Demand for abortion and post abortion care in Ibadan, Nigeria

Background: While induced abortion is considered to be illegal and socially unacceptable in Nigeria, it is still practiced by many women in the country. Poor family planning and unsafe abortion practices have daunting effects on maternal health. For instance, Nigeria is on the verge of not meeting the Millennium development goals on maternal health due to high maternal mortality ratio, estimated to be about 630 maternal deaths per 100,000 live births. Recent evidences have shown that a major factor in this trend is the high incidence of abortion in the country. The objective of this paper is, therefore, to investigate the factors determining the demand for abortion and post-abortion care in Ibadan city of Nigeria. Methods: The study employed data from a hospital-based/exploratory survey carried out between March to September 2010. Closed ended questionnaires were administered to a sample of 384 women of reproductive age from three hospitals within the Ibadan metropolis in South West Nigeria. However, only 308 valid responses were received and analysed. A probit model was fitted to determine the socioeconomic factors that influence demand for abortion and post-abortion care. Results: The results showed that 62% of respondents demanded for abortion while 52.3% of those that demanded for abortion received post-abortion care. The findings again showed that income was a significant determinant of abortion and post-abortion care demand. Women with higher income were more likely to demand abortion and post-abortion care. Married women were found to be less likely to demand for abortion and post-abortion care. Older women were significantly less likely to demand for abortion and post-abortion care. Mothers' education was only statistically significant in determining abortion demand but not post-abortion care demand. Conclusion: The findings suggest that while abortion is illegal in Nigeria, some women in the Ibadan city do abort unwanted pregnancies. The consequence of this in the absence of proper post-abortion care is daunting. There is the need for policymakers to intensify public education against indiscriminate abortion and to reduce unwanted pregnancies. In effect, there is need for effective alternative family planning methods. This is likely to reduce the demand for abortion. Further, with income found as a major constraint, post abortion services should be made accessible to both the rich and poor alike so as to prevent unnecessary maternal deaths as a result of abortion related complications

The effects of public and private health care expenditure on health status in sub-Saharan Africa: New evidence from panel data analysis

Background: Health care expenditure has been low over the years in developing regions of the world. A majority of countries in these regions, especially sub-Saharan Africa (SSA), rely on donor grants and loans to finance health care. Such expenditures are not only unsustainable but also inadequate considering the enormous health care burden in the region. The objectives of this study are to determine the effect of health care expenditure on population health status and to examine the effect by public and private expenditure sources. Methods: The study used panel data from 1995 to 2010 covering 44 countries in SSA. Fixed and random effects panel data regression models were fitted to determine the effects of health care expenditure on health outcomes. Results: The results show that health care expenditure significantly influences health status through improving life expectancy at birth, reducing death and infant mortality rates. Both public and private health care spending showed strong positive association with health status even though public health care spending had relatively higher impact. Conclusion: The findings imply that health care expenditure remains a crucial component of health status improvement in sub-Saharan African countries. Increasing health care expenditure will be a significant step in achieving the Millennium Development Goals. Further, policy makers need to establish effective public-private partnership in allocating health care expenditures

Inclusive education in Ghana: understanding inclusive pedagogical practices of primary school teachers in regular classrooms.

