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Antabe R, McIntosh M, Lawson E, Husbands W, Wong JPH, Arku G, Luginaah I. Black heterosexual men's resilience in times of HIV adversity: findings from the "weSpeak" study. BMC Public Health 2023; 23:182. [PMID: 36707783 PMCID: PMC9880929 DOI: 10.1186/s12889-023-15103-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In Canada, heterosexual African, Caribbean and Black (ACB) men tend to suffer a disproportionate burden of HIV. Consequently, studies have examined the underlying contributors to this disparity through the nexus of behavioral and structural factors. While findings from these studies have been helpful, their use of deficit and risk models only furthers our knowledge of why ACB men are more vulnerable to HIV infection. Thus far, there is a dearth of knowledge on how heterosexual ACB men mobilize protective assets to promote their resilience against HIV infection. METHODS As part of a larger Ontario-based project called weSpeak, this study examined how ACB men acquire protective assets to build their resilience to reduce their HIV vulnerability. We analyzed three focus group discussions (n = 17) and 13 in-depth interviews conducted with ACB men using NVivo and a mixed inductive-deductive thematic analyses approach. RESULTS The findings show that ACB men mostly relied on personal coping strategies, including sexual abstinence, to build resilience against HIV. Interpersonal resources such as family, friends, and religious communities also played an important role in constructing ACB men's resilience. ACB men bemoaned their lack of access to essential institutional resources, such as health services, that are important in managing HIV adversity. CONCLUSION Based on these findings, there is an urgent need for HIV policy stakeholders, including service providers, to engage the ACB community in the design of intervention programs. Additionally, addressing the socioeconomic disadvantages faced by ACB communities will increase the capacity of ACB men to develop resilience against HIV.
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Affiliation(s)
- Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, 1265 Military Trail, M1C 1A4, Toronto, ON, Canada.
| | - Martin McIntosh
- Regional HIV/AIDS Connections (RHAC), 30-186 King Street, N6A 1C7 London, ON Canada
| | - Erica Lawson
- grid.39381.300000 0004 1936 8884Department of Gender, Sexuality, and Women’s Studies, Western University, 1151 Richmond Street, Lawson Hall Room, 3260, N6A 5B8 London, ON Canada
| | - Winston Husbands
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7 Toronto, ON Canada
| | - Josephine Pui-Hing Wong
- Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan University, Podium Building, Room POD-481, 350 Victoria St, M5B 2K3 Toronto, ON Canada
| | - Godwin Arku
- grid.39381.300000 0004 1936 8884Department of Geography and Environment, Social Science Centre, Western University, 1151 Richmond St, N6A 5C2 London, ON Canada
| | - Isaac Luginaah
- grid.39381.300000 0004 1936 8884Department of Geography and Environment, Social Science Centre, Western University, 1151 Richmond St, N6A 5C2 London, ON Canada
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Braimah JA, Kuuire VZ, Bisung E, Pagra MMK, Kansanga MM, Stoner BP. Determinants of COVID-19 knowledge and self-action among African women: Evidence from Burkina Faso, the Democratic Republic of Congo, Kenya, and Nigeria. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001688. [PMID: 37134050 PMCID: PMC10156008 DOI: 10.1371/journal.pgph.0001688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/02/2023] [Indexed: 05/04/2023]
Abstract
Knowledge of infectious diseases and self-action are vital to disease control and prevention. Yet, little is known about the factors associated with knowledge of and self-action to prevent the coronavirus disease (COVID-19). This study accomplishes two objectives. Firstly, we examine the determinants of COVID-19 knowledge and preventive knowledge among women in four sub-Saharan African countries (Kenya, Nigeria, the Democratic Republic of Congo, and Burkina Faso). Secondly, we explore the factors associated with self-action to prevent COVID-19 infections among these women. Data for the study are from the Performance for Monitoring Action COVID-19 Survey, conducted in June and July 2020 among women aged 15-49. Data were analysed using linear regression technique. The study found high COVID-19 knowledge, preventive knowledge, and self-action among women in these four countries. Additionally, we found that age, marital status, education, location, level of COVID-19 information, knowledge of COVID-19 call centre, receipt of COVID-19 information from authorities, trust in authorities, and trust in social media influence COVID-19 knowledge, preventive knowledge, and self-action. We discuss the policy implications of our findings.
