Adolescent sexual and reproductive health literacy needs: a sub-national level assessment in Ghana.

This study assessed young adolescents' access and literacy challenges to sexual and reproductive health information and knowledge gaps in the Effutu Municipality in the Central Region of Ghana. We used a narrative design and a focus group discussion method to glean data from 52 in-school adolescents, aged 11-15. Focus group discussions were conducted using a discussion guide and data were processed using QDA Miner (version 6.0). We analyzed data thematically using an iterative process of data validation, coding and recording. The participants had poor knowledge of the concepts of sexual and reproductive health and its essential domains. Abstinence was the predominant sexual and reproductive health goal of the participants. Yet, many males admitted to having sexual partners. There was difficult linguistic and physical access to structured and safe information. Personal hygiene, signs of sexual maturation and abstinence were the predominant contents available to young adolescents. A revision of adolescent health policies and strategies to embrace actions for improving unrestricted access to easy-to-read educational materials and adolescent health literacy is essential. Creating adolescent corners and introducing peer education in schools within Effutu and other municipalities in the Central Region will be useful.

Literacy-related factors and knowledge of patient rights charter: evidence from nurses in selected hospitals in Ghana.

BACKGROUND: Systems of across the world have developed and implemented patient rights policies to protect and improve the provider-patient relationship. The Patient Charter of Ghana was developed in 2002 to improve service quality and protect patients' rights. However, it is not yet known whether those at the frontline of healthcare delivery can read and understand the contents of the charter. While studies have explored the socioeconomic and institutional level factors related to awareness and knowledge of the Patient Rights Charter, there is a lack of literature on its readability and comprehensibility among nurses. This study assesses nurses' knowledge of the Patient Rights Charter and associated literacy-related factors. METHOD: An exploratory cross-sectional design and quantitative methods were used to collect data on knowledge, comprehension, and readability of the Patient Rights Charter. 205 nurses from four district hospitals in the Central Region were recruited using proportional and total enumeration sampling. Data were collected using structured questionnaires and were processed using SPSS (version 26) and an online text readability consensus calculator (version 2.0). Descriptive and inferential statistical analyses were performed, and data were presented using simple frequencies, readability statistics, and regression output. RESULTS: The results show the charter is written at a higher reading grade level; Flesch-Kincaid Grade Level (13.36), Simple Measure of Gobbledygook (11.57), and Coleman-Liau Readability Index (14.2). The average reading grade level score was 14. The Gunning Fox Index (15.40) and the Flesch Reading Ease Score (34%) show the patient charter is difficult to read and will require at least 14 years of education to be able to read. 87.3% of nurses were able to read and comprehend the charter. Very few (8.3%) read at frustration level. Nurses' actual comprehension of the charter was the only significant predictor of knowledge of the charter. CONCLUSION: Comprehension of the patient charter is an important predictor of its knowledge. The results emphasize the need to enhance the readability and comprehensibility of the charter for providers. Hospitals can stimulate nurses' knowledge of the charter by simplifying the charter's language and deliberately educating nurses on its content.

Determinants of evidence use by frontline maternal, newborn and child health staff in selected health facilities in Ghana.

BACKGROUND: The current paper examines the level of use of evidence and factors affecting the use of evidence by frontline maternal, newborn and child health (MNCH) and reproductive and child health (RCH) staff in practice decisions in selected health facilities in Ghana. METHODS: Data on use of evidence and its correlates was collected from 509 frontline healthcare staff drawn from 44 health facilities in three regions in Ghana. Means were used to examine the level of use of evidence, whiles cross-tabulations and Partial Least Squares-based regression were used to examine factors associated with the use of evidence in practice decisions by frontline MNCH/RCH staff. FINDINGS: The findings suggest a high level of use of evidence by frontline MNCH/RCH staff in practice decisions (score of 3.98 out of 5), albeit that evidence use is skewed towards the use of practice guidelines and policies. For the antecedents of evidence use, attitude had the highest score (3.99), followed by knowledge (3.8), access to evidence (3.77) and organizational structure (3.57), using a threshold of 5. The regression results indicate that attitudes and knowledge of frontline MNCH/RCH staff, organizational structure (strongest association), years of experience, being a male and working in a mission health facility are significantly positive correlated with evidence use, whiles working in a private health facility or in the post-natal clinic is negatively correlated with the use of evidence. CONCLUSION: We argue that any effort to improve the use of evidence by frontline MNCH/RCH staff in practice decisions should focus on improving attitudes and knowledge of staff as well as challenges related to the structure of the organisation. Given however that the score for attitude was relatively high, emphases to improve evidence use should be on access to evidence and organizational structure in particular, which had the lowest score even though it has the strongest association with the use of evidence.

