Regional Institute for Population Studies
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Item Quality Of Maternal Health-Seeking Behaviour And Pregnancy Outcomes Among Young Women In Ghana(University Of Ghana, 2020-07) Bobo, E.K.Pregnancy among young women is a concern worldwide, especially in low- and middle-income countries i(LMICs), as they often have a higher incidence of adverse pregnancy outcomes. The utilization of maternal health care services is imperative to reducing the number of perinatal deaths and postnatal complications iamongst ipregnant iwomen. iAttempts ito iexplain ithis isituation ihave ifocusedioniindividual iandihouseholdilevel ideterminants, ibut itheiroleiofineighbourhoodifactors ihas inot ireceived imuch iattention. iUnderstanding ineighbourhood ifactors iassociated iwith imaternal ihealth-seeking ibehaviour iis iimportant. iThis iis ibecause iindividuals ireside iwithin ineighbourhoods iand itheir ihealth-related ibehaviour ican ibe iinfluenced iby ithe icharacteristics ior iconditions iof ithe ineighbourhoodiin iwhichitheyilive. This istudy iposits ithat iquality iof icare iand ineighbourhood-level icharacteristics iare ivery icritical ipredictors iof iyoung iwomen’s iutilization iof imaternal ihealth icare iand ipregnancy ioutcomes iamong iyoungiwomeniin iGhana, iin iadditionito iotheriindividual iandihouseholdicharacteristics. iDrawingion itheories iof ibehavioural imodel iof ihealthiservice iuse, ithe ithree idelays, iand iDonabedian’s iqualityiof icare imodel, ithe istudy iused ia imodified iBehavioural iModel iof iHealth iService iUse iand iQuality iof icareimodelitoiunderstandiindividualiandineighbourhood-level ifactorsionitheiutilizationiofimaternal ihealthcare iservices iandipregnancyioutcomes iamongiyoungiwomeniin iGhana. i Data ifrom ithe i2017 iGhana iMaternal iHealth iSurvey iwas iused ito iconduct ia iquantitative istudy ito iunderstand ithe ieffects iof iindividual iand ineighbourhood-level ifactors ion ithe iquality iof iantenatal icare, iskilled ibirth iattendance, iand ipregnancy ioutcomes. iThe iquantitative istudy iused ia isample iof i2,669 iyoung iwomen ibetween ithe iages iof i15 ito i24 iyears inested iwithin i900 iclusters iacross iGhana. iMultilevel ilogistic iregression imodels iwere iemployed ito iexamine ithe ieffects iof iindividual iand ineighbourhood-level ifactors ion ithe iquality iof iantenatal icare, iskilled ibirth iattendance, iand ipregnancy ioutcomes. iThe iquantitative ianalysis irevealed iboth iindividual iand icommunity-level ifactors ias isignificant ipredictors iof imaternal ihealth ioutcomes iin iGhana. iFor iinstance, iwealthier iwomen iand ithose iwith ihigher ieducation iwere isignificantly imore ilikely ito iutilize ithe iquality iof iantenatal icare iand idelivery iservices. i The ianalysis ialso irevealed ithat iafter icontrolling ifor iother ifactors, iplace iof iresidence, ia ineighbourhood ivariable ihas ino idirect iassociation iwith ithe iquality iof iANC, ihowever, iit ihas ia idirect icontribution ito iskilled ibirth iattendance iand ipregnancy ioutcomes. iNeighbourhood-level irandom ieffects iwere ialso isignificant iand ithere iwas iconfirmation iof inesting iat ithe ineighbourhood ilevel ieven iafter icontrolling ifor iindividual iand ineighbourhood-level ivariables. This istudy iprovides ifurther iempirical ievidence ithat, ito iimprove ithe istrides itowards ireducing ithe irisk iof iadverse ipregnancy ioutcomes iamong iwomen iin iGhana, iinterventions ishould ibe itargeted iat iwomen iin ipoor ihouseholds iliving iin ipoor isocioeconomic iconditions iwith ino iaccess ito iquality imaternal icare iservices. iThis iwould ihave ia isignificant iinfluence ion ithe iliving iconditions iof ithe iwomen iand ithus, ireduce itheir irisk iof ihaving ia inegative ioutcome iof ipregnancy.Item Assessing Primary Health Care Progress And Readiness Towards The Attainment Of Universal Health Coverage: The Case Of The Volta And Oti Regions Of Ghana(University Of Ghana, 2021-12) Apanga, S.Universal Health Coverage (UHC) involves the provision of quality health services without the need for out-of the pocket payments. Implementation of the Community-based Health Planning and Services and the national health insurance scheme (NHIS) which provides health service coverage and financial risk protection respectively to Ghanaians caters for the two critical of dimensions UHC. However there are inadequate metrics for measuring progress of UHC that combines its two dimensions simultaneously and primary health care system (PHC) readiness towards attaining UHC in Ghana hence the need for this study. Repeated cross-sectional surveys of household reproductive aged women and a survey of health facilities were carried out in the Oti and Volta regions of Ghana. Principal Component Analysis was used to develop composite indices for measuring progress of UHC and service readiness towards attaining UHC. Binary logistic regression models were run to assess the effect of the health system readiness on UHC at the population level. The composite for measuring progress of UHC comprised of quality of care, access to health care and active membership of NHIS as its components whilst the composite for measuring the system readiness towards attaining UHC had monitoring of health services; functioning basic equipment; essential