Dr. Michael Boah

Background Sub-Saharan Africa (SSA) has seen an increase in facility-based births over the years. However, the region has the world’s highest newborn mortality rate (42% in 2019). Quality care around the time of birth can avert these deaths. This study examined the newborn care interventions given to women who gave birth in health facilities in 17 countries in SSA. Methods A cross-sectional population-based study was conducted. We used data from the most recent Demographic and Health Surveys (DHS) conducted in 17 sub-Saharan African countries. We analysed a weighted sample of 226,706 women aged 15–49 years who gave birth in the five years preceding the surveys. We described the coverage of nine newborn care services, namely weighing at birth, breastfeeding initiation within 1 h after birth, skin-to-skin contact, temperature measurement, cord examination, counselling on newborn danger signs, counselling on breastfeeding, breastfeeding observation, and child health assessment before discharge. Results Overall, 72.0% (95% CI: 71.1, 72.8) of births occurred in health facilities, ranging from 40.0% (95% CI: 38.0, 42.1) in Nigeria to 96.3% (95% CI: 95.4, 97.1) in South Africa. Weighing at birth was the most common intervention (91.4%), followed by health checks before discharge (81%). The other interventions, including those given immediately at birth (breastfeeding and skin-to-skin contact), had suboptimal coverage. For instance, 66% of newborns were breastfed within 1 h after birth, and 56% had immediate skin-to-skin contact. Service coverage varied considerably by country and healthcare provider type. Conclusions The majority of the examined services, namely early breastfeeding, skin-to-skin contact, cord examination, temperature measurement, counselling on newborn danger signs, breastfeeding observation, and counselling on breastfeeding, were found to have suboptimal coverage. Even though many pregnant women in SSA give birth in healthcare facilities, some newborns do not always get the care they need to be healthy and live. This is a missed chance to improve newborn health and survival around the time of birth.

Despite successes in malaria control interventions over the past two decades, malaria remains a major public health concern. Over 125 million women live in endemic areas and experience adverse pregnancy outcomes due to malaria. Understanding health workers’ perspectives on malaria identification and management is important to informing policy changes on the control and eradication of the disease. This study explored the perspectives of health workers on malaria case identification and management among pregnant women in Savelugu Municipality, Ghana. A qualitative study with a phenomenology design was conducted among participants. Participants were purposively selected and interviewed using a semi-structured interview guide. Thematic analysis was performed and the results were presented as themes and sub-themes. Four themes and eight sub-themes regarding case identification and management of malaria in pregnancy were identified including malaria case identification training (trained and untrained), identification approach (signs/symptoms and routine laboratory test), diagnostic tools (rapid diagnostic test and microscopy) and management options. It revealed that attending malaria training programs was generally optional. Some of the participants had not undergone any refresher training for malaria identification after their formal training at health institutions. Participants identified malaria by its signs and symptoms. However, they often referred clients for routine laboratory tests for confirmation. When malaria is confirmed in pregnancy, quinine is used for first trimester treatment, while Artemisinin-based Combination Therapies are prescribed after the first trimester. Clindamycin was not used in the first trimester treatment. This study found that training programs were optional for health workers. Some participants have not received refresher training after graduating from health institutions. Treatment of confirmed cases did not include clindamycin for first trimester malaria infections. Malaria refresher training programs should be made mandatory for health workers. Every suspected case should be confirmed using Rapid Diagnostic Test or microscopy before treatment.

