Browsing by Author "Nyarko, P."
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Item Contemporary female migration in Ghana: Analyses of the 2000 and 2010 Censuses(Demographic Research, 2018-12) Lattof, S.R.; Coast, E.; Leone, T.; Nyarko, P.Abstract Background: Knowledge of female migration patterns is scant despite increased recognition and reporting of the feminization of migration. Recent data on female internal migration in Ghana challenges historical assumptions that underestimated female migration. Objective: This study presents the first detailed comparative analyses of female migration using microdata from Ghana’s censuses (2000 and 2010) and exploits this national data to understand the gendered dimensions of migration. Methods: Secondary analyses use direct and indirect methods to describe the scale, type, and demographic structure of contemporary female migration; assess the distribution of female migrants across age and geography; and estimate net internal female migration. Results: Excluding international migrants, census microdata identified 31.1% of females as internal migrants in 2000 and 37.4% of females as internal migrants in 2010. Working-age migration was particularly pronounced in 2010, reinforcing economic opportunity as a likely driver of migration for both sexes. Female migrants were significantly more likely than female nonmigrants to reside in urban areas and work for pay, profit, or family gain. By 2010, married women were less likely to migrate than peers who had never married. Net out-migration exceeded net in-migration in eight of Ghana’s ten regions. Contribution: Our analyses expand the evidence base on contemporary female migration and refute the outdated stereotype that girls and women do not participate in migration. The prominence of the Greater Accra and Ashanti Regions as destinations for female migrants suggests that interventions are needed in Ghana’s more rural regions to reduce poverty and develop greater economic opportunities for girls and women.Item Evaluating the impact of the community-based health planning and services initiative on uptake of skilled birth care in Ghana(Public Library of Science, 2015) Johnson, F.A.; Frempong-Ainguah, F.; Matthews, Z.; Harfoot, A.J.P.; Nyarko, P.; Baschieri, A.; Gething, P.W.; Falkingham, J.; Atkinson, P.M.Background: The Community-based Health Planning and Services (CHPS) initiative is a major government policy to improve maternal and child health and accelerate progress in the reduction of maternal mortality in Ghana. However, strategic intelligence on the impact of the initiative is lacking, given the persistant problems of patchy geographical access to care for rural women. This study investigates the impact of proximity to CHPS on facilitating uptake of skilled birth care in rural areas. Methods and Findings: Data from the 2003 and 2008 Demographic and Health Survey, on 4,349 births from 463 rural communities were linked to georeferenced data on health facilities, CHPS and topographic data on national road-networks. Distance to nearest health facility and CHPS was computed using the closest facility functionality in ArcGIS 10.1. Multilevel logistic regression was used to examine the effect of proximity to health facilities and CHPS on use of skilled care at birth, adjusting for relevant predictors and clustering within communities. The results show that a substantial proportion of births continue to occur in communities more than 8 km from both health facilities and CHPS. Increases in uptake of skilled birth care are more pronounced where both health facilities and CHPS compounds are within 8 km, but not in communities within 8 km of CHPS but lack access to health facilities. Where both health facilities and CHPS are within 8 km, the odds of skilled birth care is 16% higher than where there is only a health facility within 8km. Conclusion: Where CHPS compounds are set up near health facilities, there is improved access to care, demonstrating the facilitatory role of CHPS in stimulating access to better care at birth, in areas where health facilities are accessible.Item Geographical access to care at birth in Ghana: a barrier to safe motherhood(2012-11-16) Gething, P.W.; Johnson, F.A.; Frempong-Ainguah, F.; Nyarko, P.; Baschieri, A.; Aboagye, P.; Falkingham, J.; Matthews, Z.; Atkinson, P.M.Abstract Background Appropriate facility-based care at birth is a key determinant of safe motherhood but geographical access remains poor in many high burden regions. Despite its importance, geographical access is rarely audited systematically, preventing integration in national-level maternal health system assessment and planning. In this study, we develop a uniquely detailed set of spatially-linked data and a calibrated geospatial model to undertake a national-scale audit of geographical access to maternity care at birth in Ghana, a high-burden country typical of many in sub-Saharan Africa. Methods We assembled detailed spatial data on the population, health facilities, and landscape features influencing journeys. These were used in a geospatial model to estimate journey-time for all women of childbearing age (WoCBA) to their nearest health facility offering differing levels of care at birth, taking into account different transport types and availability. We calibrated the model using data on actual journeys made by women