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Intimate Partner Violence is a global public health problem. Attitude towards wife-beating is a major determinant of both intimate partner violence perpetration and victimization. However, little is known about the attitudes of Ghanaian young people towards wife-beating. The objectives of this study were to assess young people's attitudes towards wife-beating, and identify salient factors influencing young people's acceptance of wife-beating. Data used in this study were obtained from the 2014 Ghana Demographic and Health Survey. The survey was nationally representative and provides estimates for population and health indicators across the former ten regions of Ghana, including rural and urban areas. Data were analyzed with Stata/SE version 16. We found that 32% of young women and 19% of young men accepted wife-beating. Among young women, acceptance of wife-beating was significantly influenced by younger age, wealth index, low educational status, religion, the region of residence, ethnicity, frequency of reading newspaper and frequency of listening to radio (p < 0.05). Among young men, acceptance of wife-beating was significantly influenced by wealth index, the region of residence and frequency of reading newspaper (p < 0.05). This study demonstrates that a substantial proportion of young people in Ghana accept wife-beating. Young women were more likely to accept wife-beating compared to young men. Acceptance of wife-beating was influenced by socio-demographic and behavioral factors. Efforts to end violence against women and girls in Ghana should focus on promoting girl education, economic empowerment of women and public education on laws that prohibit Intimate Partner Violence.

Many women of reproductive age in sub Saharan Africa are not utilizing any contraceptive method which is contributing to the high burden of maternal mortality. This study determined the prevalence, trends, and the impact of exposure to family planning messages (FPM) on contraceptive use (CU) among women of reproductive age in sub-Saharan Africa (SSA). We utilized the most recent data from demographic and health surveys across 26 SSA countries between 2013 and 2019. We assessed the prevalence and trends and quantified the impact of exposure to FPM on contraceptive use using augmented inverse probability weighting with regression adjustment. Sensitivity analysis of the impact estimate was conducted using endogenous treatment effect models, inverse probability weighting, and propensity score with nearest-neighbor matching techniques. The study involved 328,386 women of reproductive age. The overall prevalence of CU and the percentage of women of reproductive age in SSA exposed to FPM were 31.1% (95% CI 30.6–31.5) and 38.9% (95% CI 38.8–39.4) respectively. Exposure to FPM increased CU by 7.1 percentage points (pp) (95% CI 6.7, 7.4; p < 0.001) among women of reproductive age in SSA. The impact of FPM on CU was highest in Central Africa (6.7 pp; 95% CI 5.7–7.7; p < 0.001) and lowest in Southern Africa (2.2 pp; 95% CI [1.3–3.0; p < 0.001). There was a marginal decline in the impact estimate among adolescents (estimate = 6.0 pp; 95% CI 5.0, 8.0; p < 0.001). Exposure to FPM has contributed to an increase in CU among women of reproductive age. Programs that are geared towards intensifying exposure to FPM through traditional media in addition to exploring avenues for promoting the appropriate use of family planning method using electronic media remain critical.

Women living with HIV (WLWH) have high risk of developing cervical cancer. High- risk Human papillomavirus (hrHPV) is the single most important cause of cervical cancer. Vaccination for and early detection of pre-malignant cervical changes, through cervical cancer screening contributes to prevention of cervical cancer. This study sought to determine the prevalence of HPV among WLWH, genotypes present and the risk factors associated with cervical cancer development. An analytical cross-sectional study of 250 sexually active women aged 18 years and above, attending HIV clinic at a tertiary health facility in Accra. Demographic data collection and risk factor assessments were done using interviewer-administered questionnaire, and patient records. Cervical swabs were collected and tested for HPV using real-time PCR assays. Genotype analysis was performed on 92 samples. Descriptive statistics and logistic regression analysis were used to establish associations between hrHPV and risk factors among WLWH. Approximately 60% of study participants tested positive for HPV. The prevalence of hr-HPV among WLH was 44.4%. Factors identified to be protective of hrHPV were employment (AOR = 0.19, 95% CI = 0.06, 0.56, p = 0.003) and highly active antiretroviral therapy (HAART) Tenofovir-Lamivudine-Ritonavir-Lopinavir (TLRL) (AOR = 0.30, 95% CI = 0.09, 0.95, p = 0.04). Women with HIV diagnosis within 6 to10 years (AOR = 4.89, 95% CI = 1.05, 22.70, p = 0.043) and diagnosis >10 years (AOR = 8.25, 95% CI = 1.24, 54.84, p = 0.029) had higher odds of hrHPV. Approximately 25% of samples analysed tested positive for hr-HPV group 1 (genotypes 16, 18, 31, 33, 35, 39, 45,51, 52, 56, 58, 69) and 46.8% for multiple HPV genotypes. A high prevalence of genotypes that include high risk genotypes 16 and 18 and multiple HPV infections was found among WLWH. Almost half of the women screened had high-risk HPV and were prone to cervical cancer without their knowledge. Regular HPV screening is recommended for high-risk patient groups.

