Regional Institute for Population Studies
Permanent URI for this collection
Browse
Recent Submissions
Item Infant and child health: Evidence from 2003 Ghana demographic and health survey(Population, Health and Development in Ghana: Attaining the Millennium Development Goals, 2007) Tawiah, E.O.3 Chapter Infant and Child Health: Evidence from 2003 Ghana Demographic and Health Survey Emmanuel O. Tawiah Introduction The unacceptably high levels of infant, child and under-five mortality in Ghana result in excessive and sheer waste of human lives. The recent increase in the under-five mortality rate from 107.6 per 1,000 live births during 1994-1998 to 111 per 1,000 live births in the period 1998-2003 makes the achievement of the Millennium Development Goal (MDG) of reducing underfive mortality by two-thirds between 1990 and 2015 quite difficult to attain. Most of these deaths are preventable through the adoption of relatively simple and inexpensive strategies such as breastfeeding promotion, childhood vaccination, provision of basic hygiene and health education. The factors associated with high infant and child mortality include poverty, malnutrition, poor sanitation and inadequacy of health facilities. In addition, human immunodeficiency virus (HIV) can be transmitted from mother to child before or during child birth and young children whose mothers die are at a very high risk of dying themselves at young age (United Nations, 1994). The health of infants and children is of crucial importance , both as a reflection of current health status of a large segment of the population and as a predictor of the health of the next generation. In 2000, persons aged less than five years comprised 14.7 % of the total population of Ghana. Protecting the health of this large population of infants and children today is an investment in the labour force of tomorrow. Good infant and child health is synonymous with wealth of the future. This chapter attempts to describe infant and child health inequalities as well as examine some of the factors that affect treatment of two common causes of illhealth among children namely; fever/cough and diarrhoea . Methodology The data are derived from the 2003 Ghana Demographic and Health Survey (GDHS), a nationally representative sample of women aged 15-49. The GDHS was designed to, among other things, collect information from female respondents, who were asked questions on topics such as respondent’s background, reproduction, antenatal and delivery care, breastfeeding, immunization, health and nutrition. The analysis is restricted to women aged 15-49 and their births in the five years preceding the survey. A total of 3,340 births comprising 1,114 or 33.4% and 2,226 or 66.6% respectively in the urban and rural areas were recorded in the five years prior to the survey. The indicators of infant and child health include breastfeeding practices, vaccination coverage, nutritional status, receipt of vitamin A supplement, prevalence of anaemia, prevalence and treatment of common childhood illnesses such as acute respiratory infection (AR1), fever and diarrhoea. The analysis does not include antenatal , delivery and postnatal care although these activities promote positive infant and child health outcomes. Two separate analyses are done. Bivariate analyses are used to examine relationships between selected demo30 POPULATION, HEALTH AND DEVELOPMENT graphic and socio-economic variables and childhood immunization coverage, breastfeeding practices, nutritional status, prevalence of anaemia, receipt of vitamin A supplement , prevalence and treatment-seeking for AR1, fever and diarrhoea. For the logistic regression analysis, all variables are categorical or grouped and for each variable, one category is selected as the reference category (RC). The two dependent variables used in the logistic regression analysis are receipt of medical treatment for fever/cough and receipt of medical treatment for diarrhoea. The results of logistic regression analysis are given as regression coefficients , odds ratio (if greater than unity, the probability of receiving medical treatment is higher than that of nonreceipt ), and p values, to assess the relative statistical significance of the selected variables. Results Childhood Mortality Poor infant and child health tends to result in high infant and child mortality levels. Table 1 provides information on early childhood mortality in Ghana to serve as a backdrop to examination of infant and child health inequalities by sex, type of place of residence and region. Under-five mortality is relatively high in Ghana. One out of nine children dies before attaining age five. Rural areas have considerably and consistently higher mortality levels than urban areas. For instance, under-five mortality in rural areas is 27% higher than it is in urban areas. There are wide regional differentials in under-five