Department of Population, Family and Reproductive Health

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    Relevance of meeting general outpatients’ information needs to their perceptions of healthcare quality in a hospital in Ghana: a Healthcare Quality Survey using modified SERVQUAL analysis
    (BMJ Open Quality, 2024) Asare,A.A.; Otchi, E.; Manu, A.
    Background Patients determine quality of healthcare by their perception of the gap between the healthcare they experience/receive and that which they expect. This can be influenced by the ability of healthcare staff to adequately communicate information about the healthcare provided. This study assessed the level of relevance of meeting patients’ information needs with respect to their assessment of healthcare quality in a private hospital’s general outpatient department in Ghana. Design Study design was cross-sectional using exit self-administered questionnaires among 390 outpatients. Healthcare quality was measured using a modified form of the Service Quality model gap analysis (gap between experience and expectations). A negative gap signifies unmet patient expectations. Microsoft Excel and Stata V.15.0 were used for analysis using t-test and multiple linear regression. A p value ≤0.05 denotes statistical significance. Findings The mean percentage of patients’ expectations of quality of healthcare was 87.6% (SE 0.031), while patient experience was 86.0% (SE 0.029), with a significant negative gap of −0.08 (p<0.002). Their highest expectation of the quality of healthcare was for their information needs to be met, with a mean score of 4.44 (SE 0.03). Two of the four items under the information needs dimension that showed no statistically significant gaps were ‘saying all their problems’ (gap=0.00; p<0.9) and ‘explanation of treatment/medications’ (gap=0.01; p<0.6). Those with statistically significant negative gaps were ‘explanation of investigations and procedures’ (gap=−0.18; p<0.0001) and ‘explanation of the diagnoses’ (gap=−0.11; p<0.02), signifying unmet expectations. Conclusions The outpatient’s greatest need for quality healthcare in this study was for their information needs to be met. Providing information on patient diagnoses and investigations are the areas least likely to be adequately communicated to patients.
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    Depressive symptoms among adolescents in six sub-Saharan African countries: A pooled analysis of associated factors
    (Preventive Medicine Reports, 2023) Partap, U.; Nyundo, A.; Manu, A.
    There is a need to identify risk factors, including nutrition-related factors, for depressive disorders among sub Saharan African (SSA) adolescents. We examined the association of multiple measures with depressive symp toms among adolescents living across six SSA countries. Building on previous analyses, we used data from a cross-sectional study conducted from 2015 to 2017 among adolescents aged 10–19 years in six SSA countries (N = 7512). Depressive symptoms were defined as highest tertile of the 6-item Kutcher Adolescent Depression Scale score. Using mixed-effects Poisson regression models, we pooled data across sites and examined the association of sociodemographic, nutrition, and other indices with depressive symptoms. We additionally assessed effect modification by sex, age, and school-going status. We observed higher risk of depressive symptoms among girls (adjusted risk ratio [RR]: 1.29, 95 % confidence interval [95 % CI]: 1.05–1.58, P = 0.016), older adolescents (RR for 18–19 years: 1.59, 95 % CI: 1.44–1.76, P < 0.001), and adolescents experiencing bullying (RR: 1.43, 95 % CI: 1.26–1.62, P < 0.001) or violence (RR: 1.34, 95 % CI: 1.24–1.45, P < 0.001). Adolescents experiencing food insecurity also had a higher risk of depressive symptoms (RR: 1.90, 95 % CI: 1.64–2.19, P < 0.001) along with those consuming ≥ 5 servings of fruit and vegetables per day (RR: 1.18, 95 % CI: 1.03–1.34, P = 0.015); conversely, those who consumed grains, roots and tubers in the past day were at decreased risk (RR: 0.73, 95 % CI: 0.69–0.77, P < 0.001). There was no strong evidence of effect modification of associations. This study re inforces the potential role of multiple sociodemographic and nutrition-related measures on risk of depressive symptoms in these populations
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    Corrigendum to “Counting adolescents in: the development of an adolescent health indicator framework for population-based settings”
    (Corrigendum, 2023) Shinde, S.; Harling, G.; Manu, A.
