Stress-related experiences and intentions to quit studies among female married postgraduate distance education students in Ghana.

BACKGROUND: Although postgraduate studies have been shown to be associated with stressful experiences, students reading programmes through the distance and e-learning mode experience greater levels of stress due to several reasons. These stressful encounters might be heightened in female married postgraduates on distance education programmes due to other family-work-related engagements. This study investigated the stress-related experiences and intentions to quit studies among female married students on a distance education programme in Ghana. METHODS: Using a sequential explanatory mixed-methods design, 164 married postgraduate distance education students were sampled to participate by responding to a questionnaire. Follow-up interviews were conducted with 10 participants to offer insight into the quantitative findings. Quantitative data were analysed using descriptive statistics, including frequency and percentages, while the qualitative data were thematically analysed. RESULTS: Stress was prevalent among the female married distance education students, with the majority having intentions of quitting their studies. The stressors identified ranged from personal (i.e., work and family demands) to institutional ones (i.e., academic load, unresolved complaints and high financial demands from the programme). CONCLUSIONS: Key findings suggest that female married postgraduate distance education students perform multiple roles as full-time employees with family and academic demands that can negatively impact their health and academic work. Implications and recommendations of the findings are discussed.

Assessing secondary school students' digital health literacy, information searching behaviours, and satisfaction with online COVID-19 information in Northern Ghana.

Available evidence suggests that managing the complexities of health information and the behaviours associated with information search call for adequate digital health literacy (DHL). Students' ability to judge the relevance of health-related information largely affects their level of satisfaction with the information. The study assessed DHL, information searching behaviours, and the link between DHL and COVID-19 information. The cross-sectional study utilised the multi-stage sampling technique in the selection of 1392 secondary school students in the Northern Region of Ghana. A DHL questionnaire was used to survey the students. The students displayed inadequate level of DHL concerning the relevance of online information. Predictably, most of them had not searched for information in the past four weeks prior to the data collection. Search engine portals, websites of public bodies, and news portals were the predominant platforms used for information search. Majority of the participants reported not being satisfied with the information they found on the internet about coronavirus. A significant association between DHL levels and utilization of COVID-19 information platforms was identified, such that students who showed high levels of DHL used platforms which had reviewed/professional content compared to those with low levels of DHL. Advanced DHL may serve as a disincentive to the consumption of information from sources which are not credible. There is an urgent call for collaboration among the ministries/agencies responsible for education and health, telecommunication networks, and civil society organisations for interventions aimed at integrating DHL in schools..

Prevalence and Predictors of Alcohol Use among School-Going Adolescents in Panama: A Population-Based Cross-Sectional Study.

This study investigated the prevalence and predictors of alcohol use among school-going-age adolescents in Panama. Using a national school-based cross-sectional survey, data from a proportionate sample of school-going adolescents aged 13-17 years were obtained from the 2018 Panama Global School-based Student Health Survey [GSHS]. Data were analysed with a Pearson's Chi-square test and weighted binary logistic regression. The results were reported with their corresponding adjusted odds ratio (AOR) at a 95% confidence interval (CI) and level of significance set at p < 0.05. The prevalence of alcohol use among adolescents in Panama was 30.6%. The odds of alcohol use were lower among adolescents in a lower grade than those in upper grades, and lower in those who did not eat from a restaurant than those who ate from a restaurant. Further, the likelihood of alcohol use was significantly high among those who engaged in physical fights, were seriously injured, were mostly worried, and whose parents used any form of tobacco. Other results showed that the odds of alcohol use were high among sedentary respondents, those who had multiple sexual partners and those who used amphetamines. Based on the present findings, a collaborative approach (i.e., stakeholders- the Ministry of Social Development and the Ministry of Education- community-individual levels) towards the development and adherence of appropriate interventions aimed at reducing alcohol use is required in Panama. Specific preventive interventions would be fundamental in promoting a positive school climate to help reduce adolescents' alcohol use and, perhaps, other anti-social behaviours (e.g., physical fights and bullying).

Ghana's Adherence to PASCAR's 10-Point Action Plan towards Hypertension Control: A Scoping Review.