Background The effect of COVID-19 has manifested both in the capacity of healthcare systems to provide services as well as create a good balance between pandemic management and maintenance of essential health services. Earlier studies in Ghana during the pandemic reported low patronage of family planning (FP) services but a sudden spike in emergency contraceptive pill utilization. This paper seeks to assess health service availability and readiness, client needs for, and utilization of FP and abortion services during the COVID-19 pandemic period in Ghana. Methods This study was a panel study with two-time data collection points six to nine months apart. Both quantitative and qualitative approaches were used. A one-time survey was used to assess SRH service utilization by 997 clients. Qualitative data involved a total of 24 Focus Group Discussions (FGDs), 128 In-depth Interviews (IDIs) with female clients and their male partners, and 32 IDIs with healthcare practitioners in the four selected facilities. Also, the WHO Service Availability, Readiness and Assessment tool was completed for the health facilities at baseline and endline. Descriptive statistics and thematic analysis were conducted for quantitative and qualitative data respectively. Results Age of clients and their male partners participating in IDIs ranged between 18 and 50 years (mean = 33.2 years) while participants for community FGDs ranged between 16 and 56 years (mean = 32.0 years). The majority (68%) of clients visiting the health facility for SRH care sought FP services while 5% sought abortion/post-abortion care of which 71% needed post-abortion care. Attendance data showed sensitivity to the occurrence of the different waves of COVID-19. Family planning and abortion services were generally available but witnessed some short-lived disruption. Healthcare managers reported financial stress which led to innovations in procurement of PPEs and hand sanitizers. Telemedicine facilities did not provide SRH care. Fear of stigma was a major barrier to access to abortion care. Conclusion The relatively low COVID-19 infection rates in Ghana preceded by the national COVID-19 preparedness strategy may explain the low impact on disruption of FP and abortion services. Development of SRH specific guidelines and strengthening telemedicine facilities to include SRH care may reduce future disruption. Plain English Summary Since 2020 most countries around the world were hit by COVID-19 infection with many deaths recorded. Measures to control the pandemic while sustaining existing services stressed health systems. Earlier studies in Ghana during the pandemic reported impact on health services. Yet, we do not know how the COVID-19 pandemic impacted the health system’s readiness and availability to provide family planning and abortion services, and client utilization, at different levels of care in public health facilities in Ghana. This study involved a survey of clients accessing care at all sexual and reproductive health units in the 4 selected hospitals. We also had in-depth interviews with 128 women and their male partners, 32 interviews with healthcare providers and 24 groups of community members to elicit their needs for sexual and reproductive health services, utilization, and perspectives on care provided at the time. We found that there was some disruption of family planning and abortion services, especially for surgical abortion methods which were suspended during the lockdown and period thereafter. However, service provision was fully restored in all facilities by the follow-up period. Fear of COVID-19 infection and stigma were barriers to accessing care even after lockdown was ended. We recorded innovative measures such as self-production of personal protective equipment and institution of telemedicine facilities. Client utilization data showed patterns related to waves of infection in Ghana. Thus, we believe that the minimal disruptions observed was due to the relatively low infection rates in Ghana.