The concept of inclusive pedagogy is an effective approach for ensuring equitable, quality learning for all children in the same classroom, regardless of their challenges. Despite the ongoing discourse about inclusive pedagogy, research examining how teachers conceptualise the concept and enact practices in their classrooms in Ghana is limited. This study adopts the sociocultural theoretical perspective to examine teachers' conceptualisation of inclusive pedagogy and how they enact, adapt and justify their pedagogical practices to promote the inclusion of children with special educational needs in Ghana. The study was guided by an overarching research question: How do teachers enact and justify their inclusive pedagogical practices in regular education classrooms in Ghana? Three sub-questions were developed to help answer the main research question: (1) How do teachers conceptualise inclusive pedagogy? (2) What is the nature of teachers' inclusive pedagogical practices within a regular classroom context? (3) What is the rationale behind teachers' inclusive pedagogical practice? The current study provides critical insights into how teachers conceptualise inclusive pedagogy and documents useful practices regarding their pedagogical practices that could be adopted or adapted by other teachers in similar research contexts. The study methodology was a qualitative case study within the constructionists' paradigm. Participants included ten classroom teachers who were purposively selected from five regular public primary schools in Ghana. Data were collected using lesson observations at two time points per teacher (20 observations) and in-depth interviews (n=17). Teachers' lesson notes and artefacts were collected to supplement data generated from the field. Data were analysed through a five-stage process using the reflective thematic analysis approach. Findings revealed that classroom teachers conceptualised inclusive pedagogy in nonuniversal ways. These include teaching all children together, promoting the participation of children with special educational needs in mainstream classrooms, making separate or inclusive provisions and adopting reflexive or reactive processes. These conceptualisations were based on their understanding of inclusive education. Further, all the participants favoured including children with special educational needs in the regular classroom. However, although all six female teachers believed that inclusion would benefit all children, three out of the four male teachers thought otherwise. They believed that making separate provisions for children with special educational needs would be more beneficial than teaching them with their typically developing peers in the same classroom. Other demographic variables, such as teachers' experiences (years taught) and their professional qualifications, appeared to have no direct impact on their views about inclusion. Additionally, findings revealed that teachers used different pedagogical strategies to deliver their lessons, described under four main themes. The themes include (1) Providing accommodations and support for all learners, (2) Promoting lesson accessibility through multiple communication techniques, (3) Encouraging learners' action using a variety of assessment techniques and (4) Building support for learners with special needs through creative collaboration. Teachers' inclusive pedagogical strategies identified in the data comprised more generic practices such as questions and answers, multiple examples, role play and field trips. Others, such as differentiated learning, deficit or strength-based approaches and peer support, were used purposely to assist children with special educational needs. The findings indicate that teachers continue to create several learning opportunities for children with special educational needs using various inclusive pedagogical approaches. However, observation showed that some children with special educational needs were excluded from some lessons. Challenges such as limited resources, inadequate training, and large class sizes impacted teachers' inclusive pedagogical practices. This situation was compounded by the diverse characteristics of special needs children in classrooms. The results demonstrate that addressing the barriers identified can improve teachers' practices and attitudes toward supporting all learners. Thus, given the appropriate support, teachers in resource-constrained countries like Ghana can adapt their lessons and practices to provide for all learners regardless of their needs. This research's output can help improve in-service and pre-service training programmes to enhance teachers' knowledge in effective inclusive pedagogical practices. Finally, the study proposed an inclusive pedagogical approach (Introspective Inclusive Pedagogical Approach), which could be adapted to study or improve practices of classroom teachers in all settings, including resource-constrained countries.The concept of inclusive pedagogy is an effective approach for ensuring equitable, quality learning for all children in the same classroom, regardless of their challenges. Despite the ongoing discourse about inclusive pedagogy, research examining how teachers conceptualise the concept and enact practices in their classrooms in Ghana is limited. This study adopts the sociocultural theoretical perspective to examine teachers' conceptualisation of inclusive pedagogy and how they enact, adapt and justify their pedagogical practices to promote the inclusion of children with special educational needs in Ghana. The study was guided by an overarching research question: How do teachers enact and justify their inclusive pedagogical practices in regular education classrooms in Ghana? Three sub-questions were developed to help answer the main research question: (1) How do teachers conceptualise inclusive pedagogy? (2) What is the nature of teachers' inclusive pedagogical practices within a regular classroom context? (3) What is the rationale behind teachers' inclusive pedagogical practice? The current study provides critical insights into how teachers conceptualise inclusive pedagogy and documents useful practices regarding their pedagogical practices that could be adopted or adapted by other teachers in similar research contexts. The study methodology was a qualitative case study within the constructionists' paradigm. Participants included ten classroom teachers who were purposively selected from five regular public primary schools in Ghana. Data were collected using lesson observations at two time points per teacher (20 observations) and in-depth interviews (n=17). Teachers' lesson notes and artefacts were collected to supplement data generated from the field. Data were analysed through a five-stage process using the reflective thematic analysis approach. Findings revealed that classroom teachers conceptualised inclusive pedagogy in nonuniversal ways. These include teaching all children together, promoting the participation of children with special educational needs in mainstream classrooms, making separate or inclusive provisions and adopting reflexive or reactive processes. These conceptualisations were based on their understanding of inclusive education. Further, all the participants favoured including children with special educational needs in the regular classroom. However, although all six female teachers believed that inclusion would benefit all children, three out of the four male teachers thought otherwise. They believed that making separate provisions for children with special educational needs would be more beneficial than teaching them with their typically developing peers in the same classroom. Other demographic variables, such as teachers' experiences (years taught) and their professional qualifications, appeared to have no direct impact on their views about inclusion. Additionally, findings revealed that teachers used different pedagogical strategies to deliver their lessons, described under four main themes. The themes include (1) Providing accommodations and support for all learners, (2) Promoting lesson accessibility through multiple communication techniques, (3) Encouraging learners' action using a variety of assessment techniques and (4) Building support for learners with special needs through creative collaboration. Teachers' inclusive pedagogical strategies identified in the data comprised more generic practices such as questions and answers, multiple examples, role play and field trips. Others, such as differentiated learning, deficit or strength-based approaches and peer support, were used purposely to assist children with special educational needs. The findings indicate that teachers continue to create several learning opportunities for children with special educational needs using various inclusive pedagogical approaches. However, observation showed that some children with special educational needs were excluded from some lessons. Challenges such as limited resources, inadequate training, and large class sizes impacted teachers' inclusive pedagogical practices. This situation was compounded by the diverse characteristics of special needs children in classrooms. The results demonstrate that addressing the barriers identified can improve teachers' practices and attitudes toward supporting all learners. Thus, given the appropriate support, teachers in resource-constrained countries like Ghana can adapt their lessons and practices to provide for all learners regardless of their needs. This research's output can help improve in-service and pre-service training programmes to enhance teachers' knowledge in effective inclusive pedagogical practices. Finally, the study proposed an inclusive pedagogical approach (Introspective Inclusive Pedagogical Approach), which could be adapted to study or improve practices of classroom teachers in all settings, including resource-constrained countries

