BackgroundUtilization of maternal health care services is key to reducing the number of perinatal deaths and post-natal complications in sub-Saharan Africa. With a few exceptions, many studies that examine the use of maternal health services in sub-Saharan Africa have focused largely on individual-level explanations and have ignored the importance of contextual and community-level explanations. In Ghana, progress has been made in reducing maternal mortality ratio from 740/100,000 in the late 1990s to 319/100,000 in 2015 but these rates are still high. Our study focuses on impact of individual and community level-factors on maternal outcomes with the hope that it will inform public policy in Ghana. This approach highlights latent or unacknowledged aspects of fragility within health systems designed to improve maternal health and opportunities for improving uptake of services.Methods and findingsUsing the 2014 Ghana Demographic and Health Survey, we examined the effects of individual and community-level factors on antenatal care, facility-based delivery, and post-natal care. Multilevel logistic regression models were used to examine the effects of individual and community-level factors on the outcome variables. Our analysis revealed that overall utilization of antenatal, facility-based delivery and post-natal care was substantial across the board; however, both individual and community-level factors were significant predictors of these maternal health outcomes. Wealthier and better educated women were more likely to use antenatal services and facility-based delivery; in contrast poor and uneducated women were more likely to use antenatal and postnatal care but not facility-based delivery. Additionally, use of National Health Insurance Scheme was statistically associated with the utilization of maternal health services.ConclusionsThe findings point to areas where services can be better tailored to meet community-specific needs. Policy makers must consider factors such as educational levels and economic security at both individual and community-levels that shape women’s preferences and uptake of maternal health care in Ghana.

BackgroundAchieving the Millennium Development Goal (MDG) of improving maternal health has become a focus in recent times for the majority of countries in sub-Saharan Africa. Ghana’s maternal mortality is still high indicating that there are challenges in the provision of quality maternal health care at the facility level. This study examined the implementation challenges of maternal health care services in the Tamale Metropolis of Ghana.MethodsPurposive sampling was used to select study participants and qualitative strategies, including in-depth interviews, focus group discussions and review of documents employed for data collection. The study participants included midwives (24) and health managers (4) at the facility level.ResultsThe study revealed inadequate in-service training, limited knowledge of health policies by midwives, increased workload, risks of infection, low motivation, inadequate labour wards, problems with transportation, and difficulties in following the procurement act, among others as some of the challenges confronting the successful implementation of the MDGs targeting maternal and child health in the Tamale Metropolis.ConclusionsImplementation of maternal health interventions should take into consideration the environment or the context under which the interventions are implemented by health care providers to ensure they are successful. The study recommends involving midwives in the health policy development process to secure their support and commitment towards successful implementation of maternal health interventions.

2Several studies indicate little congruence between selfreport and biometric data, yet very few have examined the reasons for such differences. This paper contributes to the limited but growing body of literature that tracks inconsistent reports of hypertension using data from the Study on Global Ageing and Adult Health (SAGE). Focusing on five countries with different levels of development (Ghana, China, India, South Africa, and Russia), this study offers a comparative perspective that is missing in the literature. Data were obtained from wave 1 of SAGE collected in 2007/2008. A multinomial logit model was used to examine the effects of demographic and socioeconomic variables on the likelihood of respondents self-reporting that they are not hypertensive when their biometric data show otherwise. The authors also model the likelihood of respondents self-reporting that they are hypertensive when in fact their biometric data show they are not. Socioeconomic and demographic variables were shown to be significantly associated with inconsistent reporting of hypertension. For instance, it was observed that wealth was associated with a lower likelihood of selfreporting that one is not hypertensive when their biometric data indicate otherwise. Tracking such inconsistent reports is crucial to minimizing measurement errors and generating unbiased and more precise parameter estimates in hypertension research. J Clin Hypertens (Greenwich). 2015;17: 977-984. ª 2015 Wiley Periodicals, Inc.Hypertension or high blood pressure (BP) has been described as a public health crisis and a global health emergency. Related to other cardiovascular diseases, such as stroke and diabetes, hypertension has been associated with a mortality rate of approximately 7.1 million people globally.1 Measured as the ratio of systolic BP (SBP) to diastolic BP (DBP), hypertension is defined as having an SBP ≥140 mm Hg and/or a DPB value ≥90 mm Hg. Monitoring SBP (arterial BP during cardiac contraction) and DBP (arterial BP during cardiac relaxation) has become effective in the diagnosis, management, and prevention of cardiovascular diseases including hypertensive-related conditions.2 Recognized as a noncommunicable disease, BP-related conditions are endemic worldwide. 3,4 It is well-documented that the hypertension epidemic is a rapidly emerging burden of disease in low-and middle-income countries, and this is attributable to the changing demographic characteristics as well as subsequent shift in epidemiologic transitions. 5 The prevalence of hypertension in developing countries is about twice of that observed in developed countries. 6 Most alarming is that levels of awareness, treatment, and control of hypertension in low-and middle income countries are low. 7,8 Such issues of unawareness and poor control of high BP are attributed to high illiteracy levels, poor access to health facilities, and poverty. Faced with existing issues of morbidity and mortality from communicable and infectious diseases, 10 most parts of the developing world pay less attention ...

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Like most countries in sub-Saharan Africa, hypertension contributes substantially to morbidity and mortality in Ghana, yet nationally representative studies that examine the odds of becoming hypertensive among Ghanaians are conspicuously missing. We aimed to fill this void in the literature. The data used for analysis came from the first wave of the Study on Global Ageing and Adult Health (SAGE), collected in Ghana from January 2007 to December 2008 by the World Health Organization (WHO). A total of 5573 respondents were sampled for the study. Random-effects C-log-log models were employed in examining socio-economic, lifestyle and psychosocial factors on the odds of becoming hypertensive in Ghana. Separate models were run for male and females. Results indicated there were strong significant associations between socio-economic, lifestyle and psychosocial factors on the likelihood of becoming hypertensive, among Ghanaian men and women. Compared with the poorest, Ghanaians from wealthy households were significantly more likely to be hypertensive. Educated women, as compared with the uneducated, were also more likely to be hypertensive. Ghanaians who engaged in vigorous or intensive activities continuously, for at least 10 minutes, were significantly less likely to be hypertensive, compared to those who did not. Happier men had lower odds of becoming hypertensive, and depressed women had increased odds of reporting they were hypertensive.