Background Low birth weight (LBW) rates are high in the northern region of Ghana, as is tolerance for intimate partner violence (IPV). However, the relationship between the two incidents has not been established. This study assessed the magnitude of IPV against pregnant women and its association with LBW in the northern region of Ghana. Methods A cross-sectional study was conducted among 402 postnatal women from five public health care facilities in the Tamale Metropolitan Area, northern Ghana. Data were collected electronically during face-to-face interviews. Validated methods were used to determine IPV exposure during pregnancy and birth weight. Multivariable logistic regression was used to identify the independent association between prenatal exposure to IPV and LBW. Results Of the 402 women, 46.5% (95% CI: 41.7, 51.4) experienced IPV during their most recent pregnancy. Of these, 34.8% were psychologically abused, 24.4% were sexually abused, and 6.7% were physically abused. Prenatal IPV exposure was found to be significantly associated with birth weight. Low birth weight was twice as likely among exposed women as among unexposed women (AOR = 2.42; 95% CI: 1.12, 5.26, p < 0.05). Low birth weight risk was also higher among women with anaemia in the first trimester (AOR = 3.47; 95% CI: 1.47, 8.23, p < 0.01), but was lower among women who made at least four antenatal care visits before delivery (AOR = 0.35; 95% CI: 0.14, 0.89, p < 0.05) and male newborns (AOR = 0.23; 95% CI: 0.11, 0.49, p < 0.001). Conclusion and recommendation IPV during pregnancy is prevalent in the research population, with psychological IPV being more widespread than other kinds. Women who suffered IPV during pregnancy were more likely to have LBW than those who did not. It is essential to incorporate questions about domestic violence into antenatal care protocols. In particular, every pregnant woman should be screened for IPV at least once during each trimester, and those who have experienced violence should be closely monitored for weight gain and foetal growth in the study setting to avert the LBW associated with IPV.

Background Early and frequent antenatal care (ANC) has been linked to better pregnancy outcomes. This study assessed whether having at least four ANC contacts was associated with increased prenatal care content if the first visit was started in the first trimester in Ethiopia. Methods Data from the 2019 Ethiopia Mini Demographic and Health Survey on 2894 women aged 15–49 who received ANC during their last pregnancy were analyzed. The sum of women’s responses to six questions about ANC components (blood pressure taken, urine sample taken, blood sample taken, provided or bought iron tablet, counselling by a health worker on nutrition, and told about pregnancy complications) was used to construct a composite score of routine ANC components. The main predictor was a combination of the timing of the first contact and the number of ANC contacts before birth. Results We found that 28.7% of women who began ANC early made at least four ANC contacts. More than one-third (36%) received all six components, with blood pressure monitoring being the most common (90.4%). After adjusting for potential confounding factors, women who had at least four contacts and booked early were substantially more likely than their counterparts to get a factor-of-one increase in the number of components received (IRR = 1.08; 95% CI: 1.03, 1.10). Conclusion We found a strong association between increased prenatal care content and early ANC with at least four contacts. However, less than a third of women in the study setting had at least four contacts, with the first occurring in the first trimester. In addition, less than half of women received essential prenatal care interventions before delivery. The findings suggest that the WHO’s new guidelines for ANC frequency and timing may be challenging to implement in some countries, such as Ethiopia, that already have low coverage of four or more contacts. If the recommendations are adopted, effective strategies for increasing early starts and increasing contacts are required.

The objective of this study was to determine whether adherence to the new WHO recommendations for the frequency and timing of antenatal care (ANC) contacts was associated with receiving quality prenatal care in Cameroon. The 2018 Cameroon Demographic and Health Survey yielded a weighted sample of 5,694 women aged 15 to 49 years for analysis. We found that 8.9% of women had at least eight ANC contacts, with 47.3% of those occurring during the first trimester. Overall, 28.3% (95% CI [26.4, 30.3]) of the women received all eight ANC interventions studied. Women who made at least eight ANC contacts prior to delivery had a higher chance of receiving the full set of interventions (AOR = 1.41; 95% CI [1.00, 1.99]). Even among women who started ANC in the second trimester, those who made at least eight contacts were more likely than those who made fewer contacts to receive the full set of interventions. Furthermore, women who had their first contact later in the second (AOR = 0.85; 95% CI [0.72, 0.99]) or third trimester (AOR = 0.33; 95% CI [0.19, 0.57]) were less likely to receive the full set of interventions. According to our findings, Cameroonian women who followed the new global recommendations for prenatal care were more likely to receive quality prenatal care before giving birth. To have a positive pregnancy experience, however, more women must begin ANC in the first trimester and have at least eight contacts with health care providers before delivery.

