A multilevel analysis of the predictors of health facility delivery in Ghana: Evidence from the 2014 Demographic and Health Survey.

Health facility delivery has the potential to improve birth and general health outcomes for both newborns and mothers. Regrettably, not all mothers, especially in low-and-middle income countries like Ghana deliver at health facilities, and mostly under unhygienic conditions. Using data from the 2014 Ghana Demographic and Health Survey, we fitted both weighted single-level and random intercept multilevel binary logistic regression models to analyse predictors of a health facility delivery among mothers aged 15-49 years and to quantify unobserved household and community differences in the likelihood of health facility delivery. We analysed data on 4202 mothers residing in 3936 households and 427 communities. Of the 4202 mothers who delivered, 3031 (75.3%-weighted and 72.1%-unweighted) delivered at the health facility. Substantial unobserved household only (Median Odds Ratio (MOR) = 5.1) and household conditional on community (MOR = 4.7) level differences in the likelihood of health facility delivery were found. Mothers aged 25-34 (aOR = 1.4, 95%CI: 1.0-2.1) and 35-44 (aOR = 2.9, 95%CI: 1.7-4.8), mothers with at least a secondary education (aOR = 2.7, 95%CI: 1.7-4.1), with health insurance coverage (aOR = 1.6, 95%CI: 1.2-2.2) and from richer/richest households (aOR = 8.3, 95%CI: 3.6-19.1) and with piped water (aOR = 1.5, 95%CI: 1.1-2.1) had increased odds of health facility delivery. Mothers residing in rural areas (aOR = 0.3, 95%CI: 0.2-0.5) and with no religion (aOR = 0.5, 95%CI: 0.3-1.0) and traditional religion (aOR = 0.2, 95%CI: 0.1-0.6), who reported not wanting to go to health facilities alone as a big problem (aOR = 0.5, 95%CI: 0.3-0.8) and having a parity of 2 (aOR = 0.4, 95%CI: 0.3-0.7), 3 (aOR = 0.3, 95%CI: 0.2-0.6) and ≥4 (aOR = 0.3, 95%CI: 0.1-0.5) had reduced odds of health facility delivery. Our predictive model showed outstanding predictive power of 96%. The study highlights the need for improved healthcare seeking behaviours, maternal education and household wealth, and bridge the urban-rural gaps to improve maternal and newborn health outcomes.

Potential ecological risk assessment of heavy metals associated with abattoir liquid waste: A narrative and systematic review.

The article presents a narrative and systematic review of the potential ecological risk assessment of heavy metals associated with abattoir liquid waste for knowledge advancement. The narrative review primarily focused on (i) An overview of abattoir operations; (ii) Characteristics of abattoir liquid waste; (iii) Heavy metals in the liquid waste and their health effects; (iv) Environmental impacts of abattoir liquid waste; and (v) Potential ecological risk index (RI) methodology. These provided essential literature for the systematic review. Using exclusive/inclusive criteria, 15 abattoirs that satisfied the eligibility criteria, all located in Nigeria, were used for the systematic review with meta-analysis/meta-regression. Comparative multiple linear meta-regression analyses were used to quantify the heterogeneity variances between the abattoirs based on standardized RIs (SRIs; effect sizes) using eight tau (τ) estimators in R metafor. The effects of three standardized moderators─ number of metals, metal concentrations, and relative distances between the abattoirs and a pristine environment, Gashaka-Gumti National Park (GNP), were also analyzed. The Sidik-Jonkman (SJ) estimator yielded a realistic output, and the current research findings were based on this estimator. The Cochran statistic (QE) suggested an absence of heterogeneity(p>0.99). Between-study heterogeneities, quantified by H2 (1.05), I2 (4.76%), and τ2 (0.0032 ± 0.0032 (SE)) statistics were very low, practically suggesting complete homogeneity. The moderators accounted for R*2 of 95.73% of the total explanatory capacity of the model. The beta coefficients of the moderators and intercept were significant (p-values: 0.009-0.0004). While the first two moderators showed in-phase relations with the SRIs, the third indicated an out-of-phase relation. Such links suggest the existence of abattoir-environment interactive processes. Although the abattoirs are spatially distinct and independent, their operations showed evidence-based homogeneity and posed high ecological risks. Hence, environmental legislation should be strictly enforced while ensuring human settlements are sited reasonably from abattoirs.

Family-Based Index testing for HIV; a qualitative study of acceptance, barriers/challenges and facilitators among clients in Cape Coast, Ghana.

Family-based Index HIV Testing, (FBIT) approach is known to be associated with a relatively higher testing yield compared to Provider-Initiated Testing and Counselling. The implementation of this strategy in several countries has exposed some barriers to optimal FBIT outcomes. With the scale up of FBIT in Ghana, stakeholder engagement is key in identifying and addressing barriers to implementation. This study explored acceptance, barriers/challenges and facilitators of FBIT. Seventeen in-depth qualitative interviews were conducted among clients who had been offered FBIT at the Cape Coast Teaching Hospital using a semi-structured interview guide. Data were analysed using Braun and Clarke's [(2006)] thematic analysis framework and found that (1) participants accepted the strategy and were willing to use it; (2) lack of awareness of the strategy among the general public, fear of disclosure/stigmatization, issues with confidentiality and privacy are barriers/challenges associated with the FBIT approach, and (3) increasing public education on HIV in general and FBIT in particular, ensuring confidentiality and privacy regarding testing are facilitators for increasing uptake of FBIT. It is concluded that despite acceptance of FBIT as a good strategy among index clients, general HIV education to reduce stigma and addressing confidentiality can optimize uptake.

An analysis of the environmental health impact of the Barekese Dam in Kumasi, Ghana.

Although dams have beneficial effects, they are also acknowledged as having serious environmental repercussions if they are not properly managed. The objective of this work was to examine the impact of the Barekese Dam in Ghana on the health status of three riparian communities downstream against a control. The environmental health status of the communities was analysed with reference to traditional endemic communicable water-related diseases in the catchment area, which were identified as malaria, urinary schistosomiasis, infectious hepatitis, diarrhoeal diseases and scabies. Case-control study was then conducted in the three phases of the dam (pre-construction, at the end of the construction and in the late operational phases) to analyse the health status of the communities as a function of the phases of the dam. The results showed that the control community consistently had a much better health status than two of the riparian communities, which were closer to the dam in all the three phases. However, it had a better health status than the third riparian community, which was farthest downstream, only in the first two phases. This community maintained a fairly constant health status retrospectively and did not appear to have been affected by the presence of the dam. On contrary, the health status of the two communities in close proximity to the dam deteriorated in the late operational phase. The study therefore showed that there was a strong association between the presence of the dam and poorer health status of the downstream communities in close proximity to it.