Prevalence and correlates of disability in older adults, Ghana: evidence from the Ghana 2021 Population and Housing Census.

BACKGROUND: Although there are studies on disabilities in older persons, most of these studies have been carried out in developed countries. Hence, there are limited studies on disability in older adults in sub-Saharan Africa, including Ghana. The few studies that have examined the prevalence and correlates of disability in older adults used survey data for their analyses. To contribute to addressing this knowledge gap that has arisen, this study used a national census, the 2021 Ghana Population and Housing Census, to examine the prevalence and correlates of disability in older adults in Ghana. METHODS: The 2021 Ghana Population and Housing Census data was used for this study. A sample size of 197,057 Ghanaians aged 60 years and above was used for this study. The Washington Group questions on disability were used to measure disability by asking older adults about their difficulties in performing the six domains of disability (physical, sight, intellectual, hearing, self-care, and speech). A multinomial logistic regression housed in STATA was used to analyse the correlates of disability in older adults in Ghana. A p-value less than 0.05 was used for statistical significance. RESULTS: The results show that slightly more than one-third (38.4%) of the older adults were disabled. In terms of the number of disabilities in older adults, 16.9% had one disability condition, while 2.4% had six disability conditions. Also, 9.4% had two disability conditions. Older adults who were females, aged 70-79 years and 80 years and above, resided in rural areas, with primary, JHS/Middle, SHS, unaffiliated with religion, ever married and never married, unemployed, and belonged to the middle and rich households were more likely to have a disability condition. Also, older adults residing in the Middle and Northern zones, having no health insurance, and using clean cooking fuel were less likely to have a disability condition. CONCLUSIONS: The results show that socio-demographic and household factors were associated with disability in older adults in Ghana. Hence, policymakers and researchers should target these factors when designing appropriate policies, programmes, and interventions to improve the wellbeing of older adults.

Individual and community-level factors associated with repeat induced abortion among women in Ghana: a multivariable complex sample logistic regression analysis of 2017 Ghana maternal health survey.

BACKGROUND: Repeat induced abortion is a serious public health issue that has been linked to adverse maternal health outcomes. However, knowledge about repeat induced abortion and its associated factors among reproductive age women in Ghana is very scarce. The objective of this study is to examine individual and community factors associated with repeat induced abortion in Ghana which would be helpful to design appropriate programmes and policies targeted at improving the sexual and reproductive health of women. METHODS: We used secondary cross-sectional data from the 2017 Ghana Maternal Health Survey. The study included a weighted sample of 4917 women aged 15-49 years with a history of induced abortion. A multivariable complex sample logistic regression analysis was used to investigate individual and community factors associated with repeat induced abortion among women in Ghana. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) was used to measure the association of variables. RESULTS: Of the 4917 reproductive women with a history of abortion, 34.7% have repeat induced abortion. We find that, compared to women who experience single induced abortion, women who experience repeat abortion are age 25-34 years (AOR:2.16;95%CI = 1.66-2.79) or 35-49 years (AOR:2.95;95%CI:2.18-3.99), have Middle/JHS education (AOR:1.69;95%CI = 1.25-12.27), use contraceptive at the time of conception (AOR:1.48: 95%CI = 1.03-2.14), had sexual debut before 18 years (AOR:1.57; 95%CI: 1.33-1.85) and reside in urban areas (AOR:1.29;95%CI = 1.07-1.57). On the other hand, women who reside in Central (AOR:0.68;95%CI: 0.49-0.93), Northern (AOR:0.46;95%CI:0.24-0.88), Upper West (AOR:0.24; 95%CI: 0.12-0.50) and Upper East (AOR:0.49; 95%CI = 0.24-0.99) regions were less likely to have repeat induced abortion. CONCLUSION: The study showed that both individual and community level determinants were significantly associated with repeat induced abortion. Based on the findings, it is recommended to promote sexual and reproductive health education and more emphasis should be given to adult, those with early sexual debut, those with Middle/JHS education and those who live in urban centers.

