Infertility presents challenges to individuals and couples, particularly in Sub-Saharan Africa. This study aimed to document beliefs about childbearing/children and the psychosocial implications of infertility in individuals seeking assisted fertilization in the Ghanaian context. The study had an exploratory descriptive qualitative design. Six males and 12 females were recruited purposefully from five private fertility centres in the Greater Accra Region. Face-to-face interviews were performed. In Ghanaian society, couples and individuals with infertility who are seeking assisted fertilization consider having biological children to be important. The quest to have children was broadly centred on the associated benefits of being a parent, including societal recognition, the role of family inheritance, and support. The inability of participants to have biological children was found to have a negative effect on their psychological and social well-being. Anxiety, worry, hopelessness, stigma and suicidal ideations were some of the effects identified. It is recommended that those seeking assisted fertilization should be supported through counselling to minimize the potential negative effects of childlessness.

Despite lifelong and detrimental effects, the co-occurrence of health risk behaviors (HRBs) during adolescence remains understudied in low- and middle-income countries. This study examines the co-occurrence of HRBs and its correlates among adolescents in sub-Saharan Africa, China, and India. A multi-country cross-sectional study was conducted in 2021–2022, involving 9697 adolescents (aged 10–19 years) from eight countries, namely Burkina Faso, China, Ethiopia, India, Ghana, Nigeria, Tanzania, and Uganda. A standardized questionnaire was administered to examine five types of HRBs − physical inactivity, poor dietary habits, smoking, alcohol consumption, and risky sexual behavior. Latent class analysis was employed to identify clustering patterns among the behaviors, and logistic regression was used to identify the correlates of these patterns. Three clusters of HRBs were identified, with Cluster 1 (27.73%) characterized by the absence of any specific risky behavior, Cluster 2 (68.16%) characterized by co-occurrence of physical inactivity and poor dietary habits, and Cluster 3 (4.11%) characterized by engagement in smoking, alcohol consumption, and risky sexual behavior. Relative to Cluster 1, being in Cluster 2 was associated with being female (aOR 1.20, 95% CI 1.09–1.32), not enrolled in education (aOR 0.84, 95% CI 0.71–0.99), and not engaged in paid work (aOR 1.23, 95% CI 1.08–1.41). Compared with those Cluster 1, adolescents in Cluster 3 were less likely to be female (aOR 0.41, 95% CI 0.32–0.54), be engaged in paid work (aOR 0.54, 95% CI 0.41–0.71), more likely to be older (aOR 7.56, 95% CI 5.18–11.03), not be enrolled in educational institution (aOR 1.74, 95% CI 1.27–2.38), and more likely to live with guardians other than parents (aOR 1.56, 95% CI 1.19–2.05). The significant clustering patterns of HRBs among adolescents in sub-Saharan Africa, China, and India highlights the urgent need for convergent approaches to improve adolescent health behaviors. Early life and school-based programs aimed at promoting healthy behaviors and preventing risky and unhealthy behaviors should be prioritized to equip adolescents with the tools and skills for lifelong well-being. 10.13039/501100011318 Fondation Botnar (Grant #INV-037672) and 10.13039/100008548 Harvard T.H. Chan School of Public Health , partially funded this study.