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Affiliation(s)
- Joseph A Braimah
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada
| | - Vincent Z Kuuire
- Department of Geography, Geomatics and Environment, University of Toronto Mississauga, Mississauga, Canada
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Elijah Bisung
- School of Kinesiology and Health Studies, Queen's University, Kingston, Canada
| | - Mildred M K Pagra
- Department of African and General Studies, SD Dombo University of Business & Integrated Development Studies, Wa, Ghana
| | - Moses M Kansanga
- Department of Geography, George Washington University, Washington, DC, United States of America
| | - Bradley P Stoner
- Department of Public Health Sciences, Queen's University, Kingston, Canada
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Adjei CA, Stutterheim SE, Bram F, Naab F, Ruiter RAC. Correlates of hepatitis B testing in Ghana: The role of knowledge, stigma endorsement and knowing someone with hepatitis B. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4564-e4573. [PMID: 35701984 PMCID: PMC10083906 DOI: 10.1111/hsc.13860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Hepatitis B testing is the gateway for prevention and care. However, previous studies document low hepatitis B testing uptake in sub-Saharan Africa. This study investigated knowledge, stigma endorsement and knowing someone with hepatitis B as correlates of hepatitis B testing behaviours among people in the Greater Accra and Northern regions of Ghana. A cross-sectional survey was completed by 971 participants (Greater Accra = 503, and Northern region = 468) between October 2018 and January 2019. Approximately 54% of the participants reported having been tested for hepatitis B. The logistic regression analyses showed that having greater hepatitis B knowledge was positively associated with hepatitis B testing (OR = 1.22, 95% CI: 1.14-1.30). Higher hepatitis B stigma endorsement was negatively related to hepatitis B testing (OR = 0.97, 95% CI: 0.96-0.99). Also, participants who knew someone (i.e. parent, sibling and/or friend) with hepatitis B were more likely to have tested compared to those who did not know someone with hepatitis B (OR = 7.15, 95% CI: 5.04-10.14). This study demonstrates that knowing someone with hepatitis B increases the likelihood of testing, highlighting the need to create safe and non-judgmental contexts for people with hepatitis B (PWHB) to disclose if they want to. Also, given that greater hepatitis B knowledge increases testing and hepatitis B stigma endorsement impedes testing, interventions that increase knowledge and reduce stigma should be incorporated in efforts to promote testing in Ghana.
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Affiliation(s)
| | - Sarah E. Stutterheim
- Department of Health PromotionCare and Public Health Research Institute, Maastricht UniversityMaastrichtThe Netherlands
| | - Fleuren Bram
- Department of Work and Social PsychologyMaastricht UniversityMaastrichtThe Netherlands
| | - Florence Naab
- Department of Maternal and Child HealthUniversity of GhanaAccraGhana
| | - Robert A. C. Ruiter
- Department of Work and Social PsychologyMaastricht UniversityMaastrichtThe Netherlands
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Kolbila L, Adjei CA, Kyei JM, Agyemang-Prempeh C, Fosu PK. Perceived Supportive Care Needs of Adolescents With Chronic Hepatitis B in a Resource-limited Setting. J Patient Exp 2022; 9:23743735221106596. [PMID: 35694016 PMCID: PMC9185008 DOI: 10.1177/23743735221106596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In Ghana, adolescents are disproportionately affected by hepatitis B. However, studies
into adolescents’ supportive care needs are lacking. The purpose of this exploratory
qualitative study was to explore the supportive care needs of 18 adolescents with chronic
hepatitis B who were receiving care at a tertiary hospital in Ghana. The data were
processed using QSR Nvivo version 11.0 and analyzed using the Braun and Clarke procedure
for thematic data analysis. According to the findings, adolescents with chronic hepatitis
B have unmet supportive care needs ranging from information to financial need,
psychological support, and social support. Explicitly, participants reportedly had a
dilemma as to whether to keep or terminate their pregnancy to prevent transmission of the
virus to their newborns. Physicians and nurses were perceived to be preoccupied with
medication prescription and laboratory request writing rather than giving pretest and
posttest counseling following diagnosis. This study highlights the need to have a
tailor-made liver care for adolescents. Pretest and posttest counseling for adolescents
with hepatitis B are also required.