Acceptance of COVID-19 vaccine booster doses among the Adult Population in Ghana: a cross-sectional study using the Health Belief Model.

BACKGROUND: The Health Belief Model (HBM) is a widely utilised framework for understanding vaccination behaviour against COVID-19. This study assessed the acceptance of COVID-19 vaccine booster doses in Ghana and identified predictors using HBM domains, including perceived susceptibility, severity, benefits, barriers, self-efficacy, and cues to action. Additionally, it examined the sources of information about COVID-19 vaccines. METHODS: We employed a cross-sectional quantitative design, using convenient and snowball sampling methods to recruit participants. Between March 20 and May 10, 2023, 822 Ghanaians completed a predesigned self-administered online survey via commonly used social media platforms (WhatsApp, Facebook, X (Twitter), and LinkedIn). The study used a binary logistic regression to predict COVID-19 booster dose acceptance. RESULTS: The respondents had a mean age of 29.3 ± 6.2, with 55.5 being males, 53.0% being single/never married, 93.7% having tertiary education, 83.0% being Christians, 59.1% were healthcare workers, 57.8% residing in urban areas, 95.5% having no chronic disease, 90.6% reporting negative COVID-19 history, and 78.3% reporting no reported relative/friend infected with COVID-19. The study showed that 81.1% [95% confidence interval (CI) = 78.4 - 83.8%] of respondents received the COVID-19 vaccine, and 58.3% [95% CI = 54.2 - 62.5%] of respondents were willing to accept the COVID-19 booster dose. The main reasons for non-acceptance of COVID-19 vaccine booster doses were personal reasons (41.7%) and experienced side effects or fear of side effects (32.4%). Regression analysis revealed that perceived benefits and perceived barriers (specifically worrying about serious risk factors) were the significant predictors of accepting COVID-19 booster doses in Ghana. CONCLUSIONS: Many respondents were willing to receive the COVID-19 booster dose. Personal reasons, fear of side effects, and experienced side effects were the main reasons for refusing COVID-19 booster doses. Perceived benefits and perceived barriers predicted COVID-19 booster dose acceptance in Ghana. Policymakers should consider these factors in designing public health interventions to increase the patronage of COVID-19 booster doses.

"You cannot stay with one person once you begin having sex at a young age": the prevalence, correlates and effects of early sexual debut among children in Ghana.

BACKGROUND: Children's initiation of early sex has several negative implications on their sexual and reproductive health, growth and development. In Ghana, few studies on early sexual debut have focused on adolescents. Therefore, this study examined the prevalence, causes, correlates and effects of early sexual debut among children aged 8 to 17 in Ghana using secondary data from the Department of Children of the Ministry of Gender, Children, and Social Protection. METHODS: A convergent parallel mixed-method approach guided the study. Descriptive statistics and multivariable binary logistic regression were used to analyse the quantitative data, while thematic analysis was used to analyse the qualitative data. RESULTS: The study found that the prevalence of early sexual debut among children was 13.2%, which is more predominant among female children. The main causes of early sexual debut include engaging in sex after watching pornography, self-desire to have sex, and being influenced by alcohol consumption. Also, age, sex, education, marital status, religion, ecological zone, living arrangements, and access to the Internet were significant correlates of early sexual debut. Early sexual debut increases children's risk of unwanted pregnancy, which leads to the termination of children's education or induced abortion. Also, early sexual debut had adverse impacts on the wellbeing of pregnant children and increased children's risk of multiple lifetime sexual partners. CONCLUSIONS: This study demonstrated that socio-demographic characteristics of children (e.g., age, sex, education, and marital status) were significant correlates of early sexual debut. Policymakers need to design appropriate interventions, considering the socio-demographic characteristics of children, to curb its occurrence in Ghana.

Use of any contraceptive method among women in rural communities in the eastern region of Ghana: a cross-sectional study.