medicine; and availability of trained health personnel as its components. There was some progress made towards attaining UHC over a period of time with the lower level of the health care delivery system found to be least ready towards attaining UHC. Readiness of the health system was a significant (AOR=1.06, 95%CI: 1.003-1.142, p=0.04) predictor of active NHIS membership. For Ghana to accelerate its progress and get its PHC system more ready towards attaining UHC, it needs to invest more in the various components of the two composites for measuring progress of UHC and health system readiness.Item Assessing Primary Health Care Progress And Readiness Towards The Attainment Of Universal Health Coverage: The Case Of The Volta And Oti Regions Of Ghana(University Of Ghana, 2021-12) Apanga, S.Universal Health Coverage (UHC) involves the provision of quality health services without the need for out-of the pocket payments. Implementation of the Community-based Health Planning and Services and the national health insurance scheme (NHIS) which provides health service coverage and financial risk protection respectively to Ghanaians caters for the two critical of dimensions UHC. However there are inadequate metrics for measuring progress of UHC that combines its two dimensions simultaneously and primary health care system (PHC) readiness towards attaining UHC in Ghana hence the need for this study. Repeated cross-sectional surveys of household reproductive aged women and a survey of health facilities were carried out in the Oti and Volta regions of Ghana. Principal Component Analysis was used to develop composite indices for measuring progress of UHC and service readiness towards attaining UHC. Binary logistic regression models were run to assess the effect of the health system readiness on UHC at the population level. The composite for measuring progress of UHC comprised of quality of care, access to health care and active membership of NHIS as its components whilst the composite for measuring the system readiness towards attaining UHC had monitoring of health services; functioning basic equipment; essential medicine; and availability of trained health personnel as its components. There was some progress made towards attaining UHC over a period of time with the lower level of the health care delivery system found to be least ready towards attaining UHC. Readiness of the health system was a significant (AOR=1.06, 95%CI: 1.003-1.142, p=0.04) predictor of active NHIS membership. For Ghana to accelerate its progress and get its PHC system more ready towards attaining UHC, it needs to invest more in the various components of the two composites for measuring progress of UHC and health system readiness.Item Child Sex Work In Accra: Drivers, Characteristics And Coping Mechanisms(University of Ghana, 2019-07) Gaisie-Ahiabu, E.A study was undertaken in certain locations with contextual factors conducive to the sex trade in the capital city of Ghana; Accra. The areas were as follows: Konkomba market, Agbobloshie, Abuja/CMB, Railways, Dome/St Johns, Madina, Okaishie/druglane, Awoshie/Mangoase, Chorkor and Korle Gonno. The objectives of the study were to investigate the characteristics of child sex workers, examine what drives them into the trade, identify the challenges child sex workers encounter and how they cope with the challenges. A conceptual framework was designed to guide the study and three theories; the Eco Developmental Theory, Lifestyle Exposure Theory and the Resilience Theory were used to guide the study. Quantitative and qualitative methods were used for data collection. The Respondent Driven Sampling methodology was used to collect quantitative data from a sample of 220 child sex workers in investigating the characteristics and drivers of child sex work. In-depth interview guides were used to collect qualitative data from 10 child sex workers to ascertain the challenges they faced and how they coped. Analysis of the quantitative data was done by using descriptive and explanatory analysis, cross tabulations and the binary logistic regression. Thematic network analysis was used for the qualitative data. Various findings were made from their socio-demographic characteristics, reasons for engaging in sex work, challenges they faced and their coping mechanisms among other related factors. Results showed that child sex work was rife in the locations investigated and were within the ages of 12-17 years. Majority of the child sex workers were aged between 15-17 years and are Christians, with the bivariate analysis indicating the second highest religious grouping being Muslims who mostly were among the older adolescents aged between 16-17 years. The child sex workers had very minimal educational attainment with almost 87 percent being school drop-outs. Almost all the child sex workers (97.4%) migrated to practice their trade in the locations sampled. The research showed 96 percent of them lived with either both parents, a parent or a relative prior to engaging in the sex trade. Two types of child sex workers were identified; the seaters who are sedentary at a location and the roamers who solicit for clients on the streets and places where clients might be available. Bivariate analysis indicated the roamers are generally younger than the seaters at ages 15-16 and 12-14 years respectively. They