MSc (Med), Population-Based Epidemiology, Faculty of Health Sciences, University of the Witwatersrand, 2010

MSc (Med), Population-Based Field Epidemiology, Faculty of Health Sciences, University of the Witwatersrand / Introduction: As people age, they become more vulnerable to ill‐health from acute and increasingly chronic diseases. This has elevated health care demand and utilisation in the elderly especially in the developed countries. In developing countries, ageing so far has not been a serious public health concern because of smaller number of older people in these countries. Recently however, the number of older adults in Sub‐Saharan Africa has increased rapidly, projected to stand at 130 million by 2050 from 30 million in 2000. This increase mirrors health related problems and has obvious public health implications. Thus, there is an urgent need to recognise and respond to health needs of the ageing populations in Africa. Objectives: To describe health care utilisation, health status and compare the proportions of adults aged 50+ years with moderate and poor health status to those with good health status. Another objective was to identify factors associated with health care utilisation among the elderly population in Kassena‐Nankana district, Ghana in 2007. Methods: Secondary analysis was performed on a cross‐sectional dataset collected between February and July 2007 through face‐to‐face interviews within the settings of the Navrongo DSS in Ghana. A total of 594 adults aged 50+ years participated in this study. The outcome variable was health care utilisation occurring in the last three years. Explanatory variables were grouped as predisposing, enabling and need‐related factors according to the behavioural model of health services utilisation. The predisposing variables were age, sex, marital status, ethnic background, education and smoking or use of smokeless tobacco. Occupation and financial position were included as enabling factors. Medical history of chronic conditions, self‐reported health status, difficulty with self‐care (e.g. bathing, washing, dressing etc), difficulty with picking up things in the last 30 days and cognitive impairment were grouped as need‐related factors. Logistic 382128 v univariate and multivariate regression analyses were conducted. STATA 10 statistical software was used to carry out this process. Results: The proportion of study participants reporting poor, moderate and good health status were 14.2%, 43.3% and 42.5% respectively. About one‐third (31%) of the study participants reported to have utilised health care services in the last 3 years. The following factors were identified as determinants of health care utilisation among the elderly rural Ghanaians: a medical history of at least one chronic condition (OR = 2.36; 95% CI = [1.49 – 3.75]; p < 0.001), self‐perceived health (OR = 2.00; 95% CI = [1.11 ‐ 3.59]; p = 0.021), age group (OR = 1.68; 95% CI = [1.07 ‐ 2.64]; p = 0.025), cognitive impairment (OR = 1.26; 95% CI = [1.02 – 1.56]; p = 0.032) and difficulty with picking up things in the last 30 days (OR = 0.76; 95% CI = [0.61 ‐ 0.96]; p = 0.021). Conclusion: Medical history of at least one chronic condition and poor perceived health status were the most pervasive determinants of health care utilisation. In addition, age group (60‐69 years), severe cognitive impairment and severe difficulty with picking up things in the last 30 days presented a significant influence on health care utilisation among the elderly population in rural Ghana. Recommendations: Provision of home‐based health care services could facilitate their accessibility for the elderly especially those with various difficulties. These factors could help health policy makers and health service providers identify and understand the situation of the elderly rural Ghanaians and consequently create conducive environment for providing appropriate health care services.

Unsafe abortion claims the lives of thousands of women every year. Globally, it is the women in Sub-Saharan Africa who face the highest risk of death and injury from abortion-related complications (Ahman & Shah 2011, p.123). Current global and national efforts to reduce incidences of unsafe abortion are ineffective in the rural Ghanaian community where this research was undertaken. This anthropological examination of key aspects of contemporary local social practice and the norms and customs which underpin it, demonstrates the necessity for many local women to utilise a dangerous plant to facilitate potentially fatal self-induced abortions as their primary means of resisting culturally-defined fertility patterns. This thesis is broadly structured around anthropologists’ Scheper-Hughes’ and Lock’s (1987, p.6) concept of three intersectional bodily perspectives: the phenomenological individual body-self, the social body and the body as an artefact of political control. The reader is offered insight from each of these perspectives into the social practice of unsafe abortion in the lives of rural Ghanaian women. I argue that unsafe abortion can be seen as a kind of social struggle against the local economic mode of production. The thesis provides an analysis of the position of many women within local relations of production from a neo-Marxist perspective which has been modified by concepts of class and exploitation particular to pre-industrialist societies. The modifications are taken from the theoretical positions of French anthropologists Terray (1975), Meillassoux (1972) and P.P Rey (1975). In addition, following the work of critical medical anthropologist Scheper-Hughes (1993), the thesis demonstrates the ways in which medical discourses and policy output about family planning and reproductive health which are produced and reproduced at the level of the national body politic, obscure more deeply embedded powerful ideologies and social praxis about female sexuality and reproduction which is produced and reproduced at the level of the social body within the context of popular interpretations of tradition and customary law. Ultimately, I argue that current Programmes of Action aimed at reducing incidences of unsafe abortion fail to address patterns of gender violence and patriarchal control by medicalising some village women’s social suffering.

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