mortality. Under-five mortality varies from 75 per 1,000 live births in the Greater Accra Region to 208 per 1,000 live births in the Upper West Region. The rate for the Upper...Item Adolescent sexuality and reproductive health in Ghana: Some results from a survey of Cape Coast And Mankrong(Population, Health and Development in Ghana: Attaining the Millennium Development Goals, 2007) Kwankye, S.O.4 Chapter Adolescent Sexuality and Reproductive Health in Ghana: Some Results from a Survey of Cape Coast and Mankrong Stephen O. Kwankye Introduction Adolescent sexuality and reproductive health issues are increasingly becoming of concern in many sub-Saharan African countries. This is especially the case when viewed in the context of the HIV/AIDS pandemic, a situation , which puts many young persons particularly females at risk. This constitutes a serious problem considering that most of these sexual activities are taking place outside wedlock and without contraception. As a result, teenage pregnancies and their accompanying child delinquency and poor development of female adolescent victims are unfolding problems that Ghana will have to contend with for a long time. One fundamental barrier that has worked seriously against policies that have aimed at addressing adolescent sexuality problems in Ghana has been the sociocultural environment within which the interventions are being evolved and or implemented. In Ghana, it is felt in many circles that it is culturally unwelcome to discuss sexual issues with adolescents. Again, sections of the society and even some family planning service providers frown upon the provision of family planning services to these youngsters. For example, according to the 1994 Situation Analysis of Family Planning Service Delivery Points in Ghana, 40% of service providers expressed their unwillingness to provide family planning services such as intra-uterine device (IUD) and injectables to unmarried adolescents and 25% of them would not administer the pill under the same conditions (Ghana Statistical Service, 1994). Such an unfriendly socio-cultural environment has often overtly or covertly not permitted open and frank discussions regarding issues of sexuality and reproductive health particularly among adolescents. Thus, as a result of their engagement in unprotected sex, the chances of further enhancement of their socio-economic development are often and largely foreclosed due to unplanned pregnancies and, or sexually transmitted infections (STIs) including HIV/AIDS. In Ghana, the three Demographic and Health Survey reports of 1993, 1998 and 2003 have indicated that overall a little more than one in every 10 female adolescents of 15-19 years have begun childbearing at a time they are expected to be in school (GSS and MI, 1994; 1999; 2004). The conditions are again made fertile for criminal abortion to thrive in Ghana. Data are not readily available on abortion in Ghana, but in a society where adolescents are largely indulging in sex with little or no family planning practices, the probability exists for pregnant adolescents who still want to continue their education to resort to induced, and unsafe abortion which is likely to contribute to high maternal mortality ratios in Ghana. Data on reported AIDS cases in Ghana suggest that a higher proportion of HIV contraction takes place during adolescent ages of 15-19 years. For example, available data on reported AIDS cases by age indicate that for both males and females, almost 75% of the cases were reported among persons aged 20-39 years and 4% among ado54 POPULATION, HEALTH AND DEVELOPMENT lescents aged 15-19 years. The inference is that considering that the incubation period of the disease ranges between 5 and 12 years or more, it is possible that many of the reported cases in the age group 20-39 must have been contracted within adolescent ages. Adolescent childbearing rates in Ghana have been found to be highest in the Central Region in 1993 (33.3%) and 2003 (34.1%) (see GDHS reports of 1993 and 2003). At the same time, the region has been shown to have one of the highest levels of poverty in the country in 1998/1999 (Government of Ghana/UNFPA, 2004). Linked to the high sexual activity among young women is their low contraceptive use. For example, current contraceptive use for modern methods in 1993 was 5.0% and 8.3% among women of 15-19 and 20-24 years respectively compared to 9.3% among all women in Ghana (Ghana Statistical Service, 1994). The corresponding figures for 1998 were 4.8% and 10.4% among women of 15-19 and 20-24 years respectively as against 10.7% among all women in Ghana. In 2003, modern contraceptive use was 6.4% and 15.4% among married females of 15-19 and 20-24 years respectively compared to 20.7% among all women in the country. The implication is that low contraceptive use among adolescent and young women may foreclose education and employment