have an average of 4-6 clients a day and earn an average of GHc 108.38 (US$ 27) on a good day. Sexual debut was found to be below the legal age of consent of 16 years in Ghana; first sex was between 12-15 years with first birth between 13-16 years. Childhood poverty was identified as a main driver of child sex work as nearly 65 percent reported going to bed without food. They reported encountering challenges in their trade which included abuses (physical, emotional and sexual), indebtedness, refusal of clients to pay for services rendered among others. Certain coping mechanisms were adopted to cope with these challenges. They reduced abuse by keeping to known regular clients, collected money before services, practiced interfemoral to make more money, relied on each other for social support among other strategies including use of drugs to reduce inhibitions in order to stay in the trade despite the challenges. Recommendations were made based on key findings of the study. Key recommendations include strategies to be adopted to keep the girl-child in school, parental irresponsibility should be addressed through legislation and that migration of teenagers especially the girl-child should be curbed nationally.Item Bridewealth Payment And Male-Perpetrated Intimate Partner Violence In Ghana(University of Ghana, 2019-07) Ofori, C.A.E.Physical aggression, psychological mistreatment and sexual abuse against women in intimate unions are public health concerns globally. They constitute infringements on human rights, and are a huge economic burden to nations. Research suggests that individual level factors and women’s subordinate position to men predispose them to male-perpetrated intimate partner violence (IPV). In sub-Saharan Africa where marriages are near universal, little is known about the cultural context within which marriages are arranged and the implications for IPV. Of particular interest, and central to marriage in the sub-region, is bridewealth payment which legitimizes unions and maintains kinship ties. Over time, bridewealth payment has been misconstrued by some to mean that the woman has been bought and is the property of the man. Although this cultural practice is widespread, and has persisted over time, there is little empirical data on the relationship between various aspects of bridewealth payment and IPV. This study examined how bridewealth payment, specifically, whether or not bridewealth has been negotiated and completeness of bridewealth payment, explain men’s attitudes toward wife-beating and actual perpetration of physical violence against women. Using a mixed-methods approach, the study relies on a nationally representative dataset, 2014 Ghana Demographic and Health Survey (survey sample size = 1,893 men), and a population-based study conducted in selected communities in the Eastern Region of Ghana, Bridewealth Payment and Normative Constraints on Women’s Lives in Ghana (survey sample size = 579 men and 16 key informant in-depth interviews). The 2014 Ghana Demographic and Health Survey examined men’s attitudes toward wife-beating while the Bridewealth Payment and Normative Constraints on Women’s Lives in Ghana Study examined men’s self-reported actual perpetration of abuse. The results showed that both men’s approval of wife-beating and self-reported actual perpetration of University of Ghana abuse against female partners were prevalent. While about one in ten men approved of wife-beating, nearly one in five men indicated ever physically abusing their current partners. Bridewealth payment was widespread. A large proportion of men indicated that bridewealth had been negotiated in their current union. With regard to completeness of payment, more than half of the men in both samples reported that bridewealth has been fully paid in their current union. The study showed that the implications of bridewealth payment on male-perpetrated intimate partner violence are complex. Completeness of bridewealth payment did not significantly predict men’s approval of wife-beating, but completeness of bridewealth payment was significantly associated with actual perpetration of abuse. Contrary to previous assertion, men were more likely to have ever beaten their wives when bridewealth has not been paid compared to when bridewealth has been fully paid. Religious affiliation, level of education, type of earning, and ethnicity were significant predictors of men’s attitudes toward wife-beating. The predictors of actual perpetration of abuse by men were religious affiliation, age, duration of marriage, number of children ever born, observing violence as a child, and ethnicity. Key informant interviews also showed that the implications of bridewealth payment on men’s use of violence in intimate unions are multifaceted. All key informants suggested that bridewealth payment does not give the husband authority to use violence against his wife in the union. Bridewealth payment places the man in a position of responsibility, ensuring that his wife and family are safe from harm. Bridewealth is exchanged to honour all stakeholders involved. The social support and control developed when bridewealth is exchanged potentially prevent men from being violent. Rather, the narratives showed that non-payment and partial bridewealth payment are related to conflict and abuse. Couples may argue on issues regarding