The continuous increase in the prevalence of hypertension in Ghana has led to various interventions aimed at controlling the disease burden. Nonetheless, these interventions have yielded poor health outcomes. Subsequently, the Pan-African Society of Cardiology (PASCAR), established a 10-point action plan for inclusion in policies to aid control of hypertension. This scoping review assessed the adherence of health policies to the 10-point action plan towards hypertension control/reduction in Ghana. Eight health policies met the inclusion criteria and were assessed. The programme evaluation and policy design framework were used for synthesis and analysis of extracted data. Overall, there was poor adherence to hypertension control observed in the policies. Specifically, there were low levels of integrating hypertension control/reduction measures, a poor task-sharing approach, and poor financial resource allocations to tackle hypertension control/reduction in most of the policies. There was also low support for research to produce evidence to guide future interventions. For Ghana to achieve the global target of reducing hypertension by the year 2025, its health policies must adhere to evidence-based interventions in hypertension management/control. The study recommends a follow-up study among hypertension patients and healthcare professionals to evaluate the factors militating against hypertension management/control in Ghana.

Long-acting reversible contraceptives use among adolescent girls and young women in high fertility countries in sub-Saharan Africa.

BACKGROUND: Given the instrumental role long-acting reversible contraceptives (LARCs) play in reducing unintended pregnancies, there is a need to understand the factors that predict their use among adolescent girls and young women in high fertility countries. Our study examined the prevalence and predictors of LARCs use among adolescent girls and young women in high fertility countries in sub-Saharan Africa. MATERIALS AND METHODS: We pooled data from the women's files of the most recent Demographic and Health Surveys (DHS) from 2010 to 2020 of the top ten high fertility countries in sub-Saharan Africa, which are part of the DHS programme. The total sample was 5854 sexually active adolescent girls and young women aged 15-24 who were using modern contraceptives at the time of the survey. Descriptive and multilevel logistic regression models were used in the analyses. The results were presented using percentages and adjusted odds ratio (AOR) with their respective 95% confidence intervals (CIs). RESULTS: At the descriptive level, the overall prevalence of LARCs utilisation was 17.6% in the ten countries, with the lowest of 1.7% in Angola and the highest of 55.8% in Mali. Adolescent girls and young women who were married had a lower likelihood of LARCs utilisation than those who were never married [AOR = 0.63, 95% CI = 0.45, 0.88]. Adolescent girls and young women who wanted no more children had higher odds of LARCs use compared to those who wanted more children [AOR = 1.56, 95% CI = 1.09, 2.26]. Adolescent girls and young women with one to three births [AOR = 6.42, 95% CI = 4.27, 9.67], and those with four or more births [AOR = 7.02, 95% CI = 3.88, 12.67] were more likely to use LARCs compared to those who had no children. Countries in sub-Saharan Africa with lower probability of utilizing LARCs were Angola, Niger and Mozambique, whereas adolescent girls and young women in Mali had higher probability of utilizing LARCs. CONCLUSION: Our findings suggest that LARCs utilisation among adolescent girls and young women is low in high fertility countries in sub-Saharan Africa. To reduce the rates of unplanned pregnancies and induced abortions, it is imperative that adolescent girls and young women in sub-Saharan Africa are educated on the advantages of utilising LARCs. Additionally, governments, policymakers, and stakeholders in sub-Saharan Africa should raise awareness by executing health promotion measures to enhance the demand for LARCs among adolescent girls and young women. Achieving these would not only prevent unplanned pregnancies and induced abortions, but also help meet the United Nation's health and well being for all as enshrined in Sustainable Development Goals 3 and 5.

The use of long-acting reversible contraceptives can contribute to the reduction of unintended pregnancies. Hence, knowledge of the prevalence and predictors of long-acting reversible contraceptives use among adolescent girls and young women in high fertility countries in sub-Saharan Africa is important in public health. Our study examined the predictors of long-acting reversible contraceptives among adolescent girls and young women in ten high fertility countries in sub-Saharan Africa. A sample of 5854 sexually active adolescent girls and young women were included in the study.The overall prevalence of long-acting reversible contraceptives utilisation was 17.6% in the ten countries, with the lowest of 1.7% in Angola and the highest of 55.8% in Mali. Adolescent girls and young women who were married had a lower likelihood of using long-acting reversible contraceptives than those who were never married. Adolescent girls and young women who wanted no more children had higher odds of long-acting reversible contraceptive use compared to those who wanted more children. Adolescent girls and young women with one to three births, and those with four or more births were more likely to use long-acting reversible contraceptives than those who had no child. To reduce the rates of unplanned pregnancies and induced abortions, there is the need to educate adolescent girls and young women on the advantages of utilising long-acting reversible contraceptives. Additionally, governments, policymakers, and stakeholders in sub-Saharan Africa should raise awareness by executing health promotion measures to enhance the demand for long-acting reversible contraceptives among adolescent girls and young women.

