require improving. The EN-INDEPTH multi-country survey employed a full pregnancy history approach with roster and new questions on TOP and Menstrual Restoration. This mixed methods paper assesses the completeness of responses to questions eliciting TOP information from respondents and reports on practices, barriers, and facilitators to TOP reporting. Methods: The EN-INDEPTH study was a population-based cross-sectional study. The Full Pregnancy History arm of the study surveyed 34,371 women of reproductive age between 2017 and 2018 in five Health and Demographic Surveillance System (HDSS) sites of the INDEPTH network: Bandim, Guinea-Bissau; Dabat, Ethiopia; IgangaMayuge, Uganda; Kintampo, Ghana; and Matlab, Bangladesh. Completeness and time spent in answering TOP questions were evaluated using simple tabulations and summary statistics. Exact binomial 95% confidence intervals were computed for TOP rates and ratios. Twenty-eight (28) focus group discussions were undertaken and analysed thematically. Results: Completeness of responses regarding TOP was between 90.3 and 100.0% for all question types. The new questions elicited between 2.0% (1.0–3.4), 15.5% (13.9–17.3), and 11.5% (8.8–14.7) lifetime TOP cases over the roster questions from Dabat, Ethiopia; Matlab, Bangladesh; and Kintampo, Ghana, respectively. The median response time on the roster TOP questions was below 1.3 minutes in all sites. Qualitative results revealed that TOP was frequently stigmatised and perceived as immoral, inhumane, and shameful. Hence, it was kept secret rendering it difficult and uncomfortable to report. Miscarriages were perceived to be natural, being easier to report than TOP. Interviewer techniques, which were perceived to facilitate TOP disclosure, included cultural competence, knowledge of contextually appropriate terms for TOP, adaptation to interviewee's individual circumstances, being non-judgmental, speaking a common language, and providing detailed informed consent. Conclusions: Survey roster questions may under-represent true TOP rates, since the new questions elicited responses from women who had not disclosed TOP in the roster questions. Further research is recommended particularly into standardised training and approaches to improving interview context and techniques to facilitate TOP reporting in surveys. [ABSTRACT FROM AUTHOR]

Background: In 2004, Ghana implemented a national health insurance scheme (NHIS) as a step towards achieving universal health coverage. In this paper, we assessed the level of enrollment and factors associated with NHIS membership in two predominantly rural districts of northern Ghana after eight years of implementation, with focus on the poor and vulnerable populations. Methods: A cross-sectional survey was conducted from July 2012 to December 2012 among 11,175 randomly sampled households with their heads as respondents. Information on NHIS status, category of membership and socio-demographic characteristics of household members was obtained using a structured questionnaire. Principal component analysis was used to compute wealth index from household assets as estimates of socio-economic status (SES). The factors associated with NHIS enrollment were assessed using logistic regression models. The reasons behind enrollment decisions of each household member were further investigated against their SES. Results: Approximately half of the sampled population of 39,262 were registered with a valid NHIS card; 53.2% of these were through voluntary subscriptions by payment of premium whilst the remaining (46.8%) comprising of children below the ages of 18 years, elderly 70 years and above, pregnant women and formal sector workers were exempt from premium payment. Despite an exemption policy to ameliorate the poor and vulnerable households against catastrophic health care expenditures, only 0.5% of NHIS membership representing 1.2% of total exemptions granted on accounts of poverty and other social vulnerabilities was applied for the poor. Yet, cost of premium was the main barrier to NHIS registration (92.6%) and non-renewal (78.8%), with members of the lowest SES being worst affected. Children below the ages of 18 years, females, urban residents and those with higher education and SES were significantly more likely to be enrolled with the scheme. Conclusions: Despite the introduction of policy exemptions as an equity measure, the poorest of the poor were rarely identified for exemption. The government must urgently resource the Department of Social Welfare to identify the poor for NHIS enrollment. [ABSTRACT FROM AUTHOR]

Background: Domestic waste generation has contributed significantly to hampering national waste management efforts. It poses serious threat to national development and requires proper treatment and management within and outside households. The problem of improper waste management has always been a challenge in Ghana, compelling several national surveys to report on the practice of waste management. However, little is known about how much waste is generated and managed within households and there is a serious dearth of information for national policy and planning. This paper seeks to document the handling and practice of waste management, including collection, storage, transportation and disposal along with the types and amount of waste generated by Households and their related health outcome.Methods: The study was a descriptive cross-sectional study and used a multi-stage sampling technique to sample 700 households. The study was planned and implemented from January to May 2015. It involved the use of structured questionnaires in the data collection over the period. Factors such as demographic characteristics, amount of waste generated, types of waste bins used within households, waste recycling, cost of disposing waste, and distance to dumpsite were all assessed.Results: The paper shows that each surveyed household generated 0.002 t of waste per day, of which 29% are both organic and inorganic. Though more than half of the respondents (53.6%) had positive attitude towards waste management, only 29.1% practiced waste management. The study reveals that there is no proper management of domestic waste except in few households that segregate waste. The study identified several elements as determinants of waste management practice. Female respondents were less likely to practice waste management (AOR 0.45; 95% Cl 0.29, 0.79), household size also determined respondents practice (AOR 0.26; Cl 0.09, 0.77). Practice of recycling (AOR 0.03; Cl 0.02, 0.08), distance to dumpsite (AOR 0.45; Cl 0.20, 0.99), were all significant predictors of waste management practice. Cholera which is a hygiene related disease was three times more likely to determine households' waste management practice (AOR 3.22; Cl 1.33, 7.84).Conclusion: Considering the low waste management practice among households, there is the need for improved policy and enhanced education on proper waste management practice among households. [ABSTRACT FROM AUTHOR]