Trends in utilisation and inequality in the use of reproductive health services in Sub-Saharan Africa.

BACKGROUND: The paper argues that unlike the income literature, the public health literature has not paid much attention to the distribution of substantial improvements in health outcomes over the last decade or more, especially, in the Sub-Saharan African (SSA) context. Thus, the paper examines current levels of utilisation, changes in utilisation as well as inequality in utilisation of reproductive health services over the last 10 years in SSA. METHODS: The paper uses two rounds of Demographic and Health Survey (DHS) data from 30 SSA countries (latest round) and 21 countries (earlier round) to compute simple frequencies, cross-tabulated frequencies and concentration indices for health facility deliveries, skilled delivery assistance, 4+ antenatal visits and use of modern contraceptives. RESULTS: The results confirm the fact that utilisation of the selected reproductive health services have improved substantially over the last 10 year in several SSA countries. However, current levels of inequality in the use of reproductive health services are high in many countries. Interestingly, Guinea's pro-poor inequality in health facility delivery and skilled attendance at birth changed to pro-rich inequality, with the reverse being true in the case of use of modern contraceptives for Ghana, Malawi and Rawanda. The good news however is that in a lot of countries, the use of reproductive health services has increased while inequality has decreased within the period under study. CONCLUSION: The paper argue that whiles income levels may play a key role in explaining the differences in utilisation and the levels of inequality, indepth studies may be needed to explain the reason for differential improvements and stagnation or deterioration in different countries. In this way, best practices from better performing countries can be documented and adapted by poor performing countries to improve their situation.

Facilitators and barriers of patient-centered care at the organizational-level: a study of three district hospitals in the central region of Ghana.

BACKGROUND: Improving patient experience of care has gained enormous attention from policy makers and providers of healthcare services in Ghana. In spite of the supposed support for patient-centered care as the means for improving patient experience of care, scientific evidence point to poor patient experience of care in Ghana. Moreover, there seem to be little evidence on organizational-level factors that facilitate or hamper patient-centered care. In this study we assess organizational-level factors that facilitate or impede patient-centered care in three district hospitals in the Central Region of Ghana. METHODS: The study was exploratory research that used qualitative methods to collect data from seven senior managers and 3 junior managers in three district hospitals in the Central Region of Ghana. Data were collected with the aid of an interview guide and a checklist. Data were analyzed using content analysis. RESULTS: Two main Organizational-level factors were identified, namely, facilitators and barriers of patient-centered care. Facilitators to patient-centered care included: 1) Leadership commitment. 2) Leadership support. 3) Training and education for patient-centered care. Patient-centered care barriers identified in the hospitals were: 1) Leadership conceptualization of patient-centered care. 2) Lack of goals and sufficient activities for patient-centered care. 3) Communication related challenges.4) Ownership type. 5) Degree of centralization. 6) Financial constraints. CONCLUSION: Organizational-level factors that promoted patient-centered care were fairly present in the hospitals. Yet, several other factors negatively affected patient-centered care in the hospitals. A suitable patient-focused intervention is recommended for implementation at the health system and institutional-levels to improve patient-centered care. Hospitals managers should develop suitable goals and activities to stimulate patient-centered care with the full participation of hospital employees and patients and families.

Spatial variation in the use of reproductive health services over time: a decomposition analysis.