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Affiliation(s)
| | | | - Josephine M Kyei
- School of Nursing and Midwifery, University of Ghana, Accra, Ghana
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Guingané AN, Kaboré R, Shimakawa Y, Somé EN, Kania D, Pisoni A, Nagot N, King R, Sombié R, Meda N, Van de Perre P, Tuaillon E. Screening for Hepatitis B in partners and children of women positive for surface antigen, Burkina Faso. Bull World Health Organ 2022; 100:256-267. [PMID: 35386558 PMCID: PMC8958837 DOI: 10.2471/blt.21.287015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 02/08/2023] Open
Abstract
Objective To evaluate the implementation of a screening strategy for the partners and children of pregnant women with hepatitis B virus (HBV) attending antenatal care. Methods We identified pregnant women positive for HBV surface antigen (HBsAg) at antenatal consultation in Ouagadougou, Burkina Faso. At post-test counselling, women were advised to disclose their HBV status to partners and to encourage their partner and children to be screened for HBsAg. We used multivariable logistic regression to explore factors associated with uptake of screening and HBsAg positivity among family members. Findings Of 1000 HBsAg-positive women, 436/1000 partners and 215/1281 children were screened. HBsAg was detected in 55 (12.6%) partners and 24 (11.2%) children. After adjusting for confounders, uptake of screening was higher in partners who were married, who attended the woman’s first post-test consultation and to whom the woman had disclosed her HBV status. In children, HBsAg positivity was associated with being born before the introduction of infant hepatitis B vaccination in Burkina Faso (not significant in the multivariable analysis), having a mother positive for HBV e-antigen (adjusted OR: 8.57; 95% CI: 2.49–29.48) or having a mother with HBV DNA level ≥ 200 000 IU/mL (OR: 6.83; 95% CI: 1.61–29.00). Conclusion In low-income countries, the antenatal consultation provides a cost-effective opportunity to identify HBV-infected household contacts and link them to care. Children born before the introduction of infant hepatitis B vaccination and whose mother has higher viral load or infectivity should be a priority for testing and linkage to care.
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Affiliation(s)
- Alice Nanelin Guingané
- Hepato-Gastroenterology Department, Bogodogo University Hospital Center, 01 BP 3479 Ouagadougou 01, Burkina Faso
| | - Rémi Kaboré
- Institut de Santé Publique d'Épidémiologie et du Développement, Université de Bordeaux, Bordeaux, France
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Eric Nagaonlé Somé
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | | | - Amandine Pisoni
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, Montpellier, France
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, Montpellier, France
| | - Rachel King
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, Montpellier, France
| | - Roger Sombié
- Hepato-Gastroenterology Department, Yalgado Ouédraogo University Hospital Center, Ouagadougou, Burkina Faso
| | | | - Philippe Van de Perre
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, Montpellier, France
| | - Edouard Tuaillon
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, Montpellier, France
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HIV misconceptions among married women in Malawi: the role of household decision-making autonomy. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01315-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Antabe R, Konkor I, McIntosh M, Lawson E, Husbands W, Wong J, Arku G, Luginaah I. "I went in there, had a bit of an issue with those folks": everyday challenges of heterosexual African, Caribbean and black (ACB) men in accessing HIV/AIDS services in London, Ontario. BMC Public Health 2021; 21:315. [PMID: 33557794 PMCID: PMC7871620 DOI: 10.1186/s12889-021-10321-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 01/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Canada, heterosexual African, Caribbean, and Black (ACB) men's heightened risk of HIV infection has been linked to behavioral characteristics, including practices of hegemonic masculinity that discourage the use of HIV preventive services. However, this framing is bereft of the role of structural factors that may be contributing to new HIV infections. This paper examined the underlying factors limiting access to health services among heterosexual ACB men in London, Ontario Canada. METHODS A convenient sampling technique was used to recruit thirty-seven (n = 37) self-identified heterosexual ACB men and service providers. Four focus groups (FG) were conducted; three with ACB participants of