    While both school- and community-based modalities can provide nationally representative data among eligible adolescents, several shortcomings in adolescent health measurement in LMICs were noted by the GAMA Advisory Group (Reference 13 as in the original paper). First, these measurements do not equally cover all adolescent subgroups, with evidence gaps being largest for males, younger adolescents aged 10–14 years, adolescents of diverse genders, ethnicities, and religions, as well as those out of school and migrants. Second, age-disaggregated data are often lacking—due in part to incomplete age coverage—limiting their use for program planning. Third, several aspects of adolescent health are inadequately covered including mental health, substance use, injury, sexual and reproductive health among unmarried adolescents, and positive aspects of adolescent health and well-being. Fourth, the definitions and assessment methods used across adolescent health indicator frameworks are incon sistent. For example, adolescent overweight and obesity—a major cause of non-communicable diseases and a public health risk for future and intergeneration health—is inconsistently captured across indicator frameworks and strikingly absent from the SDGs (Reference 13 as in the original paper). Additional shortcomings include, current adolescent health data systems often lack intersectoral coordination beyond health (e.g., with education, water and sanitation, and social protection systems) and suffer from irregularities in coverage and timing (Reference 6 as in the original paper).
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    Young people’s attitudes towards wife beating: Analysis of the Ghana demographic and health survey 2014
    (PLOS ONE, 2021) Anaba, E.A.; Manu, A.; Torpey, K.; et al.
    Introduction Intimate Partner Violence is a global public health problem. Attitude towards wife-beating is a major determinant of both intimate partner violence perpetration and victimization. How ever, little is known about the attitudes of Ghanaian young people towards wife-beating. The objectives of this study were to assess young people’s attitudes towards wife-beating, and identify salient factors influencing young people’s acceptance of wife-beating. Methods Data used in this study were obtained from the 2014 Ghana Demographic and Health Sur vey. The survey was nationally representative and provides estimates for population and health indicators across the former ten regions of Ghana, including rural and urban areas. Data were analyzed with Stata/SE version 16. Results We found that 32% of young women and 19% of young men accepted wife-beating. Among young women, acceptance of wife-beating was significantly influenced by younger age, wealth index, low educational status, religion, the region of residence, ethnicity, frequency of reading newspaper and frequency of listening to radio (p < 0.05). Among young men, acceptance of wife-beating was significantly influenced by wealth index, the region of resi dence and frequency of reading newspaper (p < 0.05). Conclusion This study demonstrates that a substantial proportion of young people in Ghana accept wife-beating. Young women were more likely to accept wife-beating compared to young men. Acceptance of wife-beating was influenced by socio-demographic and behavioral fac tors. Efforts to end violence against women and girls in Ghana should focus on promoting girl education, economic empowerment of women and public education on laws that prohibit Intimate Partner Violence.
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    Determinants of health facility delivery among young mothers in Ghana; insights from the 2014 Ghana Demographic and Health Survey
    (BMC Pregnancy and Childbirth, 2022) Anaba, E.A.; Alangea, D.O.; Addo‑Lartey, A.; Modey, E.J.; Manu, A.; Alor, S.K.; Torpey, K.
