Department of Population, Family and Reproductive Health
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Item Proximate determinants of child mortality in liberia(1991-07) Ahmad, O.B.; Eberstein, I.W.; Sly, D.F.The study looks at the effects of maternal sociodemographic characteristics and the quality of the environment on child survival through two intervening variables, breast-feeding and prenatal care. A linear structural equation modelling approach was used to examine infant and child survival based on a weighted sample of 5180 Liberian children aged 0-5 years. The findings confirm previous studies, but also reveal complex relationships of the role of education, maternal age and breast-feeding in enhancing child survival. PIP: The hypothesis that female education has a positive direct influence on child survival was investigated through the use of data from the 1986 Demographic and Health Survey of Liberia. Of the 5180 children born in the 5 years preceding the survey, 873 (17%) had died. Even when other socioeconomic variables were controlled, maternal education had a significant positive direct effect (0.167) on child survival at 5 years of age. The percentage of child loss was 17.9% among mothers with no education, 15.5% among those with a primary education, and 14.0% among mothers with an education above the primary level. This effect was weak, however, when compared to that of breastfeeding. The proportion of child mortality was 41.7% among non-breastfeeding mothers compared to only 8.9% among breastfeeding mothers. To the extent that high maternal educational decreased the propensity to breastfeed in this sample, education has a negative indirect effect on child survival--an effect that is counterbalanced somewhat by the tendency of education to increase the likelihood of obtaining prenatal care, the most important source of knowledge about child health. Moreover, prenatal care has the strongest direct effect on breastfeeding status. The excess risk of child mortality among teenage mothers in this survey (19.8%, compared to 14.9% among mothers 35 years of age and above) is believed to reflect to decreasing prevalence of breastfeeding in younger age groups. Overall, the risk of child death was greater in rural areas (17.75) than urban ones (15.6%), but, for breastfed children, the risk was lower in rural areas. These findings indicate a need for greater attention toward promoting breastfeeding as the central element of child survival campaigns.Item Developing a culturally appropriate family planning program for the navrongo experiment(1995) Nazzar, A.; Adongo, P.B.; Binka, F.N.; Phillips, J.F.; Debpuur, C.This article describes the first six months of the strategic planning process to develop a culturally appropriate community health and family planning program for a traditional community in a district of northern Ghana, served by the Navrongo Health Research Centre. To explain the context within which fertility decisions are made, this article describes the district's severe ecological, social, economic, and health constraints to family planning. It discusses related programmatic obstacles and presents the strategies developed to respond to them. A system of care has been developed that is closely coordinated with traditional leaders and communication networks. Management systems support outreach workers by emphasizing the importance of peer leadership, supervisory support, and community liaison in the implementation of village-based services. A large-scale experiment will be fielded to test the demographic impact of this approach. -AuthorsItem Mortality and morbidity from malaria in Gambian children after introduction of an impregnated bednetprogramme(1995-02) D'Alessandro, U.; Olaleye, B.O.; McGuire, W.; Langerock, P.; Bennett, S.; Aikins, M.K.; Thomson, M.C.; Cham, B.A.; Greenwood, B.M.After the success of a controlled trial of insecticide-treated bednets in lowering child mortality, The Gambia initiated a National Insecticide Impregnated Bednet Programme (NIBP) in 1992 with the objective of introducing this form of malaria control into all large villages in The Gambia. Five areas (population 115,895) were chosen as sentinel sites for evaluation of the NIBP. During the first year of intervention a 25% reduction was achieved in all-cause mortality in children 1-9 years old living in treated villages (rate ratio 0.75 [95% CI 0.57-0.98], p = 0.04). If one area where the programme was ineffective was excluded, the reduction was 38% (0.62 [0.46-0.83), p = 0.001). A decrease in rates of parasitaemia and high-density parasitaemia, an increase in mean packed-cell volume (rate ratio 0.75 [95% CI 0.59-0.98], p = 0.04) and an improvement in the nutritional status of children