BACKGROUND: In Ghana, there is an increase in contraceptive use for traditional and modern methods in rural areas. This study seeks to examine the prevalence and determinants of current use of any contraceptive method among women of reproductive age in the rural Eastern Region of Ghana. METHODS: A community-based cross-sectional study was conducted among women of reproductive age in the rural Eastern region of Ghana. A structured questionnaire was used to interview women in rural Lower Manya and Upper Manya Krobo districts of Eastern region who were selected using a simple random sampling technique. The data were analysed using Stata version 16. A Binary logistic regression was used to examine the determinants of current use of any contraceptive use (traditional and modern methods). RESULTS: The prevalence of contraceptive use was 27.8%. In the adjusted analysis of binary logistic regression, contraceptive use was significantly lower (aOR = 0.24; 95%CI = 0.10-0.56; p = 0.001) among respondents aged 41-49 years compared to those aged 18-35 years. Contraceptive use was significantly lower among migrants (aOR:0.53; 95%CI:0.28-0.99; p = 0.048) compared with non-migrant. CONCLUSION: The prevalence of any contraceptive use among rural women was low. Government and other stakeholders need to create awareness about contraception in the rural areas of Eastern region of Ghana and that would help increase contraceptive methods utilization. In addition, family planning programs should target migrants to design an intervention to increase contraceptive use in rural areas.

Partner support and women's contraceptive use: insight from urban poor communities in Accra, Ghana.

BACKGROUND: Despite the benefits associated with contraceptive use, there is a low prevalence of contraceptive use in sub-Saharan Africa and Ghana. Previous studies have partly and consistently attributed the low prevalence of contraceptive use to partner opposition. However, little is known about the influence of men in contraceptive related choices of their partners, particularly within the context of urban poverty. This study examines the influences of partners on women's contraceptive choices. METHODS: The study utilized a cross-sectional household survey data of 1578 currently married women and women in a union of reproductive ages 16-44 years. Women who were pregnant and those trying to be pregnant were excluded from the analysis. The dependent variables for the study were current use of any contraceptive method, types of contraceptive methods and types of modern contraceptive methods. The independent variable for the study was a woman's report of partner support in contraceptive related choices. A binary logistic regression model was used to examine the associations between partner support in contraceptive related choices and contraceptive use of women. RESULTS: The results of the study show that partner support of contraceptive related choices has a significant influence on contraceptive use of women. Women who indicated support from their partners were more likely to be current users of any contraceptive method, yet were less likely to use modern contraceptive methods. CONCLUSION: The study highlights the need to involve men in family planning programs and research, as well as educating them on the various contraceptive modern methods and the side effects.

Covert Contraceptive Use amongst the urban poor in Accra, Ghana: experiences of health providers.

BACKGROUND: An estimated one-third of women in Ghana use contraceptives without the knowledge of their partners, a phenomenon known as Covert Contraceptive Use (CCU). Most research on CCU to date has focused on individual women to the neglect of the role of health system. This study explores CCU in urban poor communities of Accra, Ghana, from the experiences and perspectives of health providers. METHODS: Qualitative in-depth interviews were conducted with health care providers in both the public and private sectors at multiple levels, from the community clinic to the tertiary hospital, to gain insights into the strategies women use and the ways in which the health system supports the practice of CCU. RESULTS: Five major thematic areas emerged: use of easily concealed-methods, discrete-access-and-information-keeping, time-of-day, non-verbal-communication and use of relationships. The study further revealed that fear, mistrust, shyness, myths, and misperceptions regarding contraceptives explain CCU among women in the communities that the providers serve. CONCLUSION: Importantly, disclosure of methods used by providers without women's consent could potentially lead to violent outcomes for both women and the providers. Our results highlight the pivotal role that providers play in confidentially supporting women's choices regarding the use of contraceptives.