BACKGROUND: The paper argues that several Sub-Saharan African countries have recorded marked improvements in the use of reproductive health services. However, the literature has hardly highlighted such progress and the factors responsible for them. The current study uses Ghana as a case to examine progress in the consumption of reproductive health services over the last two decades and the factors responsible for such progress. METHODS: The study uses two rounds (1998 and 2014) of Demographic and Health Survey data from Ghana. Standard frequencies, a logit model and decomposition of the coefficients of the logit model (i.e. Oaxaca-type decomposition) was employed to examine changes in the use of reproductive health services (4+ antenatal visits and skilled attendance at birth) at national and sub-national levels (i.e the four ecological zones of Ghana) between 1998 and 2014 as well as factors explaining observed spatial changes between the two periods. RESULTS: Descriptive results suggest that the highest level of improvement occurred in resource-poor zones (i.e. northern belt followed by the southern belt) compared to the middle belt and Greater Accra, where access to resources and infrastructure is relatively better. Results from Oaxaca-type decomposition also suggest that women and partner's education, household wealth and availability and accessibility to health facilities are the key factors explaining spatial variation in reproductive health service consumption over the two periods. Most importantly, the marginal efficiency of investment in women and partner's education and access to health services were highest in the two resource poor zones. CONCLUSION: There is the need to target resource poor settings with existing or new pro-poor reproductive health interventions. Specifically, the northern and southern zones where the key drivers of education and availability of health facilities are the lowest, will be key to further improvements in the consumption of reproductive health services in Ghana.

A review of the process of knowledge transfer and use of evidence in reproductive and child health in Ghana.

BACKGROUND: The paper carries out a situational analysis to examine the production, dissemination and utilisation of reproductive and child health-related evidence to inform policy formulation in Ghana's health sector. METHODS: The study used Wald's model of knowledge production, transfer and utilisation as a conceptual model to collect relevant data via interviews and administration of questionnaire to a network of persons who either previously or currently hold policy-relevant positions in Ghana's health sector. Additional data was also gathered through a scoping review of the knowledge transfer and research utilisation literature, existing reproductive and child health policies, protocols and guidelines and information available on the websites of relevant institutions in Ghana's health sector. RESULTS: The findings of the study suggest that the health sector in Ghana has major strengths (strong knowledge production capacity, a positive environment for the promotion of evidence-informed policy) and opportunities (access to major donors who have the resources to fund good quality research and access to both local and international networks for collaborative research). What remains a challenge, however, is the absence of a robust institutional-wide mechanism for collating research needs and communicating these to researchers, communicating research findings in forms that are friendlier to policy-makers and the inability to incorporate funding for research into the budget of the health sector. CONCLUSION: The study concludes, admonishing the Ministry of Health and its agencies to leverage on the existing strengths and opportunities to address the identified challenges.

Determinants of vaccination decisions and lived experiences of Ghanaians with the COVID-19 pandemic; a qualitative study.

Background: Two years after the WHO declared a state of emergency as a result of the rapid spread of the COVID-19 virus from Wuhan, China, the rate of new infections experienced intermittent flare-ups globally, with vaccinations still ongoing in countries such as Ghana. One year after the implementation of Ghana's COVID-19 vaccine deployment program, Ghanaians have had the opportunity to reflect on their vaccination decisions, albeit the initial vaccine hesitancy. Objectives: The current paper examined the knowledge and lived experiences of Ghanaians during the COVID-19 pandemic, and the factors influencing their vaccination decisions, one year after COVID-19 vaccinations commenced in Ghana, with special focus on the social and geographical histories which influenced their vaccination decisions. Methodology: A qualitative approach using a case study design was used to conduct in-depth interviews among 25 respondents who were 18 years and above, not pregnant, and willing to participate in the study, between 5th and 23rd September 2022. Data was collected in 5 hotspot areas in Ghana with the highest cumulative case counts. A semi-structured interview guide was used to collect data which was analyzed using a thematic approach. Findings: Respondents demonstrated a good level of knowledge on COVID-19 and related vaccines. Fear, panic, and anxiety were some of the experiences lived by respondents during the pandemic. The factors influencing vaccination decisions included conspiracy theories about COVID-19 and related vaccines, subjective notions about the COVID-19 disease, and subjective notions about the vaccine. The type of community one lived in, taboos, and previous successful vaccination programs in the community were geographic factors that informed respondents' decision to vaccinate or not. Social circles, religion, opinion leaders, and media-based campaigns were the social factors that influenced respondents' decision to vaccinate or not.