living in treated villages were also detected. In a country such as The Gambia, where nets were widely used and which has a good primary health care system, it is possible to achieve insecticide-treatment of bednets at a national level with a significant reduction in child mortality; but at a cost which the country cannot afford.Item Impact of primary health care on child morbidity and mortality in rural Ghana: The Gomoa experience(Central African Journal of Medicine, 1995-05) Afari, E.A.; Nkrumah, F.K.; Nakana, T.; Sakatoku, H.; Hori, H.; Binka, F.The impact of a combination of PHC intervention activities on child survival, growth, morbidity and mortality was assessed in three selected rural communities (Gomoa Fetteh, Gomoa Onyadze/Otsew Jukwa and Gomoa Mprumem) in the Central Region of Ghana from 1987 to 1990. EPI, provision of basic essential drugs and supplies for the treatment of common childhood diseases, treatment of the sick child, growth monitoring, health education, provision of antenatal services, family planning, training and supervision of Community Health Workers, disease surveillance and special studies were the major PHC strategies used to improve the health of the child and the pregnant woman in the three communities. These activities in their totality have had significant impact on morbidity and mortality in children under five and on maternal mortality in children under five and on maternal mortality over the study period 1987 to 1990. Although malaria, acute respiratory infections and diarrhoea diseases continue to be major causes of childhood morbidity, deaths due to these diseases have dramatically declined. Measles and other vaccine preventable diseases no longer contribute significantly to childhood morbidity and mortality. Infant and under five mortality have been reduced from 114.6/1000 and 155.6/1000 live births to 40.8/1000 and 61.2/1000 live births respectively. The crude birth rates however, remain almost the same over the five year period (43 to 48/1000 pop.) but crude death rates have declined (11 to 12.4/1000 pop.).(ABSTRACT TRUNCATED AT 250 WORDS)Item Effect of vitamin A supplementation on the growth of young children in northern Ghana.(1996-05) Kirkwood, B.R.; Ross, D.A.; Arthur, P.; Morris, S.S.; Dollimore, N.; Binka, F.N.; Shier, R.P.; Gyapong, J.O.; Addy, H.A.; Smith, P.G.The effect of prophylactic vitamin A supplementation on child growth was studied in two randomized, placebo-controlled trials carried out in adjacent areas of northern Ghana between 1989 and 1991. In the Health Study, the midupper arm circumference (MUAC) and weight of the ≃ 1500 children (aged 6- 59 mo) in the trial were measured every 4 wk for up to 52 wk. In addition, MUAC, weight, and height were measured at each of the four potential vitamin A or placebo dosing times, which were at 4-mo intervals. In the Survival Study, MUAC and weight were measured at 4-mo intervals at each of seven dosing rounds in the ≃15 000 children currently in the trial. Overall, there were > 90 000 observations of weight and MUAC in > 25 000 children, and 3347 observations of length/height in 1546 children. Within each study, the mean monthly weight, MUAC, and gains in length/height in each treatment group were compared by using multilevel modeling. There were no significant differences in either MUAC or gains in length/height. The only significant difference in weight gain was in the Survival Study: children in the vitamin A supplemented group who were ≥ 36 mo of age had a mean weight gain that was 3 g lower per month (95% CI: 0.4, 5.0, P = 0.02) than that in the placebo group; a difference that was unlikely to be functionally important in this age group. Vitamin A supplementation did not lead to any increased growth in this population of young children, in whom supplementation reduced mortality and severe morbidity substantially.Item Premarital relationships and livelihoods in Ghana(1996-10) Ankomah, A.PIP: This study is based on interviews with a sample of 400 single women aged 18-25 years from the Fante ethnic group in Cape Coast, Ghana, in 1991, and on focus groups. This case study illustrates the importance of economic and living arrangement support expected from partners in premarital relationships. Support may be for living and maintenance ('chopmoney', provisions, household items, and rent); for financial security (provision of capital); and for clothing and hairdressing. Women did not always require economic support in premarital relationships. Women expect boyfriends to provide 'chopmoney' (money for food and general upkeep) and contribute some money for the rent. Only 36% of sexually active women expected their boyfriends to supply food provisions. Premarital sexual relationships are used to obtain start-up capital. The author refers to evidence that senior government officials engaged in sexual transactions with clients before loans and credit facilities were offered. 