Background: The use of unsafe materials to collect menstrual blood predisposes women and girls to infections. There is a paucity of literature on the utilization of reusable menstrual materials in sub-Saharan Africa. This study examined factors associated with the use of reusable menstrual management materials among women of reproductive age in Ghana. Findings from this study can inform menstrual health programmes and reproductive health policy to address menstrual hygiene and specific areas of emphasis. Methods: We analysed secondary data from the 2017/18 Ghana Multiple Indicator Cluster Survey. Descriptive statistics were employed to compute frequencies and percentages, while Chi-square and complex sample Binomial Logistic Regression was conducted to identify factors associated with the use of reusable menstrual materials. Results: Half (52%) of the respondents were below 30 years old; mean (± sd) = 30.7(9.0). Thirteen percent used reusable materials to collect menstrual blood during their last period. Women aged 45–49 years (AOR = 5.34; 95% CI 3.47–8.19) were 5 times more likely to manage menstruation with reusable materials compared with those aged 15–19 years (p < 0.05). Women classified in the middle wealth quintile (AOR = 0.66; 95% CI 0.50–0.88) were 34% less likely to use reusable materials to collect menstrual blood compared with women in the poorest wealth quintile (p < 0.05). Also, women who were exposed to television (AOR = 0.78; 95% CI 0.61–0.99) had less odds of using reusable materials compared with women who were not exposed to television (p < 0.05). Conclusion: This study showed that the use of reusable menstrual materials was influenced by socio-demographic factors, economic factors and exposure to mass media. Therefore, policies and programmes aimed at promoting menstrual health should focus on less privileged women. The mass media presents an opportunity for communicating menstrual hygiene.

HIV testing, which is important for the control of the HIV pandemic, has been hampered by several factors including Intimate Partner Violence (IPV), resulting in low uptake. This study sought to determine the predictors of HIV testing among women experiencing IPV. Secondary analysis of data generated from a cross-sectional mixed-method unmatched cluster-randomized controlled trial designed to evaluate a multi-faceted community intervention to reduce the incidence of IPV in Ghana was done (N = 2000). Logistic regressions were performed to determine the predictors of HIV testing among women experiencing IPV, using the trial baseline data. The prevalence of HIV testing among women exposed to IPV in the study setting was 42.4%. Less than a third of the respondents (30.2%) had ever used condom and 96.6% had unemployed partners. Age, educational attainment, employment, residence and condom use were found to be significant predictors of HIV testing among women experiencing IPV. Women aged 25–39 years were more than twice as likely to test for HIV (AOR:2.41; 95%CI:1.45–4.02) than those above 45 years. Women with formal education (Junior-High—AOR:2.10; 95%CI:1.42–3.12; Senior-High—AOR:3.87; 95%CI:2.07–7.26); who had ever used condom (AOR:1.42; 95%CI:1.05–1.93); those reporting life satisfaction (AOR:1.44; 95%CI:1.08–1.92); and coastal residents (AOR:1.97; 95%CI:1.45–2.67) were more likely to test for HIV than those who did not and inland residents. However, employed women (AOR:0.66; 95%CI:0.45–0.96) were less likely to test for HIV than unemployed women. Less than half of the women exposed to IPV had tested for HIV. Socioeconomic disadvantages related to age, education, employment, residence and life satisfaction predicted HIV testing among women exposed to IPV. Considering the vulnerability of women experiencing IPV to HIV infection, strategies to improve uptake of HIV testing must tackle contextual socioeconomic factors that hinder access to services.