    Background: Globally, young women deliver at home, often under unhygienic conditions and without skilled birth attendants. This study identifed the determinants of health facility delivery among young mothers in Ghana. Methods: We analysed secondary data from the 2014 Ghana Demographic and Health Survey, which collected data across the former ten administrative regions of Ghana. This study analysed data from the ‘women fle’ by adjusting for the sample weight. STATA/SE version 16 was employed to analyse the data by computing descriptive statistics, Chi square, and Binary Logistic Regression. Results: Seven in ten young mothers gave birth in a health facility. Young mothers who had secondary school education were over three-fold more likely to deliver in a health facility (AOR=3.5, 95% CI: 1.33–9.23) compared with young mothers with no formal education. Young mothers who resided in rural areas had lower odds (73%) of deliver‑ ing in a health facility (AOR=0.27; 95% CI: 0.14–0.514) compared with those in urban areas. Young mothers within the richest wealth quintile also had higher odds (8 times) of delivering in a health facility (AOR=8.24; 95% CI: 0.95–71.77) compared with those within the poorest wealth quintile. Young mothers who obtained four to seven antenatal visits (AOR=0.53; 95% CI: 0.27–1.03) had lower odds of delivering in a health facility compared with those who obtained eight or more antenatal visits. Conclusion: The majority of young mothers in Ghana gave birth in a health facility. The likelihood of delivering in a health facility was infuenced by socio-demographic factors, economic factors and utilization of antenatal care ser‑ vices. Therefore, interventions aimed at increasing utilization of skilled delivery among young women should focus on promoting girl child education, economic status and antenatal care visits
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    Risky sexual behaviours and HIV testing among young people in Ghana: evidence from the 2017/2018 Multiple Indicator Cluster Survey
    (Reproductive Health, 2022) Manu, A.; Ogum‑Alangea, D.; Azilaku, J.C.; Anaba, E.A.; Torpey, K.
    Background: Young people have a higher chance of experimenting with sex before marriage, thus they engage in risky sexual behaviours that predispose them to HIV infections. The objective of this study was to assess the relation‑ ship between engaging in risky sexual behaviours and the uptake of HIV testing services among young people in Ghana. Methods: We analysed secondary data from the 2017/2018 Ghana Multiple Indicator Cluster Survey, which col‑ lected data on population and health indicators across the previous ten regions of Ghana, using a Computer Personal Assisted Interviewing application. Data were analysed using descriptive statistics, Chi-square test and Binomial Logis‑ tic regression. Results: Seventy-nine per cent (79%) of young women and 68% of young men did not use a condom during last sexual intercourse. In addition, 68% of young women and 87% of young men had not tested for HIV. Young women (AOR=2.19; 95% CI 1.56–3.07) and young men (AOR=3.38; 95% CI 1.18–9.64) aged 20–24 years had a higher likeli‑ hood of being tested for HIV compared to those aged 15–19 years. Young women with junior high school education (AOR=2.03; 95% CI 1.08–3.81) were more likely to test for HIV compared with those who had pre-primary/no formal education. In addition, young women who were never married or in a union (AOR=0.39; 95% CI 0.27–0.56) had 61% of reduced odds of being tested for HIV compared with those who were currently married or in a union. There was no signifcant association between risky sexual behaviours and HIV testing (p>0.05). Conclusion: This study demonstrated that condom use among sexually active young people was low. The uptake of HIV testing services was below expectation. Age, educational status, marital status and exposure to the mass media were the salient factors infuencing the uptake of HIV testing among young people. Stakeholders should implement interventions to help increase the uptake of HIV testing and condom use among young people in Ghana.
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    Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis
    (Systematic Reviews, 2020) Semahegn, A.; Torpey, K.; Manu, A.; Assefa, N.; Tesfaye, G.; Ankomah, A.
    Background: Major psychiatric disorders are growing public health concern that attributed 14% of the global burden of diseases. The management of major psychiatric disorders is challenging mainly due to medication non adherence. However, there is a paucity of summarized evidence on the prevalence of psychotropic medication non-adherence and associated factors. Therefore, we aimed to summarize existing primary studies’ finding to determine the pooled prevalence and factors associated with psychotropic medication non-adherence. Methods: A total of 4504 studies written in English until December 31, 2017, were searched from the main databases (n = 3125) (PubMed (MEDLINE), Embase, CINAHL, PsycINFO, and Web of Science) and other relevant sources (mainly from Google Scholar, n = 1379). Study selection, screening, and data extraction were carried out independently by two authors. Observational studies that had been conducted among adult patients (18 years and older) with major psychiatric disorders were eligible for the selection process. Critical appraisal of the included studies was carried out using the Newcastle Ottawa Scale. Systematic synthesis of the studies was carried out to summarize factors associated with psychotropic medication non-adherence. Meta-analysis was carried using Stata 14. Random effects model was used to compute the pooled prevalence, and sub-group analysis at 95% confidence interval. Results: Forty-six studies were included in the systematic review. Of these, 35 studies (schizophrenia (n = 9), depressive (n = 16), and bipolar (n = 10) disorders) were included in the meta-analysis. Overall, 49% of major psychiatric disorder patients were non-adherent to their psychotropic medication. Of these, psychotropic medication non-adherence for schizophrenia, major depressive disorders, and bipolar disorders were 56%, 50%, and 44%, respectively. Individual patient’s behaviors, lack of social support, clinical or treatment and illness-related, and health system factors influenced psychotropic medication non-adherence. Conclusion: Psychotropic medication non-adherence was high. It was influenced by various factors operating at different levels. Therefore, comprehensive intervention strategies should be designed to address factors associated with psychotropic medication non-adherence.
