Abstractobjective To identify the factors influencing dropout from Ghana's health insurance scheme among populations living in slum communities.methods Cross-sectional data were collected from residents of 22 slums in the Accra Metropolitan Assembly. Cluster and systematic random sampling techniques were used to select and interview 600 individuals who had dropped out from the scheme 6 months prior to the study. Descriptive statistics and multivariate logistic regression models were computed to account for sample characteristics and reasons associated with the decision to dropout.results The proportion of dropouts in the sample increased from the range of 6.8% in 2008 to 34.8% in 2012. Non-affordability of premium was the predominant reason followed by rare illness episodes, limited benefits of the scheme and poor service quality. Low-income earners and those with low education were significantly more likely to report premium non-affordability. Rare illness was a common reason among younger respondents, informal sector workers and respondents with higher education. All subgroups of age, education, occupation and income reported nominal benefits of the scheme as a reason for dropout.conclusion Interventions targeted at removing bottlenecks to health insurance enrolment are salient to maximising the size of the insurance pool. Strengthening service quality and extending the premium exemption to cover low-income families in slum communities is a valuable strategy to achieve universal health coverage.

BackgroundAn understanding of maternal knowledge of the danger signs of obstetric and newborn complications is fundamental to attaining universal health coverage. In Northern Ghana, where maternal and newborn morbidity and mortality is high, little is known about the current knowledge level and associated determinants of these danger signs. This study assessed the effect of social behavior change communication (SBCC) package on knowledge of obstetric and newborn danger signs among mothers with children under 24 months of age.MethodsThis study used a non-randomized controlled community-based intervention design with pre and post-intervention household surveys in the intervention and comparison communities of the East Mamprusi District in Ghana. The study population were selected using a two-stage cluster sampling procedure.ResultOnly 521 (51.1%), 300 (29.4%) and 353 (34.6%) of the study participants knew at least three key danger signs during pregnancy, delivery and postpartum period respectively.The intervention had a positive effect on maternal knowledge of danger signs. Compared to their counterparts in the comparison communities, women in the intervention communities were about 2.6 times (AOR  =  2. 58 [CI: 1.87, 3.57]), 3.4 times (AOR  =  3.39 [CI: 2.31, 4.96]) and 2.2 times (AOR  =  2.19 [CI: 1.68, 2.84]) more likely to have higher knowledge of danger signs of childbirth, postpartum and neonate, respectively.Having sought postnatal services at least once was significantly associated with the mentioning of at least three danger signs of postpartum (AOR  =  3.90 [CI: 2.01, 7.58]) and childbirth (AOR  =  1.75 [CI: 1.06, 2.85]).ConclusionThere was a significant contribution of social and behavioral change communication as an intervention to maternal knowledge in obstetric danger signs after adjusting for confounding factors such as antenatal and post-natal care attendance. Therefore, provision of information, education and communication targeting women on danger signs of pregnancy and childbirth and associated factors would be an important step towards attaining universal health coverage.

Background: Despite the fact that Chlamydia trachomatis (CT) infection in pregnancy is known to have grave impact on maternal and neonatal health, routine CT screening in pregnancy is not available in Ghana The main aim of this study was to determine the prevalence and adverse maternal outcomes of CT infection among pregnant women attending antennal clinic at the Cape Coast Teaching Hospital. Methods: Two hundred and thirty two (232) pregnant women screened for CT infection by PCR were purposively selected and enrolled into the study after informed consent had been obtained. They included one hundred and twelve (112) participants with positive CT (cases) and 120 participants without CT infections (control). A structured questionnaire was used to collect their socio demographic, obstetric and medical history. They were monitored thereafter and data on maternal outcomes were collected. Results: The prevalence of CT infection was 5.6% (112/2014). A history of STI/UTI (p<0.001) spontaneous abortion (p=0.02), preterm labour (p<0.001) and intrapartum or postpartum fever (p<0.001) were found to be associated with CT infection. However a history of Stillbirth, PID and having been treated for infertility were not associated with CT infection. Participants with CT infection were more likely to have PROM (p<0.001) and FSL (p<0.001) than those who were not infected. Parity and mode of delivery on the other hand were not associated with CT infection. Conclusions: To alleviate the adverse maternal outcomes, screening for CT infection in pregnancy should be offered routinely to pregnant women to promote early detection and treatment.

No abstract

No abstract