seeking care. Results We found that a third of women (34%) in Ghana live beyond the clinically significant two-hour threshold from facilities likely to offer emergency obstetric and neonatal care (EmONC) classed at the ‘partial’ standard or better. Nearly half (45%) live that distance or further from ‘comprehensive’ EmONC facilities, offering life-saving blood transfusion and surgery. In the most remote regions these figures rose to 63% and 81%, respectively. Poor levels of access were found in many regions that meet international targets based on facilities-per-capita ratios. Conclusions Detailed data assembly combined with geospatial modelling can provide nation-wide audits of geographical access to care at birth to support systemic maternal health planning, human resource deployment, and strategic targeting. Current international benchmarks of maternal health care provision are inadequate for these purposes because they fail to take account of the location and accessibility of services relative to the women they serve.Item Geographical inequalities and social and environmental risk factors for under-five mortality in Ghana in 2000 and 2010: Bayesian spatial analysis of census data.(PMED, 2016) Arku, R.A.; Bennett, J.E.; Castro, M.C.; Agyeman-Duah, K.; Mintah, S.E.; Ware, J.H.; Nyarko, P.; Spengler, J.D.; Agyei-Mensah, S.; Ezzati, M.Background Under-five mortality is declining in Ghana and many other countries. Very few studies have measured under-five mortality—and its social and environmental risk factors—at fine spatial resolutions, which is relevant for policy purposes. Our aim was to estimate under-five mortality and its social and environmental risk factors at the district level in Ghana. Methods and Findings We used 10% random samples of Ghana’s 2000 and 2010 National Population and Housing Censuses. We applied indirect demographic methods and a Bayesian spatial model to the information on total number of children ever born and children surviving to estimate under-five mortality (probability of dying by 5 y of age, 5q0) for each of Ghana’s 110 districts. We also used the census data to estimate the distributions of households or persons in each district in terms of fuel used for cooking, sanitation facility, drinking water source, and parental education. Median district 5q0 declined from 99 deaths per 1,000 live births in 2000 to 70 in 2010. The decline ranged from <5% in some northern districts, where 5q0 had been higher in 2000, to >40% in southern districts, where it had been lower in 2000, exacerbating existing inequalities. Primary education increased in men and women, and more households had access to improved water and sanitation and cleaner cooking fuels. Higher use of liquefied petroleum gas for cooking was associated with lower 5q0 in multivariate analysis. Conclusions Under-five mortality has declined in all of Ghana’s districts, but the cross-district inequality in mortality has increased. There is a need for additional data, including on healthcare, and additional environmental and socioeconomic measurements, to understand the reasons for the variations in mortality levels and trends.Item Is a woman's first pregnancy outcome related to her years of schooling? An assessment of women's adolescent pregnancy outcomes and subsequent educational attainment in Ghana.(2017) Biney, A.A.E.; Nyarko, P.BACKGROUND: Adolescent pregnancy and childbearing pose challenges to young women's educational attainment. Studies show that while adolescent childbearing reduces educational attainment, not becoming pregnant and resorting to induced abortion when pregnant increases women's educational levels. This study examined relationships between adolescents' resolution of their first pregnancies and subsequent educational outcomes, for all women ages 20-49 years and across three age cohorts: 20-29, 30-39 and 40-49 year olds. METHODS: Using the 2007 Ghana Maternal Health Survey (GMHS) dataset, we conducted ANOVA, bivariate and multivariate linear regression analyses on 8186 women ages 20-49 years. Women's first adolescent pregnancy outcomes were measured as live births, induced abortions, spontaneous abortions or no pregnancy, while educational attainment constituted their years of schooling. RESULTS: Findings showed years of schooling was highest for women who had induced abortions, and lowest for those who experienced live births. Women with live births as teenagers experienced significantly fewer years of schooling compared to their counterparts who terminated their pregnancies. Also, women with miscarriages and stillbirths exhibited levels similar to those who gave birth. Although women with no teenage births had higher educational levels than their childbearing counterparts, controlling for age at first pregnancy resulted in similar years of schooling compared to those who gave birth. Finally, the 30 to 39 year olds were the only age group whose results contradicted those of all women. These findings may be due to the socio-economic and political events that affected women's educational attainment at the time. CONCLUSIONS: Childbearing during adolescence does impact women's educational attainment levels. Therefore, in addition to encouraging young mothers to continue schooling, all other interventions to help keep young girls in school must focus on preventing and/or delaying their adolescent pregnancies.