legitimizing their unions and these are pointers of conflicts. The relative authority of the man may also be challenged with incomplete bridewealth payment, and this has implications on “wounded masculinities”, and hence the use and approval of violence. Further, the narratives showed that when bridewealth is paid the man may reprimand his partner or use violence if the woman does not perform certain duties. Therefore, the study concludes that the practice of bridewealth has vital implications for male-perpetrated IPV. The very practical consequences this important cultural custom has for women’s health and wellbeing cannot be overemphasized. It is necessary to focus on context, bearing in mind cultural norms, in the discourse of IPV and in developing interventions in sub-Saharan Africa if research seeks to reduce violence against women and reduce the health and economic burden of this menace.Item Alcohol Use and Mental Health in Ghana(University of Ghana, 2020-03) Obeng-Dwamena, A.D.Introduction: Previous research has documented an increase in alcohol and mental ill health-related morbidity and mortality globally. They also suggest a positive association between alcohol use and mental disorders in high and limited income countries, which has implications for future morbidity and mortality trends particularly in limited income countries. Despite these, panel and mixed methods studies, which would help to provide a holistic account of alcohol use and mental health and produce stronger evidence to inform interventions are lacking. This thesis therefore sought to examine the association between alcohol use and mental health among adults in Ghana. Methodology: Qualitative and quantitative data were combined. The quantitative data were used to examine associations between alcohol use and depression in a subsample of individuals interviewed in Wave 1 and followed up in Wave 2 of the nationally representative World Health Organization’s Study on Global Ageing and Adult Health (SAGE) Ghana survey. Among the 1499 participants of which 51% were males with mean age of 48.2±13.0 years in Wave 1, 12-month self-reported depression was assessed using DSM-IV diagnostic criteria yielding a composite outcome variable of counts of depressive symptoms. The categorical alcohol use measure comprised of lifetime abstinence, former use (alcohol not consumed 12 months prior to survey), moderate use (≤14 standard drinks for men, ≤7 standard drinks for women) and hazardous use (≥15 standard drinks for men and ≥8 standard drinks for women). Daily counts of standard drinks of alcohol was the second measure of alcohol use. Data were analysed separately for men and women using cross-sectional, panel descriptive statistics, and Poisson multivariate panel regression models with random effects and robust variance specifications. The qualitative data were used to explore community level understandings of alcohol consumption and mental health. The data comprised of transcripts from 30 focus group discussions (FGDs) on alcohol use and mental health from five communities in five regions in Ghana. Transcripts were analysed using thematic network analysis. The ages of FGD participants ranged from 20 to 80 years. Results: Descriptive statistics showed a 39.5% increase in number of depressive symptoms in the total sample with women reporting more symptoms compared to men over time. Although there was a decline in alcohol consumption among men and women over time, alcohol initiation, use (moderate or heavy use) and discontinuation (former use) was higher among the men than women. Cross-sectional multivariate results showed male former, moderate and heavy drinkers and female heavy drinkers having higher counts of depressive symptoms in Wave 1. Panel analysis, which aimed to test bidirectional associations, showed a unidirectional positive relationship between alcohol use and depression after adjusting for both time- variant and invariant confounding variables. Focus Group Discussions (FGD) of participants’ understandings of causes of mental health problems and alcohol consumption bordered on notions of both normal (biological) and abnormal (spiritual) causation. Participants indicated a bidirectional relationship between alcohol use and mental health. Their accounts of subpopulations such as females, persons living with chronic conditions and individuals undergoing stressful life events being predisposed to depression corroborated cross-sectional and longitudinal quantitative findings on depression. Local terms were used to define and describe mental illness and consequences of mental ill health as well as coping strategies adopted in the various communities were indicated. Participants described the socio-cultural context of alcohol use in their communities revealing that alcohol in contemporary times still formed part of social and religious activities in their communities. Further, they explained the causes and outcomes of alcohol consumption. Conclusions: Quantitative results showed an increased prevalence of depression particularly among females, heavy alcohol use among males, as well as both short term and long-term associations between alcohol use and depression therefore requiring increased gender-specific interventions on alcohol use and depression. In addition, qualitative results depicted community members