Department of Population, Family and Reproductive Health
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Item A Review of Leadership and Capacity Gaps in Nutrition Sensitive Agricultural Policies and Strategies for Selected Countries in Sub-Saharan Africa and Asia(Food and Nutrition Bulletin, 2020) Aryeetey, R.; Covic, N.Background: Agriculture policies and strategies designed, purposefully, to address malnutrition are considered nutrition-sensitive and are a critical component of global efforts to address malnutrition in all its forms. However, limited evidence exists on the extent and how nutrition is being integrated into agriculture sector policies, strategies, and programs. A review was conducted to address 2 questions: How nutrition-sensitive are agriculture policies, plans, and investments in selected Sub-Saharan African (SSA) and Asian countries? and Which capacity and leadership gaps limit scale up of nutrition-sensitive agriculture Policy and programs? Methods: The review of existing policies was conducted for 11 selected focus countries (9 in SSA and 2 from Asia) of the CGIAR (Consultative Group on International Agricultural Research) Collaborative Research Programme on Agriculture for Nutrition and Health led by the IFPRI (International Food Policy Research Institute). The Food and Agriculture Organization (FAO)’s 10-point key recommendation for designing nutrition-sensitive agricultural interventions was used as an analytical framework. Additionally, a rapid systematic review of published peer-reviewed and grey literature was carried out to identify capacity gaps based on the United Nations Development Program’s capacity assessment framework. Results: We found that there is nutrition sensitivity to the policies and strategies but to varying degrees. There is limited capacity for optimum implementation of these policies, programs, and strategies. For most countries, there is a capacity to articulate what needs to happen, but there are important capacity limitations to translate the given policy/program instruments into effective action. Conclusions: The gaps identified constitute important evidence to inform capacity strengthening of nutrition-sensitive actions for desired nutrition and health outcomes in Africa and Asia.Item Addressing Malnutrition: The Importance of Political Economy Analysis of Power(International Journal of Health Policy and Management, 2020) Walls, H.; Laar, A.; Nisbett, N.; et.alBackground: The exercise of power is central to understanding global health and its policy and governance processes, including how food systems operate and shape population nutrition. However, the issue of power in food systems has been little explored empirically or theoretically to date. In this article, we review previous work on understanding power in addressing malnutrition as part of food systems that could be used in taking this issue further in future food systems research. In particular, we examine why acknowledging power is vital in addressing food systems for better nutritional outcomes, approaches to assessing power in empirical research, and ways of addressing issues of power as they relate to food systems. Methods: We undertook a narrative review and synthesis. This involved identifying relevant articles from searches of PubMed and Scopus, and examining the reference lists of included studies. We considered for inclusion literature written in English and related to countries of all income levels. Data from the included articles were summarized under several themes. Results: We highlight the importance of acknowledging power as a critical issue in food systems, present approaches that can be taken by food-systems researchers and practitioners in assessing power to understand how power works in food systems and wider society, and present material relating to addressing power and developing strategies to improve food systems for better nutrition, health, and well-being. Conclusion: A range of research approaches exist that can inform the examination of power in food systems, and support the development of strategies to improve food systems for better nutrition, health, and well-being. However, there is considerable scope for further work in this under-researched area. We hope that this review will support the necessary research to understand further power in food systems and drive the much-needed transformative change.Item Assessment Of Quality Of Healthcare Among The Elderly Patients Utilising The Korle-Bu Teaching Hospital, Accra(2019-12) Wuaku, D.A.Background: The elderly tend to have a disproportionately high need for utilisation of healthcare services because they exhibit multiple disorders, have limited regenerative abilities, and are prone to diseases, syndromes, and sicknesses. These elderly persons are relatively regular consumers of the Out Patient Department’s care. The seeming lack of provision of suitable and quality healthcare services to the elderly is emerging as one of the main impediments of this era. The fundamental requirement to increase utilisation for the elderly persons is to improve the quality of healthcare services delivered in hospitals. Objective: The study sought to assess the quality of healthcare services among the elderly patients utilising the Korle-Bu Teaching Hospital, Accra. Methods: The study was a descriptive cross-sectional survey using a sequential explanatory mixed methods approach. In the quantitative study, questionnaires were used to elicit information from three hundred and sixty-one (361) elderly persons. Purposive sampling was used to select elderly persons from the seven Out-Patient Departments in the Korle-Bu Teaching Hospital in Accra. Simple random sampling [lottery method] was used to select the elderly persons in the inclusion criteria. The quantitative data was analysed by the use of chi-square test to determine the relationship between the socio-demographic characteristics of the elderly and the variables measuring utilisation of healthcare services (cost, accessibility, health personnel attitude, physical support, information and waiting time). In addition, Ordinal Logistic Regression was used to determine the relationship between the predisposing, enabling and need factors of the elderly and each of the variables measuring utilisation of healthcare services. Furthermore, one-way analysis of variance and Generalised Linear Model were used to examine the socio-demographic characteristics and quality of healthcare. In the qualitative study, purposive sampling method and then convenience sampling method were used to select seventy-six (76) elderly persons from the seven selected Out- Patient Departments. Qualitative study was conducted to obtain an in-depth understanding of the quality of healthcare services by the elderly patients utilising the Korle-Bu Teaching Hospital. Thematic content analysis was used to analyse the data. The interview transcripts were read to identify emerging themes and sub-themes, and were exported into Nvivo version 11 software for data organisation. Quantitative Results: The study showed that, the elderly persons who were accompanied to the health facility were 1.86 times more likely (OR=1.86, 95% CI; 1.13-3.08) to rate accessibility of healthcare services on a higher scale than the elderly persons who visited the hospital by themselves (p=0.016). The elderly who were beneficiaries of NHI were 0.42 times less likely (OR=0.42, 95% CI; 0.18-0.97) to rate accessibility of healthcare services on a higher scale compared with the elderly who were non-beneficiaries (p=0.042). The elderly persons with secondary school education and above were 0.53 times less likely (OR=0.53, 95% CI; 0.34-0.84) to rate cost on utilisation of healthcare services on a higher scale compared with the elderly persons with pre-secondary education (p=0.006). Adjusting for other factors, the elderly persons with multiple chronic conditions were 1.56 times more likely to rate cost on a higher scale compared with the elderly with one chronic condition (OR=1.56, 95% CI=1.04-2.34) (P=0.03). Furthermore, the study reported that, there was a decreasing trend in the rating of quality of healthcare services with increasing number of chronic conditions (p=0.042). The results indicated that both female and male elderly persons regarded quality of healthcare to be the same (p=0.808). Qualitative Findings: The elderly persons described the waiting time as long and stressful. They developed swollen feet and bodily pains due to the long waiting time. They clarified that the diagnostic investigation, medication and consultation fees were expensive, leading to postponement of their subsequent visits and deterioration of their health. Additionally, the elderly persons specified that they woke up very early to report timely at the Out-Patient Departments by means of ‘drop in’ taxi that was very costly. Furthermore, at the Out-Patient Department, they faced cumbersome procedures before seeing the doctors. With respect to the quality of healthcare provided at the hospital, feedback from the health personnel was reported harshly, and they provided negligible physical assistance. The elderly described the seats at the waiting rooms as being very low and uncomfortable. Nevertheless, the elderly persons described the health personnel as skillful and