Background Young sexual minority men (YSMM) living in slums face high risks of contracting HIV due to poverty and limited healthcare access. Certain areas in Accra's slums have much higher HIV rates than the national average, around 7% compared to 2%. YSMM in these areas struggle to access services, have lower perceptions of HIV risk, less education, and face poverty, leading to low rates of HIV testing. These YSMM also encounter increased stigma because of where they live, like in the slum area known as "Old Fadama" or "Sodom and Gomorrah." This stigma affects their willingness to get tested for HIV and adds to other stigmas related to their sexuality and gender expression. Ghana's efforts to improve HIV testing for YSMM face challenges such as stigma, low-risk perception, and concerns about confidentiality. Introducing HIV self-testing (HIVST) offers hope to increase testing among YSMM by allowing them to test in private. However, there are challenges with implementing HIVST in Ghana, including limited knowledge and fears of stigma. Advocates suggest integrating HIVST with existing testing methods to improve access and inclusivity for YSMM in Ghana. Methods The study adapts the 3MV approach into a modified version called LAFIYA to combat intersectional stigma and enhance HIVST among young cis-gender men who have sex with men (YSMM) in Ghana. Using the ADAPTT-IT framework, the study plans to implement three aims, refining the adapted intervention, creating a manual for LAFIYA, and conducting a pilot test to assess acceptance, feasibility, appropriateness, and preliminary efficacy in reducing stigma and increasing HIVST among YSMM. Conducted within urban slum communities in Accra, the research intends to recruit 20 YSMM and 20 providers, stratified into nurses and community organization providers. The study employs a starfish sampling to recruit YSMM and purposive sampling techniques for providers. Eligibility criteria for YSMM include specific age, lack of experience with unassisted HIVST kits, identification as cis-gender men, recent engagement in sex with another man, and residency in the Greater Accra Metropolitan area within a slum community. Providers must have at least one year of experience in sexual health services and working with YSMM on HIV prevention and care within the same geographical area. Discussion The adaptation of the 3MV approach into LAFIYA aimed to tackle intersectional stigma and improve HIVST among YSMM in Ghana. The study's primary objective focused on assessing the acceptance and feasibility of this modified method in reducing stigma and increasing HIVST uptake among YSMM. Organized into three core objectives, the research evaluated the presence of stigma, transformed 3MV into LAFIYA, and rigorously examined LAFIYA's effectiveness in reducing stigma and boosting HIVST uptake among YSMM. Following the ADAPTT-IT framework, the study systematically progressed through different stages to produce a comprehensive manual for the LAFIYA intervention. This foundational study set the groundwork for a larger-scale trial intended to assess LAFIYA's effectiveness in reducing stigma and enhancing HIVST among YSMM. Trail registration This study is registered on clinicalTrail.gov, with identifier number NCT06238323 on 02/02/2024 https://clinicaltrials.gov/study/NCT06238323?locStr=Ghana&country=Ghana&cond=HIV&aggFilters=status:not%20rec&rank=4

Background: Early and delayed puberty are both associated with adverse health and psychosocial outcomes. Objectives: We assessed the impact of provision of small-quantity lipid-based nutrient supplement (SQ-LNS) to mothers during pregnancy and 6 mo postpartum and to their children aged 6-18 mo, on pubertal status. Methods: This study was a follow-up to a partially double-blind randomized controlled trial. At <= 20 wk, 1320 females were randomly assigned to receive daily: iron and folic acid during pregnancy and placebo 0-6 mo postpartum; or multiple micronutrients during pregnancy and 0-6 mo postpartum; or SQ-LNS during pregnancy and 0-6 mo postpartum and to their children from 6 to 18 mo. We re-enrolled 966 and 919 children at 9-11 y and 11-13 y, respectively. We calculated a total pubertal status score based on the Petersen Pubertal Development Scale (PDS) to assess growth spurt, skin changes, body hair, facial hair, voice break, breast development, and menstruation. Pubertal status was regressed on child's age to generate age-adjusted PDS z-scores (aPDSZ); we performed interaction and mediation analyses. Results: Mean +/- standard deviation aPDSZ did not differ between the SQ-LNS and non-LNS groups at 9-11 y (0.01 +/- 0.95 compared with -0.01 +/- 0.98; P = 0.958) but was more advanced in the SQ-LNS group at 11-13 y (0.07 +/- 1.04 compared with -0.04 +/- 0.98; P = 0.049) in the adjusted model. The effect of SQ-LNS varied by sex (P-interaction = 0.003) and household asset index z-score (P-interaction = 0.002): Puberty was more advanced in the SQ-LNS compared with non-LNS group among females (P = 0.007) but not males (P = 0.877), and within lower (P = 0.002) than average (P = 0.436) and higher (P = 0.332) socioeconomic households. Conclusion: Provision of SQ-LNS during the first 1000 d of life advanced pubertal status among females. Trial registration number: This trial was registered at clinicaltrials.gov as NCT00970866 (https://clinicaltrials.gov/ct2/show/record/NCT00970866).