holding dual notions of mental illness causation different from biomedicine, which in turn influenced their coping strategies and health-seeking behaviour. These findings necessitate increased policy interventions on the adoption of healthy lifestyles, enactment and enforcement of regulations on alcohol distribution, sale and use and collaborations between orthodox and traditional medicine to meet the needs of persons with poor mental health.Item Childhood Obesity and Psychosocial Wellbeing: A Case Study in University and Achimota Basic Schools, Accra-Ghana(University Of Ghana, 2019-12) Owusu, L.Over the past two decades, the rising rate of obesity in children has become a major global health concern because childhood obesity is not only associated with a higher risk of physical morbidity, but it also increases the risk of weight-related psychosocial complications in children. However, available evidence on the association between obesity and psychosocial wellbeing, especially within the context of developing countries, is scarce. In total, 452 children participated in this study. This study aimed at examining the effect of childhood obesity on the psychological and social wellbeing of children in the University and Achimota Basic Schools in Accra using mixed methods. To determine the prevalence of child obesity in both schools, frequencies, means and percentages of estimated Body Mass Indexes from each respondent was measured. Bivariate analysis was conducted using cross tabulation analyses. Binary logistic regression was conducted to test for the probability of a child having either good or bad psychosocial outcome. The results suggest that the overall prevalence of obesity in both schools was high (8.8%). Children who were overweight were 0.381 times as likely as normal weight children to develop poor psychosocial challenges as compared to normal weight children. Similarly, obese children were 0.418 as likely as normal weight children to develop poor psychosocial outcomes. Again, children who perceived themselves to be plump or very plump were 2.057 times as likely as children who perceived themselves as slim to develop poor psychosocial outcomes. More so, children who belong to the older age group were 1.612 times as likely as children who belong to the younger age group, to be susceptible to poor psychosocial challenges. Lastly, children who attended University of Ghana Basic School were 0.608 as likely as those in Achimota Basic School to develop poor psychosocial outcomes. With regards to the qualitative analysis, 20 children were purposively selected and interviewed. It emerged that obese children experienced psychosocial distress such as name calling, poor academic performance, and social isolation among others. The study recommended that since obesity was high in both schools there was the need for the two schools to strengthen physical education and nutrition-related courses in the curriculum of the students. It was also important to teach children coping skills to overcome psychological stresses created by peers both at home and in school.Item Social Protection Initiatives and Access to Quality Healthcare among Older Persons in Ghana – Evidence from Mampong Municipality(University Of Ghana, 2020-09) Ottie-Boakye, D.Background: Population ageing is a major social issue and has become a public health concern which affects both developed and developing countries. Social protection interventions/initiatives (SPIs) that cover older persons have been implemented in many developing countries to improve household food consumption and reduce out-of-pocket payments in accessing healthcare. To reduce the poverty level, promote financial access to healthcare, and improve their health conditions among older populations, SPIs like the Livelihood Empowerment Against Poverty (LEAP) and the National Health Insurance Scheme (NHIS) have been enacted to create an efficient and safety net. Yet, the extent to which older persons' participation in SPIs influence access to quality healthcare is virtually unknown in most developing countries including Ghana. Objective: This thesis investigated the linkage between social protection initiatives and access to quality healthcare among older persons (60 years and above) in the Mampong Municipality in the Ashanti Region of Ghana. This thesis was premised on two (2) main concepts and theories: Andersen Healthcare Services Utilization Behaviour and the Donabedian's Structure, Process and Outcome models. These were integrated with access to care, and quality of care concepts and theories. Methodology: This study employed a triangulation mixed-method research design comprising of both quantitative and qualitative data collection and analysis in addition to the use of community scorecards. For quantitative research, a structured questionnaire embedded in an electronic device was utilized to collect data from 400 non-institutionalized older persons in the study area. Methods of analyses employed for the quantitative research were descriptive statistics, a multivariable reduction (factor analysis) method, and multiple logistic regression modelling with the help of STATA version 14.0 software. For the qualitative research, a total of eight (8) focus group discussions segmented by sex (male and female) and location (rural and urban) among purposively