Background Globally, intimate partner violence (IPV) epitomizes a greater proportion of the violence experienced by women, with more than a third of women (41.3%) in sub-Saharan Africa reporting IPV during their lifetime. This study examined the association between exposure to IPV and the nutritional status of women and their children in Nigeria. Methods The study analyzed secondary data obtained from the 2018 Nigeria Demographic and Health Survey. Data on women’s lifetime experience of psychological, physical, and sexual IPV, as well as demographic and socioeconomic characteristics, were collected. We used regression models to determine the association between exposure to IPV and women and child nutrition indicators. A weighted sample of 4,391 women aged 15–49 years and 2,145 children 6–59 months were analyzed. Results The lifetime experience of IPV in the study was 35.31% (95% CI: 33.35, 37.33), 30.43% (95% CI: 28.54, 32.38) experienced psychological IPV, 19.43% (95% CI: 17.79, 21.19) experienced physical IPV, and 6.03% (95% CI: 5.12, 7.09) experienced sexual IPV. After adjusting for a range of characteristics, maternal lifetime exposure to IPV was associated with underweight (ARRR = 0.63; 95% CI: 0.44, 0.91) and overweight/obesity (ARRR = 1.28; 95% CI: 1.04, 1.58). We also found that, children whose mothers experienced IPV were less likely to be underweight compared to their counterparts (ARRR = 0.69; 95% CI: 0.50, 0.96). Conclusions Overall, IPV against women, particularly psychological, physical, and sexual IPV, is common in Nigeria and has an association with the nutritional status of affected women and their children. According to the study, women with a lifetime experience of IPV were more likely to be overweight. On the other hand, affected women’s children were less likely to be underweight. A far-reaching effort is required to curb IPV against women, particularly policies, programs, and laws are needed to protect women and children from the unfavourable effects of IPV to reduce the prevalence and impact of such violence.

Background Malaria poses a greater risk to children under the age of five years due to its high morbidity and mortality rates. The use of Insecticide-Treated Net (ITN) has been proven to be an effective preventive intervention in the control of malaria. However, its utilisation remains low. This study assessed the association of mother or caregiver’s utilisation of ITN on its use by their children under five years of age in Ghana. Methods This study used data from the 2019 Ghana Malaria Indicator Survey (GMIS). The study analysed a weighted sample of 1,876 women aged 15–49 years who had at least one child under the age of five. In this study, the outcome variable is mosquito bed net use in children under five years. We performed descriptive statistics, chi-square tests, and multinomial logistic regressions. Results Of the women studied, 58.59% [95% CI: 55.39, 61.71] slept under mosquito bed nets the previous night. The utilisation of ITN in children under five was 61.88% [95% CI: 58.43, 65.2] on the night before the study. The adjusted logistic regression revealed that mothers/caregivers who slept under a mosquito bed net were more likely to have their children under five years of age sleeping under a mosquito bed net (RRR = 2.47, 95% CI: 1.48, 4.12; p <0.001). In addition, the use of ITN in children under five was also found to be predicted by the number of ANC visits, the number of children under five in the household, and wealth status. Conclusion The study found that the use of ITN by mothers/caregivers and their children remains low in Ghana. Nevertheless, we found that when a mother uses ITN, her children under the age of five are more likely to use it as well.