Validity and Reliability of Cultural Mix Coping Inventory for Stressful Situations among Healthcare Professionals in Ghana Amidst COVID-19.

The Cultural Mix Coping Inventory for Stressful Situations is one of the recent coping measures developed to overcome the weaknesses of existing coping scales. Since its development and validation, the inventory has been used by previous studies to measure coping among teachers and students in stressful situations. Health professionals are workers who typically encounter stressful situations due to their work demands. In this study, we assessed the validity and reliability of cultural mix inventory for stressful situations among healthcare professionals in Ghana. The research was guided by three major objectives: (1) to assess the factor structure of the cultural mix coping inventory, (2) to evaluate the construct validity and reliability of the cultural mix coping inventory based on internal structure and (3) to test for evidence of criterion validity based on the external structure of the measure. Approximately 312 health workers were purposefully sampled to participate in the study. The study confirmed the original four-factor solution of the coping inventory with evidence of the construct validity based on the internal structure. Validity evidence based on the external structure of the measure was found to be sufficient. Given the COVID-19 pandemic and coupled with the stressful nature in the line of duty of healthcare professionals, this inventory provides a useful and sound measure of coping options among this cohort.

Type of occupation and early antenatal care visit among women in sub-Saharan Africa.

BACKGROUND: Type of occupation has been linked to early antenatal care visits whereby women in different occupation categories tend to have different timing for antenatal care visits. Different occupations require varying levels of commitment, remuneration and energy requirements. This study, therefore, sought to investigate the association between the type of occupation and early antenatal care visits in sub-Saharan Africa. METHODS: This is a secondary analysis of Demographic and Health Survey data from 29 countries in sub-Saharan Africa conducted between 2010 and 2018. The study included 131,912 working women. We employed binary logistic regression models to assess the association between type of occupation and timely initiation of antenatal care visits. RESULTS: The overall prevalence of early initiation of antenatal care visits was 39.9%. Early antenatal care visit was high in Liberia (70.1%) but low in DR Congo (18.6%). We noted that compared to managerial workers, women in all other work categories had lower odds of early antenatal care visit and this was prominent among agricultural workers [aOR = 0.74, CI = 0.69, 0.79]. Women from Liberia [aOR = 3.14, CI = 2.84, 3.48] and Senegal [aOR = 2.55, CI = 2.31, 2.81] had higher tendency of early antenatal care visits compared with those from Angola. CONCLUSION: The findings bring to bear some essential elements worth considering to enhance early antenatal care visits within sub-Saharan Africa irrespective of the type of occupation. Women in the agricultural industry need much attention in order to bridge the early antenatal care visit gap between them and workers of other sectors. A critical review of the maternal health service delivery in DR Congo is needed considering the low rate of early antenatal care visits.

COVID-19 Pandemic and Teachers' Classroom Safety Perception, Anxiety and Coping Strategies during Instructional Delivery.

Several professionals, including teachers, have been engrossed in fear of the worst happening due to COVID-19 and the rapidly evolving nature of the virus affecting the perception of safety in any working environment. This study examined teachers' perception of classroom safety, anxiety, and coping strategies during instructional delivery in senior high schools in Ghana. Adopting the cross-sectional survey design with a quantitative approach, a convenient sample of 174 senior high school teachers in the Cape Coast Metropolis completed a questionnaire. Data were analyzed using descriptive analysis, analysis of variance, and multiple linear regression. The findings showed that teachers perceived their classroom environment as unsafe during instructional delivery amidst COVID-19 and reported modest to extreme levels of anxiety. Further, teachers with a high level of COVID-19 anxiety were found to utilize active coping strategies to manage stressful situations. The reported unsafe working environment in schools during pandemic times highlights the critical role of supportive working environments for teachers' mental and psychological wellness. School counseling psychologists, school welfare officers, and school health coordinators should collaborate to implement interventions (e.g., social emotional learning; resilience strategies) that promote the wellbeing of teachers and a safe working environment.

Relationship Between COVID-19 Related Knowledge and Anxiety Among University Students: Exploring the Moderating Roles of School Climate and Coping Strategies.