87% of sexually experienced women expected their partners to pay for at least part of clothing expenses. The study revealed that there was considerable disparity between women's expectations and actual receipt of economic support. 56% desired, but only 36% received, 'chopmoney' in full. 40% expected their partners to pay for household furnishings in full, while only 10% did so. 55% expected capital, but only 15% received it. The three most frequently received benefits in full were hair dressing, shoes, and dresses. Men provided most non-negotiable items as a means of "boosting their egos." Many young women rely on the support of men in order to improve their status. Ghanaian men control financial resources and economic power. Mothers of adolescent daughters encourage premarital sexual behavior. Prostitution is considered different from sexual exchange relationships. It is argued that gender inequalities and domestic abuse are perpetuated through sexual exchange relationships.Item Unsafe abortions: Methods used and characteristics of patients attending hospitals in Nairobi, Lima, and manila(1997-01) Ankomah, A.; Aloo-Obunga, C.; Chu, M.; Manlagnit, A.Using quantitative and qualitative data, the authors present selected characteristics of 626 women who reported complications of induced abortion in five hospitals: one in Nairobi, two in Lima, and two in Manila. Although there are some similarities, the findings show some marked differences in demographic characteristics. In Nairobi nearly all respondents were single, nulliparous, and 25 years or younger; in Lima and Manila most were either married or in union, usually aged 25 years or older and had at least 1 child. There was evidence of repeat abortions, especially in Nairobi where 26% had had at least one previous abortion. Access to safe abortions is severely restricted and is obtained through a secret referral system. A list of potentially hazardous local abortifacients range from the drinking of strong Kenyan tea to dangerous practices such as insertion of sharp objects into the uterus or drinking chemicals and toxic substances. PIP: Interviews with 626 women treated in 1993 for complications of unsafe abortion at five hospitals in Nairobi (Kenya), Lima (Peru), and Manila (Philippines) revealed marked differences in their demographic characteristics. The percentage under 25 years of age was 26% in Manila, 45% in Lima, and 91% in Nairobi. 84% of abortion patients in Nairobi were single compared with 77% in Manila and 21% in Lima; 77% of women in Nairobi had no children compared with 29% in Lima and 11% in Manila. In general, Nairobi abortion seekers tended to be young women who migrated to the city and were concerned pregnancy would impede their social mobility. In Lima and Manila, abortion was sought to limit births within union, generally for financial reasons. Never-use of contraception was reported by 80% of Kenyan women, 65% of Manila women, and 48% of those in Lima. When presented with 11 scenarios that might justify an abortion, the only indication the majority in all three cities supported was pregnancy resulting from rape. Women reported use of abortifacient agents such as livestock droppings, drinking chemicals and detergents, herbal medicines, and overdoses of over-the-counter medications, as well as insertion of sharp objects into the uterus. 98% of Kenyan respondents compared with 36% in Peru and 24% in the Philippines claimed illegal abortion was common; 92%, 75%, and 35%, respectively, were aware of at least one woman who died after an unsafe abortion. All of the women in Kenya and 89% in the Philippines reported it was difficult or very difficult to obtain an abortion; most were obtained through a secret referral system and involved unsanitary conditions. These findings indicate a need for postabortion family planning counseling as well as scrutiny of existing abortion laws and policies.Item Sex, love, money and AIDS: The dynamics of premarital sexual relationships in Ghana(1998-08)This article discusses some personal and situational factors which hinder the use of condoms among young single adults ages 18 to 25 years engaged in sexual exchange relationships in a Ghanaian town. Based on focus group discussions and in-depth interviews, this article highlights some key impediments often not adequately discussed in the discourse on condom use but considered vital in any attempt to increase condom use and ultimately reduce HIV transmission. The includes the dilemma facing women who want to use condoms for HIV prevention in premarital sexual