opportunities to many of them as they expose themselves to risks of unplanned...Item Fertility decline in Ghana: Implications for public policy(Population, Health and Development in Ghana: Attaining the Millennium Development Goals, 2007) Gaisie, S.K.2 Chapter Fertility Decline in Ghana: Implications for Public Policy S. K. Gaisie Introduction The population of Ghana has undergone a structural transformation since the beginning of the fertility decline in the late 1980s. Accompanying the decline are a number of issues that need to be investigated or researched into in order to assess their demographic, social, political and economic impact. Sample surveys (i.e. 1960 Post-Enumeration Survey, 1968/69 Demographic Sample Survey and 1971 Supplementary Inquiry) provided the information required for determination of the level of fertility in the 1960s and 1970s. All the estimates of the total fertility rates indicated that the country’s fertility was high and stable, lying in the neighbourhood of between 6.7 and 7 children per woman. A total fertility rate of 6.9 children per woman appeared to be the most plausible estimate (Gaisie, 1969; 1974; Gaisie and deGraft Johnson, 1976). Estimates based on the 1979/1980 Ghana Fertility Survey (GHS) data indicate that total fertility rate for the period 1960s to mid-1970s ranged between 6.85 and 6.99 children per woman. Evaluation and adjustment of the data for the recent period (1975-1980) yielded a total fertility rate of 6.69 as compared with the reported one of 6.47 (Gaisie, 2005). All told, the estimates derived from the data sets spanning a period of more than 25 years show that the level of fertility was high and stable during the 1960s, 1970s and early 1980s. The reported total fertility rates derived from the 1993, 1998 and 2003 Demographic and Health Surveys data indicate a significant and steady fertility decline since then; falling from 6.43 in 1988 to 5.50 in 1993, 4.55 in 1998 and then to 4.44 in 2003. However, the need to detect and measure trends in fertility with accuracy and sensitivity in a society that is experiencing population expansion is crucial for competent planning. For instance, plausible fertility estimates based on reliable data are critical for construction of population projections as well as for monitoring and evaluating action programmes for reducing the rate of growth via family limitation. A number of estimation procedures and strategies were therefore employed to derive plausible estimates of fertility levels and trends during the transition period. The results are presented elsewhere (Gaisie, 2005). Substantive issues and their implications are the subject-matter of this chapter. Quantum and Pace of Decline Three estimation procedures yielded estimates which suggest that the level of fertility in Ghana fell from about seven children per woman in the 1960s and 1970s to 4.6 children per woman by the turn of the last century; a decline of 33% during the 43 year period (1960-2000) or an annual decline of 0.8% as depicted in Figure 1. The average number of children born to a Ghanaian woman was reduced by 2.3 children; a reduction of 0.05 children per year during the entire period. The pace of the decline, however, increased to 0.2 children per year during the late 1980s and the 1990s and slowed down considerably to 0.04 children per year by the beginning of the 21st century with the total fertility rate falling from 4.8 in the late 1990s to 4.6. The change was much more marked among the younger women (20-35-year olds) 14 POPULATION, HEALTH AND DEVELOPMENT than among the older cohorts, particularly during the second half of the 1990s. However, the decline appears to have stalled. Figure 1. Total Fertility Rate: 1960-2003 Fertility Decline and High Rate of Growth Fertility trends affect the rate of growth by determining the number of births women have, and the size of the different generations. In a majority of the African countries where fertility is above replacement level, children outnumber their parents by substantial amounts and the children in turn have more children than required to replace their parents’ generations even when fertility level is declining (Table1). Consequently, as fertility falls, the number of births to relatively large generations of parents is higher for some time than the number of deaths in the population, most of which are that of grand parents and great grand-parents. This process tends to maintain a relatively high positive population growth rate even though fertility is falling. In most of the countries where fertility rate is reported to be falling, overall population growth rates are relatively high, implying that fertility rate is still high and in consequence...Item HIV/AIDS and survival challenges in Sub-Saharan Africa: An illustration with Ghana and South Africa(Population, Health and Development in Ghana: Attaining