Sometimes women use contraceptives without the knowledge of their sexual partners. That is to say, they hide their contraceptive use. Many studies have explored why women hide their contraceptive use. Reasons include the desire of men to have absolute control of their women's bodies including their sexuality and fertility regulation. This occurs in cultures where women do not have as much power as men. In Ghana, as much as one-in-three women hide their contraceptive use from their partners. This study explores the ways in which health facilities assist women to hide their contraceptives use by talking to leaders of units responsible for providing contraceptives in the hospitals. First, people prefer contraceptives like injectables that are not visible on the bodies of those using them. Second, some hospitals have modified their space to provide ample privacy and security for women. Third, some women visit the facilities at odd hours, such as very early in the morning, very late at night and at other favorable times. Sometimes nurses arrange to meet women outside the facility. Lastly, nurses create avenues through various personal relationships. For example, leaving their contacts in market spaces and arranging meeting places with market queens.

"Do we register our deaths?": Motivations and barriers to death registration in Ghana.

Death registration is generally low in sub-Saharan African countries, including Ghana. This study investigated the factors that motivate and serve as barriers in registering for a death certificate. A cross-sectional qualitative study design was used to interview twelve birth and death registration officers in Ghana. The interviews were analysed using Atlas.ti version 7.5. The results show that death registration in Ghana is generally low. Processing of a deceased person's estate emerged as the main motivation for the registration of death. Other motivators included the obligation to register deaths and the requirement of death certificates for burial. The barriers to death registration included the governance system at the cemetery, the hastiness in burying the dead, the perception of cost of death certificates, and less importance attached to death registration. Policymakers should consider these factors in the design of interventions to increase the rate of death registration in Ghana.

Factors associated with rural-urban safe disposal of children stools in Ghana.

INTRODUCTION: The burden of children's disease in many low-and middle-income countries is associated with poor sanitation, including unsafe disposal of children's stool. Infants and toddler stools pose a greater public health risk than adults. Studies on stool disposal in Sub-Saharan Africa (SSA) and Ghana have focused on prevalence, patterns, and associated factors. Nevertheless, these studies have not focused on factors that independently influence rural and/or urban child stool disposal. This study, therefore, examines factors associated with safe child stool disposal in rural areas separately from urban areas towards Ghana's readiness for ending open defaecation by 2030. METHODOLOGY: We examined young children's faecal disposal drawing on the sixth round of the nationally-representative Ghana Multiple Indicator Cluster Survey (MICS) conducted in 2017/18. This study was restricted to children under two years, yielding a sub-sample of 3,476. Responses of caregivers or mothers who disposed of children less than two years faecal matter, their characteristics in addition to the child's age in months were analysed. A binary logistic regression was used to examine the factors associated with the safe disposal of young children's stools. RESULTS: In the aggregated data, only 22% of households, regardless of their residence, dispose of their young children less than two years stools safely. From the disaggregated data, the rural analysis shows that 26% of young children's stools were safely disposed of, compared to 16% in the urban analysis. The urban analysis shows that the child's age, sex and caregiver's marital status were significantly associated with safe disposal of stools. On the other hand, child's age, caregiver listening to radio and household access to improved toilet facilities were significant in the rural analysis. CONCLUSION: The safe practice of stool disposal was very low. The results of this study show that urgent and different policies and strategies are needed to address child stool disposal in urban residences compared to rural residences if we are to meet SDG targets of ending open defaecation.

Prevalence, correlates, and reasons for substance use among adolescents aged 10-17 in Ghana: a cross-sectional convergent parallel mixed-method study.