knowledgeable. Unexpectedly, the elderly were satisfied with the healthcare services at the Korle-Bu Teaching Hospital. For the elderly participants, satisfaction meant improvement in their health. Conclusion: Cost was a determining factor in utilising healthcare by the elderly patients. The health personnel were described as being skillful and knowledgeable in providing healthcare. The improvements in the general health of the elderly made them satisfied with healthcare services. Recommendations: The study recommends that policy makers should include elderly persons from age 60 years to 69 years in the National Health Insurance exemption policy to enable the majority of them to utilise the healthcare services. Additionally, there is the need to review visits to the healthcare units to schedule time appointments to reduce the long and stressful waiting time. .Item Assessment of the Implementation of the Home Visiting Strategy: A Case Study of Maternal and New Born Health Care in the Ga South Municipality of Ghana(University Of Ghana, 2017-07) Chandi, M.G.Background: Home visiting has been the pivot of both the Primary Health Care (PHC) and currently the CHPS concepts in the Ghana Health Service; yet there is little information on how the home visit strategy improves maternal and new born health. This study aimed at assessing the implementation of the home visiting strategy and its effect on maternal and newborn health care in the Ga South Municipality in Ghana. Methods: A cross sectional study employing mixed methods approach was carried out. Four hundred and fifty three women were interviewed using a structured questionnaire. Four methods (desk review, observation, Key Informant Interviews, and two Focus Group Discussions) were used in the qualitative aspect. The quantitative data was analysed in SPSS version 22 using descriptive statistics for the background characteristics. Chi Square test was used to determine the association between ANC 4+ visits, Post natal coverage and the home visit strategy on one hand; and on the other, infection prevention and exclusive breastfeeding and the home visiting strategy. Nvivo version 11 was used to analyse the qualitative study. Triangulation of data from the quantitative and qualitative studies was done resulting in a synthesised and synergized document. Results: About 51% of respondents had not seen home visit service providers in their communities. All the respondents agreed that the heavy workload of the Community Health Officers (CHOs) makes it difficult for them to conduct home visiting. The social network of clients influenced responsiveness to home visiting services. Fifty seven percent of respondents felt socio economic status of clients do influence home visiting services but there was not enough statistical evidence to conclude. Geographical access and availability of social amenities did not statistically influence home visiting services. The home visiting strategy is more beneficial to neonates than to pregnant women Conclusion: There are intervening factors that influence home visiting service delivery. Ensuring the availability and managing the workload of service providers could enhance home visiting services. The social networks of clients are valuable resources home visit service providers need to take advantage of.Item Availability and Utilization of Health Care Services and the Health-Related Quality of Life of Older Adults in Greater Accra(University Of Ghana, 2018-07) Eliason, C.Background Although ageing is a desired phenomenon, it is associated with health-related challenges which affect the quality of life of older adults. These increase the demand for health care services as a growing number of older people are living with chronic diseases and disabilities. This study assessed the availability and utilization of health care services and the health-related quality of life of older adults living in Greater Accra region in Ghana. Methods It was a cross-sectional study using quantitative and qualitative approaches. The survey involved a total of 500 older adults aged 60 years and above, residing within the catchment areas of six selected health facilities in Greater Accra and assessed the factors influencing utilization, health-seeking behaviour, and health-related quality of life. The qualitative aspect explored the availability of health care services for older persons through key informant interviews with eleven curative and preventive health professionals working in the s ix selected health facilities. Thematic content analysis was employed in the qualitative data analysis. The survey utilized an integrated questionnaire that included health care utilization, health-seeking, and SF-36 Health survey for health-related quality of life among community-dwelling older adults. Descriptive, bivariate and multivariate logistic regression analyses were employed to examine the associations between population characteristics, use of health care services, health-seeking behaviour and health-related quality of life. Results Four major themes emerged from the key informant interviews that included; accessibility of services, availability of special services for older persons, affordability of health services and knowledge of policy for care of older persons. Dedicated services for older adults did not exist. However, some general curative and preventive services were available in the existing formal health system. Also, knowledge of the existence of a policy framework for older persons was inadequate among health workers. Utilization of healthcare was good (65%) among older adults. Determinants of utilization were age, residential status, source of income, employment, benefit from government, health status rating and diagnosed with chronic disease. Majority of the respondents (89%) intended to seek treatment from the hospital and did so when they fell sick. Employment status of the older person influenced their health-seeking behaviour. The overall health-related quality of life was good (mean score 57.5) despite the low physical health component score (43.8). The predictors of overall health-related quality of life were marital status, a rating of current health status, diagnosed with chronic disease and utilization of health care service. Conclusion Dedicated health care services for older adults were not available in the formal health system. Utilization of health care services was good. Majority of older adults sought health care from hospitals when they fell ill. Overall health-related quality of life was good, but the physical health functioning was limited. Population characteristics and utilization of health care services were significantly associated with health-related quality of life but health seeking behaviour was not. This study recommends that a dedicated service for the older adults need to be instituted. This may provide the basis for health management of older persons and will also help the central and local government to devise appropriate health intervention strategies to improve and promote the health-related quality of life of older persons. Key words: Older adults, health care service utilization, health seeking behaviour and health related quality of lifeItem Chronic Stress in Pregnancy: Implications on Maternal Mental Health in Lower Manya Krobo Municipality, Ghana(University of Ghana, 2020-07) Letsa, D.P.A.Background: Chronic stress causes adverse effects both physiologically and psychologically. Research indicates that chronic stress during pregnancy may be significantly associated with high levels of antenatal depression and anxiety. Many factors may cause chronic stress for a pregnant woman. Moreover, extant literature indicates that pregnancy itself can be a source of chronic stress and that there are pregnancy-specific stressors that could contribute to depression and anxiety during pregnancy. In Ghana and other parts of sub-Saharan Africa, there are limited scientific data on chronic stress exposure during pregnancy and its implications on maternal mental health outcomes of depression and anxiety. Objective: This study first catalogued the types of chronic stressors and pregnancy-specific stressors and determined the prevalence of these types of stressors. Secondly, it examined the association between chronic stress and (1) antenatal depression and (2) antenatal anxiety. Lastly, it identified factors associated with chronic stress and pregnancy-specific stress. Methods: An analytical cross-sectional study in three health facilities in the Lower Manya Krobo Municipality of Ghana was conducted. Chronic stressors were assessed using survey tools. The Perceived Stress Scale (PSS-14) was administered to determine the prevalence of chronic stress. The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7(GAD-7) scales were used to assess for depression and anxiety respectively. Mean scores of the 3 scales were taken and categorized into levels of stress, anxiety and depression. The Fischer’s exact test was used to test the association between chronic stress, as the main exposure variable, and depression and anxiety and other characteristics. Multivariate logistic regression was used to identify independent predictors of chronic stress, pregnancy- specific stress, depression, and anxiety. Results: A total of 603 women were recruited