ObjectiveThere is a decline in contraceptive use among sexually active unmarried young women in Ghana. This study assessed the prevalence of contraceptive knowledge and use, and the determinant of contraceptive use among sexually active unmarried young women in Ghana.DesignThis was a nationally representative cross-sectional survey, using data from the 2017 Ghana Maternal Health Survey. Weighted logistic regression was used to assess the association between background and obstetric characteristics of young women and contraceptive use.SettingGhana.ParticipantsA total of 809 sexually active unmarried adolescent girls (15–19 years) and young women (20–24 years).Primary and secondary outcome measuresKnowledge and use of both modern and traditional contraceptive methods.ResultsKnowledge of at least one modern and traditional contractive method was 99.8% and 95.0%, respectively. The prevalence of contraceptive use was 43%—with 34% modern and 9% traditional methods. From the unadjusted analyses, age (p=0.002), past pregnancy (p<0.001), abortion in the past 5 years (p=0.007) and history of childbirth (p=0.025) were independently associated with contraceptive use, whereas education (p=0.072), place of residence (p=0.702), household wealth (p=0.836) and age at first sex (p=0.924) were not independently associated with contraceptive use. In the adjusted analysis, contraceptive use was significantly higher among respondents with secondary education compared with those with primary education (OR 2.43, 95% CI 1.31 to 4.49, p=0.017), and was higher among respondents with a history of pregnancy (OR 2.13, 95% CI 1.48 to 3.06, p<0.001).ConclusionThere is a significant gap between knowledge and use of contraceptives among the study population. While intensifying knowledge of adolescents and young women on contraceptives, adolescent-friendly corners should be established at vantage points to increase utilisation and to prevent societal stigma on young women who access contraceptives services.

INTRODUCTION The Global Youth Tobacco Survey's findings have been used to support Ghana's tobacco control legislation, monitor tobacco use among the youth and also used in meeting various Articles of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). These Articles include: Article 8 (Protection for exposure to tobacco smoke); Article 12 (Education, communication, training and public awareness); Article 13 (Tobacco advertising, promotion, and sponsorship); Article 14 (Demand reduction measures concerning tobacco dependence and cessation); and Article 16 (Sales to and by minors). Among the four waves of GYTS in Ghana, the 2017 GYTS was the first to assess waterpipe smoking, through optional questions included in the GYTS questionnaire. We assessed sex, age and regional differentials in waterpipe smoking among the youth in Ghana, and also explored the association between the use of other tobacco products and waterpipe use. METHODS The GYTS employs a standardized methodology with self-administered questionnaires, consisting of core, optional, and country specific questions. Fourteen questions, out of the seventy-four (74) questions administered for the entire GYTS, assessed waterpipe tobacco smoking (WTS). Chi-squared test was used to assess sex, age, grade/form and regional differentials in waterpipe use. Furthermore, the association between smoking cigarettes, smokeless tobacco, electronic cigarettes and waterpipe smoking, was explored by employing a chisquared test with a 5% significance level. RESULTS Of a total of 5664 students who participated in the study, 90.9% were aged 13-15 years. The respondents were almost equally distributed among males and females. Overall, 3.1% of the respondents had ever smoked waterpipe. The overall prevalence of current waterpipe use was 1.7%; with 2.1% in girls (95% CI: 0.9-4.7%) and 0.9% in boys (95% CI: 0.5-1.6%), p=0.033. Additionally, more than half (55.0%) of the current waterpipe users smoked three or more sessions per day. Surprisingly, close to half (46.9%) of the current waterpipe users smoked at home. CONCLUSIONS Waterpipe use, particularly among the female student population, represents an emerging tobacco epidemic and hence deserves immediate attention from authorities. This study revealed that waterpipe is being used among Junior High students in Ghana. Education on the health implications of waterpipe use should be intensified among the youth, to help minimize its use and to prevent its associated health harms.

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INTRODUCTION Ghana has a partial smoking ban with smoking allowed in designated smoking areas. Studies evaluating smoke-free laws are scarce in Sub-Saharan Africa. Evaluation of smoke-free laws is an effective means of measuring progress towards a smoke-free society. This study assessed the level of compliance to the provisions of the current smoke-free policy using air quality measurements for fine particulate matter (PM 2.5) in hospitality venues in Ghana. METHODS This was a cross-sectional observational study conducted in 2019 using a structured observational checklist complemented with air quality measurements using Dylos monitors across 152 randomly selected hospitality venues in three large cities in Ghana. RESULTS Smoking was observed in a third of the venues visited. The median indoor PM 2.5 concentration was 14.6 μg/m 3 (range: 5.2-349). PM 2.5 concentrations were higher in venues where smoking was observed (28.3 μg/m 3) compared to venues where smoking was not observed (12.3 μg/m 3) (p<0.001). Hospitality locations in Accra, Ghana's capital city, had the lowest compliance levels (59.5%) and poorer air quality compared to the cities of Kumasi and Tamale. CONCLUSIONS The study shows that while smoking and SHS exposure continues in a substantial number of hospitality venues, there is a marked improvement in PM 2.5 concentrations compared to earlier studies in Ghana. There is still a considerable way to go to increase compliance with the law. Efforts are needed to develop an action plan to build upon recent progress in providing smoke-free public spaces in Ghana.

ObjectiveThe government of Ghana has targeted universal access to safe drinking water by 2025 and elimination of open defecation by year 2030. This study explored the use of unimproved drinking water and unimproved sanitation and assessed their association with demographic factors.DesignThis was a secondary data analysis of the 2017 Ghana Maternal Health Survey, a nationally representative cross-sectional survey. Open defecation households were mapped to show regional differences. Weighted logistic regression was used to assess the association of demographic variables with use of unimproved drinking water and unimproved toilet facilities.SettingGhana.ParticipantsA total of 26 324 households were included in the analysis.Primary and secondary outcome measuresUse of unimproved drinking water and unimproved toilet facilities.ResultsOut of the 26 324 households, 8.9% used unimproved drinking water while 81.6% used unimproved sanitation. Open defecation was practised by 15.2% of Ghanaian households, with a prevalence of 58.8%, 6.7% and 12.5% in the Northern, Middle and Coastal zones, respectively. In the multivariate analysis, rural households (p<0.001), households with more than five members (p<0.001), households with heads less than 25 years (p=0.018), male-headed households (p<0.001) and household heads with no/low level of education (p<0.001) were significantly associated with drinking unimproved water. Also, rural households (p=0.002), households in the Northern zone (p<0.001), single-member households (p<0.001), households with heads less than 25 years (p<0.001) and household heads with no/low level of education (p<0.001) were significantly associated with using unimproved toilet facilities.ConclusionThe target of universal access to safe drinking water by 2025 and elimination of open defecation by 2030 seems impossible to be achieved if appropriate measures are not implemented. We recommend that state authorities, health partners and non-governmental organisations support local-level sanitation plans and strategies.