BACKGROUND: Substance use among adolescents poses significant risks to their health, wellbeing, and development, particularly in low- and middle-income countries, including Ghana. However, little is known about the outlets and reasons for substance use among Ghanaian adolescents. This study examined the prevalence, correlates, reasons for substance use, and outlets of these substances among adolescents aged 10-17 in Ghana. METHODS: Data were obtained from the Department of Children, Ministry of Gender, Children, and Social Protection, Ghana, which employed a cross-sectional convergent parallel mixed-methods technique to collect quantitative and qualitative data from children aged 8-17, parents or legal guardians and officials of state institutions responsible for the promotion and protection of children's rights and wellbeing. Overall, 4144 adolescents aged 10-17 were interviewed for the quantitative data, while 92 adolescents participated in 10 focus group discussions. Descriptive statistics, Pearson's chi-square test, and multivariable binary logistic regression were used to analyse the quantitative data, while the qualitative data was analysed thematically. RESULTS: The prevalence of substance use was 12.3%. Regarding the types of substance use, alcohol (56.9%) and cigarettes (26.4%) were the most common substances. Being a male and currently working are significant risk factors, whereas being aged 10-13, and residing in the Middle- and Northern-ecological belts of Ghana are significant protective factors of substance use. Peers, household members who use substances, drug stores, and drug peddlers are the major outlets. The reasons for substance use were fun, substance as an aphrodisiac, boosting self-confidence, dealing with anxiety, and improved social status. CONCLUSIONS: There is a relatively high substance use among adolescents in Ghana, and this calls for a multi-sectoral approach to addressing substance use by providing risk-behaviour counselling, parental control, and effective implementation of substance use laws and regulations.

Perceptions about COVID-19 preventive measures among Ghanaian women.

Though the advent of COVID-19 vaccines has significantly reduced severe morbidity and mortality, infection rates continue to rise. Therefore, adhering to COVID-19 preventive measures remains essential in the fight against the pandemic, particularly in Africa, where vaccination rates remain low. However, the perceived risk associated with COVID-19 and public education and awareness campaigns has waned over time. COVID-19 vaccine hesitancy is consistently high among women globally. This study, therefore, assessed the facilitators, and barriers to adherence to COVID-19 preventive measures. A qualitative descriptive study was conducted among Ghanaian women. Twenty-seven in-depth interviews were conducted with women in the Greater Accra and Ashanti regions. All interviews were audio-recorded and transcribed verbatim into English. The data were analysed using NVivo 10 software. While some participants found the use of face masks as the easiest, others found it as the most difficult. In addition, institutional and policy decisions such as access to water and the use of public transport impacted individual level adherence to preventive measures. In conclusion, the fight against COVID-19 is not over; hence public education and the provision of facilities that would enhance compliance with preventive measures should continue to be prioritised.

Rural-urban differentials in early childhood education and child development: Evidence from Multiple Indicator Cluster Survey (MICS) in Ghana.

Children's early development is a key component that affects their wellbeing and health as they age. In recent times, scholars' interest in Early Childhood Education (ECE) and Early Child Development (ECD) has grown exponentially. However, rural-urban differentials in early childhood development in sub-Saharan Africa (SSA) and particularly in Ghana are unknown. This study examined the rural-urban differentials in Early Childhood Education (ECE) and Early Child Development (ECD) in Ghana. We used cross-sectional data from 2017/2018 Multiple Indicator Cluster Survey (MICS) by the Ghana Statistical Service. We restricted the data to children aged 3 and 4 years. A sample size of 3683 children was used in this study. Poisson regression analysis was used to examine the relationship between Early Childhood Education (ECE) and Early Child Development (ECD) in rural and urban Ghana. Both ECE and ECD scores were higher in the urban areas than in the rural areas. The regression shows the rural-urban disparity in ECD by ECE. The Preschool Program (ECE) has a good impact on children's early development in Ghana. However, the Relative Risk Ratio (RRR) in rural areas was higher than in urban areas. Beyond this, other factors such as age of child, ecological zone, maternal education and wealth index were associated with ECD. Our findings show a significant disparity in Early Childhood Education and Childhood Development in rural and urban areas This study therefore recommends that more resources be channeled in rural areas to help improve ECE and ECD while policies should be tailored to Early Childhood Education.

Parents' and guardians' acceptability of COVID-19 vaccination for children in Ghana: An online survey.