the Millennium Development Goals, 2007) Mba, C.J.6 Chapter HIV/AIDS and Survival Challenges in Sub-Saharan Africa: An Illustration with Ghana and South Africa Chuks J. Mba Introduction and Rationale The acquired immune deficiency syndrome (AIDS), which is caused by the human immunodeficiency virus (HIV), emerged in the 1980s as the most terrifying epidemic of modern times. The AIDS pandemic affects primarily young to middle-aged adults, on whom both the national economy and family survival depend. HIV/AIDS has the potential to devastate human development, setting countries backward in their efforts to increase infant and child survival, achieve longer life expectancy and promote better life chances through education, as well as productive and secure livelihoods. Worldwide, AIDS kills more than 8,000 people every day; one person every 10 seconds, while one child dies and one child is infected every minute. Out of a total of 39.4 million adults (defined as people aged 15-49) and children (defined as people below age 15) estimated to be living with HIV as of end of 2004, 25.4 million of them, representing about 64%, are from sub-Saharan Africa (UNAIDS/WHO 2005). Available evidence indicates that whereas 10.6 million adults lived with HIV/AIDS in 1994 in sub-Saharan Africa, there were about 30 million adults and children living with the disease by 2003, with 3.5 million new infections in 2002 alone (UNAIDS/WHO 2004; 2002). According to the estimates of UNAIDS (2002), the HIV prevalence rate in adults aged 15-49 ranges from 1.6 to 11.8% in Western Africa, from 0.1 to 2.6% in Northern Africa, from 3.6 to 12.9% in Central Africa, and from 2.8 to 15.0% in Southern Africa. Of the 45 countries most severely affected by HIV/AIDS, 35 of them (78%) are in sub-Saharan Africa (United Nations, 2001)9. It is conceded that there are no simple explanations as to why some countries are more affected by HIV than others. However, poverty, illiteracy and engaging in identified risk behaviours account for much of the epidemic (Mba, 2003a; Caldwell, 2000; Mbamaonyeukwu, 2001a; 2000; Philipson and Posner, 1995). People who are infected with HIV often have no symptoms of disease for many years and can infect others without realising that they themselves are infected. The HIV continues to spread in Africa and around the world, moving into communities previously little troubled by the epidemic and strengthening its grip on areas where AIDS is already the leading cause of death in adults. Unless a cure is found, or life-prolonging therapy can be made more widely available, the majority of those now living with HIV will die within a decade. Against this background, it is important to raise awareness and expanding knowledge about the deleterious effect of HIV/AIDS on Africa’s life expectancy, with particular reference to South Africa and Ghana, for possible policy interventions. Apart from the fact that relevant data to warrant this study are available for the two countries, available evidence suggests that about 3.1% of the adult population in Ghana are living with the HIV virus, while the prevalence rate is about 21.5% in South Africa. Besides, South Africa has the highest number of HIV/AIDS persons in the world (6 million people; 600 die everyday). It should be noted also that many southern and eastern African countries had HIV prevalence rates 136 POPULATION, HEALTH AND DEVELOPMENT in the late 1980s similar to those currently found in Ghana, but the situation worsened rapidly. This suggests that an unchecked epidemic could lead to much higher prevalence levels in Ghana. The two countries are therefore selected because they lie at opposite ends of the spectrum, so that analyzing their HIV/AIDS profiles will reveal more clearly the devastating impact of the pandemic. Given these unsettling realities, it is important to find out what some of the severely affected countries are doing to combat the HIV/AIDS pandemic. In particular, the following key research questions are addressed in this study: What are the current HIV/AIDS prevalence levels across Africa? How far have we come with respect to combating HIV/AIDS? What is the contribution of HIV/AIDS mortality to the overall mortality of South Africa and Ghana? To what extent will life expectancy be enhanced if HIV/AIDS were absent in the mortality experience of these countries? What are the successes that have been chalked in the endeavour to combat HIV/AIDS? What lessons have been learnt? and...Item Introduction(Population, Health and Development in Ghana: Attaining the Millennium Development Goals, 2007) Mba, C.J.; Kwankye, S.O.Introduction Stephen O. Kwankye and Chuks J. Mba The Population Association of Ghana (PAG), in line with its aim of furthering the scientific study of population and related activities with a view to improving the quality of life of the people of Ghana, organized a two-day