exchange relationships (quite different from prostitution) contracted with material gain in mind. Women may face the risk of losing material benefits from sexual exchange relationships if the man is unwilling to use condoms. It is recommended that HIV health educators must increase the involvement of young single adults in exploring these and situational impediments and together design interventions to improve condom use. PIP: Focus group discussions and in-depth interviews conducted in Cape Coast, Ghana, revealed significant obstacles to condom use among single women 18-25 years of age. Most female respondents were self-employed small-scale traders with low incomes, while male participants tended to be clerks or fishermen. In this society, men are considered the source of economic and physical power and in a position to demand sexual favors. Material recompense (e.g., money, food, or clothing) for premarital sex is standard practice outside the commercial sex work establishment and women often switch rapidly from relationship to relationship in search of a more materially rewarding arrangement. Such behavior is condoned--often encouraged--by young women's mothers. Condom use is rare and associated with infidelity. Thus, Ghanaian women face the dilemma of choosing between economic survival and unsafe sex. Since men perceive condoms as reducing sexual sensitivity, they are unlikely to remain with a partner who insists on condom use. Moreover, sexual relationships are embedded in an atmosphere of fear of violence. If women are to insist on condom use, they must believe the risk of HIV infection is not adequately compensated by the material gains received from the sexual encounter. It is recommended that community-level HIV preventive interventions target men with messages about the importance of trying condom use. Ultimately, however, reconstruction of gender-based power relationships and improvements in women's economic status are essential to reduce women's dependence on sexual networking.Item Condom use in sexual exchange relationships among young single adults in Ghana(1998-08) Ankomah, A.This article discusses some personal and situational factors which hinder the use of condoms among young single adults ages 18 to 25 years engaged in sexual exchange relationships in a Ghanaian town. Based on focus group discussions and in-depth interviews, this article highlights some key impediments often not adequately discussed in the discourse on condom use but considered vital in any attempt to increase condom use and ultimately reduce HIV transmission. The includes the dilemma facing women who want to use condoms for HIV prevention in premarital sexual exchange relationships (quite different from prostitution) contracted with material gain in mind. Women may face the risk of losing material benefits from sexual exchange relationships if the man is unwilling to use condoms. It is recommended that HIV health educators must increase the involvement of young single adults in exploring these and situational impediments and together design interventions to improve condom use. PIP: Focus group discussions and in-depth interviews conducted in Cape Coast, Ghana, revealed significant obstacles to condom use among single women 18-25 years of age. Most female respondents were self-employed small-scale traders with low incomes, while male participants tended to be clerks or fishermen. In this society, men are considered the source of economic and physical power and in a position to demand sexual favors. Material recompense (e.g., money, food, or clothing) for premarital sex is standard practice outside the commercial sex work establishment and women often switch rapidly from relationship to relationship in search of a more materially rewarding arrangement. Such behavior is condoned--often encouraged--by young women's mothers. Condom use is rare and associated with infidelity. Thus, Ghanaian women face the dilemma of choosing between economic survival and unsafe sex. Since men perceive condoms as reducing sexual sensitivity, they are unlikely to remain with a partner who insists on condom use. Moreover, sexual relationships are embedded in an atmosphere of fear of violence. If women are to insist on condom use, they must believe the risk of HIV infection is not adequately compensated by the material gains received from the sexual encounter. It is recommended that community-level HIV preventive interventions target men with messages about the importance of trying condom use. Ultimately, however, reconstruction of gender-based power relationships and improvements in women's economic status are essential to reduce women's dependence on sexual networking.Item Women's fears and men's anxieties: The impact of family