Few studies have examined the intentions of parents and guardians to vaccinate their children younger than 18 years against COVID-19 in Ghana. Parents are the decision makers for children younger than 18 years; therefore, we examined parents' and guardians' intentions to accept the COVID-19 vaccines for their children. An online survey was conducted among 415 parents and guardians in Ghana. The Statistical Package for Social Sciences version 25 was used to analyse the data. We found that 73.3% of parents/guardians would allow their children to be vaccinated against COVID-19. The binary logistic regression analysis shows that parents/guardians with Senior High School education, those who believed COVID-19 could not be cured, and those who agreed and those who neither agreed nor disagreed with the statement "once the vaccine is available and approved, it would be safe" were less likely to accept COVID-19 vaccine for their children. Also, parents/guardians who neither agreed nor disagreed that "the best way to avoid the complications of COVID-19 is by being vaccinated", those who agreed that "I am of the notion that physiological/natural community is better compared to vaccine-induced immunity" and "I believe the vaccine programming may be likened to the new world order" were less likely to accept COVID-19 vaccine for their children. There is a need for public health practitioners to intensify education on the benefits and side effects of COVID-19 vaccines, as well as provide regular and up-to-date information about vaccines' safety to parents and guardians.

Factors associated with comorbidity of diarrhoea and acute respiratory infections among children under five years in Ghana.

INTRODUCTION: Globally, childhood mortality is an important public health concern. In Ghana, both diarrhoea and acute respiratory infections (ARIs) are among the top five causes of morbidity and mortality among children under five years old (CU5). Yet, there is a paucity of studies on the comorbidity of diarrhoea and ARIs in CU5 in Ghana. AIM: This study sought to examine factors associated with comorbidity of diarrhoea and ARIs among CU5 in Ghana. METHODS: The Ghana Demographic and Health Survey (GDHS) 2014 was used for this study. A total of 932 CU5 who had at least one morbidity were included in the study. Binary logistic regression was used to predict the factors associated with comorbidity among CU5. RESULTS: The prevalence of comorbidity of diarrhoea and ARI among CU5 was 11%. Factors including unimproved source of water, unimproved main floor material, age of child, and initiation of breastmilk were significantly associated with comorbidity of diarrhea and ARI. Improved source of water (AOR = 0.42; 95% CI = 0.22-0.78; p = 0.01) reduces the likelihood of having comorbidity than unimproved source of water. Children aged 36-47 months were less likely (AOR = 0.36; 95% CI = 0.14-0.93; p = 0.04) to have comorbidity than those aged 48-59 months. Also, improved floor materials (AOR = 0.45; 95% CI = 0.22-0.95; p = 0.03) reduces the likelihood of having comorbidity than unimproved floor materials. Children breastfed within the first day of birth were more likely (AOR = 1.66; 95% CI = 1.01-0.2.72; p = 0.04) to have comorbidity than those breastfed immediately after birth. CONCLUSION: Policymakers and health practitioners should consider risk factors such as age of child, initiation of breastfeeding, unimproved floor material, and unimproved water supply in the design of interventions to reduce morbidity and mortality associated with comorbidity of diarrhoea and ARI among CU5.

Is Infant birth weight and mothers perceived birth size associated with the practice of exclusive breastfeeding in Ghana?

