Suchergebnisse

Ellen Eyi Klutsey,1 Augustine Ankomah2 1School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Volta Region, 2Department of Population, Family and Reproductive Health School of Public Health, University of Ghana, Legon, Accra, Ghana Background: Induced abortion rates remained persistently high in the Volta Region of Ghana in the 5 years from 2006 to 2011. Some hospitals, both rural and urban, report induced abortion-related complications as one of the top ten conditions in hospital admissions. This study explored demographic and other factors associated with induced abortion, and also assessed awareness of abortion-related complications among women of reproductive age in the Volta Region. Methods: A quantitative, hospital-based, unmatched case-control study was performed. The Volta Region was stratified into two health administration zones, ie, north and south. For each zone, hospitals were stratified into government and private hospitals. Employing simple random sampling, one private and three government hospitals were selected from each zone. This study is therefore based on eight hospitals, ie, six government hospitals and two private hospitals. Results: Marital status, employment status, number of total pregnancies, and knowledge about contraception were found to be associated with induced abortion. Multiple logistic regression showed a 4% reduction in the odds of induced abortion in married women compared with women who were single (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.07–0.22). Unemployed women of reproductive age were found to be 0.35 times less likely to seek induced abortion compared with their employed counterparts (OR 0.35, CI 0.19–0.65). It was also observed that women with their second pregnancies were 3.8 times more likely to seek induced abortion and women with more than two pregnancies were 6.6 times more likely to do so (OR 3.81, CI 1.94–7.49 and OR 6.58, CI 2.58–16.79, respectively). Women with no knowledge of contraceptive methods were 4.6 times likely to seek induced abortion (OR 4.64, CI 1.39–15.4). Compared with women who had not had induced abortion, women with a high number of pregnancies and no contraceptive knowledge were more likely to have induced abortion. Conclusion: It was found that lack of knowledge about contraceptives and being single or employed were associated with increased likelihood of induced abortion. It was also found that women with a higher number of pregnancies have a greater odds of induced abortion. No association was found between induced abortion and maternal age, education, contraceptive use, or religion. Keywords: induced abortion, case control, maternal mortality, hospital-based, Volta Region, Ghana

Nana Yaa Konadu Gyesaw,1 Augustine Ankomah2 1Regional Health Directorate, Ghana Health Service, Koforidua, Eastern Region, 2Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana Background: The proportion of teenage girls who are mothers or who are currently pregnant in sub-Saharan African countries is staggering. There are many studies regarding teenage pregnancy, unsafe abortions, and family planning among teenagers, but very little is known about what happens after pregnancy, ie, the experience of teenage motherhood. Several studies in Ghana have identified the determinants of early sexual activity, contraception, and unsafe abortion, with teenage motherhood only mentioned in passing. Few studies have explored the experiences of adolescent mothers in detail with regard to their pregnancy and childbirth. This qualitative study explores the experiences of adolescent mothers during pregnancy, childbirth, and care of their newborns. Methods: This qualitative study was based on data from focus group discussions and indepth interviews with teenage mothers in a suburb in Accra. Participants were recruited from health facilities as well as by snowball sampling. Results: Some of the participants became pregnant as a result of transactional sex in order to meet their basic needs, while others became pregnant as a result of sexual violence and exploitation. A few others wanted to become pregnant to command respect from people in society. In nearly all cases, parents and guardians of the adolescent mothers were upset in the initial stages when they heard the news of the pregnancy. One key finding, quite different from in other societies, was how often teenage pregnancies are eventually accepted, by both the young women and their families. Also observed was a rarity of willingness to resort to induced abortion. Conclusion: Special programs should be initiated by the government and the various responsible departments to address ignorance on sexual matters, and the challenges and risks associated with pregnancy and parenting by adolescents. Parenting techniques should be taught in sex education programs. Keywords: teenage pregnancy, teenage motherhood, adolescents, unmarried teenagers, focus group discussions, Ghana

SummaryUnderstanding the level, trend, geographical variations and determinants of use of modern family planning (FP) plays a major role in designing effective interventions leading to increased usage. This study assessed these characteristics of FP use in Nigeria using data from the 2003, 2005 and 2007 National HIV/AIDS and Reproductive Health Survey, a national population-based household survey. A Bayesian geo-additive procedure was used, which provides flexible modelling of non-linear and spatial effects at a highly disaggregated level of states. The findings reveal considerable geographical variation in the use of modern FP in Nigeria, with a distinct north–south divide. Furthermore, a significant trend in the use of modern FP was evident, with an increase between 2003 and 2005 followed by a decline between 2005 and 2007. The effect of respondent's age was non-linear, and use of modern FP was found to differ significantly between never-married and currently/formerly married respondents. Awareness of FP methods and knowledge of where to get/buy FP services/methods were found to be significantly associated with usage. The findings provide policymakers with tools to prioritize the use of scarce resources for implementing FP and reproductive health interventions.

AbstractThis study assessed the impact of the COVID‐19 pandemic on the number of new contraceptive acceptors in Senegal overall and by method. Monthly service data from March 2019 to December 2020 were extracted for the number of new contraceptive users of IUDs, implants, injectables, and oral contraceptive pills (OCPs). Data were analyzed using descriptive statistics and interrupted time series analysis for trend analyses overall and by the contraceptive method. Following the announcement of the first COVID‐19 case in Senegal in March 2020, there was an immediate significant decrease in the number of new acceptors overall, and for new users of implants and injectables. From March–December 2020, the trend in monthly new family planning acceptors increased overall, mainly driven by significant increases in new IUD and implant acceptors. Compared to the period before the onset of COVID‐19, there was a statistically significant shift from shorter‐acting methods (OCPs, injectables) to long‐acting reversible methods (IUDs, implants). Despite the immediate adverse impact of COVID‐19‐related restrictions, the number of new acceptors rebounded, trends in the number of new monthly acceptors significantly increased, and there was a significant shift to longer‐acting methods.