into the study. Financial (65.9%, n=392), work- related (47.6%, n=287), and marital/relationship (25.2%, n=152) factors were the primary self- reported stressors. Fear of childbirth (61.2%, n=369), fear of giving birth to a child with a congenital anomaly (22.3%, n= 134), were primary pregnancy-specific stressors. The prevalence of stress, depression and anxiety were (49.9%, n= 301), (37%, n=223), and (17.4%, n=105) respectively. After adjustment for maternal socio-demographic and obstetric factors, the logit multivariate regression model revealed that marital status and pregnancy concerns about the ability to care for and nurture the child were predictors of chronic stress and pregnancy-specific stress. Participants who had high chronic stress had 83% increased odds of depression compared to those with lower stress (AOR: 1.83, 95% CI: 1.15-2.9). Depression increased by approximately one and a third times higher (AOR: 1.30, 95% CI: [1.02-1.67]) for each increase in the number of pregnancies a woman had had. For pregnant women who reported fear of birthing a child with a congenital anomaly as a pregnancy-specific stressor, the odds of anxiety were 64% higher (AOR: 1.64, 95% CI: [1.04-2.58]) compared to those who did not report this stressor. Conclusion: Chronic stress in pregnancy is influenced by several critical factors: marital status, education, employment and socioeconomic status. Pregnancy-specific factors like fear of childbirth and fear of a child with a congenital anomaly are key concerns of pregnant women. As hypothesized, chronic stress is a significant contributory factor to antenatal depression and anxiety and its ensuing adverse health outcomes.Item Community-Based Intervention to Prevent Domestic Violence against Women in the Reproductive Age in Northwestern Ethiopia: A Quasi-Experimental Implementation Research(University of Ghana, 2019-07) Demisie, A.S.Background: Violence against women is a devastating public health challenge and a pervasive human rights abuse. Worldwide, a third of women experience domestic violence from either intimate or non-intimate partner in their lifetime. In sub-Saharan Africa region, the prevalence of domestic violence against women is similar with the global picture (36.6%). In Ethiopia, domestic violence against women is a common phenomenon and forms part of women’s life experiences ranging from 19% to 78%. However, there is paucity of translation of existing evidence into community-based intervention, and piloting its implementation applicability and effectiveness in preventing domestic violence against women in Ethiopia. Objective: Assessed the implementation and outcome of a community-based intervention on the prevention of domestic violence against women and its associated factors in Awi Zone, Northwestern Ethiopia. Methods: A community-based quasi-experimental study was conducted using mixed methods to assess domestic violence against women in the Northwestern Ethiopia. Complex probability sampling design and purposive methods were used to recruit study participants for quantitative and qualitative study, respectively. Study participants were assigned into three groups; Intervention, Active comparator, and Control and given the intervention packages. The women in the intervention group received all the intervention packages. These consisted of stakeholder advocacy workshop, community mobilization, training of community agents, house-to-house women’s awareness-creation and participating partners. In the active comparator group, only partners’ participating component was not implemented. The control group were sustained on standard services. A sequential explanatory data collection method was applied for both pre and post intervention surveys. Gathered data were entered into EpiData software and exported into SPSS version 23.0 for analysis. Descriptive, Generalized Linear Models and Difference in Differences (DID) statistical analysis methods were carried out. Statistical associations were reported using adjusted prevalence ratio at 95% confidence interval (CI) and p-value less than 0.05. The qualitative data were transcribed, coded, and thematically analyzed using Nvivo 11. The study protocol was registered on trial registry platform (ClinicalTrials.gov: NCT03265626). Results: The level of domestic violence against women reduced from pre-intervention 48.3% to 40.1% at post-intervention survey. Women’s receptive attitudes towards justified wife-beating reduced from 69.9% to 59.0%. Likewise, women’s receptive attitudes towards inequitable gender-norms between wives and partners declined from 67.6% to 55.9%. In the DID analysis, women’s experience of sexual violence declined by 10% among women in the active comparator group than the control group (DID, -0.10; 95% CI: -0.19, -0.02). Women’s receptive attitude towards justified wife-beating reduced by 17% in the active comparator group compared to the control group (DID, -0.17; 95% CI: -0.26, -0.08). Likewise, women’s receptive attitude towards inequitable gender-norms reduced by 17% in the intervention as compared with the control group (DID, -0.17, 95% CI: -0.26, -0.08). Furthermore, budget constraints, lack of commitment, having community-traditional gender-norms, poor planning, lack of integration and inter-sectoral collaboration were barriers to existing policy implementation to prevent domestic violence against women. The existing community health extension program, women development ‘army’ group, existing policy frameworks, government’s political willingness, presence of school-based gender clubs and development partners were some of the enabling conditions for ensuring the sustainable implementation of domestic violence prevention programs in the study area. Conclusions: The community-based piloted intervention was effective in preventing domestic violence, receptive attitudes towards justified wife-beating and inequity-norms. However, the prevalence of the different forms of domestic VAW were still high. Both women’s receptive attitude towards justified wife-beating and inequitable gender-norms were interlinked factors associated with persistently high domestic violence against women. The community’s receptive attitude is also exhibited by local politicians and or implementers. Community-based intervention was found to be effective, feasible and applicable in reducing domestic violence and its receptive attitudes. The implementation of existing policies to prevent domestic violence against women was poor due to lack of inter-sectoral collaboration, poor integration and stakeholders having competing priorities among others. It is suggested that programs focus on intersectoral collaboration and service integration with existing programs to sustain and synergize domestic violence prevention intervention.Item Continuity and Fragmentation of Antenatal and Delivery Care in the Volta Region of Ghana(University Of Ghana, 2017-03) Dery, S.K.K.Maternal mortality has over the years remained a global health issue with most of the deaths occurring in sub-Saharan Africa. With skilled antenatal care (ANC), many of these deaths can be prevented and as such skilled ANC attendance and skilled delivery have become key global indicators for measuring maternal health programmes across the world. The World Health Organization, until recently (2016) had recommended a minimum of 4 antenatal visits for pregnant women without any medical condition and whose pregnancies were progressing smoothly. This has since been updated to a minimum of 8 ANC contacts for a positive pregnancy experience. Ghana, over the years has been improving on the skilled ANC and delivery indicators with the 2014 Ghana Demographic and Health Survey (GDHS) showing that 87% of the pregnant women received the minimum 4 ANC visits, an increase from the 69% in 2003 while skilled delivery increased from 46% in 2003 to 74% in 2014. However, what remained unanswered is whether these ANC visits were made to several health facilities or to a single facility. In addition, it is unclear whether some pregnant women change their ANC facilities during delivery considering that labour and delivery constitute a critical point in the fight against maternal mortality, since complications during labour and delivery account for most of the maternal deaths in Ghana. In addition, though evidence from other studies show that some pregnant women receive care from multiple facilities, the extent of continuity and fragmentation of care during pregnancy and childbirth have not been quantified in Ghana. This study therefore sought to measure the level of longitudinal continuity and fragmentation of care during pregnancy and childbirth in the Volta Region of Ghana. iv Using National Health Insurance claims data for 2013 in the Volta Region, all the ANC and obstetrics data from all the facilities for the various months were merged into one file, deliveries were identified and classified as cesarean section or vaginal delivery. Visits of all the women that delivered were extracted from the data. Five continuity of care (CoC) indices (MFPC, MMCI, CoC, SECON and PDC) were calculated for each pregnant woman. Extent of repeat visits to each facility (provider continuity) and repeat visits to facilities in a district (district continuity) were calculated to represent the average of the