Coercive experiences at sexual debut have been shown to be associated with other sexual risks throughout the life course. Using nationally representative surveys from 12-19 year old girls in Burkina Faso, Ghana, Malawi, and Uganda collected in 2004, we examine the prevalence of sexual coercion at sexual debut among unmarried girls and its correlates. In Malawi, 38 percent of girls said that they were "not willing at all" at their first sexual experience followed by Ghana at 30 percent, Uganda at 23 percent and Burkina Faso at 15 percent. In-depth interviews collected in 2003 with the same demographic shows that there are four primary types of sexual coercion: forced sex; pressure through money or gifts; flattery, pestering, and threatening to have sex with other girls; and passive acceptance. The article concludes with the research and policy implications of these findings.

This paper examines connectedness to, communication with and monitoring of unmarried adolescents in Ghana by parents, other adults, friends and key social institutions and the roles these groups play with respect to adolescent sexual activity. The paper draws on 2004 nationallyrepresentative survey data and qualitative evidence from focus group discussions and in-depth interviews with adolescents in 2003. Adolescents show high levels of connectedness to family, adults, friends, school and religious groups. High levels of adult monitoring are also observed, but communication with family about sex-related matters was not as high as with non-family members. The qualitative data highlight gender differences in communication. Multivariate analysis of survey data shows a strong negative relationship between parental monitoring and recent sexual activity for males and females, and limited effects of communication. Creating a supportive environment and showing interest in the welfare of adolescents appear to promote positive sexual and reproductive health outcomes.

BackgroundMothers are encouraged to practice exclusive breastfeeding for the first six months of a child’s life. The general objective of the study was to assess the predictors of exclusive breastfeeding among mothers in Ghana.MethodsThis was a cross-sectional study using data from the 2008 Ghana Demographic and Health Survey (GDHS). The study sample (n = 316) was based on infants (0–5 months old) during the survey period; extracted from the individual (women) data set. Binary logistic regression was used to examine the association between selected independent variables.ResultsIn general, the rate of exclusive breastfeeding was 64 percent. Marital status, region and place of delivery were found to be associated with the practice of exclusive breastfeeding. The logistic regression model illustrated mothers from the Volta Region, those who delivered in a government health facility, and mothers who perceived their infants to be average in size were more likely to practice exclusive breastfeeding.ConclusionAppropriate health education programmes by the Ministry of Health targeting mothers who are less likely to practice exclusive breastfeeding are recommended.

BackgroundRealisation of universal health coverage is not possible without health financing systems that ensure financial risk protection. To ensure this, some African countries have instituted health insurance schemes as venues for ensuring universal access to health care for their populace. In this paper, we examined variations in health insurance coverage in Ghana, Kenya, Nigeria, and Tanzania.MethodsWe used data from demographic and health surveys of Ghana (2014), Kenya (2014), Nigeria (2013), and Tanzania (2015). Women aged 15–49 and men aged 15–59 years were included in the study. Our study population comprised 9,378 women and 4,371 men from Ghana, 14,656 women and 12,712 men from Kenya, 38,598 women and 17,185 men from Nigeria, and 10,123 women and 2,514 men from Tanzania. Bivariate and multivariate techniques were used to analyse the data.ResultsCoverage was highest in Ghana (Females = 62.4%, Males = 49.1%) and lowest in Nigeria (Females = 1.1%, Males = 3.1%). Age, level of education, residence, wealth status, and occupation were the socio-economic factors influencing variations in health insurance coverage.ConclusionsThere are variations in health insurance coverage in Ghana, Kenya, Nigeria, and Tanzania, with Ghana recording the highest coverage. Kenya, Tanzania, and Nigeria may not be able to achieve universal health coverage and meet the sustainable development goals on health by the year 2030 if the current fragmented public health insurance systems persist in those countries. Therefore, the various schemes of these countries should be harmonised to help maximise the size of their risk pools and increase the confidence of potential subscribers in the systems, which may encourage them to enrol.

BackgroundStunting, is a linear growth retardation, which results from inadequate intake of food over a long period of time that may be worsened by chronic illness. Over a long period of time, inadequate nutrition or its effects could result in stunting. This paper examines the correlates of stunting among children in Ghana using data from the 2008 Ghana Demographic and Health Survey (GDHS).MethodsThe paper uses data from the children recode file of the 2008 Demographic and Health Survey (DHS), a nationally representative cross sectional survey conducted in Ghana. A total of 2379 children under five years who had valid anthropometric data were used for the study. Data on the stunting of children were collected by measuring the height of all children under six years of age. A measuring board produced by Shorr Productions was used to obtain the height of the children. Children under 2 years of age were measured lying down on the board while those above 2 years were measured standing. In the DHS data, a z-score is given for the child’s height relative to the age. Both bi-variate and multi-variate statistics are used to examine the correlates of stunting.ResultsStunting was common among males than females. Age of child was a significant determinant of stunting with the highest odd of stunting been among children aged 36–47 months. Region was significantly related to stunting. Children from the Eastern Region were more likely to be stunted than children from the Western Region which is the reference group (OR = 1.7 at p < 0.05). Number of children in household was significantly related to stunting. Children in households with 5–8 children were 1.3 times more likely to be stunted compared to those with 1–4 children (p < .05). Mother’s age was a significant predictor of stunting with children whose mothers were aged 35–44 years being more likely to be stunted.ConclusionCulturally appropriate interventions and policies should be put in place to minimise the effects of the distal, proximal and intermediate factors on stunting among under 5 children in Ghana.