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    Determinants of induced abortion among women of reproductive age: evidence from the 2013 and 2019 Sierra Leone Demographic and Health Surve
    (BMC Women’s Health, 2023) Sesay, F.R.; Anaba, E.A.; Manu, A.; Maya, E.; Torpey, K.; Adanu, R.M.K.
    Background Worldwide, pregnancy termination due to unintended pregnancy is crucial in maternal health, par ticularly in settings where abortion laws are restrictive. Presently, there is a paucity of literature on determinants of induced abortion among women of reproductive age in Sierra Leone. The study fndings could be used to improve the country’s maternal mortality indices and inform health programs and reproductive health policies geared toward tackling induced abortion. Methods We analyzed secondary data from the 2013 and 2019 Sierra Leone Demographic and Health Surveys. The surveys were nationally representative, with weighted samples comprising 16,658 (2013) and 15,574 (2019) women of reproductive age. Descriptive statistics, including frequencies and percentages, were computed, while Chi-square and Binomial Logistics Regression were employed to identify correlates of induced abortion. Results The results showed that a minority (9%) of the participants had induced abortion in both surveys. Abor tion was signifcantly associated with age, marital status, employment status, education, parity, and frequency of listening to the radio and watching television (p<0.05). For instance, women aged 45–49 years (AOR=7.91; 95% CI: 5.76–10.87), married women (AOR=2.52; 95% CI: 1.95–3.26), and working women (AOR=1.65; 95% CI: 1.45–1.87) had a higher likelihood of induced abortion compared to their counterparts. Moreover, women with primary educa tion (AOR=1.27; 95% CI:1.11–1.46) and those who watch television once a week (AOR=1.29; 95% CI: 1.11–1.49) were more likely to terminate a pregnancy. Women with six or more children (AOR=0.40; 95% CI: 0.31–0.52) were less likely to terminate a pregnancy compared to those with no child. Conclusion The study revealed that a minority of the women had induced abortions. The prevalence of induced abortion did not change over time. Induced abortion was infuenced by age, marital status, employment status, edu cation, parity, and exposure to mass media. Therefore, policies and programs to reduce unwanted pregnancies should focus on increasing access to modern contraceptives among women of lower socio-economic status
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    The Role of Lifestyle Factors in Controlling Blood Pressure among Hypertensive Patients in Two Health Facilities in Urban Ghana: A Cross-Sectional Study
    (International Journal of Hypertension, 2020) Amoah, E.M.; Okai, D.E.; Manu, A.; Laar, A.; Akamah, J.; Torpey, K.