proportion of visits that a facility/district got for all the women who visited the facility/district compared to other facilities/districts that those same women visited. Client-sharing between facilities and districts were identified. Two facilities shared a pregnant woman during ANC if the woman moves from facility of previous visit to the other facility of subsequent visit. A woman is said to have fragmented her care during delivery if she delivers at a facility different from where she sought most of her antenatal care. Five different types of network graphs were constructed using Gephi to help visualize the fragmentation of care among facilities and districts during ANC and delivery. A total of 14,474 pregnant women with a total of 92,095 visits (average of 5 visits per woman) were included in the study with 15.1% delivering by cesarean section (CS). The median maternal age was 27 and those that had CS were slightly older with a median age of 29. Although hospitals constituted 13% of the facilities in the study, they accounted for 73% of all visits and 83% of all deliveries. About 58% of all the pregnant women had perfect CoC: maintaining only one facility throughout ANC and delivery. There were medium to high levels of CoC among the various CoC indices (MFPC: 0.82 ±0.25; MMCI: 0.86 ±0.20; COC: 0.76 ±0.30; SECON: 0.80 ±0.28; PDC: 0.68 ±0.41). In addition, 32% of all the women and v 78% of those that visited multiple facilities made less than three quarters of their visits to the most frequently visited facility. The average provider (facility) continuity and district continuity in the region were 67% and 81% respectively and varies by districts and type of provider. About 19% of all subsequent visits, 26% of all deliveries, 32% of all CS deliveries, 63% of all deliveries by women with multiple facilities, 73% of all CS deliveries by women with multiple facilities were fragmented among facilities. In addition, 15% of all deliveries (36% among those with multiple facilities) and 20% of all CS deliveries (45% among those with multiple facilities) were performed at facilities that the pregnant women did not receive any ANC services from. Nine percent (8.9) of all subsequent visits, 13% of all deliveries, 20% of all CS deliveries and 30.5% of all deliveries by women with multiple facilities were fragmented across districts. In addition, 51.6% of all deliveries performed at facilities that the pregnant women never received ANC services from were fragmented across districts. Despite the high levels of CoC among the pregnant women, there is high fragmentation during the critical period of labour and delivery among those who visited multiple facilities. This situation seems to be exacerbated by the fact that there is high preference for hospital delivery, resulting in high levels of fragmentation of care during delivery among the various care facilities and across districts in the region, and is even more profound in districts that do not have hospitals, with higher proportions of the women moving from these districts to other districts with hospitals for delivery services. There is therefore the need for concerted effort to guarantee continuity and coordination of care throughout the ANC and delivery period by requiring every pregnant woman to have a primary care provider who will be responsible and accountable for coordinating the care that she receives.Item Contraceptive Discontinuation and Switching among Women in the Shai-Osudoku and Ningo Prampram Districts, Ghana(University Of Ghana, 2018-07) Modey, E.J.INTRODUCTION: The intended and continued use of contraceptives is critical for attaining individual reproductive health goals and the prevention of unintended births that may be subject to induced abortions. Women who eventually overcome barriers and adopt a contraceptive method, encounter challenges that result in discontinuation, switching, or method failure. The occurrence of discontinuation for reasons other than the desire to conceive or switching to less effective methods, places women at an increased risk of unintended pregnancies. Identifying the period within which any form of discontinuation or switching is likely to occur and the reasons influencing these, will facilitate the identification of opportunities for providing a more accurate guide to users and encourage the delivery of context–appropriate support to users of family planning services. OBJECTIVE: This study sought to identify the occurrence of contraceptive discontinuation and switching among women in the Shai-Osudoku and Ningo Prampram districts, Ghana. METHODS: Individual in-depth interviews with 20 women reporting for reproductive and child health care services at the district Hospital were undertaken. This was complimented by a retrospective survey of 1,114 women using a structured questionnaire that incorporated the contraceptive calendar to collect reproductive histories. Cox regression and life table analysis was used to estimate discontinuation or switching. RESULTS: All method discontinuation for any reason at 12, 24 and 36 months after starting use were 4%, 18% and 38% respectively. This study identifies increasing age, number of children, use of contraceptives between births, after childbearing and receiving counselling on methods were associated with the reduced risk of contraceptive discontinuation at all times of follow up. A change in marital status and was associated with increased contraceptive discontinuation. At 12 months of use 10% of women discontinued because they are afraid of side effects of contraceptives, this increases to 37% at 24 months of use. Women who expressed fear of side effects of contraceptives had a 60% increase in the hazard of discontinuation at all times of follow up [HR=1.60 95% CI (1.17, 2.20)] whilst women who experienced side effects had a 50% increase in the hazard of discontinuation [HR=1.34; 95% CI (1.04, 1.75)] compared to women who discontinued for any other reason implying dissatisfaction with the method. A reduced need for contraceptives was associated with a 57% increase in the hazard of discontinuation at all times of follow up [HR=1.57; 95% CI (1.22, 2.01)]. Discontinuation of the pill was significantly increased compared to users of the male condom [HR=2.35, 95% CI (1.40, 3.97)] and compared to all other methods [HR=1.68; 95% CI (1.26, 2.25)]. Approximately 39% of switching occurred within the next month of use. Increasing number of children and counselling on methods were associated with a reduction in the hazard of discontinuation. The choice of switching to modern method was associated with an increased hazard at all times of follow up and the male condom was the preferred method for 20% of all switchers. Overall, 3.4% of pregnancies were identified as unintended, with the emergency contraceptive identified as the method with the most failures recorded. CONCLUSION: A reduced need for contraceptives, fear of side effects and the experience of side effects carry an increased risk of discontinuation compared to all other reasons. The strength of the influence that fears of side effects play in method selection, discontinuation and choice of method switched to where switching occurs, is a critical but amenable element if allocated the necessary attention.Item Coping with Assisted Reproductive Technology: Evidence from Clients Seeking Infertility Interventions in Selected Private Health Facilities in Ghana(University Of Ghana, 2018-10) Kyei, J.M.BACKGROUND: Infertility remains a challenge for some couples globally. Recent evidence shows that one in every six couples will face fertility problem in their reproductive age. For the past four decades, Assisted Reproductive Technology (ART) has been an effective intervention for infertility. The complexities associated with the ART presents many challenges to couples including psychological, social, and emotional difficulties. These challenges underscore the relevance of coping particularly during the process of the ART. Objectives: This study therefore sought to understand the challenges associated with ART and the various coping strategies infertile couples adopt when seeking ART. Methods: The study employed convergent parallel mixed method design. Exploratory phenomenological approach and cross-sectional survey were used for the qualitative and the quantitative studies respectively. Overall, 12 women and 6 men participated in the qualitative study, whereas 211 women participated in the quantitative study. The qualitative study employed purposive sampling technique and the quantitative used convenience sampling technique to recruit the respondents. The qualitative data was collected using in-depth interviews and the Ways of Coping questionnaire was used to collect the quantitative data. Analysis of the quantitative data was done using content analysis technique whereas the quantitative data was analysed using the Stata version 14.0. Descriptive statistics such as the mean, frequencies were determined from the quantitative data. Inferential statistics such as Chi-square test of independence, Fishers exact test, one-way analysis of variance and Kruskal Wallis were used to determine association between each of the predictors of coping and levels of coping strategy. Results: The study revealed couples with infertility problems highly