Browsing by Author "Achana, S.F."
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Item The child survival impact of the Ghana Essential Health Interventions Program: A health systems strengthening plausibility trial in Northern Ghana(PLoS ONE, 2019-05-23) Bawah, A.A.; Awoonor-Williams, J.K.; Asuming, P.O.; Jackson, E.F.; Boyer, C.B.; Kanmiki, E.W.; Achana, S.F.; Akazil, J.; Phillips, J.F.Background The Ghana Health Service in collaboration with partner institutions implemented a five-year primary health systems strengthening program known as the Ghana Essential Health Intervention Program (GEHIP). GEHIP was a plausibility trial implemented in an impoverished region of northern Ghana around the World Health Organizations (WHO) six pillars combined with community engagement, leadership development and grassroots political support, the program organized a program of training and action focused on strategies for saving newborn lives and community-engaged emergency referral services. This paper analyzes the effect of the GEHIP program on child survival. Methods Birth history data assembled from baseline and endline surveys are used to assess the hazard of child mortality in GEHIP treatment and comparison areas prior to and after the start of treatment. Difference-in-differences (DiD) methods are used to compare mortality change over time among children exposed to GEHIP relative to children in the comparison area over the same time period. Models test the hypothesis that a package of systems strengthening activities improved childhood survival. Models adjusted for the potentially confounding effects of baseline differentials, secular mortality trends, household characteristics such as relative wealth and parental educational attainment, and geographic accessibility of clinical care. Results The GEHIP combination of health systems strengthening activities reduced neonatal mortality by approximately one half (HR = 0.52, 95% CI = 0.28,0.98, p = 0.045). There was a nullincremental effect of GEHIP on mortality of post-neonate infants (from 1 to 12 months old) (HR = 0.72; 95% CI = 0.30,1.79; p = 0.480) and post-infants (from 1 year to 5 years old) -(HR = 1.02; 95% CI = 0.55–1.90; p = 0.940). Age-specific analyses show that impact was concentrated among neonates. However, effect ratios for post-infancy were inefficiently assessed owing to extensive survival history censoring for the later months of childhood. Children were observed only rarely for periods over 40 months of age. Conclusion GEHIP results show that a comprehensive approach to newborn care is feasible, if care is augmented by community-based nurses. It supports the assertion that if appropriate mechanisms are put in place to enable the various pillars of the health system as espoused by WHO in rural impoverished settings where childhood mortality is high, it could lead to accelerated reductions in mortality thereby increasing survival of children. Policy implications of the pronounced neonatal effect of GEHIP merit national review for possible scale-up.Item Contraceptive use intentions and unmet need for family planning among reproductive-aged women in the Upper East Region of Ghana(Reproductive Health, 2019-03) Bawah, A.A.; Asuming, P.; Achana, S.F.; Kanmiki, E.W.; Awoonor-Williams, J.K.; Phillips, J.F.Background Motivations for use of contraceptives vary across populations. While some women use contraceptives for birth spacing, others adopt contraception for stopping childbearing. As part of efforts to guide the policy framework to promote contraceptive utilization among women in Ghana, this paper examines the intentions for contraceptive use among reproductive-aged women in one of the most impoverished regions of Ghana. Methods This paper utilizes data collected in 2011 from seven districts in the Upper East Region of northern Ghana to examine whether women who reported the use of contraceptives did so for the purposes of stopping or spacing childbirth. A total of 5511 women were interviewed on various health and reproductive health related issues, including fertility and family planning behavior. Women were asked if they would like to have any more children (for those who already had children or those who were pregnant at the time of the survey). Results The prevalence of contraceptive use was low at 13%, while unmet need is highly pervasive and demand for family planning is predominantly for spacing future childbearing rather than for the purpose of stopping. Overall, about 31.7%of women not using contraceptives reported a need for spacing while 17.6% expressed a need for limiting. Thus, the latent demand for family planning is dominated by preferences for space rather than limiting childbearing. Conclusion Results show that there is latent demand for family planning and therefore if family planning programs are appropriately implemented they can yield the desired impact.Item Contraceptive use intentions and unmet need for family planning among reproductive-aged women in the Upper East Region of Ghana(Reproductive Health, 2019-03) Bawah, A.A.; Asuming, P.; Achana, S.F.; Kanmiki, E.W.; Awoonor-Williams, J.K.; Phillips, J.F.Background:Motivations for use of contraceptives vary across populations. While some women use contraceptivesfor birth spacing, others adopt contraception for stopping childbearing. As part of efforts to guide the policyframework to promote contraceptive utilization among women in Ghana, this paper