similar age category (i.e., 16-24; 25-38; 39+), and one with service providers. The FGs focused on the barriers to using health services and interrogated the ease of access to HIV intervention programs by ACB men respectively. Recurring themes from the FGs were probed further using in-depth interviews (n = 13). FGs and in-depth interviews complemented each other in reducing uneven power dynamics, fact checking, and allowing for detail discussion of the topic under study. Data analyses were done in NVivo using a mixed inductive-deductive thematic analyses approach. RESULTS Most ACB men lacked information on HIV and were unaware of their increased risk of infection. Contrary to the notion that behavioral characteristics keep ACB men away from health services, we found that most ACB men were unaware of the availability of these services. Those that had some knowledge about the services reported that they were not appropriately tailored to their needs. In addition, stereotypes and stigma about the etiology of HIV among Blacks, and systemic neglect served as significant barriers to ACB men's use of services. CONCLUSION The findings suggest that, to enhance preventive health service use among heterosexual ACB men, there is the need to remove structural barriers. Engaging ACB men in the design and implementation of policies may be useful at improving access to HIV information, testing, and treatment services. Increased information dissemination to ACB men would create awareness of the availability of HIV services. Finally, service providers should be conscious of ACB men's concern about experiences of discrimination and racism at service centers.
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Affiliation(s)
- Roger Antabe
- The Department of Geography, University of Western Ontario, Social Science Centre, 1151 Richmond Street, London, Ontario N6A 5C2 Canada
| | - Irenius Konkor
- The Department of Geography, University of Western Ontario, Social Science Centre, 1151 Richmond Street, London, Ontario N6A 5C2 Canada
| | - Martin McIntosh
- Regional HIV/AIDS Connections (RHAC), 30-186 King Street, London, Ontario N6A 1C7 Canada
| | - Erica Lawson
- The Department of Women’s Studies and Feminist Research, University of Western Ontario, Social Science Centre, 1151 Richmond Street, London, Ontario N6A 5C2 Canada
| | - Winston Husbands
- Ontario HIV Treatment Network, 1300 Yonge Street, Suite 600, Toronto, Ontario M4T 1X3 Canada
| | - Josephine Wong
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Podium Building, Room POD-481, 350 Victoria St., Toronto, Ontario M5B 2K3 Canada
| | - Godwin Arku
- The Department of Geography, University of Western Ontario, Social Science Centre, 1151 Richmond Street, London, Ontario N6A 5C2 Canada
| | - Isaac Luginaah
- The Department of Geography, University of Western Ontario, Social Science Centre, 1151 Richmond Street, London, Ontario N6A 5C2 Canada
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Anfaara FW, Atuoye KN, Antabe R, Sano Y, Luginaah I. Hepatitis B knowledge among women and men in the upper west region of Ghana: What sources of health information matter? Int J Health Plann Manage 2020; 35:1098-1110. [PMID: 32663905 DOI: 10.1002/hpm.3013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/20/2020] [Accepted: 06/05/2020] [Indexed: 11/06/2022] Open
Abstract
Despite the vital role of accurate health information in reducing the spread of Hepatitis B virus (HBV) in endemic contexts such as Ghana, little is known about how health information sources may influence disparities in the knowledge of HBV transmission among women and men. This study examines the association between sources of health information and knowledge of HBV transmission in the Upper West Region (UWR) of Ghana. Data from a cross-sectional survey (n = 1061) was analyzed using gender-specific multivariate ordered logistic regression models. The results show that, women who obtained health information from religious-based programs (OR = 4.04, P < .05), higher-level facilities (OR = 2.37, P < .05), and primary health facilities (OR = 1.83, P < .1) were more likely to have good knowledge of HBV transmission compared to non-facility-based programs. Similarly, men who accessed health information from religious-based programs only, were more likely to have good knowledge of HBV transmission (OR = 2.14, P < .05) compared to non-facility-based programs. The results demonstrate the importance of health information sources on knowledge of disease transmission and prevention in a resource-poor context. Based on our findings, we suggest the scaling-up of information programs at health facilities in rural areas and the expansion of HBV services in the UWR in contribution towards the attainment of SDG #3.3.