value biological children due to social stigmatization about childlessness. Some respondents indicated that they have suffered various forms of psychological, emotional, and social afflictions because of their inability to have their own children. Respondents utilised ART the best alternative solution to infertility problem. Factors such as advanced age of the woman, pressure from families, particularly mothers-in-law, and friends influenced respondents’ uptake of ART. Furthermore, various ART uptake challenges, identified included anxiety about treatment outcome, high cost of ART, and long distance to ART centres. The study respondents used different coping strategies to cope with ART. These included confrontational, distance, self-control, social support, acceptance responsibility, escape-avoidance, problem solving and positive reappraisal coping strategy. The most highly used coping strategy was positive-reappraisal (n = 104, 49.3%). Fertility centre and cause of infertility were the two covariates that were significantly related to overall coping strategy. None of the covariates were associated with the positive reappraisal coping strategy. Conclusions: Having children in marriage in the Ghanaian society is very crucial. Even though ART offers a better solution to infertility, it has its own associated challenges necessitating the adoption of various forms of coping strategies. Given the importance couples attach to biological children, evidence of infertility prevalence in Ghana, Government should consider integrating ART services into the existing obstetric and gynecological facilities to serve as an alternate solution to the challenges of infertility in Ghana. Again, the reproductive health unit of the Ghana Health Service should sensitise the general public about the availability of ART, its effectiveness as well as the associated benefits. This will reduce the negative consequences of childlessness in the Ghanaian society. Given the emotional and psychological challenges reported by the clients in this study, it is recommended that counseling units should be established in these centres to offer services to clients at every stage of the treatment.Item Determinants of Adherence and Treatment Outcomes Among Adolescents Living with HIV in Cameroon(University of Ghana, 2019-07) Bongfen, M.C.Background: Despite over three decades of HIV, its prevalence especially among adolescents remains a public health concern. In 2015, there were more than two million adolescents living with HIV, with a higher proportion coming from sub-Sahara Africa. In Cameroon, there are over 40,000 adolescents living with HIV and there are still concerns about the provision of care to them as adolescents are trapped between paediatric and adult services which are unable to address their specific needs. However, there are limited studies in Cameroon that have examined adherence to antiretroviral treatment and associated factors as well as treatment outcomes among adolescents. It is therefore essential to clearly understand the determinants of adherence of these adolescents and their treatment outcomes. Objectives: The main objective of the study was to assess the determinants of adherence to Anti-Retroviral Therapy and treatment outcomes among adolescents living with HIV in Cameroon. Methods: The study was an analytical cross-sectional Study with a record review component. A total of 460 respondents were recruited from nine health facilities. A systematic random sampling procedure was used to select the required participants. Pretested questionnaires were administered to participants to collect data. The main outcome of interest (adherence) was measured in two ways: self-report adherence, and medication possession ratio (MPR). Three treatment outcome measures that were assessed included viral load suppression, retention in treatment, and CD4 counts. Finally, health facility readiness towards care for adolescents on ARV was assessed using the John Snow Inc. (JSI) tool. Descriptive (frequencies and proportions) and inferential (chi square and multivariate logistic regression) statistical analyses methods were used to analyse the data. Statistical significance was set at p<0.05 at a 95% confidence level. Results: A total of 455 questionnaires were retained and this gave a response rate of 99%. The average age of the adolescents was 14.8years (SD= ±2.9years). There were more females (55%) than males (45%) in the study. A larger proportion of the respondents were on first line treatment (77%) and had been on treatment for an average of five years. Self report adherence was 83% while MPR was 73%. The difference in adherence between self report and the Medication Possession ratio was not statistically significant (p=0.97). Regarding the determinants of adherence, 12 out of 30 independent variables examined showed significant statistical association with adherence at the bivariate level. In multivariable logistic regression analyses however, only two variables significantly predicted adherence, namely experiencing side effects (AOR= 2.63; 95%CI=1.14, 6.09; p = 0.02) and internalized stigma (AOR=2.51; 95%CI =1.04, 6.04; P = 0.04). The major challenges to adherence were stigma (59%) and forgetfulness to take medications (59%) while sending reminder messages and having friendlier health providers were the main suggestions to help improve on adherence. In terms of treatment outcomes, 70% of the respondents had their viral load suppressed. The retention rates were observed to decrease over time: 88%, 72% and 58% at 6months, 12 months and 24 months respectively. All the selected facilities were shown to be ready to receive adolescents into treatment as 7 out of the 9 facilities were in stage 5 of the facility readiness assessment. Conclusion: The determinants of adherence among adolescents are more psychological than the physical characteristics that differentiate them. There is therefore a need for more individual-targeted counselling for adolescents and their guardians to improve adherence levels among adolescents on antiretroviral treatment.Item Diet Quality And Cardiovascular Disease Risk Factors Among People Living With Hiv.(University of Ghana, 2022-10) Abdulai, K.Introduction: With improved life expectancy, people living with HIV (PLHIV) are burdened with cardiovascular diseases (CVD) as a result of prolonged exposure to the traditional risk factors for CVD (smoking, obesity, alcohol, and sedentary lifestyle), and complications associated with HIV infection such as inflammation, endothelial dysfunction, hyper-coagulation, and immune activation. The role of diet and prolonged use of antiretroviral medications (ARVs) in CVD is also well established. Interactions between dietary habits, HIV infection itself, and ART may escalate the risk of developing CVDs among PLHIV. These complex relationships between HIV, diet, and CVD risk factors among PLHIV is yet to be comprehensively studied in Ghana. Aim: To assess diet quality and cardiovascular disease risk factors among ARV-exposed PLHIV. Methodology: A multi-methods study was conducted; a systematic review and meta-analysis, and a facility-based analytical cross-sectional design study. The systematic review and meta-analysis preceded the facility-based analytical cross-sectional study. Cochrane Central, Scopus, PubMed, and Google Scholar databases were systemically searched for papers that compared prevalence of CVD risk factors (diabetes, hypertension, dyslipidemia, and obesity) between PLHIV on ART and PLHIV who are ART-naive in low and middle-income countries (LMIC). Papers that satisfied the inclusion criteria were included in the meta-analysis. Pooled estimates for prevalence were generated using random fixed effects models. The cross-sectional study was conducted among 440 adults living with HIV randomly selected from two hospitals - St. Martins De Porres Hospital and Atua Government Hospital - providing specialized HIV care in the Lower Manya Krobo Municipality of the Eastern Region, Ghana. Medline, Cochrane, A structured questionnaire was administered to collect data on socio-demographic information, and lifestyle factors. Dietary intake of participants was measured with a two-day 24-hour recall of their usual food intake (one weekday and one weekend). Individual Dietary Diversity Score (IDDS) was used to measure diet quality of the participants. Height was measured with a stadiometer calibrated to 1.0 cm. Omron Body Composition Monitor and Scale (Model HBF-516) was used to determine weight, Body Mass Index (BMI), percentage muscle mass, percentage body fat, and visceral fat of the participants. Three measurements of participants’ blood pressure were taken at a minute’s interval in the right arm with participants sitting upright using the Omron HEM 907 oscillometric monitor (Matsusaka, Japan). Lipid Profile and blood glucose were checked using LipidPlus Lipid Profile and Glucose Monitoring System and Blood glucose with OneTouch Select glucometer respectively. Mean and standard deviations of continuous variables were determined. Frequencies and percentages were used to describe categorical variables. Univariate, bivariate, and multivariate analyses were conducted using Chi-square test, independent Student’s t-test, binary logistic regression, and ordinal logistic regression. Statistical