Background Globally, young women deliver at home, often under unhygienic conditions and without skilled birth attendants. This study identified the determinants of health facility delivery among young mothers in Ghana. Methods We analysed secondary data from the 2014 Ghana Demographic and Health Survey, which collected data across the former ten administrative regions of Ghana. This study analysed data from the ‘women file’ by adjusting for the sample weight. STATA/SE version 16 was employed to analyse the data by computing descriptive statistics, Chi-square, and Binary Logistic Regression. Results Seven in ten young mothers gave birth in a health facility. Young mothers who had secondary school education were over three-fold more likely to deliver in a health facility (AOR = 3.5, 95% CI: 1.33–9.23) compared with young mothers with no formal education. Young mothers who resided in rural areas had lower odds (73%) of delivering in a health facility (AOR = 0.27; 95% CI: 0.14–0.514) compared with those in urban areas. Young mothers within the richest wealth quintile also had higher odds (8 times) of delivering in a health facility (AOR = 8.24; 95% CI: 0.95–71.77) compared with those within the poorest wealth quintile. Young mothers who obtained four to seven antenatal visits (AOR = 0.53; 95% CI: 0.27–1.03) had lower odds of delivering in a health facility compared with those who obtained eight or more antenatal visits. Conclusion The majority of young mothers in Ghana gave birth in a health facility. The likelihood of delivering in a health facility was influenced by socio-demographic factors, economic factors and utilization of antenatal care services. Therefore, interventions aimed at increasing utilization of skilled delivery among young women should focus on promoting girl child education, economic status and antenatal care visits.

Background Effective control of blood pressure is necessary to avert the risk of cardiovascular diseases from uncontrolled hypertension. Despite evidence on the benefits of hypertension control, rates of control in Ghana remain low. This study assessed the patient-level factors that influence hypertension control among adults in Accra, Ghana. Methods A total of 360 hypertensive patients from two hospitals in Accra, Ghana were enrolled in the study. Patient socio-demographic characteristics were tabulated and associations between patient characteristics and hypertension control were estimated using chi-square tests and logistic regression. Results Less than a quarter of the patients had a controlled blood pressure. The patient’s sex [AOR = 3.53 (95% CI:1.73–7.25], educational at junior high school [AOR = 3.52(95% CI 1.72–7.22)], senior and junior high school [AOR = 2.64 (95% CI 1.40–6.66_] and AOR = 3.06 (95% CI 1.03–6.67)] and presence of a comorbidity [AOR = 2.41 (95% CI 1.32; 4.42)] predicted BP control among patients. Dyslipidaemia [AOR = 0.31, [0.11–0.89)] an increased pill burden, and length of diagnosis of 2–5 years (AOR = 0.27 (0.1–0.73)] however, were associated with reduced BP control [AOR = 0.32(95% CI: 0.18–0.57)]. The majority of patients reported forgetfulness, side effects of medication and high pill burden as reasons for missing their medications. Conclusion Knowledge of hypertension among patients is low. Sex, formal education and the presence of comorbidity and more specifically dyslipidaemia influences blood pressure control. High pill burden and 2–5 years since diagnosis negatively affects the attainment of blood pressure control.

IntroductionWHO has generated standardised clinical and epidemiological research protocols to address key public health questions for SARS-CoV-2 (COVID-19) pandemic. We present a standardised protocol with the aim to fill a gap in understanding the needs, attitudes and practices related to sexual and reproductive health in the context of COVID-19 pandemic, focusing on pregnancy, pregnancy prevention and abortion.Methods and analysis planThis protocol is a prospective qualitative research, using semi-structured interviews with at least 15 pregnant women at different gestational ages and after delivery, 6 months apart from the first interview. At least 10 partners, 10 non-pregnant women and 5 healthcare professionals will be interviewed once during the course of the research. Higher number of subjects may be needed if a saturation is not achieved with these numbers. Data collection will be performed in a standardised way by skilled trained interviewers using written notes or audio-record of the interview. The data will be explored using the thematic content analysis and the researchers will look for broad patterns, generalisations or theories from these categories.Ethics and disseminationThe current protocol was first technically assessed and approved by the WHO scientific committee and then approved by its ethics review committee as a guidance document. It is expected that each country/setting implementing such a generic protocol adapted to their conditions also obtain local ethical approval. Comments for the user’s consideration are provided the document, as the user may need to modify methods slightly because of the local context in which this study will be carried out.