Background: Key Population size estimation (PSE) is instrumental for HIV/STI preventive, treatment and care services planning, implementation and delivery. The objective was to estimate the overall population of female sex workers (FSW) in all the 16 regions of Ghana using different PSE methods. Method: Mapping of venues and complete enumeration of seaters was conducted at the formative stage prior to the bio-behavioral survey (BBS). Three PSE methods were used to derive the size estimates of FSW in the 16 regions. These include: Capture-recapture (CRC), service multiplier and three-source capture recapture (3SCRC) methods. The final choice of the estimation method used to estimate the roamer population was 3SCRC. This method was chosen because of its perfect record-linkage–hierarchic combination of three names that minimizes overmatching as well as the addition of an interaction term in the model which corrects for the dependencies in CRC. Results: The total population size estimate of the female sex workers in the country obtained for roamers using capture re-capture was 41,746 (95% CI: 41,488–41,932). Using the service multiplier, the total population for both the roamers and seaters was 41,153 (95% CI: 37,242–45,984). The 3-source capture re-capture yielded 55,686 roamers FSW (95% CI: 47,686–63,686). The seater population was 4,363 FSW based on census/complete enumeration. The total population size estimate of FSW (seaters and roamers) in Ghana was 60,049 when 3SCRC and census were added. This represents about 0.76% of all estimated adult females aged 15–49 yrs in Ghana. Conclusion: We report population size estimates (PSE) for FSW in Ghana. These estimates are the results of 3SCRC. These findings provide a valid and reliable source of information that should be referenced by government officials and policymakers to plan, implement and provide HIV/STI preventive, treatment, and care services for FSW in Ghana.

While access to and uptake of modern family planning (FP) in Ghana has steadily risen over the last decade, the modern Contraceptive Prevalence Rate (mCPR) among all women reached only 22% in 2019 with 30% of women still reporting unmet need. To increase FP uptake via mitigation of cost barriers among women with unmet need, the Government of Ghana is seeking to integrate claims-based FP services into the National Health Insurance Scheme benefits package. The impact of these activities has the potential to be significant with the proportion of women accessing modern FP shifting dramatically to public facilities over the past decade. The Ghana Ministry of Health, the National Health Insurance Authority, Marie Stopes International Ghana, and the Population Council launched a pilot in nine districts from 2018–20. This report uses data from pilot activity to model four scenarios involving implementation of cost removal, demand generation, and long-acting reversible contraceptives training to estimate impact on mCPR. These are input into the Health Policy Project's ImpactNow tool to obtain estimates of health and economic benefits, intended to inform decisions regarding scale-up of these activities across the country.

BACKGROUND: Key Population size estimation (PSE) is instrumental for HIV/STI preventive, treatment and care services planning, implementation and delivery. The objective was to estimate the overall population of female sex workers (FSW) in all the 16 regions of Ghana using different PSE methods. METHOD: Mapping of venues and complete enumeration of seaters was conducted at the formative stage prior to the bio-behavioral survey (BBS). Three PSE methods were used to derive the size estimates of FSW in the 16 regions. These include: Capture-recapture (CRC), service multiplier and three-source capture recapture (3SCRC) methods. The final choice of the estimation method used to estimate the roamer population was 3SCRC. This method was chosen because of its perfect record-linkage–hierarchic combination of three names that minimizes overmatching as well as the addition of an interaction term in the model which corrects for the dependencies in CRC. RESULTS: The total population size estimate of the female sex workers in the country obtained for roamers using capture re-capture was 41,746 (95% CI: 41,488–41,932). Using the service multiplier, the total population for both the roamers and seaters was 41,153 (95% CI: 37,242–45,984). The 3-source capture re-capture yielded 55,686 roamers FSW (95% CI: 47,686–63,686). The seater population was 4,363 FSW based on census/complete enumeration. The total population size estimate of FSW (seaters and roamers) in Ghana was 60,049 when 3SCRC and census were added. This represents about 0.76% of all estimated adult females aged 15-49yrs in Ghana. CONCLUSION: We report population size estimates (PSE) for FSW in Ghana. These estimates are the results of 3SCRC. These findings provide a valid and reliable source of information that should be referenced by government officials and policymakers to plan, implement and provide HIV/STI preventive, treatment, and care services for FSW in Ghana.

AbstractGlobally, there is a need for more family planning method options as currently, available options do not adequately meet the needs of women, specifically those who have infrequent sex. Levonorgestrel (LNG) 1.5 mg is widely available as emergency contraception pills (ECP), and recent research has shown that certain women take it as their main form of contraception. Furthermore, limited studies have found repeat, on‐demand use safe and efficacious.This 12‐month prospective, single‐arm, interventional study in Ghana tested whether a single LNG 1.5 mg on‐demand or pericoital ("around the time of sex") dose contraceptive was acceptable to women who have infrequent sex and if pharmacy provision was feasible. The study sample (1,890) comprised women of reproductive age recruited from urban areas, having infrequent sex (i.e., coital frequency ≤ 6× per month), and not using any other modern methods except condoms or ECP at the time of study inclusion.Results indicated that there is demand and acceptability for a pericoital pill and that pharmacy provision is feasible. Furthermore, precoital use of the pill had high levels of satisfaction and was popular with new users. Adding LNG 1.5 mg for pericoital use to the family planning method mix has the potential to address an important segment of the population currently underserved, decrease unwanted pregnancies, and increase modern contraceptive prevalence rates.