significance was set at p < 0.05. Data analyses were conducted using SPSS for windows version 20, and Microsoft Excel 2016. Results: Results from the systematic review and meta-analysis showed an association between ART intake and prevalence of hypertension, dyslipidemia, and obesity among PLHIV (p<0.01 for all). Results from the cross-sectional study showed that proportion of PLHIV with high IDDS (diet quality) was about 14 percent, proportion of those having diet needing improvement was 56 percent, whiles about 30 percent actually had low IDDS (poor diet). Prevalence of cardiovascular risk factors including diabetes, hypertension, and dyslipidemia were found to 20.1%, 33.3%, and 63.5% respectively. The average IDDS (diet quality) was significantly higher among PLHIV whoItem The Effect Of Mobile Health Communication Intervention On Female Teachers’ Knowledge On Cervical Cancer And Cervical Screening Uptake In Accra Metropolis(University Of Ghana, 2022-08) Mustapha, S.A.Background: Cervical cancer is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death among women. Without significant intervention, the global burden is expected to increase to nearly 700,000 cases and 400,000 deaths by 2030, Ninety percent of these occur in sub-Saharan Africa including Ghana. Mobile health is an emerging technology around the world that can be effective in improving knowledge on cervical cancer and cervical cancer screening uptake. Because mobile phone adoption is growing at an exponential rate in low- and middle-income nations, employing mobile phones to promote cervical cancer services might reach a larger number of individuals in resource-constrained settings than traditional healthcare delivery methods. Objective: This study sought to assess the effect of mhealth communication intervention on female teachers’ knowledge on cervical cancer and cervical cancer screening uptake. Methodology: The study employed a cluster randomized design with baseline and endline stages. Multistage cluster randomized sampling was used to select 237 teachers from 61 private and government schools in 4 sub-districts in Accra metropolis. Two cross sectional surveys were carried out at baseline and endline across all intervention arms with control. SMS only (40), WhatsApp (50), SMS+WhatsApp (80) and Control ( 67). Questionnaire was the main tool for data collection. Modified ordinary least square regression(OLS) with Difference in Difference analysis and robust standard error were used to determine the effect of the mhealth communication intervention on cervical cancer knowledge and cervical screening uptake Results: The study assessed the effectiveness of WhatsApp only, SMS only, and WhatsApp + SMS with control on knowledge of cervical cancer and cervical cancer screening uptake. The results showed that, receiving at least one intervention, increased knowledge score on cervical cancer and overall knowledge of cervical screening by 11.5% and 19% respectively(p<0.001). Among the three interventions, WhatsApp text yielded the largest improvement on knowledge. It increased knowledge on cervical cancer by 17.34% (p<0.001), Knowledge on risk factors by 18.26% (p<0.001) and overall knowledge by 17.53% (p<0.001) and the three interventions had a significant effect on knowledge on cervical cancer but did not have significant effect on cervical screening uptake Conclusion This study concludes that SMS and WhatsApp interventions had an impact on knowledge of risk factors of cervical cancer and general knowledge of cervical cancer. However, WhatsApp was the most effective in terms of raising awareness on cervical cancerItem Factors of Rapid Repeat Pregnancy and Its Consequences on Depression among Adolescents in the Greater Accra Region, Ghana.(University Of Ghana, 2018-07) Amuasi, S.A.Rapid repeat pregnancy (RRP) is defined as pregnancy onset within 24 months of the previous pregnancy outcome. RRP has been identified to result from different situations and as such might create different risks to the individual. Several studies have shown an association between RRP and mental health issues such as anxiety, emotional stress, depression, aggression and poorer education attainment. There is a pint-size consensus as to which risk factors are the very key predictors of RRP and whether the outcome (RRP) may lead to depression. This study seeks to identify the main risk factors that could lead to RRP and its consequences on depression among adolescents. METHODS: A mixed method approach (quantitative and qualitative) was used for this study which was conducted in 12 public health facilities in the Greater Accra Region. An unmatched case-control study design was used for the study. The cases were adolescent girls aged between 15 and 19 years who have had more than one pregnancy within two years. Controls were adolescent girls aged between 15 and 19 years who have had one pregnancy which either ended an abortion or delivery with more than twenty-four months spacing. The sample size for the quantitative method was n= 417 with 209 controls and 208 cases. Both the qualitative and quantitative components were hospital-based. Six FGDs were conducted among the control group in six of the selected hospitals and involved a total of forty-six adolescents. Eleven In-depth Interviews (IDI) were also held with every eligible adolescent who had experienced RRP (case) in six of the twelve health facilities selected for the research. STATA 15 MP (StataCorp, College Station, TX, USA) was used to analyze the quantitative aspect of the work. Univariate, bivariate and multivariate logistic regression analyses were conducted with p-value of <0.05 considered as significant. Composite score analysis was used in estimating the level of depression among the participants using Beck’s Depression Inventory scale. The qualitative data were audio recorded, translated into English and transcribed verbatim. Thematic content analysis was adopted for the analysis. Data triangulation was done to support the quantitative data using the qualitative data. RESULTS: There were two outcome variables in the study. The first one was the risk factors for RRP and the second was the effect of RRP on depression. Risk factors for RRP: The median ages at menarche between cases and controls were 12 and 13 years respectively and it was observed that most of the girls who experienced menarche at age 12 years and below were involved in early sexual activity (age at first sexual intercourse) than those who did not. It was also revealed in the study that the number of times a pregnant adolescent visits the hospital for ANC had some form of influence on the risk of RRP. The peers of the adolescents were the main source of information on issues of sex among the cases as compared with the control group. Transactional sex was more common among the cases than the controls. In a univariate analysis variables that showed significance as risk factors for RRP were planning of last pregnancy, history of miscarriage, married or living with partner, parental care, and at least 4 ANC visits. All these variables were significantly associated with odds of RRP. There was an evidence that the odds of RRP for the adolescents who have ever had a miscarriage was about eight times more than that among those who have never had a miscarriage (aOR=7.92; 95%CL: 3.18-19.71; p<0.0001). Effect of RRP on depression: The risk of being depressed among cases were 19% higher than the control group (crude RR=1.19; 95%Cl=0.99 to 1.43; p=0.070). After adjusting for the confounding variables, this increased significantly to 36% higher risk of being depressed (adjusted RR=1.36; 95%Cl=1.11 to 1.67; p=0.003) suggesting an evidence of association between RRP and depression. CONCLUSION: This research has identified the main risk factors of RRP to be, age at menarche, marital status, parental care and support, number of times of ANC visits, sex education and transactional sex. Again the study has investigated the extent to which having subsequent birth in less than 24 months (Rapid Repeat Pregnancy) could adversely affect psychological state of an adolescent mother. The results from this study could provide an insight into designing targeted interventions by policy makers and other stakeholders. Key words: Rapid Repeat Pregnancy, depression, unmatched case-control, mixed method, Antenatal visits transactional sex, menarche, cases, controls.Item Influence Of Temperature On The Growth, Development And Susceptibility Of Anopheles Gambiae (S.L.) Mosquitoes To Pyrethroids.