Population Seminar in Accra in collaboration with the Ghana Health Service and the National Population Council Secretariat on 26th – 27th October 2005 on the theme: Population, Health and Development in Relation to the Millennium Development Goals. This book is the outcome of the seminar. A number of papers were presented during the twoday seminar which brought together over 100 participants from the academic, health, civil society and the media to deliberate on key findings of the research papers in relation to the overall drive towards the Millennium Development Goals (MDGs). The presentations covered issues of population, health, infant and child mortality, sexual and reproductive health of adolescents, HIV/AIDS and survival, water and sanitation, among others. The principal objective of the seminar was to create the platform to engage both researchers, policy makers/implementers and the media in discussions on the critical population and health related issues that should be subjects of concern in order to chart a common cause towards the attainment of the MDGs by 2015. Dr. Gloria Quansah Asare of the Ghana Health Service chaired the opening session of the Seminar. In her 1 Chapter address, she underscored the relevance of the theme of the Seminar for the development of Ghana. According to her, health (preventive and curative) is an issue for all members of the household and therefore should be of concern to everyone. She called on researchers to involve the health sector in their work and re-enforced the commitment of the health sector to such a process of partnership . She expressed the hope that there would be further discussions beyond the presentation of research papers at the Seminar as a way of informing policies towards the attainment of the MDGs. Prof. S.K. Gaisie, the Interim President of PAG, in his welcome address stressed the relevance of using science to solve problems that afflict the human population of every country. Describing the Seminar as a novelty from a young association such as PAG, he drew attention to the fact that population interacts with all development variables and cautioned that “we cannot postpone action because of ignorance”. He therefore called for serious attention to be given to research findings to direct the nation’s policy actions, emphasising that functional integration of population into development is what Ghana needs as a country if indeed she wishes to achieve any of the MDGs by the set date. In her address, Mrs. Esther Apewokin, the Executive Director of the National Population Council (NPC) Secretariat, acknowledged the pool of expertise the membership of PAG has and called on them to use their research findings to assist in addressing populationrelated problems especially towards poverty reduction as one key component of the MDGs. In the submission of Mr. Amadu Bawa from the UNFPA Ghana Office, who represented the UNFPA Representative in Ghana, he stressed that one of the main aims of the UNFPA is to ensure that any pregnancy is wanted and women are treated with dignity. He acknowledged that research could be very frustrating due to funding problems. However, one cannot make any development progress by ignoring research. He was therefore glad that the UNFPA was associated with the 2 POPULATION, HEALTH AND DEVELOPMENT Seminar and pledged the support of the UNFPA towards the publication of the Seminar papers to expand their dissemination. The publication of this book is therefore a fulfilment of that pledge for which PAG is very much grateful. The Minister of Health, Hon. Major (Retd.) Courage Quashiga, gave the keynote address. In presenting his address, the Minister did not hide his commitment to crusading a cause that would lead to a change in the way of doing things in the health sector. He was of the opinion that the population of any nation includes all ages that must be converted into human resource. He noted that of the eight MDGs, three are directly related to health and the other five indirectly. Quoting from the 1992 Republican Constitution of Ghana, the Minister of Health made it clear that the mandate of his Ministry is to reduce ill-health. He recalled that the Government’s approach towards the attainment of middle-income status by the year 2015 is founded on good...Item Conclusion(Population, Health and Development in Ghana: Attaining the Millennium Development Goals, 2007) Mba, C.J.; Kwankye, S.O.9 Chapter Conclusion Stephen O. Kwankye and Chuks J. Mba The papers that were presented at the Seminar raised a number of relevant developmental issues and generated a wide range of discussions. A number of recommendations and conclusions were also made. The salient features of these discussions and concomitant recommendations are presented in this chapter. First, it is important to undertake more qualitative studies to investigate the factors that are responsible for