The level and determinants of COVID-19 vaccine acceptance in Ghana.

OBJECTIVE: As part of the efforts to curb the COVID-19 pandemic, the government of Ghana has received several shipments of approved vaccines, and administration has begun in the country. Studies examining the determinants of COVID-19 vaccine acceptance in Ghana were mostly conducted before the vaccination exercise. Vaccine acceptance decisions however vary with time and hence, peoples' decisions may have changed once vaccines became accessible. This study examines the level and determinants of COVID-19 vaccine acceptance among adult Ghanaians during the vaccination exercise. METHODS: The study was a cross-sectional online survey involving Ghanaian adults (18 years and above) eligible to take the COVID-19 vaccine. The study was conducted from 18th May 2021 to 14th July 2021 and the questionnaire was answered by 362 respondents. Snowball sampling technique was utilized to obtain the respondents. Probit regression analysis was used to identify factors influencing COVID-19 vaccine acceptance. KEY FINDINGS: Only 62.7% of the respondents indicated that they will accept the COVID-19 vaccine if provided. The regression results revealed that the decision to accept the COVID-19 vaccine was influenced by occupation, perceived susceptibility, perceived benefits and attitudes towards the vaccines. CONCLUSION: The findings suggest that government must implement strategies to enhance positive attitudes toward vaccines, increase the risk perception of contracting the virus and also educate the populace about the benefits of the vaccine.

Readiness of Ghanaian health facilities to deploy a health insurance claims management software (CLAIM-it).

INTRODUCTION: Inadequate, inefficient and slow processing of claims are major contributors to the cost of health insurance schemes, and therefore undermining their sustainability. This study uses the Technology, Organisation and Environment (TOE) framework to examine the preparedness of health facilities of the Christian Health Association of Ghana (CHAG) to implement a digital mobile health insurance claims processing software (CLAIM-it), which aims to increase efficiency. METHODS: The study used a cross-sectional mixed method design to collect data (technology and human capital capacity and baseline operational performance of claims management) from a sample of 20 CHAG health facilities across Ghana. While quantitative data was analysed using simple descriptive statistics statistics (frequencies, mean, minimum and maximum values), qualitative interviews were recorded, transcribed and abstracted into two major themes that were reported to re-enforce the quantitative findings. RESULTS: The quantitative results revealed challenges including inadequate computers and accessories, adequate numbers and skills for claims processing, poor intranets and internet access, absence of a robust post-implementation support system and inadequate standard operating procedures (SOPs) for seamless automation of claims processing. In addition to the above, the qualitative results emphasised the need to make CLAIM-it more flexible and capable of being integrated into third-party softwares. Notwithstanding the challenges, decision-makers in CHAG health facilities see the CLAIM-it software as having better functionality and superior capabilities compared to existing claims processing systems in Ghana. CONCLUSION: Notwithstanding the challenges, the CLAIM-it software is more likely to be adopted by decision-makers, given the positive perception in terms of superior functionality. It is important that key actors in claims management at the National Health Insurance collaborate with relevant stakeholders to adopt the CLAIM-it software for claims processing and management in Ghana.

Awareness, knowledge, and attitude toward adverse drug reaction (ADR) reporting among healthcare professionals in Ghana.