The emergence of the COVID-19 pandemic resulted in abrupt disruptions in teaching and learning activities in higher education, with students from diverse programs suffering varying levels of anxieties. The physical education field happens to be one of the most affected academic areas due to its experiential content as a medium of instruction. In this study, we investigated the roles of school climate and coping strategies in the relationship between COVID-19 related knowledge and anxiety. Through the census approach, a cross-sectional sample of 760 students was administered a questionnaire in two universities offering Physical Education in Ghana: the University of Education, Winneba, and University of Cape Coast. The outcome of the study found a positive and significant link between COVID-19 knowledge and anxiety. Further, school climate and coping strategies significantly moderated the relationship between students' COVID-19 knowledge and associated anxiety. The findings have implications for creating a conducive school environment that reduces the risk of COVID-19 infection and through students' adoption of active coping strategies in an attempt to reduce psychological distress associated with COVID-19 anxiety.

Ethics in healthcare: Knowledge, attitude and practices of nurses in the Cape Coast Metropolis of Ghana.

BACKGROUND: Nursing is a profession that care for personal and private aspects of people's lives. Therefore, nurses need to know the basic ethical aspects of nursing which is integral in nursing practices. The purpose of the study was to describe the ethical knowledge, attitude and practice of nurses in the Cape Coast Metropolis of Ghana. METHOD: A cross-section design was used to collect data from 264 nurses in three selected healthcare facilities in the Metropolis. A structured questionnaire was administered to all the categories of these nurses in the selected facilities. Frequency counts and multiple regression statistics were used to analyze the data. RESULTS: The results show 78% of nurses possess good ethical knowledge, 84% had a positive attitude, while 98% had good ethical practices. The results further show that nurses' professional rank [F (1, 259), 2.35, p = .02] and academic qualification [F (1, 259), 2.67, p = .008] were significant predictors of their ethical knowledge and attitude, respectively. CONCLUSION: Inadequate resources, poor set up of working areas and understaffing are the major barriers limiting the practice of good ethical standards among the nurses. The Regional Health Directorate, the Ministry of Health and the Managers in charge of the health facilities need to work together to eliminate these barriers as they have the potential to negatively impact quality healthcare delivery in the Metropolis.

Perceived Safety of Learning Environment and Associated Anxiety Factors during COVID-19 in Ghana: Evidence from Physical Education Practical-Oriented Program.

The outbreak of COVID-19 led to the swift migration to alternate instructional delivery models and pedagogical practices in educational institutions. This study examined the perceived safety of the learning environment and associated anxiety factors among physical education students amidst COVID-19. Using a cross-sectional design, a sample of 638 students drawn purposively and conveniently from a public university in Ghana completed a self-developed questionnaire. Frequency counts, percentages, and ordered logistic regression were used to analyze the data. Findings of the study showed that students perceived the practical lesson environment as unsafe, with self-reported moderate to high levels of anxiety during their practical lessons. The ordered logistic regression results revealed that varied factors such as age, COVID-19 information platforms, certainty about personal safety, and adequacy of preparation to manage COVID-19 cases were associated with anxiety. The study concluded that an unsafe practical physical education learning environment increases the anxiety levels of students. Academic departments/units should provide periodic interventions (e.g., positive self-talk, mental rehearsal, cognitive restructuring) and counseling services for students amidst the ongoing pandemic to help moderate situational-specific anxiety. In addition, key to the management of students' anxiety is the provision of a safe and supportive school environment, including the provision of adequate personal protective equipment for practical lessons by school authorities.

Bride Price Payment and Justification of Sexual Violence Among Women in Ghana.

Although insights on bride price and domestic violence have been explored in Ghana, very little is known about payment of bride price and the justification of sexual violence. We investigated the payment of bride price and justification of sexual violence among women (N = 4,222) in Ghana, dwelling on the 2014 Ghana Demographic and Health Survey. Two binary logistic regression models were fitted. We adjusted for significant sociodemographic variables. The findings revealed that women whose partners had paid their bride price had higher odds [OR = 1.54; CI = 1.174, 2.00] of justifying sexual violence, compared to those whose partners had not paid. We found that women with primary [AOR = 0.55; CI = 0.44-0.71] and secondary/higher [AOR = 0.47; CI = 0.36-0.60] levels of education had lower odds of accepting sexual violence. Women in the rich wealth quintile [AOR = 0.32; CI = 0.22, 0.46] had lower odds of justifying sexual violence. Our study has illustrated the need for women to appreciate that payment of bride price does not imply that their fundamental human rights have been bought by men, but they rather become partners. This information can form part of premarriage counselling and human rights initiatives by the Ministry of Gender and Social Protection. That is, the content of marriage counselling may be expanded to include issues on IPV, its implications, and legal consequences. Such information can develop personal realization and urge women to report any violent advances to the police and appropriate authorities for the required legal action to be taken. This may deter others to desist from violence perpetration against women. At the community level, chiefs and other leaders of high repute can be made anti-IPV ambassadors. The Ministry of Health and other nongovernmental anti-violence organizations can also collaborate to strengthen education on anti-sexual violence programs by using the mass media.