Background Children born with adverse birth outcomes (ABOs) have a greater risk of mortality, stunting, and poor cognitive development. In 2016, the World Health Organization (WHO) recommended at least eight antenatal care (ANC) contacts before delivery for a healthy mother and baby. We examined the association between compliance with this recommendation and the risk of ABOs, such as low birthweight (LBW) and preterm birth (PTB), in the Tamale Metropolitan Area of the northern region of Ghana. Methods We conducted a cross-sectional study in the Tamale Metropolis of the northern region of Ghana. We analysed a systematic random sample of 402 postnatal women aged 15–49 drawn from five public health facilities. We gathered information electronically on their birth outcomes, specifically their birthweight and gestation at delivery, using a structured questionnaire. Information on women’s background characteristics, including the number of ANC contacts made before delivery, was also collected. The association between the number of ANC contacts and ABOs was investigated using regression models. Results We found that 37.6% (95% CI: 32.9, 42.4) of our sample had at least eight ANC contacts before delivery. We estimated that 18.9% of babies were born prematurely and 9.0% were born LBW. ABOs were found in 22.9% (95% CI: 19.0, 27.3) of babies. A minimum of eight ANC contacts before delivery reduced the risk of ABOs (adjusted IRR = 0.43; 95% CI: 0.25, 0.73), PTB (AOR = 0.28; 95% CI: 0.14, 0.58), and LBW (AOR = 0.36; 95% CI: 0.14, 0.91). Conclusion In the current study’s setting, about a quarter of newborns have ABOs, jeopardising their survival, health, and development. Compliance with at least eight ANC contacts prior to birth was associated with a reduced incidence rate ratio of ABOs. However, less than four out of every ten pregnant women make at least eight ANC contacts before delivery. Efforts are needed to increase coverage of eight contacts among pregnant women before delivery to reduce the risk of ABOs in the study setting.

Objective The aim of the study was to examine the relationship between a history of induced abortion and current use of contraception among reproductive-aged women in Ghana. Methods The analysed data were a weighted sample of 6544 sexually active, non-pregnant women aged 15–49 years, obtained from the 2014 Ghana Demographic and Health Survey. Survey logistic regression analysis was used to estimate the odds of currently using any contraception and of using a modern method of contraception, given a history of induced abortion in the period 2009–2014. Results A history of induced abortion between 2009 and 2014 was reported by 17.4% of women (95% CI 16.0%, 18.9%); 28.7% (95% CI 26.9%, 30.6%) were currently using a method of contraception and 23.0% (95% CI 21.4%, 24.7%) were currently using a modern method of contraception. The majority (80.1%) of current contraceptive users were using a modern method. The adjusted analysis revealed no statistically significant association between a history of induced abortion and current contraceptive behaviour. Other factors were associated with modern contraceptive use. Conclusion Overall, the use of contraception among sexually active women in Ghana was found to be low. Our findings showed that women’s experience of induced abortion was unlikely to influence their current use of modern contraception.

This paper explores the importance of equitable global health research collaborations that prioritize human dignity. It addresses the need for Global North partners to increase their efforts in raising awareness among all actors in global health. The aim is to bridge the gap in research collaborations and promote equitable practices that uphold the principles of human dignity and equity. A comprehensive review of existing literature and case studies was conducted to examine current practices and challenges in global health research collaborations. The review focused on the role of Global North partners in promoting equitable collaborations, capacity building efforts, and the impact of colonial legacies on research dynamics. The findings highlight the need for deliberate actions by Global North partners to raise awareness and promote equitable research collaborations. Initiatives such as Principal Investigator positions to partners from low- and middle-income countries (LMICs) during grant applications have been observed. Assigning first/last authorship positions to LMIC members is gaining momentum. However, further efforts are necessary to enhance the inclusivity of global health research collaborations. We emphasize the need for standardized definitions of global health that encompass human dignity and equity. Urgent action is required to ensure that all actors in global health research collaborations embrace human dignity. By deploying new techniques and tools where they are most needed, we can effectively promote equitable research collaborations that contribute to improving the health of individuals worldwide.

