Browsing by Author "Apenkwa, Joana"

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    Community-Based Management of Acute Malnutrition Programme: Rural and Urban Maternal Socio-Demographic and Implementation Differentials in Ghana
    (Journal of Food Science and Nutrition Research, 2022-05-19) Apenkwa, Joana; Amponsah, Samuel Kofi; Edusei, Anthony; Nakua, Emmanuel; Newton, Sam; Otupiri, Easmon; Adaobi, Chukwuma Chinaza; 0000-0001-8986-1648
    Malnutrition is a public health problem in Ghana, and is estimated to contribute indirectly to more than half of under-five deaths. This study was designed to describe how implementation of the Community based Management of Malnutrition (CMAM) programme in Ghana differs in the rural and urban parts of the country. A mixed methods approach was used in a community-based survey that studied 497 mothers/caregivers and under-five pairs quantitatively, 25 health service providers qualitatively, and 25 mothers caregivers qualitatively. Quantitative data were analysed descriptively with Stata 14.0 (Stata Corp, Texas, USA) while the qualitative data were analysed thematically with Atlas.ti, version 7.5 (Scientific Software Development GmbH, Berlin). Programme implementation was assessed using the following variables: availability of CMAM tools, availability of CMAM supplies, organization of out-patient therapeutic and supplementary feeding programmes, personnel availability, availability of community-based components of CMAM and maternal experience with CMAM services. While the number of children alive, provision of nutrition education and counselling, and demonstration of food preparation significantly influenced program effectiveness (p<0.05) in the urban site, no variables were found to do similar in the rural district. The rural facilities were more likely than the urban ones to be without tools. Less than 10% of mothers/caregivers in both study sites acknowledged the availability of the community-based components of CMAM. Programme implementation in the two study districts is poor; in order to ensure that the CMAM intervention translates into a reduced malnutrition burden among children under-five in Ghana, the programme implementation should be revised to address the identified shortcomings.
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    Contraceptive and abortion practices of young Ghanaian women aged 15–24: evidence from a nationally representative survey
    (Reproductive Health, 2021) Keogh, Sarah C.; Otupiri, Easmon; Castillo, Philicia W.; Li, Naomi W.; Apenkwa, Joana; Polis, Chelsea B.; 0000-0001-8986-1648
    Background: Young Ghanaian women experience high rates of unmet need for contraception and unintended pregnancy, and face unique barriers to accessing sexual and reproductive health services. This study provides a comprehensive national analysis of young women’s contraceptive and abortion practices and needs. Methods: In 2018, we conducted a nationally representative survey of women aged 15–49, including 1039 women aged 15–24. We used descriptive statistics, multivariable logistic and multinomial regression to compare young versus older (25–49 year-old) women’s preferred contraceptive attributes, reasons for discontinuing contraception, quality of counseling, use of Primolut N-tablet, method choice correlates, and friends’ and partners’ influence. We also examined youth’s self-reported abortion incidence, abortion methods, post-abortion care, and barriers to safe abortion. Results: Among Ghanaian 15–24 year-olds who had ever had sex, one-third (32%) were using contraception. Compared to older women, they had higher desires to avoid pregnancy, lower ever use of contraception, more intermittent sexual activity, and were more likely to report pregnancies as unintended and to have recently ended a pregnancy. Young contraceptors most commonly used condoms (22%), injectables (21%), withdrawal (20%) or implants (20%); and were more likely than older women to use condoms, withdrawal, emergency contraception, and N-tablet. They valued methods for effectiveness (70%), no risk of harming health (31%) nor future fertility (26%), ease of use (20%), and no effect on menstruation (19%). Infrequent sex accounted for over half of youth contraceptive dis continuation. Relative to older women, young women’s social networks were more influential on contraceptive use. The annual self-reported abortion rate among young women was 30 per thousand. Over half of young women used abortion methods obtained from non-formal providers. Among the third of young women who experienced abortion complications, 40% did not access treatment. Conclusions: Young people’s intermittent sexual activity, desire for methods that do not harm their health, access barriers and provider bias, likely contribute to their greater use of coital-dependent methods. Providers should be equipped to provide confidential, non-discriminatory counseling addressing concerns about infertility, side effects.and alternative methods. Use of social networks can be leveraged to educate around issues like safe abortion and correct use of N-tablet.
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    Coverage Assessment for Community-Based Management of Acute Malnutrition In Rural and Urban Ghana: A Comparative Cross-Sectional Study
    (Journal of Food Science and Nutrition Research, 2022) Apenkwa, Joana; Amponsah, Samuel K.; Newton, K. Sam; Osei-Antwi, Reuben; Nakua, Emmanuel; Edusei, Anthony K.; Otupiri, Easmon; 0000-0001-8986-1648
    Background: Ghana for years has implemented the Community-based Management of Acute Malnutrition (CMAM) to reduce malnutrition in children. However, the prevalence of malnutrition remains high. This study aimed to determine CMAM coverage levels in the Ahafo Ano South (AAS), a rural district and Kumasi Subin sub-metropolis (KSSM), an urban district. Methods: The study was a cross-sectional comparative study with a mixed-methods approach. In all, 497 mothers/caregivers and children under-five were surveyed using a quantitative approach while qualitative methods were used to study 25 service providers and 40 mothers/ caregivers who did not participate in the quantitative survey. Four types of coverage indicators were assessed: point coverage (defined as the number of Severe Acute Malnutrition cases [SAM] in treatment divided by total number of Severe Acute Malnutrition cases in the study district), geographical coverage (defined as total number of health facilities delivering treatment for SAM divided by total number of healthcare facilities in the study district), treatment coverage (defined as children with SAM receiving therapeutic care divided by total number of SAM children in the study district) and programme coverage (defined as number of SAM cases in the CMAM programme ÷ Number of SAM cases that should be in the programme). The qualitative approach was used to support the assessment of the coverage indicators. Data were analyzed using STATA version 14, and Atlas.ti, version 7.5 for the quantitative and qualitative data respectively. Results: Geographically, only 6% of the facilities in the urban communities were participating in the CMAM programme as against 29% of rural district facilities. The districts had point coverage of 41% and 10% for the urban and rural districts respectively. The urban setting recorded a SAM prevalence of 52% as against 36% in the rural setting. The proportion of SAM children enrolled in CMAM was higher in KSSM as compared to AAS; 41% and 33% respectively. In both districts, the most likely factors to attract mothers/caregivers to utilize the CMAM services were: ‘free services’ and ‘a cured child.’ The qualitative approach showed that coverage improvement in both districts is hampered by distance, transportation cost, lack of trained personnel in the communities for community mobilization home visits and insufficient feeds. Conclusion: To improve CMAM coverage, there is the need to train health workers to embark on aggressive health education strategies to encourage mothers/caregivers of malnourished children to utilize CMAM while ensuring that services reach those who need them.