Participation in household decision making and justification of wife beating: evidence from the 2018 Mali Demographic and Health Survey.

BACKGROUND: We assessed the association between women's participation in household decision making and justification of wife beating among married women ages 15-49 y in Mali. METHODS: We employed a cross-sectional study design among 7893 women of reproductive age involving a two-stage sampling technique using version 6 of the Mali Demographic and Health Survey (MDHS) data, which was conducted in 2018. RESULTS: Approximately 37% participated in at least one household decision while 23.4% reported that they would not justify wife beating in any of the stated circumstances. Women who participated in at least one household decision had lower odds (adjusted odds ratio [AOR] 0.834 [confidence interval {CI} 0.744 to 0.935]) of justifying wife beating. With respect to the covariates, we found that women 45-49 y of age had lower odds of justifying wife beating compared with those ages 15-19 y (AOR 0.569 [CI 0.424 to 0.764]). Women with higher education (AOR 0.419 [CI 0.265 to 0.662]) and those whose husbands had secondary education (AOR 0.825 [CI 0.683 to 0.995]) had lower odds of justifying wife beating. Women who lived in urban areas were less likely to justify wife-beating (AOR 0.328 [CI 0.275 to 0.390]) compared with those who lived in rural areas. CONCLUSION: This study suggests that participation in household decision making is associated with a significantly lower rate of justifying wife beating in Mali. These results underscore the need for various interventions to empower women to increase women's participation in decision making to reduce justification of domestic violence.

Rural-urban variation in hypertension among women in Ghana: insights from a national survey.

BACKGROUND: Hypertension is one of the leading causes of cardiovascular morbidities in Ghana and represents a major public health concern. There is dearth of information on the rural-urban disparity in hypertension among women in Ghana. Therefore, this study aimed at examining the rural-urban variation in hypertension among women in Ghana. METHODS: We extracted data from the women's file of the 2014 Ghana Demographic and Health Survey. The sample included 9333 women aged 15-49 with complete data on hypertension. The analysis was done using Pearson Chi-square and binary logistic regression at 95% confidence interval. The results of the binary logistic regression were presented as Odds Ratios (ORs) and Adjusted Odds Ratios (AORs). Statistical significance was set at p < 0.05. RESULTS: Hypertension prevalence among urban and rural residents were 9.5% and 5.1% respectively. Rural women had lower odds of hypertension [OR = 0.59; 95% CI = 0.52, 0.67] compared to urban women, however, this was insignificant in the adjusted model [aOR = 0.84; 95% CI = 0.70, 1.00]. The propensity to be hypertensive was lower for women aged 15-19 [aOR = 0.07; 95% CI = 0.05, 0.11]. The poorest were less likely to be hypertensive [aOR = 0.63; 95% CI = 0.45, 0.89]. Single women were also less probable to have hypertension [aOR = 0.66; 95% CI = 0.46, 0.97]. CONCLUSIONS: Women from urban and rural areas shed similar chance to be hypertensive in Ghana. Therefore, the health sector needs to target women from both areas of residence (rural/urban) when designing their programmes that are intended to modify women's lifestyle in order to reduce their risks of hypertension. Other categories of women that need to be prioritised to avert hypertension are those who are heading towards the end of their reproductive age, richest women and the divorced.

Maternal and child factors associated with timely initiation of breastfeeding in sub-Saharan Africa.

