Ownership and use of insecticide-treated nets under Ghana's National Malaria Control Program: What are the correlates?

OBJECTIVES: Ghana's National Malaria Control Program distributes free insecticide-treated nets (ITNs) as a malaria control measure. Some households with the ITN do not use it, however. This paper explores the socioeconomic and demographic determinants of ITN ownership and use among Ghanaian families. METHODS: Data on 5741 households were obtained from the 2019 Ghana Malaria Indicator Survey. The survey is a nationally representative survey that obtains data on malaria-related issues. Negative binomial and Tobit regressions were applied to achieve the study's objectives. RESULTS: Residence (rural-urban), wealth, and administrative region emerged as the most important predictors of ITN ownership and usage in Ghana. The results favoured rural and non-Greater Accra residents. However, wealth had a contrasting association with ITN ownership and use. Whereas affluent households owned more ITNs than the extremely poor, the latter used them more. Also, age and household size were significant for ITN ownership. Both variables had a nonlinear (inverted U-shaped) relationship with ITN ownership. In contrast, the proportion of household members under 5 and the bed net-to-household size ratio were positive and statistically significant determinants of ITN use. CONCLUSION: The study highlights the need to effectively target the poor, especially in rural areas, for ITNs under the NMCP instead of universal distribution.

Subscribers' perception of quality of services provided by Ghana's National Health Insurance Scheme - what are the correlates?

BACKGROUND: Ghana's National Health Insurance Scheme (NHIS) has witnessed an upsurge in enrollment since its inception in 2003, with over 40% of the Ghanaian population actively enrolled in the scheme. While the scheme strives to achieve universal health coverage, this quest is derailed by negative perceptions of the quality of services rendered to NHIS subscribers. This paper presents an analysis on perceptions of service quality provided to subscribers of Ghana's NHIS with emphasis on rural and urban scheme policy holders, using a nationally representative data. METHODS: The study used data from the 2014 Ghana Demographic and Health Survey. Ordered logistic regressions were estimated to identify the correlates of perceived quality of care of services rendered by the NHIS. Also, chi-square statistics were performed to test for significant differences in the proportions of subscribers in the two subsamples (rural and urban). RESULTS: Rural subscribers of the NHIS were found to identify more with better perception of quality of services provided by the NHIS than urban subscribers. Results from the chi-square statistics further indicated that rural subscribers are significantly different from urban subscribers in terms of the selected socioeconomic and demographic characteristics. In the full sample; age, out-of-pocket payment for healthcare and region of residence proved significant in explaining perceived quality of services rendered by the NHIS. Age, out-of-pocket payment for healthcare, region of residence, wealth status, and access to media were found to be significant predictors of perceived quality of services provided to both rural and urban subscribers of the NHIS. The significance of these variables varied among men and women in rural and urban areas. CONCLUSION: Different factors affect the perception of quality of services provided to rural and urban subscribers of Ghana's NHIS. Health financing policies geared toward improving the NHIS-related services in rural and urban areas should be varied.

Determinants of cigarette smoking and smoking intensity among adult males in Ghana.

BACKGROUND: In spite of the adverse health and financial implications of smoking, it still remains one of the leading causes of preventable diseases and deaths in the world. Key to discouraging the habit of smoking is knowledge of the drivers of smoking. In Ghana, though smoking behaviours are relatively more associated with adult males than youth and adolescents, studies on smoking behaviours of adult males are scant. This study, therefore, investigates the determinants of cigarette smoking and smoking intensity among adult males in Ghana. METHODS: Data were obtained from the most recent Ghana Demographic and Health Survey (DHS) conducted in 2014. Based on the 2014 GDHS, a negative binomial-logit hurdle model was estimated to explore the socioeconomic and demographic characteristics associated with cigarette consumption and smoking intensity among adult males in Ghana. To ensure robustness, separate estimations were performed for the respective logit and negative binomial models used in the two-part model. RESULTS: We find that men in lower socioeconomic category (poor and low education) have a higher likelihood to smoke. Also, age proved significant in explaining smoking behaviors in Ghana. Moreover, religion and region of residence are reported to affect cigarette consumption decision. Furthermore, we find that among the men who smoke, those between the ages of 44 and 60 years and have attained approximately primary education have a higher likelihood to smoke greater quantities of cigarette daily. Also, the smokers who reside in the Upper East and Upper West regions are reported to smoke more intensely than their counterparts in the Greater Accra region. CONCLUSION: Since smoking remains one of the major causes of diseases and deaths the world over, the current study provides recent empirical evidence based on a nationally representative sample for public health policies geared towards smoking reduction and ultimately cessation. This study suggests that public policies that promote higher educational attainment and improved incomes (wealth) are crucial in smoking reduction and cessation in Ghana.