The Coronavirus Disease, 2019 (COVID-19) disrupted healthcare delivery. Health workers, particularly nurses are key members of the interdisciplinary healthcare team. They are faced with many challenges due to the pandemic. In addition to providing basic healthcare services, nurses are required to adhere to the COVID-19 recommended safety protocols. This study explored experiences of nurses on the implementation of COVID-19 preventive protocols in Tamale Metropolis, Ghana. A qualitative study was conducted among seventeen (17) nurses, comprising five (5) staff with COVID-19 infection, and twelve (12) ward managers or in-charges who did not have COVID-19 infection, using explorative design and an interview guide. The participants were purposively selected. The ward managers/in-charges and infected staff were interviewed face-to-face and by mobile phone respectively. Content analysis was conducted on the data and the results presented as themes and sub-themes. After the analysis, five (5) main themes and fourteen (14) sub-themes were identified on experiences of nurses regarding COVID-19 preventive protocols implementation. These included understanding COVID-19 transmission/spread (patients-to-staff, staff-to-staff and through fomites), communicating the preventive protocols (social media, ward meetings and administrative memoranda), and attitude of nurses on the protocol’s implementation (growing apathy, discomfort in applying personal protective equipment (PPEs) and outright defiance). Nurses also experienced some challenges and inadequate support (progressive decline in supply of PPEs, infrequent supply of water and limited infrastructure), in addition to dealing with issues of protocols implementation in healthcare setting (inapplicability of social distancing in hospital setting and improvising PPEs). In conclusion, the nurses had varied experiences on COVID-19 preventive protocols implementation. The themes explored were mode of COVID-19 transmission, communication approaches, negative attitudes, inadequate logistics and inability to implement social distance. Overall, these affected the effective implementation of the protocols. Thus, health facilities should be provided with adequate logistics/supplies and trainings to enable nurses implement COVID-19 preventive protocols effectively.

Studies show that increased knowledge of the human immunodeficiency virus (HIV) is achieved through exposure to mass media, which then contributes to positive attitudes and behaviours towards people living with HIV and acquired immune deficiency syndrome (AIDS). This study examined the relationship between the frequency of exposure to the media and the level of HIV-related knowledge and stigmatising attitudes towards HIV and AIDS among adults in Ghana. A weighted sample of 13 484 men and women 15 to 59 years old took part in the study. The main outcome variable was the HIV-related knowledge score, calculated based on responses to eight questions about general HIV concepts and HIV transmission modes. The frequency of exposure to the media was the primary explanatory variable. The relationship between the frequency of media exposure and the level of HIV-related knowledge was investigated using Poisson regression methods in Stata 13.0. Of the 13 484 respondents analysed, 25%, 88.2% and 79.7% reported reading print media, listening to the radio and watching TV at least once a week respectively. The average HIV-related knowledge score was 4.9 (SD 1.6), with 22.9% of respondents correctly answering five questions and about 2.0% correctly answering all eight questions. The frequency of exposure to the media, particularly print media and television, was associated with an increase in the level of HIV-related knowledge. When compared to having a low level of HIV-related knowledge, having a moderate and high level of HIV-related knowledge reduced the score of stigmatising attitude by 0.065 and 0.277 points, respectively. The adult population in Ghana has a very low level of HIV or AIDS knowledge, as well as a significant level of stigma associated with HIV or AIDS, which could stymie HIV prevention efforts. The media, on the other hand, provide a platform for these issues to be addressed.

The value of the glutathione S-transferase (GST) null genotype in patients with arsenic poisoning has been recognized, but the conclusions of previous studies remain inconsistent. The objective of this study was to evaluate the relationship between GST mu 1 (GSTM1) and GST theta 1 (GSTT1) null genotype polymorphisms and susceptibility to arsenic poisoning. PubMed, Medline, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, and WeiPu databases were systematically searched for publications up to March 31, 2020. The quality of the studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. The pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated to estimate the relationship between GSTM1 and GSTT1 null genotype polymorphisms and arsenic poisoning. The meta-analysis was conducted using STATA 14.0 software. Nine articles with 3324 subjects were included in the meta-analysis. A significantly negative correlation was observed between the GSTM1 null genotype and susceptibility to arsenic poisoning (OR = 0.731; 95% CI: 0.536-0.999; P = 0.049; I2 = 70.5%). There was no significant correlation between the GSTT1 null genotype (OR = 1.009; 95% CI: 0.856-1.189; P = 0.915, I2 = 36.8%) and GSTM1-GSTT1 double null genotype (OR = 1.105; 95% CI: 0.670-1.822; P = 0.695; I2 = 64.7%) and the risk of arsenic poisoning. Egger's and Begg's tests indicated no publishing bias. Compared with controls, individuals with the GSTM1 null genotype were less susceptible to arsenic poisoning. The GSTT1 single null genotype and GSTM1-GSTT1 dual-null genotype were not associated with the risk of arsenic poisoning. The GSTM1 single null genotype may have potential as a genotoxic biomarker to identify individuals who are not prone to arsenic poisoning, and as a reference for guiding the prevention of arsenic poisoning.