(University of Ghana, 2023-02) Peprah Agyekum, T.Background: Anopheles mosquitoes are responsible for transmitting malaria and lymphatic filariasis. They are among the notable vector species for their crucial role in transmitting malaria. The survival of the vector is of great interest as it affects its ability to transmit diseases. The biology and ecology of mosquitoes are strongly dependent on ambient temperature. The mosquito's life cycle includes four stages: egg, larva, pupa and adult. Indeed, the rearing temperature of the immature stages (egg, larva, and pupa) can significantly impact the completion of the life cycle, the overall fitness of the adult, and ability to transmit disease. In recent years, global warming and possible future warmer climate have prompted many studies to focus on the effects of elevated temperatures on both the morphology and the biology of various species, including vectors. Despite the importance of temperature variability on An. gambiae (s.l.) mosquito's development and survival, there is still the need to explore how and whether or not elevated temperatures associated with climate change is likely to reduce or increase the vector's population dynamics by modifying the life cycle, reduce the efficacy of insecticides, and increase the expression of metabolic enzymes in An. gambiae (s.l.) mosquitoes. Objective: This study aimed to investigate the influence of elevated temperatures on the growth and development of An. gambiae (s.l.) mosquitoes, and the effectiveness of pyrethroid insecticides in such higher temperatures. Methods: Anopheles gambiae (s.l.) eggs were obtained from colonies established in the laboratory and were incubated, hatched and reared under eight temperature regimes (25, 28, 30, 32, 34, 36, 38 and 40 °C) using climate-controlled incubators (RTOP-1000D, Zhejiang, China), with photoperiod of 12:12 (L:D) and 80 ± 10% relative humidity. Larvae were fed 10 mg of TetraFin goldfish flakes (Tetra Werke, Melle, Germany). All adults were fed with a 10% sugar solution soaked in cotton wool. In addition, female mosquitoes used to estimate fecundity and longevity were blood-fed using a guinea pig on day four (4) post-emergence. Larvae were monitored daily for development to the next stage. The time to pupation, pupation success, number of adults produced, and sex ratio of the newly emerged adult was recorded. Molecular identification of An. gambiae (s.l.) mosquitoes was done using polymerase chain reaction (PCR) to identify the composition of sibling species in the An. gambiae complex. Larval survival and adult longevity were monitored every 24 hours, and data were analyzed using Kaplan-Meier survival analysis. Furthermore, analysis of variance (ANOVA) was used to assess the relationship between temperature and development time, time to pupation, length of the gonotrophic cycle, biting rate and fecundity. Kruskal-Wallis test was also used to assess the relationship between temperature and pupation success, pupal mortality, the number of adults produced, and sex ratio. Digital images of larvae, pupae, adult wings and proboscis were captured using stereo microscope with inbuilt camera (Leica EZ4 HD, Leica Microsystems Limited, Switzerland) and body parts were measured using Leica Application Software, version 3.4.0 (Leica Microsystems Limited, Switzerland). Data on larval, and pupal weight and size, adult weight, size and proboscis length were log-transformed and analyzed using ordinary least square (OLS) regression with robust standard errors. In addition, three to five-day-old non-blood-fed An. gambiae (s.l.) mosquitoes were used for insecticide susceptibility test following the WHO bioassay protocol. Batches of 20 – 25 non-blood-fed female adult An. gambiae (s.l.) mosquitoes from each temperature regime (25 – 32 °C) were exposed to two pyrethroid insecticides (0.75% permethrin and 0.05% deltamethrin). The knockdown rate after 60 min and mortality at 24 h were recorded. The levels of four metabolic enzymes (MFO, GST, α-EST and β-EST) were examined in both mosquitoes that were not exposed and those exposed to pyrethroids. mosquitoes and provides helpful information for modelling vector population dynamics in a future warmer climate.Item Institutional Approaches to Research Integrity in Ghana(Science and Engineering Ethics, 2020) Laar, A.K.; Redman, B.K.; Ferguson, K.; Caplan, A.Research misconduct (RM) remains an important problem in health research despite decades of local, national, regional, and international efforts to eliminate it. The ultimate goal of every health research project, irrespective of setting, is to produce trustworthy findings to address local as well as global health issues. To be able to lead or participate meaningfully in international research collaborations, individual and institutional capacities for research integrity (RI) are paramount. Accordingly, this paper concerns itself not only with individuals’ research skills but also with institutional and national policies and governance. Such policies and governance provide an ethical scaffold for the production of knowledge and structure incentives. This paper’s operational definition of research therefore draws from the Institute of Medicine’s articulation of health research as an inquiry that aims to produce knowledge about the structure, processes, or effects of personal health services; and from an existing health systems framework. The paper reviews the research regulatory environment and the ethics apparatus in Ghana and describes a project jointly undertaken by Ghanaian researchers in collaboration with New York University to assess the perceived adequacy of current institutional practices, opportunities, and incentives for promoting RI.Item Moringa Oleifera Leaf Supplementation on Vitamin a Status of Children in Ada-East District of Ghana(University of Ghana, 2015-03) Glover-Amengor, M.; Nyarko, A.; Afari, E.; Aryeetey, R.; University of Ghana, College of Health Sciences School of Public Health Department of Population, Family and Reproductive HealthBackground Globally over 195 million pre-school children are vitamin A deficient, whilst in Ghana, it was estimated that 72 % of pre-school children are vitamin A deficient. Periodic administration of high dose vitamin A capsules is currently used as a prevention strategy, but this requires appropriate healthcare infrastructure and is donor dependent, hence may not be sustainable if donor support is withdrawn. Inadequate dietary intake of vitamin A-rich foods is a major etiological factor in vitamin A deficiency, so one other prevention strategy could be to promote the consumption of these foods. Plant-based foods such as orange-fleshed roots and tubers, fruits and dark green leafy vegetables like Moringa oleifera (M. oleifera) leaves are rich sources of pro-vitamin A carotenoids that could be beneficial to vulnerable populations in low socio-economic households who mostly derive their nutrition from plant sources. M. oleifera leaves have been reported to improve retinol levels in rats. However, there are only anecdotal reports on the ability of M. oleifera leaves to improve retinol levels in humans. There is the need therefore to conduct evidence-based research to assess the effect of M. oleifera leaves on retinol levels in humans. Objective The objective of the study was to assess the efficacy of M. oleifera leaf supplementation to improve the vitamin A status of children in Ada-East district of Ghana. Methods The interventional study was preceded by an assessment of dietary uses of M. oleifera leaves in Ada-East district through a community survey of mothers/caregivers aged 19 years and above, and an acceptability test of M. oleifera leaf-fortified dishes by children in Ada-East district. Thereafter, children aged 5-12 years were randomized to either receive or not receive dried M. oleifera leaves for 9 weeks in three local dishes. The Intervention group (n = 85) consumed M. oleifera leaf-fortified dishes at 0.2 g/kg body weight, three times a week, whilst the Control group (n = 85) consumed the same food without M. oleifera leaves. Vitamin A, haemoglobin, haematocrit, erythrocytes, mean corpuscular volume, kidney and liver chemistry, and infections were assessed at the beginning and end of study. Vitamin A was assessed by high performance liquid chromatography (HPLC). Red blood indices were assessed on EDTA whole blood samples in the laboratory using Sysmex KX - 21N, an automated haematology analyser. Kidney and liver chemistry were assessed with EliTech clinical systems kits. Results One hundred and eighty (79.7 %) of respondents use M. oleifera leaves as a food ingredient in the district, but on an irregular basis, while two hundred and twelve (93.8 %) said they would feed their children when requested to do so, because they learned the leaves would make the children strong. M. oleifera leaf-fortified dishes were also highly acceptable to the children. Leaf supplementation improved retinol levels in the Intervention group significantly (P < 0.05). Those with marginal vitamin A status (serum retinol < 0.7 μmol/l) at baseline showed significant increases at end of study. There was a significant positive association between vitamin A and haemoglobin in the Intervention group (P < 0.05), but not in the Control group. All markers of kidney and liver safety did not show any significant changes at end of study. Conclusion M. oleifera leaf supplementation was efficacious to improve the vitamin A status of children in Ada-East district of Ghana.Item Negative Early Reproductive Health Decisions and Associated Outcomes Among Women in the Northern Region of Ghana(University of Ghana, 2019-03) Iddrisu, M.R.Background: A growing body of demographic and sociological literature indicates that early life decisions and choices individuals make have important health consequences in later life Within reproductive health in particular, a number of studies suggest that early reproductive health decisions that women make have an impact on their reproductive health outcomes in later life. Despite this growing evidence, little understanding