The end point of it is abstinence: a qualitative analysis of underlying factors influencing Christian leaders' adoption and implementation of sex and sexuality education in Bolgatanga, Ghana.

Adolescents' sexual and reproductive health challenges are of global public health concern and good quality sexual and reproductive health (SRH) education has an important role to play in addressing these negative sexual health outcomes. Yet in most Sub-Saharan African countries including Ghana, there is limited implementation of SRH education. Several environmental factors hinder the implementation of SRH education with the attitudes expressed by religious leaders having a major impact. We conducted semi-structured interviews with 15 Christian leaders in Bolgatanga, Ghana, to explore the factors influencing their decision to adopt and implement SRH education. Findings show that although Christian leaders were aware of (unsafe) sexual practices among adolescents, they held a conservative position on SRH education. While leaders were open to educating adolescents about sexual health, most held the opinion that SRH education for adolescents should be limited to abstinence-only and not acknowledge sexual activity or promote contraceptive use. Beliefs related to sexual morality, the perceived cause(s) of teenage pregnancy, and perceived responsibility for SRH education influenced Christian leaders' thinking about SRH education. Implementing SRH education programmes to address young people's sexual behaviour will require intervention programmes to change Christian leaders' beliefs and attitudes towards SRH education.

"Our Work, Our Health, No One's Concern": Domestic Waste Collectors' Perceptions of Occupational Safety and Self-Reported Health Issues in an Urban Town in Ghana.

Domestic waste collectors face major public health hazards that result in injuries and morbidity globally. This study explored domestic waste collectors' perceptions of occupational safety and self-reported health issues in a city in Ghana using a phenomenological qualitative research design. In-depth interviews and focus group discussions were held with 64 domestic waste collectors from two waste companies. The transcribed data were imported into NVivo 11.0 software (QSR International, Burlington, MA, USA) for coding, and a content analysis was applied to analyze all the transcribed data using the processes of induction and deduction. The consensual views from the domestic waste collectors showed the waste-company employers' non-interest in the domestic waste collectors' occupational safety and health. Poor communication from employers to domestic waste collectors and huge workloads were identified as the causes of the poor implementation of occupational safety practices, which exposed the domestic waste collectors to occupational health hazards. The domestic waste collectors reported that they suffered from occupational injuries, psychosocial disorders, work-related stress, and frequent burnout. The domestic waste collectors adopted coping strategies, such as self-medication, to deal with these occupational hazards, since most of them were not covered by guaranteed health insurance. In addition, the study revealed the non-compliance and non-enforcement of occupational health and safety policies by the employers to guide health and safety training and practices among the domestic waste collectors. In conclusion, the findings suggest that DWCs are exposed to occupational safety and health hazards in their work. Waste-company employers should extend welfare benefits to DWCs, such as health insurance and social security benefits, to ensure their security, health, and well-being. The findings could inform the design of intervention programs and policies to guide training and practices for domestic waste collectors.

Managing urban solid waste in Ghana: Perspectives and experiences of municipal waste company managers and supervisors in an urban municipality.

Increased population growth and rapid urbanization have resulted in the generation of large quantities of solid waste across major urban cities in Ghana, outstripping local authorities' ability to manage and dispose of waste in a sanitary manner. This study explored the perspectives and experiences of municipal waste company managers and supervisors in the Ho municipality of Ghana on solid waste management practices. A qualitative inquiry was conducted by adopting a phenomenological approach, using in-depth interviews and focus group discussions for data collection. A total of 35 participants, made up of 12 managers and 23 supervisors took part in the study. Transcribed data were imported into NVivo 11.0 software for coding. Content analysis was applied to analyze all transcribed data using processes of induction and deduction. The results showed that organizational capacity, resources, and expertise; community factors such as socio-cultural beliefs and a low sense of responsibility towards solid waste management among urban residents; contextual factors such as regulations, and weak enforcement all influence and shape the level of efficiency and effectiveness of solid waste management practices in the study setting. The findings suggest that policy frameworks and procedures implemented to curb poor urban waste management practices should be systematic and thorough in order to tackle the issue of solid waste in the study setting and Ghana in general. The nature of the identified issues and challenges requires multidimensional and multilevel interventions to provide sustainable solutions for managing urban waste in Ghana.

SPEEK: effect evaluation of a Ghanaian school-based and peer-led sexual education programme.

In sub-Saharan Africa, theory and evidenced-based interventions that are systematically designed and using sound evaluation methods to report on effectiveness are limited. A sex education programme called SPEEK was developed, implemented and evaluated in Ghana using the Intervention Mapping approach. SPEEK aimed at delaying sexual initiation, reducing sexually transmitted infections (STIs) and preventing pregnancy, targeting junior high school students in a West African rural setting. The final programme included 11 (interactive) lessons using a diverse range of theory-based methods. In this article, we report on the effect evaluation of the programme. Participating schools were randomized to the intervention (N = 10 schools) and a waiting-list control group (N = 11 schools). The students completed survey questionnaires at baseline (N = 1822), at direct post-test (N = 1805) and at six months follow-up (N = 1959), measuring cognitive and affective psychosocial determinants of sexual delay, condom use and STI testing. Mixed regression models showed that at direct post-test, students having received the SPEEK programme scored significantly more positively on knowledge on condom use, pregnancy and STIs testing; attitude toward exercising sexual rights, condom availability and condom use; perceived behavioural control toward sexual delay, condom use and sexual intercourse; and perceived risk toward STIs (P's < 0.002). The results suggest that the programme may improve adolescent sexual health in Ghana or in similar cultures, but would need further study that include behavioural measures and a longer follow-up to make this assertion with more confidence.

Girls cannot be trusted: young men's perspectives on contraceptive decision making and sexual relationships in Bolgatanga, Ghana.

BACKGROUND: There is extensive research on African girls sexual experiences, but much less is known about boys thoughts and actions. There is a need to understand the male perspective in order to develop sexuality education programmes that address the high rates of teenage pregnancy and sexually transmitted infections in sub-Saharan Africa. METHODS: For this qualitative, phenomenological study we spoke to 20 boys from Bolgatanga, Ghana and explored their sexual decision making, using semi-structured interviews designed to highlight psychosocial and environmental factors. Content analysis was used to construct categories and later the themes. RESULTS: Boys often had negative perceptions about sexual relationships. They believed that girls could not be trusted and mostly embarked on sexual relationships for material gain. The boys reported engaging in multiple sexual partnerships to secure their masculine status; however, they expected girls to be 'faithful'. We found that accurate knowledge of safe sex was lacking, boys were under peer pressure to conform to beliefs about masculinity and communication about sex mainly took place within peer groups. CONCLUSIONS: There is a need to emphasise condom use in established relationships. There should also be more discussion of issues surrounding fidelity and gender equality, as part of sexuality programmes aimed at boys in Ghana and in similar cultures.