INTRODUCTION: Despite widespread advocacy for exclusive breastfeeding, and the associated benefits of exclusive breastfeeding for both infants and mothers, there is low prevalence in both developed and developing countries. Additionally, although several studies have been conducted on exclusive breastfeeding, very few of such studies have linked birth weight and birth size to exclusive breastfeeding. This study seeks to examine the influence of birth weight and birth size on exclusive breastfeeding. METHODOLOGY: This study adopted a sequential explanatory mixed method approach using both quantitative and qualitative methods. The quantitative approach used cross-sectional data from the 2014 Ghana Demographic and Health Survey (GDHS) and the qualitative data from interviews with exclusive breastfeeding mothers from two health facilities in La Nkwantanang Municipal Assembly in Accra, Ghana. Logistic regression analysis was used to examine whether infants birth weight and mothers perceived birth size are associated with the practice of exclusive breastfeeding while the qualitative data provided further insights into the findings from the quantitative analysis. RESULTS: Majority (85%) of the infants in the study were of normal birth weight while 52% of the infants were perceived by their mothers to be of small birth size. The prevalence of exclusive breastfeeding was found to be 54.8%. The birth weight of infants and mothers' perceived birth size were found to be significant predictors of exclusive breastfeeding. Infants of normal birth weight (OR = 7.532; 95% CI: 2.171-26.132) and high birth weight (OR = 6.654; 95% CI: 1.477-29.978) were more likely to be exclusively breastfed compared to low-birth-weight infants. Similarly, infants perceived to be of normal birth size were more likely (OR = 1.908; 95% CI: 1.058-3.441) to be exclusively breastfed compared to infants perceived to be of small birth size. The findings from the qualitative analysis show that birth weight rather than birth size influence mothers' decision to practice exclusive breastfeeding. CONCLUSION: The findings of the study underscore the relevance of infant birth weight and perceived birth size in the practice of exclusive breastfeeding and highlights the need to incorporate both actual measurement of birth weight, and perception of infant's birth size into policies targeted at exclusive breastfeeding. There is the need for deliberate targeted efforts at women who deliver infants of low birth weight and women who perceive their children to be of small birth size to practice exclusive breastfeeding.

Enablers and inhibitors of exclusive breastfeeding: perspectives from mothers and health workers in Accra, Ghana.

BACKGROUND: Despite the health and economic benefits of exclusive breastfeeding, there is evidence of a decline globally and in Ghana. Previous studies addressing this problem are mostly quantitative with only a few of such studies using qualitative or mixed methods to examine the predictors, benefits, ways of improving and managing exclusive breastfeeding, and the challenges associated with exclusive breastfeeding from the perspective of exclusive and nonexclusive breastfeeding mothers, and health workers. This study employs the health belief model to examine the experiences of mothers and health workers regarding exclusive breastfeeding to fill this gap in the literature. METHODS: A cross-sectional qualitative study involving in-depth interviews was conducted among health workers and mothers attending child welfare clinic at two polyclinics in Madina, Accra-Ghana in 2019. Purposive sampling was used to select health facilities and participants for the study. Twenty participants comprising ten exclusive breastfeeding mothers, six non-exclusive breastfeeding mothers and four health workers were interviewed for the study. The data were analyzed based on emerging themes from inductive and deductive coding. RESULTS: The decision to practice exclusive breastfeeding was based on mothers' work, advertisement on exclusive breastfeeding and education on breastfeeding provided by health workers. Insufficient flow of breast milk, pressure from family and friends, and insufficient breast milk for infants were among the reasons for discontinuing exclusive breastfeeding. The factors that help improve exclusive breastfeeding include eating healthy food and breastfeeding on demand, while counselling and monitoring, restricting advertisement on infant formula and granting maternity leave for breastfeeding mothers were identified as factors that can  facilitate the practice of exclusive breastfeeding. CONCLUSION: Different levels of experience affect and shape exclusive breastfeeding practice in Ghana. The decision to practice exclusive breastfeeding, as well as the challenges and strategies employed in managing exclusive breastfeeding, emanates from mothers' personal experiences and interactions with institutional factors. In view of this, there should be counselling on the management of challenges associated with exclusive breastfeeding and provision of accurate information on exclusive breastfeeding to enable mothers practice exclusive breastfeeding.

Facilitators and barriers to COVID-19 vaccine uptake among women in two regions of Ghana: A qualitative study.