examines the intentions forcontraceptive use among reproductive-aged women in one of the most impoverished regions of Ghana.Methods:This paper utilizes data collected in 2011 from seven districts in the Upper East Region of northernGhana to examine whether women who reported the use of contraceptives did so for the purposes of stopping orspacing childbirth. A total of 5511 women were interviewed on various health and reproductive health relatedissues, including fertility and family planning behavior. Women were asked if they would like to have any morechildren (for those who already had children or those who were pregnant at the time of the survey).Results:The prevalence of contraceptive use was low at 13%, while unmet need is highly pervasive and demandfor family planning is predominantly for spacing future childbearing rather than for the purpose of stopping.Overall, about 31.7%of women not using contraceptives reported a need for spacing while 17.6% expressed a needfor limiting. Thus, the latent demand for family planning is dominated by preferences for space rather than limitingchildbearing.Conclusion:Results show that there is latent demand for family planning and therefore if family planningprograms are appropriately implemented they can yield the desired impact.Item Contraceptive use intentions and unmet need for family planning among reproductive-aged women in the Upper East Region of Ghana 11 Medical and Health Sciences 1117 Public Health and Health Services 11 Medical and Health Sciences 1114 Paediatrics and Reproductive Medicine(Reproductive Health, 2019-02-21) Bawah, A.A.; Asuming, P.; Achana, S.F.; Kanmiki, E.W.; Awoonor-Williams, J.K.; Phillips, J.F.Background: Motivations for use of contraceptives vary across populations. While some women use contraceptives for birth spacing, others adopt contraception for stopping childbearing. As part of efforts to guide the policy framework to promote contraceptive utilization among women in Ghana, this paper examines the intentions for contraceptive use among reproductive-aged women in one of the most impoverished regions of Ghana. Methods: This paper utilizes data collected in 2011 from seven districts in the Upper East Region of northern Ghana to examine whether women who reported the use of contraceptives did so for the purposes of stopping or spacing childbirth. A total of 5511 women were interviewed on various health and reproductive health related issues, including fertility and family planning behavior. Women were asked if they would like to have any more children (for those who already had children or those who were pregnant at the time of the survey). Results: The prevalence of contraceptive use was low at 13%, while unmet need is highly pervasive and demand for family planning is predominantly for spacing future childbearing rather than for the purpose of stopping. Overall, about 31.7%of women not using contraceptives reported a need for spacing while 17.6% expressed a need for limiting. Thus, the latent demand for family planning is dominated by preferences for space rather than limiting childbearing. Conclusion: Results show that there is latent demand for family planning and therefore if family planning programs are appropriately implemented they can yield the desired impact.Item Socio-economic and demographic disparities in ownership and use of insecticide-treated bed nets for preventing malaria among rural reproductive-aged women in northern Ghana(PLoS ONE, 2019-01) Kanmiki, E.W.; Awoonor-Williams, J.K.; Phillips, J.F.; Kachur, S.P.; Achana, S.F.; Akazili, J.; Bawah, A.A.Background Malaria continues to be a leading cause of morbidity and mortality in most countries in Sub-Saharan Africa. Insecticide-treated bed nets (ITNs) is one of the cost-effective interventions for preventing malaria in endemic settings. Ghana has made tremendous efforts to ensure widespread ownership and use of ITNs. However, national coverage statistics can mask important inequities that demand targeted attention. This study assesses the disparities in ownership and utilization of ITNs among reproductive-aged women in a rural impoverished setting of Ghana. Methods Population-based cross-sectional data of 3,993 women between the age of 15 and 49 years were collected in seven districts of the Upper East region of Ghana using a two-stage cluster sampling approach. Bivariate and multivariate regression models were used to assess the social, economic and demographic disparities in ownership and utilization of ITN and to compare utilization rates among women in households owning at least one ITN. Results As high as 79% of respondents were found to own ITN while 62% of ITN owners used them the night preceding the survey. We identified disparities in both ownership and utilization of ITNs in wealth index, occupational status, religion, and district of residence. Respondents in the relative richest wealth quintile were 74% more likely to own ITNs compared to those in the poorest quintile (p-value< 0.001, CI = 1.29–2.34) however, they were 33% less likely to use ITNs compared to the poorest (p-value = 0.01, CI = 0.50–0.91). Conclusion Interventions aimed at preventing and controlling malaria through the use of bed nets in rural Ghana and other similar settings should give more attention to disadvantage populations such as the poor and unemployed. Tailored massages and educational campaigns are required to ensure consistent use of treated bed nets.