Background Sex work in Ghana is deeply intertwined with economic hardship, criminalization, and social stigma, which subjects female sex workers (FSWs) to significant vulnerabilities. In Ghana, many FSWs, particularly immigrants, face compounded challenges, including physical and sexual abuse, police harassment, and discrimination, which are exacerbated by their migrant status. This study aims to address the gap in understanding the specific lived experiences of transnational FSWs in Ghana, with a focus on the intersection of gender, migration, and economic vulnerability. Methods This study utilized a qualitative phenomenological approach to explore the lived experiences of transnational FSWs in Ghana’s two largest cities, Accra and Kumasi. Participants were purposively selected through snowball sampling technique until thematic saturation was achieved, interviewing fourteen FSWs. In-depth interviews were conducted in English. Data collection took place in November and December 2024, with basic demographic data gathered at the beginning of each interview, and thematic analysis was employed to analyze the anonymized transcripts. Results Economic necessity was the primary driver behind migration and entry into sex work for FSWs, with many revealing that promises of legitimate employment often led to coerced involvement into the trade. Participants also reported high levels of violence, including physical assault, theft, and sexual coercion from clients, often in isolated locations. They also experienced harassment and exploitation by law enforcement, which compounded their vulnerability. Additionally, discrimination based on nationality also exacerbated their vulnerability, as foreign FSWs were often treated more harshly than their Ghanaian counterparts by clients, police, and the public. Conclusion This study’s findings highlight the urgent need for comprehensive policy reforms that address the root causes of migrant sex work, including better economic opportunities for women and the decriminalization or regulation of sex work to protect sex workers from the risks associated with its illegal status, such as police harassment, exploitation, and lack of legal protections.

Background: Ageing often leads to multimorbidity, frailty, and disability; these interconnected conditions significantly impact quality of life (QoL) and strain healthcare systems through increased dependency and care needs. Despite their importance for health system planning, they remain understudied in Rwanda's older population. Here we describe the epidemiology of these outcomes in Rwanda's ageing population. Methods: We conducted a cross-sectional, population-based study among Rwandan adults aged ≥40 years across urban and rural districts, whereby we used validated tools to assess multimorbidity (≥2 chronic conditions), frailty (Fried Frailty Score), disability (World Health Organization Disability Assessment Schedule (WHODAS) 2.0), and QoL (European Health Interview Survey - World Health Organization Quality of Life (EUROHIS-QoL)). We used multivariable analyses to examine associations between the outcomes and demographic and socioeconomic factors. Results: Among 4369 adults, multimorbidity prevalence was 55.2% (95% confidence interval (CI) = 53.7, 56.6), with frailty affecting 14.5% (95% CI = 13.5, 15.6) of this population. Disability prevalence was relatively low, with a median score of 10.4% (interquartile range = 2.1-25.0), while the mean QoL score was 48.2% (standard deviation = 15.6). We observed impairment in activities of daily living (ADL) in 16.0% (95% CI = 14.9, 17.1) of the sample. Health outcomes worsened with age, particularly among those aged ≥70 years, and among females compared to males. Multivariable analyses showed that higher socioeconomic status and urban residence were significantly associated with lower frailty, disability, and ADL impairment, though urban residents had higher multimorbidity rates and poorer QoL. Higher educational status was associated with reduced disability and improved QoL. Conclusions: Our findings show a substantial burden of multimorbidity and frailty among older adults in Rwanda, with significant gender, socioeconomic, and urban-rural disparities. Integrated care models that address both the physical and social determinants of health, with a focus on reducing gender, socioeconomic, and geographical disparities, are needed to improve the well-being of older adults in Rwanda.