planning on gender relations in northern Ghana(1999-03) Bawah, A.A.; Akweongo, P.; Simmons, R.; Phillips, J.F.The Navrongo experiment, a family planning and health project in northern Ghana, has demonstrated that an appropriately designed, community-based family planning program can produce a change in contraceptive practice that had been considered unattainable in such a setting. Simultaneously, however, evidence suggests that newly introduced family planning services and contraceptive availability can activate tension in gender relations. In this society, where payment of bridewealth signifies a woman's requirement to bear children, there are deeply ingrained expectations about women's reproductive obligations. Physical abuse and reprisals from the extended family pose substantial threats to women; men are anxious that women who practice contraception might be unfaithful. Data from focus-group discussions with men and women are examined in this report and highlight the strains on gender relations resulting from contraceptive use. The measures taken to address this problem and methods of minimizing the risk of adverse social consequences are discussed. PIP: The perspectives of older and younger men and women and village leaders concerning the impact of family planning on gender relations were distilled from a series of 36 focus group discussions held during 1994-96 in conjunction with the launching of the Navrongo experiment in northern Ghana. The primary aim of the focus groups was to monitor the community's reaction to the introduction of family planning and health services and provide feedback to project managers. Focus group participants made clear that, although contraception can reconcile a husband's sexual desire with the wife's desire to space births, it also generates marital discord, wife beating, and opposition from members of the extended family. Violence against women was considered justified by 51% of female and 43% of male respondents if the wife used a contraceptive method without the husband's knowledge. Women feared that their husband's disapproval of family planning could lead to withholding of affection or sex or even divorce. In the traditional local society, payment of bridewealth in cows and sheep signifies the wife's obligation to bear children. Some men worry that their wives might be unfaithful if they used contraception or that contraceptive use might create conflict among multiple wives. The possibility that women may act independently is regarded as a threat to the strong patriarchal tradition. The Navrongo project has attempted to respond to community concerns by acting through existing local institutions whenever possible while still supporting women and their autonomy.Item Maternal mortality among the kassena-nankana of northern Ghana(1999-06) Ngom, P.; Akweongo, P.; Adongo, P.; Bawah, A.A.; Binka, F.This report presents key findings from a maternal mortality study conducted in the Kassena-Nankana District of northern Ghana in 1997-98. Sibling history data collected in the course of this survey are analyzed together with longitudinal data from the Navrongo Demographic Surveillance System (NDSS). A comparison between mortality data from these two sources indicates that obtaining reasonably accurate estimates of age-specific death rates is possible by using the sisterhood method. Direct and indirect estimates from the maternal mortality study and the NDSS suggest a decline in the maternal mortality ratio for the Kassena-Nankana District from 800 to 600 maternal deaths per 100,000 live births over the past 14 years.Item The decline in child mortality: A reappraisal(2000) Ahmad, O.B.; Lopez, A.D.; Inoue, M.The present paper examines, describes and documents country-specific trends in under-five mortality rates (i.e., mortality among children under five years of age) in the 1990s. Our analysis updates previous studies by UNICEF, the World Bank and the United Nations. It identifies countries and WHO regions where sustained improvement has occurred and those where setbacks are evident. A consistent series of estimates of under-five mortality rate is provided and an indication is given of historical trends during the period 1950-2000 for both developed and developing countries. It is estimated that 10.5 million children aged 0-4 years died in 1999, about 2.2 million or 17.5% fewer than a decade earlier. On average about 15% of newborn children in Africa are expected to die before reaching their fifth birthday. The corresponding figures for many other parts of the developing world are in the range 3-8% and that for Europe is under 2%. During the 1990s the decline in child mortality decelerated in all the WHO regions except the Western Pacific but there is no