Predictors of maternal mortality in Ghana: evidence from the 2017 GMHS Verbal Autopsy data.

BACKGROUND: Maternal mortality remains a significant public health challenge in many low and middle-income countries, including Ghana. From Ghana's 2017 Maternal Health Survey verbal autopsy data, we examined the predictors of maternal mortality in Ghana. METHODS: A total of 1240 deaths of women aged 15-49 were involved in the survey across all regions in Ghana. Binary and multivariate logistic regression analyses were employed; confidence level was set at 95%. RESULTS: The results show that the prevalence of maternal death was 13.2% (164/1240). After adjusting for potential covariates, women aged 20-29 years (aOR = 4.270, 95%CI= 1.864 - 9.781, p=0.001), bled during labour/delivery (aOR= 0.241, 95%CI = 0.059 - 0.992, p=0.049), and those who used traditional/herbal medicines during pregnancy were more likely to die compared to non-users (aOR= 3.461, 95%CI = 1.651 - 7.258, p=0.001). CONCLUSION: Our findings highlight the need to intensify maternal education regarding the value to be gained by increasing skilled healthcare during complications in pregnancy to allow effective management of complications during labour/delivery. Also, education for pregnant women and their families on possible adverse effects of using unapproved traditional/herbal medicines during pregnancy as well as a need to seek timely care before the onset of labour to allow healthcare providers ample opportunity to address labour and birth complications, is urgently required.

A Mixed-Methods Evaluation of a Community-Based Behavior Change Program to Improve Maternal Health Outcomes in the Upper West Region of Ghana.

BACKGROUND: The Community Benefits Health (CBH) program introduced a community-based behavior change intervention to address social norms and cultural practices influencing maternal health and breastfeeding behaviors in rural Ghana. The purpose of this study was to determine if CBH influenced maternal health outcomes by stimulating community-level support in woman's social networks. METHODS: A mixed-methods study was conducted to evaluate changes in six antenatal/postpartum care, birth attendance, and breastfeeding behaviors in response to the CBH intervention and to assess how the program was implemented and to what extent conditions during implementation influenced the results. RESULTS: We found increases in five of the six outcomes in both the intervention and control areas. Qualitative findings indicated that this may have resulted from program spillover. We considered the dose of exposure to program activities and found that women were significantly more likely to practice maternal health behaviors with increased exposure to program activities while controlling for study area and time. CONCLUSIONS: Overall, we determined that exposure to the CBH program significantly improved uptake of three of the six study outcomes, indicating that efforts aimed at increasing communication across women and their social networks may lead to improved health outcomes.

Mapping the vulnerability of indigenous fruit trees to environmental change in the fragile savannah ecological zone of Northern Ghana.

Following the incidence of environmental change globally and its negative consequences on livelihoods of local populations, vulnerability assessment has become central to mitigation and adaptation response in the global south. However, researches on vulnerability to climate change in the African continent have seldom focused on Indigenous Fruit Trees (IFTs) although they are an essential part of the strategic forest resources and livelihood systems of local communities. This paper explores the vulnerability of two IFTs, shea (Vitellaria paradoxa) and dawadawa (Parkia biglobosa) to climatic and other stressors that are not directly linked to climate change in rural Ghana and the implications for planning. The paper analyzed vulnerability from farmer perspectives elicited through a mixed study design involving the use of Participatory Rural Appraisal (PRA) methods and a household survey. The results reveal that IFTs are highly vulnerable to drought, rainstorms, bushfires and charcoal production and less vulnerable to heavy precipitation, flash floods and sand mining. Such vulnerability arising from the combined effects of multiple stressors has led to a decreasing trend in production and yields of IFTS over the past few decades, adversely affecting livelihoods of rural women and households. To reduce vulnerability, it is an imperative to promote Environmental Change Adaptation Planning (ECAP) that prioritizes conservation and propagation of IFTs, and diversification of rural livelihoods.

The double tragedy of agriculture vulnerability to climate variability in Africa: How vulnerable is smallholder agriculture to rainfall variability in Ghana?

This article analysed vulnerability of smallholder agriculture to climate variability, particularly the alternating incidences of drought and heavy precipitation events in Ghana. Although there is an unmet need for understanding the linkages between climate change and livelihoods, the urgent need for climate change adaptation planning (CCAP) in response to climate change makes vulnerability assessment even more compelling in development research. The data for analysis were collected from two complementary studies. These included a regional survey in the Upper West Region and an in-depth study in three selected communities in the Sissala East District. The results showed that smallholder agriculture is significantly vulnerable to climate variability in the region and that three layers of vulnerability can be identified in a ladder of vulnerability. Firstly, farmers are confronted with the double tragedy of droughts and heavy precipitation events, which adversely affect both crops and livestock. Secondly, farmers have to decide on crops for adaptation, but each option - whether indigenous crops, new early-maturing crops or genetically modified crops - predisposes farmers to a different set of risks. Finally, the overall impact is a higher-level vulnerability, namely the risk of total livelihood failure and food insecurity. The article recommended CCAP and an endogenous development (ED) approach to addressing agriculture vulnerability to climate variability within the framework of decentralisation and local governance in Ghana.

Repackaging exemptions under National Health Insurance in Ghana: how can access to care for the poor be improved?

For the past 10 years the Ghana Government has been trying to replace the old user fee system with an overall health insurance scheme, but one problem of the old system continues to bedevil the new policy: exemption of the poor. This paper presents data from empirical fieldwork and also puts forward an opinion. It discusses how past experiences of user fee exemptions for the poor can inform exemptions under the new 'National Health Insurance Scheme' (NHIS) as a means to ensuring equity in health care. Drawing on a study of exemptions in the three regions of northern Ghana, and utilizing both qualitative and quantitative methods and data, the findings show that exemptions were applied in favour of under-fives, antenatal care, the aged and public servants to the disadvantage of the poor. As a result, the poor had very little access to exemptions. Exemptions therefore failed to address equity concerns in health care, the very reason for which they were introduced. Thus, although the paper acknowledges that provision for the enrolment of the poor into the NHIS is a step in the right direction, it underscores that effective enrolment will be essential for attaining the equity goal of the policy. Informed by past experiences that undermined the equity goal of exemptions, three policy recommendations are put forward for improving exemptions for the poor under the NHIS. These are: (1) effective community education for enhancing premium paying enrolments into the NHIS alongside education on exemptions for the poor; (2) reviewing and clarifying policy guidelines for guiding local-level identification of the poor based on communities' own understanding of poverty; and (3) providing the requisite resources to enable the Department of Social Welfare to discharge its core mandate of identifying the poor for exemptions.