BackgroundThe Ghana Community based Health Planning and Services (CHPS) strategy targets to bring health services to the doorsteps of clients in a manner that improves maternal and child health outcomes. In this strategy, referral is an important component but it is threatened in a rural context where transportation service is a problem. Few studies have examined perceptions of rural dwellers on transportation challenges in accessing maternal health care services within CHPS.MethodsUsing the political ecology of health framework, this paper investigates transportation barriers in health access in a rural context based on perceived cause, coping mechanisms and strategies for a sustainable transportation system. Eight (8) focus group discussions involving males (n = 40) and females (n = 45) in rural communities in a CHPS zone in the Upper West Region of Ghana were conducted between September and December 2013.ResultsLack of vehicular transport is suppressing the potential positive impact of CHPS on maternal and child health. Consistent neglect of road infrastructural development and endemic poverty in the study area makes provision of alternative transport services for health care difficult. As a result, pregnant women use risky methods such as bicycle/tricycle/motorbikes to access obstetric health care services, and some turn to traditional medicines and traditional birth attendants for maternal health care services.ConclusionThese findings underscore the need for policy to address rural transport problems in order to improve maternal health. Community based transport strategy with CHPS is proposed to improve adherence to referral and access to emergency obstetric services.

Objective. The main aim of the study was to assess the magnitude of concurrent wasting and stunting among Ghanaian preschool children. Secondly, we investigated the relationship between wasting and stunting as well as factors associated with these conditions. Methods. This paper is based on reanalysis of anthropometric and other relevant data which was collected in the 2014 Ghana Demographic and Health Survey. The data set consisted of 2,720 preschool children aged 0–59 months. We conducted three-step moderated hierarchical multiple regression analyses to determine independent predictors and moderators of height-for-age Z-score. Results. Nationally, the prevalence of concurrent wasting and stunting among children aged 0–59 months was low at 1.4% but it varied geographically with the Upper East Region having the highest prevalence of 3.2% (95% CI: 1.7–5.8). Children who had low weight-for-height Z-scores were at a higher risk of linear growth retardation (stunting) especially among children aged less than three years. A 1-unit increase in weight-for-height Z-score (WHZ) was associated with 0.07 standard units' increase in height-for-age Z-score (HAZ) [β = 0.071 (95% CI: 0.03, 0.15)]. Conclusions. The study results suggest that weight-for-height relates to linear growth but this relationship is moderated by age of child. Stunting and wasting share some common risk factors. Therefore, measures to prevent wasting may positively influence linear growth.

Improved access to and utilization of various maternal healthcare services have been seen as the panacea to poor maternal and child health outcomes characterizing many developing countries. Focused Antenatal Care (FANC) replaced the regular antenatal care model about a decade and a half ago. This study sought to document empirical outcomes of how the FANC approach translates access and utilization of maternal health services into positive maternal health outcomes. We utilized a descriptive qualitative design and analysis. We applied key informant interviewing to collect data from 206 respondents consisting of 140 women in their fertility age and 66 health workers across 14 communities in the study district. We found that FANC has been widely implemented across the district with most of the required services integrated into the existing healthcare delivery system. Overall, there has been successful implementation of FANC in the district, resulting in several benefits including the increased utilization of maternal healthcare services, acceptance of family planning, increased skilled delivery, and utilization of postnatal care (PNC) services. This notwithstanding, a number of issues need to be addressed to improve FANC services. These include provision of adequate infrastructure, essential supplies, communication and transportation systems, and manpower and adoption of positive sociocultural practices. No effort should be spared in providing these to sustain the successes and ensure sustainability of FANC.

BackgroundThe prevalence of HIV in Malawi is one of the highest in sub-Saharan Africa, and misconceptions about its mode of transmission are considered a major contributor to the continued spread of the virus.MethodsUsing the 2010 Malawi Demographic and Health Survey, the current study explored factors associated with misconceptions about HIV transmission among males and females.ResultsWe found that higher levels of ABC prevention knowledge were associated with lower likelihood of endorsing misconceptions among females and males (OR = 0.85, p < 0.001; OR = 0.85, p < 0.001, respectively). Compared to those in the Northern region, both females and males in the Central (OR = 0.54, p < 0.001; OR = 0.53, p < 0.001, respectively) and Southern regions (OR = 0.49, p < 0.001; OR = 0.43, p < 0.001, respectively) were less likely to endorse misconceptions about HIV transmission. Moreover, marital status and ethnicity were significant predictors of HIV transmission misconceptions among females but not among males. Also, household wealth quintiles, education, religion, and urban–rural residence were significantly associated with endorsing misconceptions about HIV transmission.ConclusionBased on our findings, we recommend that education on HIV transmission in Malawi should integrate cultural and ethnic considerations of HIV/AIDS.

BackgroundAlthough use of modern contraception is considered beneficial in lowering maternal and child mortality rates, the prevalence of contraceptive use remains low in the Democratic Republic of Congo. This study examined modern contraceptive use and its linkage to women’s autonomy.MethodsData were drawn from the 2013–2014 Democratic Republic of Congo Demographic and Health Survey. We selected unsterilized and non-pregnant married women who have given birth in the last three years (N = 6680). Logistic regression models were fitted to explore the relationship between women’s autonomy and modern contraceptive use.ResultsThe study found that only 7.1% of married women who had delivered within three years used modern contraceptive methods. After controlling for socioeconomic and demographic factors, the association between women’s autonomy and modern contraceptive use remained positively significant (OR = 1.16; 95% CI = 1.05, 1.29).ConclusionThe findings from this study indicate that it is not enough to provide women with educational and employment opportunities to increase the uptake of modern contraception, but also to enhance women’s assertiveness to make their own decisions regardless of their partners’ preferences within household settings. It is critical for government and other stakeholders to roll out programs aimed at reducing gender inequality and improving women’s autonomy in decision-making about reproductive health.