widespread evidence of rising child mortality rates. At the country level there are exceptions in southern Africa where the prevalence of HIV is extremely high and in Asia where a few countries are beset by economic difficulties. The slowdown in the rate of decline is of particular concern in Africa and South-East Asia because it is occurring at relatively high levels of mortality, and in countries experiencing severe economic dislocation. As the HIV/AIDS epidemic continues in Africa, particularly southern Africa, and in parts of Asia, further reductions in child mortality become increasingly unlikely until substantial progress in controlling the spread of HIV is achieved.Item The impact of the Navrongo Project on contraceptive knowledge and use, reproductive preferences, and fertility(Studies in Family Planning, 2002-06) Debpuur, C.; Phillips, J.F.; Jackson, E.F.; Nazzar, A.; Ngom, P.; Binka, F.N.The Navrongo Community Health and Family Planning Project is a quasi-experimental study designed to test the hypothesis that introducing health and family planning services in a traditional African societal setting will introduce reproductive change. This article presents the impact of the initial three years of project exposure on contraceptive knowledge, awareness of supply sources, reproductive preferences, contraceptive use, and fertility. Findings show that knowledge of methods and supply sources increased as a result of exposure to project activities and that deployment of nurses to communities was associated with the emergence of preferences to limit childbearing. Fertility impact is evident in all treatment cells, most prominently in areas where nurse-outreach activities are combined with strategies for involving traditional leaders and male volunteers in promoting the program. In this combined cell, the initial three years of project exposure reduced the total fertility rate by one birth, comprising a 15 percent fertility decline relative to fertility levels in comparison communities.Item A review of traditional Ghanaian and Western philosophies of adult education(International Journal of Lifelong Education, 2003-01) Fordjor, P.; Kotoh, A.; Kumah Kpeli, K.; Kwamefio, A.; Bernard Mensa, Q.; Owusu, E.; Mullins, B.The primary objective of this article is to critically examine some aspects of the traditional Ghanaian and Western philosophies of adult education. It is a well-attested fact that many of the pre-colonial and early colonial writers about Africa portrayed Africa as a dark continent devoid of advanced centres of learning worthy of emulation by others. The old West African civilizations of Ghana, Mali and Songhai with advanced centres of learning at Timbuktu and Djenne in the 11th century seemed to have been completely ignored by these writers (Boahen 1967: 20, Davidson 1966b: 50). Even though many other writers including several missionaries, anthropologists and historians, depicted Africa in a rather positive and scientific manner (Davidson 1966b, Goody 1966), much of the negative image created long ago still exists and needs to be examined and corrected. The formal Western system of school education was introduced in Ghana more than a century ago. Despite this, about 60% of the adult population today makes its living as illiterate farmers, workers, apprentices or master craftsmen in the various traditional art and craft production centres. Consequently, traditional adult education continues to play an important role in the social and economic development of the country. Like the Western system of adult education the Ghanaian traditional education has sound philosophical foundations, which have helped to maintain political stability and social cohesion in the country over the years. Much is written about Western and eastern philosophies but there is a dearth of literature on philosophies of adult education from Africa. Given that Africa is the second largest continent on the globe and that adult education proliferates throughout the continent, the authors felt their investigation would make a significant contribution to a global understanding of the field. Additionally, there is an increasing need for African students to appreciate and re-establish confidence in their own culture. This review cannot cover all of Africa so the focus is on Ghana, one country in West Africa. © 2003 Taylor & Francis Group, LLC.Item Ruptured uterus: A seven-year review of cases from Accra, Ghana.