Background: Spontaneous reporting systems are the commonest means of reporting adverse drug reactions (ADRs) worldwide. Under-reporting remains a challenge particularly in developing countries among healthcare professionals (HCPs) who are considered the primary stakeholders in the reporting of ADRs. The challenge with studies in countries such as Ghana is that the focus has been on a single professional group or health facility. This study examines the rate of reporting as well as awareness, knowledge, and attitudes toward ADR reporting across professional groups (doctors, nurses, and pharmacist) and selected health facilities (ownership types: government, quasi-government, and private; hierarchy: district, regional, and teaching) in Ghana. Method: A cross-sectional survey was conducted to select and interview 424 healthcare professionals (HCPs) from 8 hospitals in the Greater Accra and Eastern regions of Ghana on issues of ADR reporting, awareness, knowledge, and attitudes toward ADR reporting. Valid responses from 378 HCPs were obtained and analyzed using frequencies and percentages. Findings: The results suggest that about 82.8% of the HCPs interviewed have come across an ADR incidence, but only 52.6% of them have reported such incidence, with pharmacist (66.7%) being the most likely to report. The results further suggest that about 85.8% of HCPs are aware of ADR reporting procedures and display positive attitudes toward same. In addition, the knowledge of HCPs on ADR reporting is low with training being a major area of need. Conclusion: There is the need for healthcare managers and the regulator to pay attention to existing gaps in awareness, attitudes, and most importantly knowledge of HCPs on structures and modalities for ADR reporting. Plain Language Summary: Awareness, knowledge, and attitude toward adverse drug reaction (ADR) reporting among healthcare professionals in Ghana Reporting of unpleasant reactions related to the use of medicinal products has been very low in less developed countries. Studies conducted in Ghana to examine the reporting of unpleasant reactions associated with the use of medicinal products have focused mainly on one health facility or health care provider group. This article examines the level of awareness, knowledge, and attitudes toward the reporting of unpleasant reactions to the use of medicinal products.The authors used a quantitative method to examine the level of awareness, knowledge, and attitude toward reporting of unpleasant reactions to medicinal products. The study was conducted in eight hospitals in Greater Accra and Eastern regions of Ghana using a structured questionnaire. Only 378 out of 424 healthcare providers returned the completed questionnaire.The findings of the study show that 213 of the healthcare providers have encountered at least one patient with an unpleasant reaction to the use of medicinal products, although only 112 reported the unpleasant reactions. Pharmacists were found to be more likely to report unpleasant reactions as 12 out of 18 pharmacists who responded to the questionnaire indicated that they report the unpleasant reactions seen.In addition, 321 of the healthcare providers knew of the reporting procedures for unpleasant reactions to a medicinal product in Ghana. Only 219 healthcare providers knew of the reporting procedures in the facilities in which they worked, however. Furthermore, the knowledge of healthcare providers on the method of reporting is low.

Predictors of satisfaction with child birth services in public hospitals in Ghana.

PURPOSE: The purpose of this paper is to examine the association between experiences during childbirth and satisfaction with childbirth services. DESIGN/METHODOLOGY/APPROACH: A cross-sectional analytical approach using a structured questionnaire and exit interviews was employed to gather data from 885 women who delivered vaginally in two public hospitals. Data were analysed by generating frequencies and chi-square which was used in running a binary logistic regression using a stepwise backward elimination approach. FINDINGS: With a response rate of 78.75 percent the key predictor variables of satisfaction with care were: friendliness of staff (OR = 15.12, p = 0.00); the amount of information provided on the condition and treatment of women (OR = 9.3857, p = 0.007); the feeling of being treated with respect (OR = 3.5581, p = 0.023); and the provision of information about channels of complaint about care (OR = 50.0839, p = 0.000). It is therefore recommended that steps be instituted to improve client-/health worker interpersonal relationships, to improve the amount and quality of information provided to clients, and also to establish formal structures for complaint management in hospitals. RESEARCH LIMITATIONS/IMPLICATIONS: The study sampled only women with vaginal deliveries, considering the fact that women with caesarean deliveries have different experiences. Thus views of those with caesarean deliveries are excluded. ORIGINALITY/VALUE: Several studies have been conducted in Ghana on issues of health service satisfaction and quality, but this is about the first, critically looking at satisfaction with child birth services in Ghana.