    Introduction. Despite efforts to combat hypertension by pharmacotherapy, hypertension control rates remain low. Lifestyle modifications of individuals diagnosed with hypertension have prospects for the prevention and control of hypertension. )is study assessed the effect of modifiable lifestyle factors on blood pressure control among adults in urban Accra. Methods. In this cross-sectional study, 360 diagnosed hypertensive patients who were ≥18 years old, selected from two secondary-level referral hospitals in the Greater Accra Region, were interviewed. Demographic information, diet components, and exercise assessments as well as blood pressure measurements were taken. Chi-squared tests and binomial logistic regression were used to determine the association between demographic and lifestyle factors with blood pressure control. Area under the receiver-operator curves (AUROC) was used to identify lifestyle factors predicting optimal blood pressure control among patients diagnosed with hy pertension. Results. Approximately 54.2% of participants had no knowledge of either causes or complications of hypertension. Similarly, 52.5% of patients that had not achieved blood pressure control lacked knowledge of causes or complications of hypertension. Longer time since diagnosis of 2–5 years (AOR 0.08 (95% CI: 0.01–0.47)) and 6–10 years (AOR 0.08 (95% CI: 0.01–0.50)) and diets, mainly composed of meat (AOR 0.13 (95% CI: 0.02–0.70)) and starch (AOR 0.14 (95% CI: 0.03–0.79)), predicted poor blood pressure control compared to patients diagnosed within a year and diets without meat and starch as main components, respectively. Additionally, engaging in some physical activity of 30 minutes to one hour (AOR 5.64 (95% CI: 2.08–15.32)) and more than an hour (AOR 11.38, 95% CI: 2.01–64.47)) predicted blood pressure control. Conclusion. )e study concludes that increased physical activity, abstaining from alcohol and smoking, increased intake of fruits and vegetables, and reduced intake of carbohydrates, meat, and fat have a positive influence on blood pressure control. Lifestyle modifying factors have a key role in complementing pharmacotherapy in hypertension control.
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    Women’s Contraceptive Use, Fertility Intention, and Associated Factors: Evidence from Health and Demographic Surveillance System, Eastern Ethiopia
    (East African Journal of Health and Biomedical Sciences, 2018) Semahegn, A.; Torpey, K.; Manu, A.; Assefa, N.; Ankomah, A.
    Background: Improving maternal health condition is a critical global health concern. But in 2012, 222 million women who want to avoid pregnancy are not using contraceptives in developing countries. The main purpose of this study was to assess women’s contraceptive use and fertility intention, and the associated factors in eastern Ethiopia. Methods: Community based survey was conducted among 2,072 women (15-49 years) in Harar Health Demographic Surveillance System (HDSS) site in eastern Ethiopia. Data were gathered by trained data collectors, and entered into computer based software and exported to Statistical Package for Social Sciences (SPSS) version 20.0 for analysis. Descriptive, binary and multiple logistic regression analysis were carried out. A statistical association was declared using adjusted odds ratio at 95% confidence interval and p values <0.05. Results: Almost all the women (99.5%, n=2,061) have ever heard about family planning methods. Health professionals (62.1%, n=1286) were the main source of information about the family planning methods. The women who had ever used contraceptive and who were using currently (during study period) were 89.4% (1,853) and 73.0% (n=1512), respectively. Injectable method (52.3%) was the most popular method, followed by pills (24.8%). Implanon, Intrauterine contraceptive device and surgical methods were used 15.5%, 2.1% and 0.2%, respectively. Forty seven percent of the women had no desire to have a baby in the next two years. The women’s age ranged 30-39 years (AOR =0.49; 95% CI: 0.37, 0.64), women’s age ranged from 40-49 years (AOR=0.25; 95% CI: 0.18, 0.35), women unable to unable to read and write (AOR=0.64; 95% CI: 0.50, 0.84), women who had >2 alive children (AOR=0.28; 95% CI: 0.13, 0.57) had significant association with their contraceptive use. Also, women’s age ranged 30-39 years (AOR=0 .68; 95% CI: 0.54, 0.85), women’s age ranged from 40-49 years (AOR=0.24; 95% CI: 0.17, 0.32), women who had no alive children (AOR=5.42; 95% CI: 1.59, 18.46) and had <2 alive children (AOR=2.42; 95% CI: 1.22, 4.82) were significantly associated with women’s fertility intention. Conclusion: The women’s contraceptive use and an intention not to have a baby were high compared with 2016 EDHS report of Harari Regional State. The study participants’ age, educational status, and having alive children were the factors associated with their contraceptive use and fertility intention. Therefore, we recommend that concerned stakeholders focus on the associated factors to address the contraceptive use and realize the women’s fertility intention.