sampled older persons, and thirteen (13) in-depth interviews with key informants (program planners and implementers, and service providers) were carried out. Interview guides were used for data collection and analysed with Atlas-ti version 7.5.7 software using thematic analysis. Results: About 96.0% of study participants were aware of the existence of at least one form of SPIs in their communities. Overall, 64.5% of the participants were beneficiaries of SPIs. The significant predictors of participating in SPIs were: age, household food security, and place of accessing healthcare service. The generated sub-scales on perceived access to quality of care were adequate service delivery, provider attitude, patient/client dignity, easy accessibility to the facility, and patient autonomy. Further, 63.7% had good perception level about the quality of care accessed as against 36.3% with poor perception. The main promoter of quality healthcare was a good attitude of health staff while drugs perceived to be of low quality was the main barrier. Participating in SPIs did not significantly predict the perceived level of access to quality healthcare (quality of care). Rather, the predictors of access to quality healthcare in the context of SPIs participation were age, household food security, household size, and primary caregiver. Other established factors that influenced this linkage emanated from both the community and institutional levels. Conclusion: Addressing access to quality of care among older persons in the context of SPIs participation requires a multidimensional approach, in addition to strengthening the associated promoters to accessing quality health services. This could contribute to model healthcare for older persons in Ghana, especially in the study setting.Item Bridewealth Payment and Male-Perpetrated Intimate Partner Violence in Ghana(University of Ghana, 2019-07) Ofori, C.A.E.Physical aggression, psychological mistreatment and sexual abuse against women in intimate unions are public health concerns globally. They constitute infringements on human rights, and are a huge economic burden to nations. Research suggests that individual level factors and women’s subordinate position to men predispose them to male-perpetrated intimate partner violence (IPV). In sub-Saharan Africa where marriages are near universal, little is known about the cultural context within which marriages are arranged and the implications for IPV. Of particular interest, and central to marriage in the sub-region, is bridewealth payment which legitimizes unions and maintains kinship ties. Over time, bridewealth payment has been misconstrued by some to mean that the woman has been bought and is the property of the man. Although this cultural practice is widespread, and has persisted over time, there is little empirical data on the relationship between various aspects of bridewealth payment and IPV. This study examined how bridewealth payment, specifically, whether or not bridewealth has been negotiated and completeness of bridewealth payment, explain men’s attitudes toward wife-beating and actual perpetration of physical violence against women. Using a mixed-methods approach, the study relies on a nationally representative dataset, 2014 Ghana Demographic and Health Survey (survey sample size = 1,893 men), and a population-based study conducted in selected communities in the Eastern Region of Ghana, Bridewealth Payment and Normative Constraints on Women’s Lives in Ghana (survey sample size = 579 men and 16 key informant in-depth interviews). The 2014 Ghana Demographic and Health Survey examined men’s attitudes toward wife-beating while the Bridewealth Payment and Normative Constraints on Women’s Lives in Ghana Study examined men’s self-reported actual perpetration of abuse. The results showed that both men’s approval of wife-beating and self-reported actual perpetration of abuse against female partners were prevalent. While about one in ten men approved of wife-beating, nearly one in five men indicated ever physically abusing their current partners. Bridewealth payment was widespread. A large proportion of men indicated that bridewealth had been negotiated in their current union. With regard to completeness of payment, more than half of the men in both samples reported that bridewealth has been fully paid in their current union. The study showed that the implications of bridewealth payment on male-perpetrated intimate partner violence are complex. Completeness of bridewealth payment did not significantly predict men’s approval of wife-beating, but completeness of bridewealth payment was significantly associated with actual perpetration of abuse. Contrary to previous assertion, men were more likely to have ever beaten their wives when bridewealth has not been paid compared to when bridewealth has been fully paid. Religious affiliation, level of education, type of earning, and ethnicity were significant predictors of men’s attitudes toward wife-beating. The predictors of actual perpetration of abuse by men were religious affiliation, age, duration of marriage, number of children ever born, observing violence as a child, and ethnicity. Key informant interviews also showed that the implications of bridewealth payment on men’s use of violence in intimate unions are multifaceted. All key informants suggested that