Managing healthcare quality in Ghana: a necessity of patient satisfaction.

PURPOSE: The study aims to examine how communication, provider courtesy, support/care, environment of the facility and waiting time significantly predict patients' satisfaction with quality of healthcare in two hospitals located in northern Ghana. DESIGN/METHODOLOGY/APPROACH: An exploratory study of which 324 respondents were selected using stratified and convenient sampling techniques. Results are presented using a multiple regression model. FINDINGS: The results revealed that of the five-factor model, support/care, environment of the facility and waiting time determine patients' satisfaction with quality of healthcare delivery. The explanatory power of the dependent variable was explained by 51 percent. ORIGINALITY/VALUE: The findings suggest that internal and external health sector stakeholders may possibly use this study as a precursor to improve service quality in the two hospitals in particular and others in general.

Improving maternal healthcare utilisation in sub-Saharan Africa through micro-finance.

PURPOSE: This paper aims to examine links between women's access to micro-finance and how they use maternal healthcare services in sub-Saharan Africa (SSA). DESIGN/METHODOLOGY/APPROACH: The authors use theoretical and empirical literature to propose a framework to sustain and improve women's access to maternal healthcare services through micro-financing. FINDINGS: It is found that improved access to micro-finance by women, combined with education may enhance maternal health service uptake. RESEARCH LIMITATIONS/IMPLICATIONS: The paper does not consider empirical data in the analysis. The authors advocate empirically testing the framework proposed in other SSA countries. SOCIAL IMPLICATIONS: It is important to empower women by facilitating their access to education and micro-finance. This has implications for improving maternal healthcare utilization in SSA. ORIGINALITY/VALUE: The paper moves beyond poor access to maternal health services in SSA and proposes a framework for providing sustainable solutions.

Perceived work environment and patient-centered behavior: A study of selected district hospitals in the central region of Ghana.

INTRODUCTION: Quality work environment has been established as a marker of employee value creation. A plethora of qualitative evidence suggested that sustained focus on employee satisfaction through changes in the work environment, communication of patient-centered care strategic vision, management of staff workload, and workplace social support are factors that stimulate Patient-centered care. Yet, it seems that the effect of work environment on the patient-centered behavior of hospital employees has not been statistically estimated, and it is unclear which of the elements of the work environment best predict patient-centered behavior. METHODS: Using a survey design and quantitative methods to gather and analyze data, a sample of 179 respondents from three district hospitals were included in the study using a multi-stage proportional sampling technique. Data were collected using self-administered Likert item questionnaires. Simple linear regression was used to estimate the influence of work environment elements on patient-centered behavior. Stepwise multiple regression was used to determine the best predictors of patient-centered behavior of hospital employees. RESULTS: Perceived internal communication of patient-centered care strategies (ß = 0.23; P<0.001), supervisor support (ß = 0.31; P<0.001), coworker support (ß = 0.50; P<0.001), and working conditions (ß = 0.18; P<0.013) had a positive significant effect on patient-centered behavior of employees. Good predictors of employees' patient-centered behavior were perceived coworker support (ß = 0.51; P<0.001) and job characteristics (ß = 0.16; P<0.01). CONCLUSION: The work environment of hospital employees significantly affects their patient-centered behavior. Co-worker support and job characteristics were the best predictors of the patient-centered behavior of hospital employees. Hospitals Managers seeking to improve patient-centered behavior through employee value creation may consider improved job characteristics in combination with workplace social support and or communication of PCC strategies and goals.

Examining working mothers' experience of exclusive breastfeeding in Ghana.