Correlates of Early Sexual Debut Among Sexually Active Youth in Ghana.

Using the 2014 Ghana Demographic and Health Survey, this study explores the correlates of early sexual debut among 2,746 (males = 670 and females = 2,076) sexually active youth aged 15 to 24 years in Ghana. The results indicate that males aged 15 to 19 years (odds ratio [ OR] = 8.84, p < .001) and who had basic education ( OR = 3.17, p < .001) were significantly more likely to initiate sexual debut early. Urban males who had used modern contraceptive ( OR = 0.35, p < .001) were significantly less likely to initiate early sexual debut. Meanwhile, females aged 15 to 19 years ( OR = 4.26, p < .001); who had used modern contraceptive ( OR = 1.99, p < .001); with no formal ( OR = 2.90, p < .001) or basic ( OR = 3.12, p < .001) education; with partial access to media ( OR = 1.58, p < .01); and from the Akans ( OR = 1.73, p < .001), Ewes ( OR = 1.92, p < .001), and other ethnic groups ( OR = 1.63, p < .001) were significantly more likely to initiate early sexual debut. However, employed females living in rural areas ( OR = 0.70, p < .01) and those with average ( OR = 0.54, p < .01) or rich ( OR = 0.51, p < .01) household living in urban areas were significantly less likely to initiate early sexual debut. Interventions and policies targeting those living in both rural and urban areas are therefore needed for adolescent males and females in their early teens before they start engaging in sexual intercourse.

Consistent condom use among sexually active young adults in Ghana: an analysis of prevalence and associated factors.

Consistent and proper condom use offers a safer, economically cheap and practically effective means of preventing HIV infection. Using the 2014 Ghana Demographic and Health Survey with a sample of 2779 sexually active youth (males = 682 and females = 2,097) in the age range 15-24, this study explored the prevalence of, and factors associated with consistent condom use among sexually active young adults in Ghana. Multivariate logistic regression was used to analyse the data. Our results showed that approximately 11% of the respondents reported consistent condom use in their previous sexual activity. Females were more likely than males to have used a condom consistently. The logistic regression results showed that females who had tested for HIV were less likely to use a condom consistently. However, those who have obtained family planning information from print media and those from the northern part of Ghana were more likely to practise consistent condom use. Furthermore, males who professed the Traditional African religion were less likely to use a condom consistently. In contrast, males in the rich wealth category were more likely to use a condom consistently. These findings underscore the need for behavioural change campaigns targeting young adults, particularly those who are sexually active, to encourage consistent condom use. These interventions should target young adults with less family planning knowledge, those who know their HIV status and those who profess the Traditional African religion.

Socioeconomic determinants of use and choice of modern contraceptive methods in Ghana.

BACKGROUND: The slow pace of fertility decline in Africa relative to other parts of the world has important implications for the region's economic development. Modern contraceptive use is seen as important population control and family planning strategy by governments worldwide. This paper examines the socioeconomic determinants of modern contraceptive use and choice among Ghanaian men and women. METHODS: We use the most recent and nationally representative Ghana Demographic and Health Survey conducted in 2014. The analysis is observational, with no causal implications. Bivariate and multivariate methods are used to analyse the data. We first use logistic regression to explore the correlates of modern contraceptive use among Ghanaian men and women. Second, we explore the socioeconomic factors influencing the choice of modern contraceptive methods among contraceptive users using multinomial logistic regression. We classify the modern methods of contraception into three groups: long-acting reversible contraceptives (LARC), short-acting contraceptives (SAC), and permanent contraceptives. RESULTS: Marital status proves to be the most significant predictor for both men and women, with women in monogamous unions having a greater propensity to use modern methods of contraception (OR = 1.4, p < 0.00). We also find that different factors affect the use and choice of modern methods of contraception among men and women in Ghana. Muslim men had a higher likelihood than Catholics to choose the permanent (sterilisation) method (OR = 11.9, p < 0.05), while their female counterparts were 0.25 times less likely to choose sterilisation over SAC (p < 0.05). Moreover, women who ever tested for HIV had higher use of LAC than the SAC ((RRR = 1.6, p < 0.01). The modern contraceptive users (women) with at most basic education were more likely than those with tertiary education to choose LAC over SAC. Finally, rural women with health insurance were 0.75 times (p < 0.01) less likely to use modern methods of contraception. CONCLUSIONS: The paper reiterates the need to intensify and sustain public health education on the health benefits of using modern methods of contraception among the adult population. The paper suggests that including family planning services on Ghana's national health insurance benefits package is commendable. It can promote modern contraceptive use and curtail unwarranted population growth.