Mothers are recommended to exclusively breastfeed their infants for the first six months of their lives. Also, after the sixth month, breastfeeding should continue with added complementary foods to the diets of children. Studies designed to sought the views of mothers on breastfeeding practices are limited. The aim of this study was to explore challenges to breastfeeding practices by considering spatial, societal and maternal characteristics in Ghana. Twenty mothers aged 15–49 years were interviewed purposively in selected communities within two regions of the country. Thematic content analytical procedures were applied to interpret and present findings. Challenges (to both exclusive breastfeeding and complementary feeding) spanned across spatial (home and work places), societal, and maternal characteristics. Key themes identified were in relation to household chores, work schedules, family influence, low breast milk production, swollen breasts or sore nipples, access to food items and preparation or giving foods. Addressing these challenges would require co-creation of supportive environments between couples and significant others as well as tackling institutional barriers that obstruct adequate breastfeeding among mothers. On complementary feeding, there is the need to form community health volunteers help educate mothers more on how to appropriately use local foods to feed their children.

Acute Lower Respiratory Infections (ALRIs) account for 5.8 million deaths globally and 50% of these deaths occur in sub-Saharan Africa. In this paper, we examined the prevalence and determinants of ALRIs among children under-five years in 28 sub–Saharan African countries. We used data from the most recent (2011–2016) Demographic and Health Surveys of the 28 countries. Women aged 15–49 (N = 13,495) with children under-five years participated in the study. Data were extracted and analysed using STATA version 14.2. Bivariate and multivariate analyses were done to establish associations between the outcome and explanatory variables. The prevalence of ALRI for all the countries was 25.3%. Congo (39.8%), Gabon (38.1%), Lesotho (35.2%), and Tanzania (35.2%) were the countries with the highest prevalence of ALRIs. The results from the multivariate analyses showed that children aged 24–59 months (AOR = 1.15; 95% CI = 1.04–1.28), and children who received intestinal parasite in the 6 months preceding the survey (AOR = 1.11; 95% CI = 1.02–1.22) had higher odds of developing ALRIs. However, children whose mothers were employed (AOR = 0.77; 95% CI = 0.64–0.94) and those whose households used improved toilet facilities (AOR = 0.72; 95% CI = 0.64–0.97) had lower odds of contracting ALRIs. Our findings underscore the need for stakeholders in health in the various sub-Saharan African countries, especially those worst affected by ALRIs to implement programmes and develop policies at different levels aimed at reducing infections among children under-five years. Such strategies should specifically focus on improving the administration of medications for intestinal worms, health education to mothers with children under five on ALRIs and improving the sanitation situations of households through the provision of improved toilet facilities.

The disease burden in both developed and developing countries is moving towards higher proportions of chronic diseases, and diseases such as cancers are now considered to be of public health concern. In sub-Saharan Africa, healthy behaviours such as fruit and vegetable consumption are recommended to reduce the chances of onset of chronic diseases. This paper examines the determinants of fruit and vegetable consumption in Ghana with particular emphasis on consumption by ecological zone. Data were from the 2008 Ghana Demographic and Health Survey (n=4916 females; n=4568 males). Univariate and multivariate analyses were performed using basic descriptive and Poisson regression. The main independent variable was ecological zone and the dependent variables were levels of fruit and vegetable consumption. The mean number of fruits and vegetables consumed in a week was higher among females (fruits: 7.5, 95% CI=7.3-7.7; vegetables: 8.1, 95% CI=7.8-8.3) than males (fruits: 6.2, 95% CI=6.0-6.4; vegetables: 7.9, 95% CI=7.7-8.2). There were significant differences in consumption by ecological zone. Respondents in the Savannah zone consumed less fruit than those in the Coastal and Forest zones, but the differences in fruit and vegetable consumption between the Coastal and Savannah zones were not consistent, especially for vegetable consumption. The findings suggest that one of the key interventions to improve fruit and vegetable consumption could lie in improving distribution systems since their consumption is significantly higher in the Forest zone, where the production of fruit and vegetables is more developed than in the Savannah and Coastal zones. The findings relating to household wealth challenge conventional knowledge on fruit and vegetable consumption, and rather argue for equal consideration of spatial differences in critical health outcomes.