the fertility transition in Ghana, considering that the socio-cultural environment plays critical roles in shaping fertility behaviour, choices and decisions not only in Ghana but throughout sub-Saharan Africa. For now however, efforts should be made to develop the large army of youthful population into a useful human resource for nation building. In all the presentations, education has been highlighted as a key factor towards the achievement of almost all the MDGs. In response to this recognition therefore, while ensuring that all children of school going age go to school, equally adequate attention should be paid to adult literacy. This is important considering the high rate of early school drop out especially among females in the rural areas. Formal education alone may not provide us with the full antidote. The analysis of HIV prevalence across sub-Saharan Africa suggests quite plausibly that poor countries are not necessarily those with the highest rates of HIV infection. It is therefore not quite clear the extent to which poverty stands to blame as a major cause of HIV. While this may appear to be a valid argument at the country by country comparison, within each country, the situation may be to the contrary and poverty may be a very important factor or condition in understanding HIV infection and spread although the role of other conditions and factors like education cannot be discounted. The need for more research in this area cannot also be underestimated. There appears to be a conflict between the policy environment and the legal framework regarding sexuality and contraception. While the policy makes it clear that all sexually active adolescents (i.e., 10-19-year-olds) should have access to contraception, the law on defilement rules out sexual consent by persons less than 16 years. By implication, persons less than 16 years cannot and should not be sexually active and are therefore not eligible to have access to, or use any form of contraception in Ghana. This is a clear conflict, which requires resolution to guide institutions and organisations like the Ghana Social Marketing Foundation (GSMF), which are into contraceptive advocacy, provision and sensitisation programmes. Again, there are still concerns about condom educational campaigns as a way of counteracting the upsurge of HIV/AIDS in Ghana and elsewhere in Africa. With reference to young persons however, this practice is clearly in conflict with Ghana’s law on defilement. Consequently, there should be audience segmentation, which should seek to place emphasis on abstinence for young persons to keep them away from early sex and condoms for persons who are sexually active beyond the age at which one could have consent for sex as is enshrined in the laws of the state. From the papers and discussions at the Seminar, one issue on which consensus was again reached is preventive as opposed to curative health. While efforts at encouraging the population to adopt the use of insecticide treated bed nets are ongoing and ought to be intensified , we need to equally intensify public education and attitudinal change regarding environmental sanitation and the sustainability of the eco-system as a critical 184 POPULATION, HEALTH AND DEVELOPMENT component of sustainable development. Garbage collection in our cities and towns should be regular while choked drains ought to be de-silted frequently. As a permanent solution, newly constructed drains should be covered and persons who indiscriminately litter the environment should be prosecuted and heavy fines imposed without delay to serve as deterrent to others. All indicators of the health status of the population appear to be poor in the three northern regions in Ghana, i.e., Northern, Upper East and Upper West. Yet, there are several interventions that are ongoing in these regions by government and several non-governmental organisations (NGOs). In these regions, we have high fertility because among other things, infant mortality is high. The situation in these regions should however, not be misconstrued to indicate a failure of the interventions . This is because demographic phenomena often require long periods of time to register tangible changes.Item Population growth, water/sanitation and health(Population, Health and Development in Ghana: Attaining the Millennium Development Goals, 2007) Gaisie, S.K.; Gyau-Boakye, P.G.Health services are utilized to reduce mortality and to prolong life. Clean water and sanitation also have a considerable effect on reducing mortality and morbidity. In fact, water is a necessary condition for human existence. Life is therefore sustained by continuous circulation of water. Improved health depends on increasing household water supplies. Population expansion tends to engender severe water sustainability problems such as rapidly increasing water scarcity (and/or food scarcity) and protection of