(Journal of Obstetrics and Gynaecology Canada, 2003-03) Adanu, R.M.; Obed, S.A.OBJECTIVE: To determine the incidence, causes, management, and the means of prevention of uterine rupture, as well as the characteristics of women with the condition, recorded in the Department of Obstetrics and Gynaecology at Korle-Bu Teaching Hospital in Accra, Ghana. DESIGN: A retrospective study between January 1, 1995, and December 31, 2001. RESULTS: During the study period, of 82061 deliveries at the Korle-Bu Teaching Hospital, 193 women developed uterine rupture, an incidence of 2.4 per 1000 deliveries. Of these 193 women, 24.6% had had a previous Caesarean section. The most frequent associated factor of uterine rupture was prolonged labour (33.6%). The perinatal mortality rate was 74.3%. Almost 70% (66.9%) of women underwent a total abdominal hysterectomy as management. The case fatality rate was 1.0%. CONCLUSION: A more vigilant approach to preventing prolonged and obstructed labour in delivery units within and around Accra, Ghana, is required to reduce the incidence of this condition.Item TRIPS, the Doha Declaration and increasing access to medicines: policy options for Ghana(Globalization and Health, 2005) Cohen, J.C.; Gyansa-Lutterodt, M.; Torpey, K.; et al.There are acute disparities in pharmaceutical access between developing and industrialized countries. Developing countries make up approximately 80% of the world's population but only represent approximately 20% of global pharmaceutical consumption. Among the many barriers to drug access are the potential consequences of the Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement. Many developing countries have recently modified their patent laws to conform to the TRIPS standards, given the 2005 deadline for developing countries. Safeguards to protect public health have been incorporated into the TRIPS Agreement; however, in practice governments may be reluctant to exercise such rights given concern about the international trade and political ramifications. The Doha Declaration and the recent Decision on the Implementation of Paragraph 6 of the Doha Declaration on the TRIPS Agreement and Public Health may provide more freedom for developing countries in using these safeguards. This paper focuses on Ghana, a developing country that recently changed its patent laws to conform to TRIPS standards. We examine Ghana's patent law changes in the context of the Doha Declaration and assess their meaning for access to drugs of its population. We discuss new and existing barriers, as well as possible solutions, to provide policy-makers with lessons learned from the Ghanaian experience.Item Profile of women with abortion complications in Ghana.(Tropical Doctor, 2005-07) Adanu, R.M.K.; Ntumy, M.N.; Tweneboah, E.A cross-sectional study of 150 women was performed at the gynaecology department of the Korle-BuTeaching Hospital to describe the characteristics of patients with complications of induced or spontaneous abortions, and to find out the reasons behind induced abortions. In all, 31% of the study sample presented with complications of induced abortions. This group was younger, of lower parity, more educated, with lower economic potential, in less stable relationships and with a higher knowledge of modern contraceptive methods than the group with spontaneous abortions. The chief reason for procuring an induced abortion was the presence of relationship problems with the subject's partner. We conclude that measures to prevent induced abortions and their subsequent problems will yield major results if directed at women in their early 20s with at least primary education, no children, low economic potential, not in a stable relationship and who have had a previous induced abortion.Item Contemporary issues in women's health.(International Journal of Gynecology and Obstetrics, 2006) Adanu, R.M.K.; Boama, V.; Guinto V.T.; Sosa C.G.No abstractItem Constraints on the use of animal source foods for young children in ghana: A participatory rapid appraisal approach.(2006) Colecraft, E.; Marquis, G. S.; Aryeetey, R.; Sakyi-Dawson, O.; Lartey, A.; Ahunu, B.; Canacoo, E.Micronutrient deficiencies limit child health and development. Although animal source foods (ASF) provide highly bioavailable micronutrients, Ghanaian preschoolers consume little. Participatory rapid appraisal methods identified constraints to the availability, accessibility, and utilization of ASF. Stakeholders working with or living in six communities in three agro-ecological zones reported constraints including low income, lack of access to technology and markets, inequitable household food allocation, inadequate knowledge, and beliefs. The least expensive ASF was fish, which was easy to preserve and consumed by all communities. Since ASF was primarily purchased, interventions that increase income may be most successful in improving Ghanaian children's diets.Item Contemporary issues in women's health.(International Journal of Gynecology and Obstetrics, 2006-01) Johnson, T.R.B.; Adanu, R.M.K.No abstract