bridewealth payment does not give the husband authority to use violence against his wife in the union. Bridewealth payment places the man in a position of responsibility, ensuring that his wife and family are safe from harm. Bridewealth is exchanged to honour all stakeholders involved. The social support and control developed when bridewealth is exchanged potentially prevent men from being violent. Rather, the narratives showed that non-payment and partial bridewealth payment are related to conflict and abuse. Couples may argue on issues regarding legitimizing their unions and these are pointers of conflicts. The relative authority of the man may also be challenged with incomplete bridewealth payment, and this has implications on “wounded masculinities”, and hence the use and approval of violence. Further, the narratives showed that when bridewealth is paid the man may reprimand his partner or use violence if the woman does not perform certain duties. Therefore, the study concludes that the practice of bridewealth has vital implications for male-perpetrated IPV. The very practical consequences this important cultural custom has for women’s health and wellbeing cannot be overemphasized. It is necessary to focus on context, bearing in mind cultural norms, in the discourse of IPV and in developing interventions in sub-Saharan Africa if research seeks to reduce violence against women and reduce the health and economic burden of this menace.Item Child Sex Work in Accra: Drivers, Characteristics and Coping Mechanisms(University of Ghana, 2019-07) Gaisie-Ahiabu, E.A study was undertaken in certain locations with contextual factors conducive to the sex trade in the capital city of Ghana; Accra. The areas were as follows: Konkomba market, Agbobloshie, Abuja/CMB, Railways, Dome/St Johns, Madina, Okaishie/druglane, Awoshie/Mangoase, Chorkor and Korle Gonno. The objectives of the study were to investigate the characteristics of child sex workers, examine what drives them into the trade, identify the challenges child sex workers encounter and how they cope with the challenges. A conceptual framework was designed to guide the study and three theories; the Eco Developmental Theory, Lifestyle Exposure Theory and the Resilience Theory were used to guide the study. Quantitative and qualitative methods were used for data collection. The Respondent Driven Sampling methodology was used to collect quantitative data from a sample of 220 child sex workers in investigating the characteristics and drivers of child sex work. In-depth interview guides were used to collect qualitative data from 10 child sex workers to ascertain the challenges they faced and how they coped. Analysis of the quantitative data was done by using descriptive and explanatory analysis, cross tabulations and the binary logistic regression. Thematic network analysis was used for the qualitative data. Various findings were made from their socio-demographic characteristics, reasons for engaging in sex work, challenges they faced and their coping mechanisms among other related factors. Results showed that child sex work was rife in the locations investigated and were within the ages of 12-17 years. Majority of the child sex workers were aged between 15-17 years and are Christians, with the bivariate analysis indicating the second highest religious grouping being Muslims who mostly were among the older adolescents aged between 16-17 years. The child sex workers had very minimal educational attainment with almost 87 percent being school drop-outs. Almost all the child sex workers (97.4%) migrated to practice their trade in the locations sampled. The research showed 96 percent of them lived with either both parents, a parent or a relative prior to engaging in the sex trade. Two types of child sex workers were identified; the seaters who are sedentary at a location and the roamers who solicit for clients on the streets and places where clients might be available. Bivariate analysis indicated the roamers are generally younger than the seaters at ages 15-16 and 12-14 years respectively. They have an average of 4-6 clients a day and earn an average of GHc 108.38 (US$ 27) on a good day. Sexual debut was found to be below the legal age of consent of 16 years in Ghana; first sex was between 12-15 years with first birth between 13-16 years. Childhood poverty was identified as a main driver of child sex work as nearly 65 percent reported going to bed without food. They reported encountering challenges in their trade which included abuses (physical, emotional and sexual), indebtedness, refusal of clients to pay for services rendered among others. Certain coping mechanisms were adopted to cope with these challenges. They reduced abuse by keeping to known regular clients, collected money before services, practiced interfemoral to make more money, relied on each other for social support among other strategies including use of drugs to reduce inhibitions in order to stay in the trade despite the challenges. Recommendations were made based on key findings of the study. Key recommendations include strategies to be adopted to keep the girl-child in school, parental irresponsibility should be addressed through legislation and that migration of teenagers especially the girl-child should be curbed nationally.
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