Although COVID-19 vaccines are available, evidence suggests that several factors hinder or facilitate their use. Several studies have found gender differences in COVID-19 vaccine uptake, with women less likely to vaccinate than men in many countries, including Ghana. These studies, however, have primarily been quantitative. This study used a qualitative approach to examine the facilitators and barriers to vaccine uptake among women in Ghana. Using a cross-sectional descriptive qualitative research design, 30 women in the Greater Accra and Ashanti regions of Ghana were conveniently sampled and interviewed using a semi-structured interview guide. Fifteen (15) interviews were conducted in each region. The data were transcribed verbatim and analysed thematically using QSR NVivo version 10 software. Among the key factors that facilitate COVID-19 vaccination are the desire to protect oneself and family against COVID-19, education about COVID-19 vaccines, seeing others receive the COVID-19 vaccine, and vaccine being cost-free. On the other hand, long queues at the vaccination centres, fear of side effects, misconceptions about the vaccines, and shortage of vaccines were the main barriers against COVID-19 vaccination. The study results show that individual, institutional, and vaccine-related factors facilitate or hinder COVID-19 vaccination among women. Addressing these factors need continuous comprehensive health education, and ensuring vaccine availability at vaccination sites will improve women's uptake of the COVID-19 vaccines.

Postpartum contraceptive initiation and use: Evidence from Accra, Ghana.

BACKGROUND: Postpartum contraceptive use reduces unintended pregnancies and results in better health outcomes for children and women. However, there is a dearth of knowledge on postpartum contraceptive use in Ghana, particularly among women in low-income urban settings. To shed light on strategies that might enhance access to postpartum family planning services in low-income urban settings, we examined contraceptive use among postpartum women in Accra, Ghana, at 1, 3, 6, and 12 months following the birth and the methods used. The predictors of modern contraceptive use in the 12-month postpartum period were also examined. METHODS: Data come from a cross-sectional survey conducted in 2018 among 624 women aged 16-44 years who reported giving birth in the past 13-31 months prior to the interview. We generated descriptive statistics to examine the prevalence of contraceptive use among postpartum women at 1, 3, 6, and 12 months after birth. We further estimated a binary logistic regression to examine the predictors of modern contraceptive use at 12 months postpartum. RESULTS: Forty percent of postpartum women never used any contraceptive method during 1 year after birth and of those who used a method, 40% relied on traditional methods. Moreover, 29% of women started using a method the immediate 1 month post-birth. Results further show that postpartum modern contraceptive uptake was positively associated with higher education, having more live births, and being currently in a union. CONCLUSIONS: Findings highlight that there may be opportunities to improve the quality of counseling during antenatal and postnatal care visits by clients to ensure fully informed choices regarding postpartum contraception. Community outreach by health providers/promoters or similar models should be promoted in low-income population settings to educate postpartum women on modern contraceptive use. Women who plan to use traditional methods should be provided with information on the consistent and correct use of these methods.

The association between paternal characteristics and exclusive breastfeeding in Ghana.

BACKGROUND: Studies have shown that partners play an influential role in exclusive breastfeeding practice and that they can act as either deterrents or supporters to breastfeeding. However, there are limited studies on the influence of partners' characteristics on exclusive breastfeeding in Ghana. This study examined the association between partners' characteristics and exclusive breastfeeding in Ghana. METHODS: This cross-sectional study used data from the 2014 Ghana Demographic and Health Survey. Infants less than 6 months old (exclusively breastfed or not) with maternal and paternal characteristics were included in the study. A total of 180 participants were used for the study. A binary logistic regression was used to examine the influence of partners' characteristics on exclusive breastfeeding. RESULTS: Partners' characteristics such as education, desire for children, religion, and children ever born were associated with exclusive breastfeeding. Mothers whose partners had primary education (AOR = 0.12; CI 95%: 0.02-0.93; p = 0.04) were less likely to practice exclusive breastfeeding compared to those whose partners had no formal education. Also, mothers whose partners desired more children (AOR = 0.20; CI 95%: 0.06-0.70; p = 0.01) were less likely to practice exclusive breastfeeding compared to those whose partners desire fewer children. CONCLUSION: Improving EBF requires the involvement of partners in exclusive breastfeeding campaigns/programmes. A more couple-oriented approach is required by health practitioners to educate and counsel both mothers and partners on the importance of exclusive breastfeeding in Ghana.