BACKGROUND: Although substantial evidence exists on factors that influence exclusive breastfeeding, there is a general lack of qualitative studies that examine how specific workplace factors constrain or promote exclusive breastfeeding among working mothers. The current study therefore examines working mothers' experience of exclusive breastfeeding, laying emphasis on the influence of workplace factors on working mothers' decision to exclusively breastfeed their babies. METHODS: The study uses a qualitative research approach and a three-stage purposive sampling procedure to select 20 mothers from 10 organizations in five industries for in-depth interviews on their exclusive breastfeeding experience. Data collected from the interviews were analysed using content analysis, with two major themes emerging for discussion. RESULTS: The results suggest that two major factors influence exclusive breastfeeding among working mothers: practice of exclusive breast feeding (knowledge and understanding of exclusive breastfeeding, and experience in exclusive breastfeeding) and workplace factors (length of maternity leave, closing time, absence of maternity policy in organizations, inadequate institutional support and family work-life balance). CONCLUSION: The results of the study suggest that workplace factors play an equally crucial role in the decision by mothers to exclusively breastfeed their babies. Thus, in the special case of working mothers where breastfeeding prevalence is low, the findings of this study can be crucial in evolving appropriate policies to support working mothers in their effort to exclusively breastfeed their babies.

Perceptions and trends in the use of community pharmacies in Ghana.

OBJECTIVE: To examine the patterns in utilization of community pharmacies and perceptions of the general public towards community pharmacists' role in health services delivery. METHOD: A cross-sectional household survey was conducted in Ga West district. A total of 497 adults (18 years and above) were chosen using a three-stage cluster random sampling technique. information on respondents' contact with community pharmacies (i.e. 12 months prior to the study), reasons for visiting the pharmacies, factors influencing the choice of a particular pharmacy and perception towards community pharmacists' roles were collected. Data collected were analyzed using stata version 14. KEY FINDINGS: Out of the 497 respondents, 415 indicated that they had used pharmacies within the last 12 months prior to the study, while 82 indicated that they had not used the facilities within the same time frame. majority of the pharmacy users (33.7%) visited community pharmacies once a month. Approximately 84% of the pharmacy users frequently visited community pharmacies to get treatment for minor ailments. most users (about 75%) chose to visit a particular pharmacy as it was close to their home/workplace/hospital/clinic. More than half of the pharmacy users identified the pharmacist as the first point of contact in case of any drug-related problem. Less than half of the respondents (44.9%) perceived community pharmacists as health professionals with a good balance between health and business matters. CONCLUSION: The findings of the study suggest that beside the fact that majority of the respondents believe that community pharmacists are responsive, friendlier and have the capacity to handle minor ailments, they are indeed using community pharmacies for the treatment of minor ailments. It will therefore be important to develop appropriate policy and regulations that enables community pharmacies to adequately participate in the delivery of primary care and thereby improve population health.

Socioeconomic determinants of use of reproductive health services in Ghana.

BACKGROUND: The study examines trends in the consumption of reproductive health services (use of modern contraceptives, health facility deliveries, assisted deliveries, first trimester antenatal visit and 4+ antenatal visits) and their determinants using four rounds of Ghana Demographic and Health Surveys (1993, 1998, 2003 and 2008) data. METHODS: The study uses cross-sectional and pooled probit and negative bionomial regressions models to estimate the determinants of use of the above listed reproductive health services for the period from 1993 to 2008. RESULTS: Summary statistics suggest that the above-listed reproductive health services have consistently improved from 1993 to 2008. However, use of traditional methods of contraception increased in urban centers between 2003 and 2008, although the reverse was the case in rural areas. Regression results suggest that place of residence, access to and availability of health services, religion, and birth order are significant correlates of use of reproductive health services. Additionally, the study suggests that the number of living children has the largest effect on use of modern contraception. The effect of a partner's education on use of modern contraception is higher than that of the woman, and a much stronger correlation exists between household wealth and use of reproductive health inputs than expected. CONCLUSION: The study associates the increasing use of traditional contraceptives in urban centers and the much stronger effect of household wealth with urban poverty and the increasing indirect cost of health services, and argues for interventions to improve quality of service in public facilities and reduce inequities in the distribution of health facilities. Finally, the study advocates for family planning-related interventions that involve and target partners given the importance of partner education in the use of modern contraception.