water quality in order to avoid the menace of water-related diseases (e.g. diarrhoea, cholera, guinea worm etc.). It has been estimated that, in addition to rising demand, continued population growth implies that the actual ceiling of the affordable water use would decrease to half its present level when the population doubles its size and to a quarter when it quadruples its size (Falknermark, 1990). Population growth therefore consumes potentially available water in order to meet an increasing water demand. The influence on population of natural resource constraints is reflected, among other things, in water scarcity that generates high levels of morbidity among the population. Development involves, among other things, meeting rising water demand for improved health, quality of life, and food security. Population expansion, as noted earlier on, places severe constraints on the water availability to achieve these goals. Thus, as a result of water shortages , it is increasingly becoming an uphill task to provide for future improvements in the quality of life. Consequently, increasing water scarcity in response to unavoidable population growth and food and water needs that go with it forms the greatest challenge for humanity to address. There is therefore the need to raise awareness of increasing water shortage due to rapid population expansion so that realistic policy options to reduce the threat can be identified and urgently formulated and implemented . This is crucial for the ongoing poverty reduction programme because poverty reduction in a developing country is critical for sustainable development. This chapter attempts to assess the amount of water available for use in the Volta, South Western and Coastal river systems; estimate the percentage of the overall availability that can be made accessible for withdrawal; determine the relationship between present water demand levels and population size or relationship between population size and levels of water scarcity; estimate the future water demand in terms of projected population ; and infer the impact of water scarcity on health. Access to Sources of Drinking Water The results of the 2000 Population and Housing Census indicate that about 40% of the households in the country have access to pipe-borne water (14% within and 26% outside the households) and tankers provide water to 2% of the households. One third of the households obtain their drinking water from wells and boreholes while the remainder of the households (25%) depend on natural sources such as springs, rain water, rivers, streams, lakes and dugout wells. 92 POPULATION, HEALTH AND DEVELOPMENT Drinking water needs to be of a quality that denotes a tolerable level of risk. The quality of water that is consumed is widely known as an important transmission conduit for infectious diarrhoeal and other diseases. Thus, water produced for direct consumption and ingestion via food should be of a quality that does not pose a significant risk to human life. Figure 1 shows that a sizeable proportion of households in the country obtains drinking water from unprotected sources. Under normal circumstances, pipe-borne water is regarded as safe for human consumption. What one is not sure of is the extent to which the other sources are well protected. A significant proportion of the households consume water from rivers, streams, lakes, springs and dugout wells, a major health concern. The sources are indicative of a substantial risk to the health of the members of the households. Furthermore, where water supplies are intermittent as a rule rather than an exception, as in many parts of the suburbs in the capital cities and towns, the risk of contaminated water finding its way into the domestic water supplies will escalate. Even where water is supplied through multiple taps in the household, but the supply is intermittent as constantly being experienced in most parts of Accra, a further risk to health may result from mal-functioning of the water borne facilities. Figure 1 also shows that drinking water is obtained at different levels of service.Item Population, health and development in Ghana: Attaining the millennium development goals(African Books Collective, 2007) Mba, C.J.; Kwankye, S.O.The Millennium Development Goals address poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women, by the year 2015. In this volume scholars and policymakers in the fields of population and health reflect on the attainments of some of these goals, on the basis of empirical evidence in the Ghanaian context. The eight paper, with an introduction by the editors, synthesises papers presented at a seminar held in Ghana on ?Population, Health and Development in Relation to the Millennium Development Goals?, organised by the Population Association of Ghana. © Population Association of Ghana, University of Ghana, Legon, 2007. All rights reserved.