HIV/AIDS-related stigma and HIV test uptake in Ghana: evidence from the 2008 Demographic and Health Survey

The study examined the association between HIV test uptake and socioeconomic characteristics of individuals, including HIV-related stigma behaviours. The study also investigated the socioeconomic determinants of HIV-related stigma in Ghana. Cross tabulations and logistic regression techniques were applied to data from the 2008 Ghana Demographic and Health Survey. The results showed significantly low HIV test uptake and some level of HIV-related stigma prevalence in Ghana. Higher wealth status, educational attainment and HIV-related stigma were significant determinants of HIV test uptake. Aside wealth status and education, rural place of residence and religious affiliation were positive and significant determinants of HIV-related stigma. The findings call for comprehensive HIV education including treatment, prevention and care. Legislations to discourage stigma and improve HIV-testing will be critical policy steps in the right direction.

Trend and determinants of contraceptive use among women of reproductive age in Ghana

The study examined the trend in contraceptive use among sexually active women of reproductive age in Ghana. The study also investigated the socioeconomic determinants of contraceptive use. Cross tabulations and logistic regression analyses were performed on data from the Ghana Demographic and Health Surveys 1988 - 2008. The results indicate low contraceptive use among women with marked variation in contraceptive use across various socioeconomic groups and administrative regions. Evidence from the logistic regressions suggests that improving education and reducing poverty are critical in improving contraceptive use and reducing unmet need for family planning. Child survival, access to family planning services and knowledge of contraceptive methods were also found to be significant determinants of contraceptive use. The importance of improving financial and infrastructural access to contraceptives was confirmed by the findings of the study.

Health expenditure and child health outcomes in Sub-Saharan Africa

This study sought to understand the relationship between child health outcomes and health spending while investigating lagged effects. The study employed panel data from 45 Sub-Saharan African countries between 1995 and 2011 obtained from the World Bank’s World Development Indicators. Fixed and Random effect models were estimated. Under-five, infant and neonatal mortality were used as child health outcomes while total health spending was disaggregated into public and private spending. The effects of one and two period lags of expenditure were estimated. The results show a positive and significant relationship between health expenditure and child health outcomes with elasticities of -0.11 for infant mortality, -0.15 (under-five mortality) and -0.08 (neonatal mortality). Public health expenditure was found to be relatively more significant than private expenditure. Positive and significant lagged effects were also estimated between health expenditure and child health. The findings suggest that, while health expenditure is crucial for the improvement of child health, it is equally important for this expenditure to be sustainable as it also has delayed effects.Keywords: Health expenditure; Child health outcomes; Lag effects; SSA

Estimating household vulnerability to poverty from cross section data: an empirical evidence from Ghana

Background In many developing countries, policies aimed at improving welfare through poverty reduction tend to target the current poor to the neglect of the vulnerable. An understanding of household susceptibility to future poverty will be crucial for sustainable growth and development. The objective of the study is to assess ex-ante welfare through vulnerability to poverty estimates among households in Ghana and to examine the effect of various socioeconomic characteristics on vulnerability to poverty. Method The study uses cross section data from the fifth round of the Ghana Living Standards Survey (GLSS) with a nationally representative sample of 8,687 households from all administrative regions in Ghana. The study employs a three step Feasible Generalized Least Squares (FGLS) estimation procedure to estimate vulnerability to poverty and to model the effect of household socioeconomic status on expected future consumption and variations in future consumption. Results The results show that, about 56% of households in Ghana are vulnerable to poverty and this is significantly higher than observed poverty level of about 28%. While the Eastern region was found to have the highest average vulnerability of approximately 73%, the Upper West region had the least vulnerability with about 21% average vulnerability to poverty. Other regions with relatively high incidence of vulnerability to poverty include the Western region (70%) and the Volta region (69%). Vulnerability to poverty was estimated to be 61% among urban households and 25% among rural households. Moreover, household health status, household size and education attainments significantly influence vulnerability to poverty. Male headed households were found to be less vulnerable to future poverty. Conclusion The results suggest that poverty and vulnerability to poverty are independent concepts. This implies that policies directed towards poverty reduction need to take into account the vulnerability of current non-poor households. Also, various household characteristics should be considered in developing poverty reduction strategies