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Affiliation(s)
- Florence Wullo Anfaara
- Department of Women's Studies and Feminist Research, University of Western Ontario, Faculty of Arts and Humanities, London, Ontario, Canada
| | - Kilian Nasung Atuoye
- Department of Geography, University of Toronto Mississauga, Toronto, Ontario, Canada
| | - Roger Antabe
- Department of Geography, University of Western Ontario, London, Ontario, Canada
| | - Yujiro Sano
- Department of Sociology, Nipissing University, North Bay, Ontario, Canada
| | - Isaac Luginaah
- Department of Geography, University of Western Ontario, London, Ontario, Canada
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Boye S, Shimakawa Y, Vray M, Giles-Vernick T. Limited Awareness of Hepatitis B but Widespread Recognition of Its Sequelae in Rural Senegal: A Qualitative Study. Am J Trop Med Hyg 2020; 102:637-643. [PMID: 31971148 DOI: 10.4269/ajtmh.19-0477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
To achieve the WHO's global strategy of eliminating hepatitis B virus (HBV) infection, it is essential to ensure adequate understanding of hepatitis B disease to facilitate uptake of screening, linkage to care, and adherence to antiviral therapy. Sub-Saharan Africa has the world's highest prevalence of HBV infection, yet less than 1% of HBV-infected people have been diagnosed. Lay populations do not widely recognize "hepatitis B." Hypothesizing that visible signs and symptoms of chronic HBV infection sequelae (jaundice, ascites, or cachexia) might be more easily recognizable, we conducted a qualitative study to determine how rural populations in Senegal understood these sequelae. We led six focus groups and 149 individual interviews with lay populations and formal and informal health workers in three rural study sites in Senegal. Only a third of lay populations (30/105) had ever heard of "hepatitis B," nor did they evoke local language diagnostic terms resembling this illness. Nevertheless, more than two-thirds (71/105) recognized signs and symptoms of end-stage liver disease but considered these physical manifestations to be a consequence of the manipulation of occult forces. Lay populations also contended that traditional healers, not formal medical structures, should treat such illnesses. Formal and informal health workers had limited knowledge about hepatitis B and difficulties identifying terms in local languages to explain the disease. Communication strategies based on the population's widespread recognition of the hepatitis sequelae may enhance awareness of hepatitis, which is a crucial element to increase screening uptake, linkage to care, and commitment to lifelong treatment in African communities.
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Affiliation(s)
- Sokhna Boye
- Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Yusuke Shimakawa
- Emerging Diseases Epidemiology Unit, Pasteur Institute, Paris, France
| | - Muriel Vray
- Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal.,National Institute of Health and Medical Research (INSERM), Paris, France
| | - Tamara Giles-Vernick
- Anthropology and Ecology of Disease Emergence Unit, Pasteur Institute, Paris, France
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Access to primary health care among women: the role of Ghana's community-based health planning and services policy. Prim Health Care Res Dev 2019; 20:e82. [PMID: 32799990 PMCID: PMC8060816 DOI: 10.1017/s1463423619000185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Ghana in 1999 adopted the Community-based Health Planning and Service (CHPS) policy to enhance access to primary health care (PHC) service. After two decades of implementation, there remains a considerable proportion of the country’s population, especially women who lack access to basic health care services. Aim: The aim of this paper is to understand the contribution of Ghana’s CHPS policy to women’s access to PHC services in the Upper West Region (UWR) of Ghana. Methods: A logistic regression technique was employed to analyse cross-sectional data collected among women (805) from the UWR. Findings: We found that women who resided in CHPS zones (OR = 1.612; P ≤ 0.01) were more likely to have access to health care compared with their counterparts who resided in non-CHPS zones. Also, rural-urban residence, distance to health facility, household wealth status and marital status predicted access to health care among women in the region. Our findings underscore the need to expand the CHPS policy to cover many areas in the country, especially rural communities and other deprived localities in urban settings.
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