BACKGROUND: The probability of not breastfeeding within the first hour after delivery (timely initiation of breastfeeding) is particularly pronounced in sub-Saharan Africa. In this study, we examined the maternal and child factors associated with timely initiation of breastfeeding in sub-Saharan Africa. METHODS: We pooled data from 29 sub-Saharan African countries' Demographic and Health Surveys conducted from 2010 to 2018. A total of 60,038 childbearing women were included. Frequencies, percentages, and binary logistic regression analyses were carried out. Binary logistic regression was used to examine the maternal and child factors associated with timely initiation of breastfeeding and the results were presented as adjusted odds ratios (aOR) at 95% confidence interval (CI).  RESULTS: We found a prevalence of 55.81% of timely initiation of breastfeeding in the sub-region. The country with the highest prevalence of timely initiation of breastfeeding was Burundi (86.19%), whereas Guinea had the lowest prevalence (15.17%). The likelihood of timely initiation of breastfeeding was lower among married women, compared to never married women (aOR 0.91; 95% CI 0.85, 0.98); working women compared to non-working women (aOR 0.90; 95% CI 0.87, 0.93); women who watched television at least once a week, compared to those who never watched television (aOR 0.74; 95% CI 0.70, 0.78); women who delivered through caesarean section, compared to vaginal birth (aOR 0.30; 95% CI 0.27, 0.32); and those with multiple births, compared to those with single births (aOR 0.67; 95% CI 0.59, 0.76). Women who lived in Central Africa were less likely to initiate breastfeeding timely compared to those who lived in West Africa (aOR 0.80; 95% CI 0.75, 0.84). CONCLUSIONS: The findings call for the need for a behavioural change communication programmes, targeted at timely initiation of breastfeeding, to reverse and close the timely initiation of breastfeeding gaps stratified by the maternal and child factors. Prioritising policies to enhance timely initiation of breastfeeding is needed, particularly among Cental African countries where timely initiation of breastfeeding remains a challenge. Sufficient supportive care, especially for mothers with multiple births and those who undergo caesarean section, is needed to resolve timely initiation of breastfeeding inequalities.

Mass Media Exposure and Women's Household Decision-Making Capacity in 30 Sub-Saharan African Countries: Analysis of Demographic and Health Surveys.

BACKGROUND: Women's household decision-making capacity is an essential component of their empowerment which include decisions related to personal health care, large household purchase and family visitations. Despite research evidence acknowledging mass media's influences on women's empowerment, including their ability to take household decisions, empirical data through multi-country comparison on mass media exposure and women's decision making capacity are sparse. This study sought to assess the association between exposure to mass media (television, radio and newspaper/magazine) and women's household decision-making capacity in 30 countries in sub-Saharan Africa (SSA). MATERIALS AND METHODS: Data from current Demographic and Health Surveys (DHS) conducted in 30 countries in SSA from January 1, 2010 to December 31, 2016 were used. Binary Logistic Regression analysis was used to assess the association between mass media exposure and women's household decision-making capacity in SSA. Results were presented using crude odds ratios (COR) and adjusted odds ratios (AOR). RESULTS: Women who watched television almost every day had higher capacity to take household decisions, compared to those who did not watch television at all. Women who read newspaper/magazine less than once a week were less likely to take household decisions compared to those who never read newspaper/magazine. However, there was no association between exposure to radio and household decision-making capacity. Regarding the covariates, age, level of education, wealth index, occupation, and parity showed significant associations with women's household decision-making capacity. CONCLUSION: Findings stressed the positive contribution of mass media in enhancing women's household decision-making capacity in SSA. Viewing television, a model of mass media, is a very powerful conduit to enhance the household decision-making capacity of women. The use of mass media, especially television in communicating the relevance and ways of achieving household decision-making capacity for all women in SSA is paramount and perhaps, in other low and middle-income countries of the world. Interest groups that require greater attention are women with less exposure to television as well as women in their early reproductive age, the poor, women who are not working and rural residents.

Women's autonomy in healthcare decision-making and healthcare seeking behaviour for childhood illness in Ghana: Analysis of data from the 2014 Ghana Demographic and Health Survey.