Background Humanitarian crises can lead to the rapid change in the health needs of women and newborns, which may give rise to a complex situation that would require various interventions as solutions. This study aimed to examine the health education and promotion patterns, health-seeking behaviour of mothers, and barriers to the use of maternal health services from public health facilities in two rural areas of Yemen. Methods We used a qualitative approach. We conducted in-depth interviews and focus group discussions with frontline health professionals and mothers respectively. Nine in-depth interviews were conducted with the health professionals, including 4 health leaders and 5 midwives, and 2 focus group discussions with mothers aged 18–45 years in Abyan and Lahj. Thematic analysis approach was used to analyze the data in Atlas.ti (version 8) Software. Results Our data showed that health education and promotion activities on maternal health were ad hoc and coverage was poor. Maternal health services were underutilized by women. According to the data from the focus group discussions, the poor quality of services, as indicated by inadequate numbers of female doctors, lack of medical equipment and medicines, and costs of services were barriers to use maternal health services. Moreover, the use of prenatal and postnatal care services was associated with women’s’ perceived need. However, according to the health professionals, the inadequate human resource, workload, and inadequate funding from government have contributed significantly to the perceived quality of maternal health services provided by public health facilities. Despite the identified barriers, we found that a safe motherhood voucher scheme was instituted in Lahj which facilitated the use of maternal health services by disadvantaged women by removing financial barriers associated with the use of maternal health services. Conclusion This study identified several obstacles, which worked independently or jointly to minimize the delivery and use of health services by rural women. These included, inadequate funding, inadequate human resources, poor quality of health services, and high cost of services. These barriers need to be addressed to improve the use of reproductive health services in Yemen.

Background Maternal mortality remains a major challenge to health systems in low and middle-incoming countries. Some pregnant women develop potentially life-threatening complications during childbirth. Therefore, home delivery is a precursor for maternal mortality. In this study, we aimed at not only estimating the percentage of deliveries occurring at home and examining the factors associated with home delivery, but we also explored the reasons for home delivery among women in rural Ghana. Methods The study was conducted among mothers with delivery experience in selected communities in the Builsa South district located in the Upper East Region of Ghana. Both quantitative and qualitative data were collected using semi-structured questionnaires and Focus Group Discussion (FGD) guide respectively. A total of 456 mothers participated in this study. Regression models were used in the quantitative analysis whereas a thematic analysis approach was used to analyze the qualitative data. Results Of the 423 mothers in the quantitative research, 38.1% (95% CI: 33.5–42.8) delivered their index child at home. In adjusted analysis, women who were not exposed to information (AOR = 13.64, p<0.001) and women with 2 (AOR = 4.64, p = 0.014), 3 (AOR = 4.96, p = 0.025) or at least 4 living children (AOR = 9.59, p = 0.001) had higher odds of delivering at home. From the qualitative analysis, the poor attitude of nurses (midwives), lack of, and cost of transportation, cost of delivery kits, and traditional beliefs and practices were cited as reasons for home delivery. Conclusion Despite the government’s efforts to provide free maternal care services to women in Ghana, a significant proportion of rural women still deliver at home due to other ‘hidden costs’. Addressing poor staff attitude, transportation challenges, and negative traditional beliefs and practices through awareness creation may contribute to improving health facility delivery by rural pregnant women in Ghana.

Some contraceptive methods, such as long-acting and permanent methods, are more effective than others in preventing conception and are key predictors of fertility in a community. This study aimed to determine which factors were linked to married women of childbearing age who no longer desired children using long-acting reversible contraceptives (LARCs) in Yemen. We used a population-based secondary dataset from Yemen’s National Health and Demographic Survey (YNHDS), conducted in 2013. The study analyzed a weighted sample of 5149 currently married women aged 15 to 49 years who had no plans to have children. Logistic regression analyses were used to investigate the parameters linked to the present use of LARCs. The final model’s specifications were evaluated using a goodness-of-fit test. An alpha threshold of 5% was used to determine statistical significance. Of the total sample, 45.3% (95% CI: 43.3–47.4) were using contraception. LARCs were used by 21.8% (95% CI: 19.6–24.1) of current contraceptive users, with the majority (63.8%) opting for short-acting reversible contraceptives (SARCs). In the adjusted analysis, maternal education, husbands’ fertility intention, place of residence, governorate, and wealth groups were all linked to the usage of LARCs. According to the findings, women whose spouses sought more children, for example, were more likely to use LARCs than those who shared their partners’ fertility intentions (AOR = 1.44; 95% CI: 1.07–1.94; P = .015). In this study, married women of reproductive age who had no intention of having children infrequently used contraception and long-acting methods. Improving women’s education and socioeconomic status could contribute to increasing their use of LARCs.