exists in Ghana about the relationship between negative early reproductive health decisions of women and later life reproductive health outcomes. Based on a life course perspective, this study aimed to examine the early reproductive health decisions of women and their associated reproductive health outcomes in the northern region of Ghana. Methods: A concurrent mixed methods retrospective study design was conducted to elicit information from married women within the ages of 15-49 years as well as other key informants. Systematic sampling was used to sample a total of 390 married women to take part in the survey. A combination of purposive and snowball sampling was used to select 40 key informants and a total of 130 women between ages 15- 49 with a minimum marriage experience of five years to take part in qualitative focus group discussions, in-depth interviews and key informant interviews. Quantitative data were collected through a face-face interview using structured questionnaires. Qualitative data were collected through focus group discussions, in-depth interviews and key informant interviews using unstructured topic/discussion guides. Descriptive statistical methods were used to describe important characteristics of survey respondents. Bivariate and multivariate logistic regression analyses were performed to examine association between early reproductive health decisions and reproductive health outcomes in later life. Confidence level and statistical significance were set at 95% and a p-value<0.05 respectively. Stata 13 version software was used in the analysis of the quantitative data. Qualitative interviews were audio-recorded, transcribed verbatim and analysed thematically with Nvivo 10 software. Results: Prevalence of early sex (first intercourse before age 16) was 58%, early marriage (union contracted before the age 18) was 30.0% and 80% of respondents did not consent to their marriage partner. About 42% of women have engaged in spousal communication on contraceptives. Also 24% experienced gender-based violence, 25% respondents' ever experienced unintended pregnancy and 44% experienced high fertility. The results from the qualitative study showed that persons who influence negative early Reproductive Health (RI-l) decisions of early sex, early marriage and consent of marriage partner were future partner, fathers of respondents and arranged marriages. Women who married before age 18 (early marriage) were also 3.27 times more likely to experience poor spousal communication relative to those who married between the age bracket of 26 - 36. Also women who had early sex and married early were significantly more likely to experience Gender Based Violence (GBV). The study further established a significant association between respondents experiencing early sex and GBV (p= 0.001). The odds of experiencing GBV were 2.65 times higher among women who first had sex before age 16 years (early sex) compared to those who first had sex between the ages of 16-25. Also of the respondents who had experienced unintended pregnancy, 72.5% (n=71) engaged in early sex (first intercourse before age 16). The odds of experiencing unintended pregnancy was 3.10 times higher among women who had sex before age 16 (early sex) compared to those who had sex between the ages of 16 to 25. Again, 39.8% (n=39) of the respondents who had unintended pregnancy married early. Also 81.6% (n=80) of the respondents who experienced unintended pregnancy did not consent to their marriage partner. Conclusion: The study found evidence linking negative early RH decisions of women to RH outcomes in the adult lives, suggesting that early RH choices affect later life reproductive health outcomes of respondents. These findings suggest that understanding women's current RH outcomes in the northern region requires looking closely at early life decisions which are likely to affect women later in life. Interventions in this direction can considerably improve women's health in the Northern region.Item Parent Training and Parent-Adolescent Communication about Sexuality in Accra Metropolis, Ghana(University of Ghana, 2014-07) Baku, E.A; Sally-Ann, O.; Laar, A.K.; Adanu, R.M.; University of Ghana, College of Health Sciences , School of Public Health , Department of Population, Family and Reproductive HealthBackground: Talking about sexual issues with children is a difficult task for most parents. This is because most parents are not trained to talk to their children about sexual issues. Many parents also lack the knowledge and skills to talk to their children about sexual issues. Evidence shows that intervention studies that trained parents on how to communicate with their children about sexuality have shown positive results. Training parents to talk to their adolescents about sexual issues will reduce sexual risk behaviours among adolescents and young people. Objective: To assess the effects of training parents on parent-adolescent communication about sexuality in the Accra Metropolis, Ghana. Methods: An intervention study which consisted of 138 parent-adolescent pairs from 12 public Junior High Schools in two sub-metropolises in the Accra Metropolis answered baseline survey on parent-adolescent communication on sexual topics and were put into intervention and control groups (intervention group, 73 parent-adolescent pairs in 6 schools; control group, 72 parent-adolescent pairs in 6 schools). Parents and adolescents completed a follow up survey of questionnaires on parent-adolescent discussion about sexual topics three months after the programme. Results: The proportion of parents with very good knowledge increased more in the intervention group (37.0% to 60.0%) than the control group (27.7% to 34.7%). After the training, the parents in the intervention group (30.1% to 82.9%) had better attitudes towards adolescents’ use of reproductive health services than the control group. The proportion of parents in the intervention group who ever discussed sexual topics with their sons increased (60.3% to 88.6%) after the training. Most parents in both in the intervention (54.4%) and control (51.4%) groups would like to start talking to their children about sexual issues when the child is between 10 and 12 years old after the intervention. Mothers discussed more sexual topics with adolescents on all the categories of sexual topics than fathers. Sexual discussions focused mostly on sexual risk protection and risky sexual topics. Conclusion: The training increased the parents’ knowledge about sexuality, their ability and frequency of discussing sexual topics with their children. The training also improved the parents’ attitudes towards adolescent sexual issues. Key words: Adolescents, parents, sexuality, intervention and communication.Item Policy Action Within Urban African Food Systems to Promote Healthy Food Consumption: A Realist Synthesis in Ghana and Kenya(International Journal of Health Policy and Management, 2021) Booth, A.; Laar, A.; Barnes, A.; et.alBackground: Obesity and nutrition-related non-communicable diseases (NR-NCDs) are increasing throughout Africa, driven by urbanization and changing food environments. Policy action has been limited - and influenced by high-income countries. Socioeconomic/political environments of African food systems must be considered to understand what policy might work to prevent NR-NCDs, for whom, and under what circumstances. Methods: A realist synthesis of five policy areas to support healthier food consumption in urban Africa: regulating trade/foreign investment; regulating health/nutrition claims/labels; setting composition standards for processed foods; restricting unhealthy food marketing; and school food policy. We drew upon Ghana and Kenya to contextualize the evidence base. Program theories were generated by stakeholders in Ghana/Kenya. A two-stage search interrogated MEDLINE, Web of Science, and Scopus. Program theories were tested and refined to produce a synthesized model. Results: The five policies operate through complex, interconnected pathways moderated by global-, national- and local contexts. Consumers and the food environment interact to enable/disable food accessibility, affordability, and availability. Consumer relationships with each other and retailers are important contextual influences, along with political/ economic interests, stakeholder alliances, and globalized trade. Coherent laws/regulatory frameworks and government capacities are fundamental across all policies. The increasing importance of convenience is shaped by demographic and sociocultural drivers. Awareness of healthy diets mediates food consumption through comprehension, education, literacy, and beliefs. Contextualized data (especially food composition data) and inter-sectoral collaboration are critical to policy implementation. Conclusion: Evidence indicates that coherent action across the five policy areas could positively influence the healthiness of food environments and consumption in urban Africa. However, drivers of (un)healthy food environments and consumption reflect the complex interplay of socio-economic and political drivers acting at diverse geographical levels. Stakeholders at local, national, and global levels have important, yet differing, roles to play in ensuring healthy food environments and consumption in urban Africa.