INTRODUCTION: The capacity of women to decide on their healthcare plays a key role in their health. In this study, we examined the association between women's healthcare decision-making capacity and their healthcare seeking behaviour for childhood illnesses in Ghana. MATERIALS AND METHODS: We used data from the 2014 Ghana Demographic and Health Survey. A total sample of 2,900 women with children less than 5 years was used for the analysis. Data were processed and analysed using STATA version 14.0. Chi-square test of independence and binary logistic regression were carried out to generate the results. Statistical significance was pegged at 95% confidence intervals (CIs). We relied on the 'Strengthening the Reporting of Observational Studies in Epidemiology' (STROBE) statement in writing the manuscript. RESULTS: Out of the 2,900 women, approximately 25.7% could take healthcare decisions alone and 89.7% sought healthcare for childhood illnesses. Women who decided alone on personal healthcare had 30% reduced odds of seeking healthcare for childhood illnesses compared to those who did not decide alone [AOR = 0.70, CI = 0.51-0.97]. With age, women aged 45-49 had 69% reduced odds of seeking healthcare for childhood illnesses compared to those aged 25-29 [AOR = 0.31, CI = 0.14-0.70]. Women from the Northern and Upper West regions had 72% [AOR: 0.28, CI: 0.11-0.70] and 77% [AOR: 0.23, CI: 0.09-0.58] reduced odds of seeking healthcare for childhood illnesses respectively, compared to those from the Western region. CONCLUSION: Ghanaian women with autonomy in healthcare decision-making, those who were older and those from the Northern and Upper West regions were less likely to seek healthcare for childhood illness. To reduce childhood mortalities and morbidities in Ghana, we recommend educating women such as those who take healthcare decisions alone, older women and women from deprived regions like the Northern and Upper West regions on the need to seek healthcare for childhood illnesses.

Women's healthcare decision-making capacity and HIV testing in sub-Saharan Africa: a multi-country analysis of demographic and health surveys.

BACKGROUND: Global commitment to stop Human Immunodeficiency Virus (HIV) and ensure access to HIV treatment calls for women empowerment, as these efforts play major roles in mother-to-child transmission. We examined the association between women's healthcare decision-making capacity and uptake of HIV testing in sub-Saharan Africa. METHODS: We used data from the current Demographic and Health Surveys (DHS) of 28 countries in sub-Saharan Africa, conducted between January 1, 2010 and December 31, 2018. At the descriptive level, we calculated the prevalence of HIV testing in each of the countries. This was followed by the distribution of HIV testing across the socio-demographic characteristics of women. Finally, we used binary logistic regression assess the likelihood of HIV testing uptake by women's health care decision-making capacity and socio-demographic characteristics. The results were presented as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with their corresponding 95% confidence intervals signifying precision. Statistical significance was set at p-value < 0.05. RESULTS: We found that prevalence of HIV testing uptake in the 28 sub-Saharan African countries was 64.4%, with Congo DR having the least (20.2%) and the highest occurred in Rwanda (97.4%). Women who took healthcare decisions alone [COR = 3.183, CI = 2.880-3.519] or with their partners [COR = 2.577, CI = 2.335-2.844] were more likely to test for HIV, compared to those whose healthcare decisions were taken by others, and this persisted after controlling for significant covariates: [AOR = 1.507, CI = 1.321-1.720] and [AOR = 1.518, CI = 1.334-1.728] respectively. CONCLUSION: Sub-Saharan African countries intending to improve HIV testing need to incorporate women's healthcare decision-making capacity strategies. These strategies can include education and counselling. This is essential because our study indicates that the capacity of women to make healthcare decisions has an association with decision to test for their HIV status.

Socio-economic and demographic determinants of female genital mutilation in sub-Saharan Africa: analysis of data from demographic and health surveys.