Background: Studies have established the negative effects of workplace disrespect and violence on the personal and professional well-being of nurses. In spite of this, only a few have directly investigated the effects of these issues on nurses' job satisfaction. In Africa, research on nurses' job satisfaction continues to focus largely on economic factors. The aim of this paper was, therefore, to investigate the impact of the non-economic factors of workplace violence and respect on the job satisfaction levels of nurses in Ghana.Methods: The study employed a cross-sectional questionnaire survey. It involved 592 qualified practising nurses working in public hospitals in Ghana. Data were collected between September 2013 and April 2014.Results: The results showed that, overall, nurses were neither satisfied nor dissatisfied with their jobs (M = 3.19, SD = .54). More than half (52.7%) of the participants had been abused verbally, and 12% had been sexually harassed in the 12 months prior to the study. The majority of nurses, however, believed they were respected at the workplace (M = 3.77, SD = .70, Mode = 4). Multiple regression analyses showed that verbal abuse and perceived respect were statistically significant predictors of nurses' job satisfaction. Nurses who experienced verbal abuse and low level of respect were more likely to report low job satisfaction scores.Conclusion: It is concluded that non-financial strategies such as safe work environments which are devoid of workplace violence may enhance nurses' job satisfaction levels. A policy of "zero tolerance" for violence and low tolerance for disrespect could be put in place to protect nurses and healthcare professionals in general. [ABSTRACT FROM AUTHOR]

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

Background: This study is part of a larger project aimed at exploring the workplace experiences of nurses working in public general hospitals in Ghana. The current paper explores the causes of workplace violence against nurses in Ghana. Methods: Twenty-four semi-structured in-depth interviews were conducted with professional nurses working in five regions of Ghana. They were selected through purposive and participant-to-participant snowball sampling techniques. Data was analysed through thematic analyses. Results: The findings of the study suggest that nurses are not (always) passive recipients of violence. Workplace violence can be instigated by either of the parties to the nurse-patient/relative interaction. Nurses' accounts of the causes of violence suggest that violence could be instrumental or reactive. The study further suggests that the causes of violence may differ depending on which party instigated the violence. The main causes of violence identified include ineffective communication, long waiting times and perceived unresponsiveness, and enforcement of visiting hours. Conclusion: It is concluded that workplace violence could be reduced through the provision of adequate information to patients and their relatives. Nurses could also be trained in effective communication and interpersonal skills; and on how to identify and avoid potentially violent situations. It is also imperative that policies and measures aimed at addressing workplace violence are instituted to address the problem. Mass education may also be carried out to sensitise the general public on the adverse effects of violence against nurses. [ABSTRACT FROM AUTHOR]

Background: Ghana introduced capitation payment for primary care in 2012 with the view to containing escalating claims expenditure. This shift in provider payment method raised issues about its potential impact on patient-provider trust relationship and insured-patients' trust in the Ghana National Health Insurance Scheme. This paper presents findings of a study that explored insured-patients' perception about, and attitude towards capitation payment in Ghana; and determined whether capitation payment affect insured-patients' trust in their preferred primary care provider and the National Health Insurance Scheme in general.Methods: We adopted a survey design for the study. We administered closed-ended questionnaires to collect data from insurance card-bearing members aged 18 years and above. We performed both descriptive statistics to determine proportions of observations relating to the variables of interest and chi-square test statistics to determine differences within gender and setting.Results: Sixty-nine per cent (69 %) out of 344 of respondents selected hospital level of care as their primary care provider. The two most important motivations for the choice of a provider were proximity in terms of geographical access (40 %) and perceived quality of care (38 %). Eighty-eight per cent (88 %) rated their trust in their provider as (very) high. Eighty-two per cent (82 %) actively selected their providers. Eighty-eight per cent (88 %) had no intention to switch provider. A majority (91 %) would renew their membership when it expires. Female respondents (91 %; n = 281) were more likely to renew their membership than males (87 %; n = 63). Notwithstanding capitation payment experience, 81 % of respondents would recommend to their peers to enrol with the NHIS with rural dwellers (87 %; n = 156) being more likely to do so than urban dwellers (76 %; n = 188). Almost all respondents (92 %) rated the NHIS as (very) good.Conclusion: Health Insurance subscribers in Ghana have high trust in their primary care provider giving them quality care under capitation payment despite their negative attitude towards capitation payment. They are guided by proximity and quality of care considerations in their choice of provider. The NHIA would, however, have to address itself to the negative perceptions about the capitation payment policy. [ABSTRACT FROM AUTHOR]

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

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