Background Low birth weight (LBW) rates are high in the northern region of Ghana, as is tolerance for intimate partner violence (IPV). However, the relationship between the two incidents has not been established. This study assessed the magnitude of IPV against pregnant women and its association with LBW in the northern region of Ghana. Methods A cross-sectional study was conducted among 402 postnatal women from five public health care facilities in the Tamale Metropolitan Area, northern Ghana. Data were collected electronically during face-to-face interviews. Validated methods were used to determine IPV exposure during pregnancy and birth weight. Multivariable logistic regression was used to identify the independent association between prenatal exposure to IPV and LBW. Results Of the 402 women, 46.5% (95% CI: 41.7, 51.4) experienced IPV during their most recent pregnancy. Of these, 34.8% were psychologically abused, 24.4% were sexually abused, and 6.7% were physically abused. Prenatal IPV exposure was found to be significantly associated with birth weight. Low birth weight was twice as likely among exposed women as among unexposed women (AOR = 2.42; 95% CI: 1.12, 5.26, p < 0.05). Low birth weight risk was also higher among women with anaemia in the first trimester (AOR = 3.47; 95% CI: 1.47, 8.23, p < 0.01), but was lower among women who made at least four antenatal care visits before delivery (AOR = 0.35; 95% CI: 0.14, 0.89, p < 0.05) and male newborns (AOR = 0.23; 95% CI: 0.11, 0.49, p < 0.001). Conclusion and recommendation IPV during pregnancy is prevalent in the research population, with psychological IPV being more widespread than other kinds. Women who suffered IPV during pregnancy were more likely to have LBW than those who did not. It is essential to incorporate questions about domestic violence into antenatal care protocols. In particular, every pregnant woman should be screened for IPV at least once during each trimester, and those who have experienced violence should be closely monitored for weight gain and foetal growth in the study setting to avert the LBW associated with IPV.

Objective Household food insecurity is positively associated with depression; however, the association among adolescents is not well known. We examined the association between household food insecurity and depression among adolescent girls in Northern Ghana. Methods We analysed data from the Ten2Twenty-Ghana randomised controlled trial end-line for adolescent girls aged 10–17 years (n=582). The girls were chosen at random from 19 primary schools in the Mion District of Ghana’s northern region. The children’s depression inventory and the Food Insecurity Experience Scale were used in face-to-face interviews to assess depression and household food insecurity. Hierarchical survey binary logistic regression and linear mixed models were used to examine the association between household food insecurity and depressive symptoms. We took into account a number of potential confounders in the analysis, such as life satisfaction, self-efficacy, self-esteem, health complaints, child’s age, menarche status, pubertal development, anaemia, stunting, frequency of consuming fruits and vegetables, frequency of consuming animal-sourced foods, maternal age, household wealth index and size, and the intervention group the girl was assigned to in the trial. Results About 20.1% of adolescent girls were classified as likely depressed, and 70.3% of their households were food insecure, with 22.9% and 18.0% being moderately and severely food insecure, respectively. Compared with girls from food-secure households, those from moderately (adjusted OR (AOR) 2.63, 95% CI (1.35 to 5.12)) and severely (AOR 3.28, 95% CI (1.66 to 6.49)) food insecure households had about three times the odds of being classified as depressed, after controlling for potential confounders. The odds of being likely depressed were about twice for adolescent girls from food-insecure households compared with their peers from food-secure households in both the crude and final adjusted model. Conclusion The study discovered high levels of household food insecurity and depression in adolescent girls in Northern Ghana, with a dose-response association between the two.