BACKGROUND: Owing to the severe repercussions associated with female genital mutilation (FGM) and its illicit status in many countries, the WHO, human rights organisations and governments of most sub-Saharan African countries have garnered concerted efforts to end the practice. This study examined the socioeconomic and demographic factors associated with FGM among women and their daughters in sub-Saharan Africa (SSA). METHODS: We used pooled data from current Demographic and Health Surveys (DHS) conducted between January 1, 2010 and December 31, 2018 in 12 countries in SSA. In this study, two different samples were considered. The first sample was made up of women aged 15-49 who responded to questions on whether they had undergone FGM. The second sample was made up of women aged 15-49 who had at least one daughter and responded to questions on whether their daughter(s) had undergone FGM. Both bivariate and multivariable analyses were performed using STATA version 13.0. RESULTS: The results showed that FGM among women and their daughters are significantly associated with household wealth index, with women in the richest wealth quintile (AOR, 0.51 CI 0.48-0.55) and their daughters (AOR, 0.64 CI 0.59-0.70) less likely to undergo FGM compared to those in the poorest wealth quintile. Across education, the odds of women and their daughters undergoing FGM decreased with increasing level of education as women with higher level of education had the lowest propensity of undergoing FGM (AOR, 0.62 CI 0.57-0.68) as well as their daughters (AOR, 0.32 CI 0.24-0.38). FGM among women and their daughters increased with age, with women aged 45-49 (AOR = 1.85, CI 1.73-1.99) and their daughters (AOR = 12.61, CI 10.86-14.64) more likely to undergo FGM. Whiles women in rural areas were less likely to undergo FGM (AOR = 0.81, CI 0.78-0.84), their daughters were more likely to undergo FGM (AOR = 1.09, CI 1.03-1.15). Married women (AOR = 1.67, CI 1.59-1.75) and their daughters (AOR = 8.24, CI 6.88-9.87) had the highest odds of undergoing FGM. CONCLUSION: Based on the findings, there is the need to implement multifaceted interventions such as advocacy and educational strategies like focus group discussions, peer teaching, mentor-mentee programmes at both national and community levels in countries in SSA where FGM is practiced. Other legislative instruments, women capacity-building (e.g., entrepreneurial training), media advocacy and community dialogue could help address the challenges associated with FGM. Future studies could consider the determinants of intention to discontinue or continue the practice using more accurate measures in countries identified with low to high FGM prevalence.

What has women's reproductive health decision-making capacity and other factors got to do with pregnancy termination in sub-Saharan Africa? evidence from 27 cross-sectional surveys.

INTRODUCTION: Pregnancy termination is one of the key issues that require urgent attention in achieving the third Sustainable Development Goal (SDG) of ensuring healthy lives and promoting well-being for all at all ages. The reproductive health decision-making (RHDM) capacity of women plays a key role in their reproductive health outcomes, including pregnancy termination. Based on this premise, we examined RHDM capacity and pregnancy termination among women of reproductive age in sub-Saharan Africa (SSA). MATERIALS AND METHODS: We pooled data from the women's files of the most recent Demographic and Health Surveys (DHS) of 27 countries in SSA, which are part of the DHS programme. The total sample was 240,489 women aged 15 to 49. We calculated the overall prevalence of pregnancy termination in the 27 countries as well as the prevalence in each individual country. We also examined the association between RHDM capacity, socio-demographic characteristics and pregnancy termination. RHDM was generated from two variables: decision-making on sexual intercourse and decision-making on condom use. Binary logistic regression analysis was conducted and presented as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with their corresponding 95% confidence intervals (CI). Statistical significance was declared p<0.05. RESULTS: The prevalence of pregnancy termination ranged from 7.5% in Benin to 39.5% in Gabon with an average of 16.5%. Women who were capable of taking reproductive health decisions had higher odds of terminating a pregnancy than those who were incapable (AOR = 1.20, 95% CI = 1.17-1.24). We also found that women aged 45-49 (AOR = 5.54, 95% CI = 5.11-6.01), women with primary level of education (AOR = 1.14, 95% CI = 1.20-1.17), those cohabiting (AOR = 1.08, 95% CI = 1.04-1.11), those in the richest wealth quintile (AOR = 1.06, 95% CI = 1.02-1.11) and women employed in the services sector (AOR = 1.35, 95% CI = 1.27-1.44) were more likely to terminate pregnancies. Relatedly, women who did not intend to use contraceptive (AOR = 1.47, 95% CI = 1.39-1.56), those who knew only folkloric contraceptive method (AOR = 1.25, 95% CI = 1.18-1.32), women who watched television almost every day (AOR = 1.16, 95% CI = 1.20-1.24) and those who listened to radio almost every day (AOR = 1.11, 95% CI = 1.04-1.18) had higher odds of terminating a pregnancy. However, women with four or more children had the lowest odds (AOR = 0.5, 95% CI = 0.54-0.60) of terminating a pregnancy. CONCLUSION: We found that women who are capable of taking reproductive health decisions are more likely to terminate pregnancies. Our findings also suggest that age, level of education, contraceptive use and intention, place of residence, and parity are associated with pregnancy termination. Our findings call for the implementation of policies or the strengthening of existing ones to empower women about RHDM capacity. Such empowerment could have a positive impact on their uptake of safe abortions. Achieving this will not only accelerate progress towards the achievement of maternal health-related SDGs but would also immensely reduce the number of women who die as a result of pregnancy termination in SSA.