Estimating household vulnerability to poverty from cross section data: an empirical evidence from Ghana

Background In many developing countries, policies aimed at improving welfare through poverty reduction tend to target the current poor to the neglect of the vulnerable. An understanding of household susceptibility to future poverty will be crucial for sustainable growth and development. The objective of the study is to assess ex-ante welfare through vulnerability to poverty estimates among households in Ghana and to examine the effect of various socioeconomic characteristics on vulnerability to poverty. Method The study uses cross section data from the fifth round of the Ghana Living Standards Survey (GLSS) with a nationally representative sample of 8,687 households from all administrative regions in Ghana. The study employs a three step Feasible Generalized Least Squares (FGLS) estimation procedure to estimate vulnerability to poverty and to model the effect of household socioeconomic status on expected future consumption and variations in future consumption. Results The results show that, about 56% of households in Ghana are vulnerable to poverty and this is significantly higher than observed poverty level of about 28%. While the Eastern region was found to have the highest average vulnerability of approximately 73%, the Upper West region had the least vulnerability with about 21% average vulnerability to poverty. Other regions with relatively high incidence of vulnerability to poverty include the Western region (70%) and the Volta region (69%). Vulnerability to poverty was estimated to be 61% among urban households and 25% among rural households. Moreover, household health status, household size and education attainments significantly influence vulnerability to poverty. Male headed households were found to be less vulnerable to future poverty. Conclusion The results suggest that poverty and vulnerability to poverty are independent concepts. This implies that policies directed towards poverty reduction need to take into account the vulnerability of current non-poor households. Also, various household characteristics should be considered in developing poverty reduction strategies

On the efficiency of public health expenditure in Sub-Saharan Africa: Does corruption and quality of public institutions matter?

Health expenditure in Sub-Saharan Africa (SSA) has improved over the years with several recent efforts to improve resource commitments to the health sector. Health outcomes in the region have, however, seen little improvements over the years. Several reasons, including the efficiency of health expenditure, have been given to justify this mismatch. Studies on health expenditure efficiency have mainly focused on developed regions with little attention to SSA. The objective of the study was, therefore, to examine The effects of corruption and public institution quality on efficiency. The efficiency of health expenditure was also compared across selected SSA countries. Data for the study was sourced from the World Bank's World Development Indicators for 45 countries covering the period 2005 to 2011. The two-stage Data Envelopment Analysis (DEA) was employed for the analysis. The first stage computes efficiency scores while the second stage examines the determinants of efficiency using the Tobit model. Per capita health expenditure was used as input while infant, under-five mortality and crude death rates were used as outputs. The results show that health expenditure efficiency was low with average scores of approximately 0.5. This suggests that there exist significant potential for SSA countries to improve population health outcomes given the level of expenditure. There was significant variation across countries with Cape Verde, Eritrea and Mauritius among the efficient countries while Equatorial Guinea, Sierra Leone and Swaziland were relatively inefficient. High corruption and poor public sector institutions reduced health expenditure efficiency. The findings emphasize the fact that, while increased health spending is necessary, it is also important to ensure efficiency in resource use across SSA countries. This can be achieved by effective monitoring and evaluation programmes that ensure reduced corruption and improved public institutions

Socioeconomic inequalities in maternal health care utilization in Ghana

BACKGROUND: Improving maternal and child health remains a public health priority in Ghana. Despite efforts made towards universal coverage, there are still challenges with access to and utilization of maternal health care. This study examined socioeconomic inequalities in maternal health care utilization related to pregnancy and identified factors that account for these inequalities. METHODS: We used data from three rounds of the Ghana Demographic and Health Surveys (2003, 2008 and 2014). Two health care utilization measures were used; (i) four or more antenatal care (ANC) visits and (ii) delivery by trained attendants (DTA). We first constructed the concentration curve (CC) and estimated concentration indices (CI) to examine the trend in inequality. Secondly, the CI was decomposed to estimate the contribution of various factors to inequality in these outcomes. RESULTS: The CCs show that utilization of at least four ANC visits and DTA were concentrated among women from wealthier households. However, the trends show the levels of inequality decreased in 2014. The CI of at least four ANC visits was 0.30 in 2003 and 0.18 in 2014. Similarly, the CIs for DTA was 0.60 in 2003 and 0.42 in 2014. The decomposition results show that access to National Health Insurance Scheme (NHIS) and women's education levels were the most important contributors to the reduction in inequality in maternal health care utilization. CONCLUSIONS: The findings highlight the importance of the NHIS and formal education in bridging the socioeconomic gap in maternal health care utilization