Background The validity of the theory of planned behavior (TPB) in predicting health behavior intention has proven its applicability to various health behaviors, such as condom uptake, HIV prevention, and contraception use in resource-limited settings. However, the effectiveness of the TPB framework in understanding refugee women’s intention to switch from short-acting contraceptives (SAC) to long-acting and reversible contraceptives (LARC) remains unclear. This study examined how the TPB predicts refugee women’s intention to switch from SAC to LARC. Methods This study is a nested component of a larger retrospective cohort examining contraceptive use dynamics among women in Ethiopian refugee camps. Initially, 1,290 family planning records from selected health facilities in Ethiopian refugee camps were reviewed. These records included 551 women who began using contraceptives between September 2022 and February 2023 (387 started SAC and 164 started LARC). Among SAC users, 238 women who were current users and familiar with LARC methods (implants and/or IUDs) participated in this study. Data collection involved computer-assisted face-to-face interviews conducted using the Open Data Kit (ODK) toolkit. Four constructs, based on the TPB variables, measured using a 7-point Likert scale, were analyzed to explore the relationship between attitude, subjective norms, and perceived behavioral control as predictors of the intention to switch from SAC to LARC. The Structural Equation Model (SEM) with the Stata SEM Builder and maximum likelihood estimation was used to evaluate how well the data fit the TPB model and identify the key predictors of the intention to switch from SAC to LARC. Results All specified relations between the three constructs and the intention to switch from SAC to LARC in TPB were exhibited as statistically significant. The TPB model accounted for 66.3% of the variation in the intention to switch from SAC to LARC. A positive attitude toward LARC use (β = 0.16; P  = .014), strong subjective norms (β = 0.46; P  = .001), and higher perceived behavioral controls (β = 0.17; P  = .001) had a positive influence on refugee women’s intention to switch from SAC to LARC. Conclusion The TPB model demonstrated a good fit for examining refugee women’s intention to switch from SAC to LARC, with the subjective norm being the strongest predictor.

Introduction A generic research protocol was developed for a prospective cohort study to allow systematic, harmonized data collection of the impact of SARS-CoV-2 infection and vaccination during pregnancy on maternal, obstetric, and neonatal outcomes across different settings. This article describes the study conception, development, implementation, challenges, and key lessons learned within study sites across the world. Methods The protocol was implemented in 43 facilities in 10 countries during the pandemic, involving consecutive recruitment of over 16,000 pregnant or postpartum women. We evaluated selection of study sites, ethical approvals, staff recruitment and training, recruitment and follow-up, and incorporation of new elements over the course of the pandemic across the study sites. Results Study implementation in multiple LMIC settings was feasible; however, major challenges included delays in study implementation due to ethical approval procedures and availability of testing for exposure assessment. Implementation of research during a constantly evolving pandemic context led to the need for amended protocols, adjusted sample sizes, new outcomes and variables, repeated review by the Ethical Committees and adapted laboratory protocols. For example, the first COVID-19 vaccines became available after the study had started, with the need to modify the data collection forms and serologic testing algorithm to allow incorporation of this information in the study structure and analysis. Conclusion Study implementation during a pandemic in different countries and periods was challenging but is not only expected to provide important information on the effects of SARS-CoV-2 infection and vaccination on pregnancy, but also on conducting research during future outbreaks. More streamlined ethics reviews during pandemics, availability of generic protocols in advance, and sites in LMICs ready to activate in an outbreak, as opposed to triggering processes during a crisis, would be highly beneficial.

IntroductionCOVID-19 has led to an unprecedented increase in demand on health systems to care for people infected, necessitating the allocation of significant resources, especially medical resources, towards the response. This, compounded by the restrictions on movement instituted may have led to disruptions in the provision of essential services, including sexual and reproductive health (SRH) services. This study aims to assess the availability of contraception, comprehensive abortion care, sexually transmitted infection prevention and treatment and sexual and gender-based violence care and support services in local health facilities during COVID-19 pandemic. This is a standardised generic protocol designed for use across different global settings.Methods and analysisThis study adopts both quantitative and qualitative methods to assess health facilities’ SRH service availability and readiness, and clients’ and providers’ perceptions of the availability and readiness of these services in COVID-19-affected areas. The study has two levels: (1) perceptions of clients (and the partners) and healthcare providers, using qualitative methods, and (2) assessment of infrastructure availability and readiness to provide SRH services through reviews, facility service statistics for clients and a qualitative survey for healthcare provider perspectives. The health system assessment will use a cross-sectional panel survey design with two data collection points to capture changes in SRH services availability as a result of the COVID-19 epidemic. Data will be collected using focus group discussions, in-depth interviews and a health facility assessment survey.Ethics and disseminationEthical approval for this study was obtained from the WHO Scientific and Ethics Review Committee (protocol ID CERC.0103). Each study site is required to obtain the necessary ethical and regulatory approvals that are required in each specific country.