Maternal health care utilization following the implementation of the free maternal health care policy in Ghana: analysis of Ghana demographic and health surveys 2008-2014.

BACKGROUND: In July 2008, Ghana introduced a 'free' maternal health care policy (FMHCP) through the national health insurance scheme (NHIS) to provide comprehensive antenatal, delivery and post-natal care services to pregnant women. In this study, we evaluated the 'free' policy impact on antenatal care uptake and facility-level delivery utilization since the policy inception. METHODS: The study used two rounds of repeated cross-sectional data from the Ghana Demographic and Health Survey (GDHS, 2008-2014) and constructed exposure variable of the FMHCP using mothers' national health insurance status as a proxy variable and another group of mothers who did not subscribe to the policy. We then generated the propensity scores of the two groups, ex-post, and matched them to determine the impact of the 'free' maternal health care policy as an intervention on antenatal care uptake and facility-level delivery utilization, using probit and logit models. RESULTS: Antenatal care uptake and facility-level delivery utilization increased by 8 and 13 percentage points difference, observed coefficients; 0.08; CI: 95% [0.06-0.10]; p < 0.001 and 0.13; CI: 95% [0.11-0.15], p < 0.001, respectively. Pregnant women were 1.97 times more likely to make four plus [a WHO recommended number of visits at the time] antenatal care visits and 1.87 times more likely to give birth in a health care facility of any level in Ghana between 2008 and 2104; aOR = 1.97; CI: 95% [1.61-2.4]; p < 0.001 and aOR = 1.87; CI: 95% [1.57-2.23]; p < 0.001, respectively. CONCLUSIONS: Antenatal care uptake and facility-level delivery utilization improved significantly in Ghana indicating a positive impact of the FMHCP on maternal health care utilization in Ghana since its implementation.

Assessing the Effectiveness of mHealth Interventions for Diabetes and Hypertension Management in Africa: Systematic Review and Meta-Analysis.

Background: Mobile health (mHealth) interventions are effective in improving chronic disease management, mainly in high-income countries. However, less is known about the efficacy of mHealth interventions for the reduction of cardiovascular risk factors, including for hypertension and diabetes, which are rapidly increasing in low- and middle-income countries. Objective: This study aimed to assess the efficacy of mHealth interventions for diabetes and hypertension management in Africa. Methods: We searched PubMed, Cochrane Library, Google Scholar, African Journals Online, and Web of Science for relevant studies published from inception to July 2022. The main outcomes of interest were changes in hemoglobin A1c (HbA1c), systolic blood pressure, and diastolic blood pressure. The random or fixed effect model was used for the meta-analysis, and the I2 statistic was used to gauge study heterogeneity. Z tests and P values were used to evaluate the effect of mHealth interventions on HbA1c and blood pressure levels. Results: This review included 7 studies (randomized controlled trials) with a total of 2249 participants. Two studies assessed the effect of mHealth on glycemic control, and 5 studies assessed the effect of mHealth on blood pressure control. The use of mHealth interventions was not associated with significant reductions in HbA1c levels (weighted mean difference [WMD] 0.20, 95% CI -0.40 to 0.80; P=.51) among patients with diabetes and systolic blood pressure (WMD -1.39, 95% CI -4.46 to 1.68; P=.37) and diastolic blood pressure (WMD 0.36, 95% CI -1.37 to 2.05; P=.69) among patients with hypertension. After conducting sensitivity analyses using the leave-one-out method, the Kingue et al study had an impact on the intervention, resulting in a 2 mm Hg reduction in systolic blood pressure (WMD -2.22, 95% CI -3.94 to -0.60; P=.01) but was nonsignificant for diastolic blood pressure and HbA1c levels after omitting the study. Conclusions: Our review provided no conclusive evidence for the effectiveness of mHealth interventions in reducing blood pressure and glycemic control in Africa among persons with diabetes and hypertension. To confirm these findings, larger randomized controlled trials are required.

Maternal Age and Stage of Pregnancy as Determinants of UTI in Pregnancy: A Case of Tamale, Ghana.

Introduction: Urinary tract infection (UTI) is the world's second most common cause of death, trailing only respiratory tract infections. Because of anatomical and physiological changes along the urinary tract, pregnant women accounted for approximately 20% of all cases of urinary tract infection. Aim: This study sought to assess maternal age and stage of pregnancy as determinants of UTI among pregnant women in Tamale. Methods: This study employed a descriptive cross-sectional survey as the study design in the antenatal clinic of Tamale Central Hospital (TCH). This was carried out by reviewing laboratory records of urinalysis results done on pregnant women. Data entry and analysis were performed by the Statistical Package for the Social Sciences (SPSS) version 20. Chi-square and binary logistics analysis were used to determine the relationship. Results: Data analysis was done for 158 pregnant women, most (35.4%) were within the age group of 36-45 years, and most (38.6%) were within their first trimester. The overall prevalence of UTI infections among pregnant women was 33.5%. The prevalence was 27.8% for candiduria and 8.9% for bacteriuria. Women in the first trimester of their pregnancy were more likely to have UTI (AOR = 2.48, 95% CI =1.03-5.94). Also, Pregnant women of the age group of 26-35 years were less likely to get UTIs as compared to those of the age group 15-25 years (AOR = 0.40, 95% CI =0.17-0.92). Finally, those of the age group of 36-45 years were less likely to get UTI as compared to those of the age group 15-25 years (AOR = 0.28, 95% CI =0.12-0.66). Conclusion: The prevalence of UTI among studied pregnant women was high (38.0%), and the most prone maternal age group and trimesters to UTI are 15-25 years and first trimester, respectively.

Early Sexual Debut among Ghanaian Women: Correlates and Psychological Effect.

Early sexual initiation is linked to an increased risk of HIV/AIDS and other STIs among teenagers, as well as having multiple partners, not using contraception, unintended pregnancy, and illegal abortions. Aim. To identify the correlates and psychological effects of early sexual debut among not-in-union women in Ghana. A descriptive cross-sectional survey was used for this study using data from Ghana Multiple Indicator Cluster Survey (MICS) for the year 2017/2018. SPSS software was used for data analysis, bivariate analysis for association was done using chi-square, and the prediction was done using a binary logistic regression model. The national prevalence of nonmarital early sexual initiation this current study recorded was 56.9%. Predictors variables were age, 15-24/≥35 years (AOR = 1.51, 1.28-1.78), ever educated (AOR = 0.50, 0.43-0.60), urban address (AOR = 0.85, 0.74-0.98), married/single (AOR = 1.23, 1.07-1.42), cohabitation/single (AOR = 1.43, 1.19-1.72), Greater Accra Region/Upper West Region (AOR = 0.67, 0.49-0.92), and health insurance (AOR = 0.89, 0.79-0.998). As the wealth indices of the woman decrease from the richest to poorest, the likelihood of early sexual debut inversely increases: fourth/richest (AOR = 1.23, 1.04-1.45), middle/richest (AOR = 1.31, 1.09-1.58), second/richest (AOR = 1.38, 1.11-1.72), and poorest/richest (AOR = 1.44, 1.12-1.86); use of the internet (AOR = 0.58, 0.50-068); substance use and alcohol ever use (AOR = 1.32, 1.17-1.49); cigarette ever use (AOR = 2.58, 1.44-4.64); contraceptive use (AOR = 1.31, 1.16-1.49); and ever heard of HIV (AOR = 59, 0.42-0.82). In conclusion, the prevalence of early sexual debut is still high in Ghana, especially among the northern regions. Several factors predicted early sex debut, and low life satisfaction and happiness were related to early sexual debut.